Society and families, he believed, had abdicated their responsibility to the dying man, passing ‘this responsibility on to the scientific miracle worker, who possessed the secrets of health and sickness and who knew better than anyone else what should be done’. But the ‘scientific miracle worker’ was ill-equipped to deal with the reality of dying. Ariès wondered how traditional rituals about mourning all but disappeared in the twentieth century: ‘...the community feels less and less involved in the death of one of its members... The community in the traditional sense of the word no longer exists. It has been replaced by an enormous mass of atomized individuals.’
Although Ariès acknowledged the benign influence of the hospice movement, and the work of Elizabeth Kübler-Ross and others, he did not believe that death would ever be ‘re-tamed’. Ariès wrote his book in the mid-1970s, when the hospice movement was in its infancy, and he predicted that hospices would take over what should rightfully be the duties of the family and community. Neither did he approve of the syringe-driver, which robbed the dying person of his moment of leave-taking: ‘...the patient’s passivity is maintained by sedatives, especially at the end...’
Ariès was a romantic reactionary who looked back to an idealized, pre-industrial past where life was governed by community, family and religion. He lamented the individualism, egoism and atomization of modern Europe. He correctly argued for the importance of community and ritual. But I am not persuaded that death in Ariès’s Middle Ages was as painless and easy as he seems to suggest. The death of the 16th century French philosopher Montaigne (see Chapter 8) was, I suspect, typical of ‘tame death’: public, acknowledged and ritualized, certainly, but also full of pain, terror and horror.
GEOFFREY GORER:
THE PORNOGRAPHY OF DEATH
The British anthropologist Geoffrey Gorer (1905–85) was, like Philippe Ariès, a scholar who worked outside the academy. His inherited wealth gave him the freedom and luxury to indulge his passions. After a brilliant undergraduate career at Jesus College, Cambridge, where he graduated with a double-first in classics and modern languages in 1927, he embarked on an abortive career as a playwright and novelist. He then wrote a well-received critical study, The Revolutionary Ideas of the Marquis de Sade (1934), which, among other things, attempted to explain popular support for the Nazis in psychological, rather than political, terms.
In 1934, with the insouciance typical of his class and social milieu, Gorer took his male lover, the Senegalese ballet dancer Ferál Benga, to the French colonies of West Africa. They travelled from Dakar through Senegal, Guinea, the Ivory Coast, Dahomey and Nigeria. Africa Dances, his account of this journey, was a bestseller, and brought Gorer to the attention of the anthropologist Margaret Mead. Mead, along with her lover and colleague Ruth Benedict, instructed Gorer in social anthropology. He had found his calling: Gorer studied and wrote about not only ‘primitive’ peoples, such as the Himalayan Lepchas, but also about developed societies, such as Japan, the US and his native Britain.
His writing style is limpid, authoritative, untainted by jargon. Gorer was also a literary critic, who numbered W. H. Auden and George Orwell among his friends. His closest friend, however, was Margaret Mead, with whom he maintained an intense correspondence and holidayed with annually. Many speculated that they might marry, but this was never likely since, although Mead was bisexual, Gorer was exclusively gay.
Gorer wrote a famous essay, ‘The Pornography of Death’, published in Encounter in 1955, in which he argued that death had replaced sex as the great contemporary taboo: ‘The natural processes of corruption and decay have become disgusting, as disgusting as the natural processes of birth and copulation were a century ago.’ Gorer, anticipating Ariès, described a pre-industrial world where
...funerals were the occasion of the greatest display for working class, middle class, and aristocrat. The cemetery was the centre of every old-established village, and they were prominent in most towns... In the 20th century, however, there seems to have been an unremarked shift in prudery; whereas copulation has become more and more ‘mentionable’, particularly in the Anglo-Saxon societies, death has become more and more ‘unmentionable’ as a natural process...
Gorer linked this change in attitudes to death with the decline in religious belief:
But in England, at any rate, belief in the future life as taught in Christian doctrine is very uncommon today even in the minority who make church-going or prayer a consistent part of their lives; and without some such belief natural death and physical decomposition have become too horrible to contemplate or discuss.
In 1961, Gorer’s brother Peter died of cancer, leaving a wife and children. He was only fifty-four and an eminent immunologist whose work eventually made human organ transplantation possible. Peter Gorer was a Fellow of the Royal Society and, had he survived, he would have almost certainly won the Nobel Prize for Medicine. A heavy smoker, he died quickly after he was diagnosed with lung cancer. Geoffrey Gorer took charge of the burial and looked after his sister-in-law, niece and nephew. He was struck by the rejection of traditional ways of behaving, and by the harmful effects of this rejection on the bereaved. The experience inspired him to write Death, Grief, and Mourning in Contemporary Britain (1965). The book was based on a survey of 1,628 people, undertaken in May 1963.
Gorer described how his friends were offended by his decision to go into mourning after the death of his brother: ‘A couple of times I refused invitations to cocktail parties, explaining that I was in mourning; the people who invited me responded to this statement with shocked embarrassment, as if I had voiced some appalling obscenity.’ He speculated that the origins of this attitude date back to the Great War, when the numbers of casualties were so overwhelming that the only way of dealing with it was to grieve communally, but to remain stoical about one’s personal loss. Another commentator, Pat Jalland, referred to this as ‘the suppression of privatised grieving’. Gorer observed, too, that society tacitly demanded that the bereaved keep their grief to themselves. In Britain and the US, the trend was ‘to treat mourning as morbid self-indulgence, and to give social admiration to the bereaved who hide their grief so fully that no one would guess anything had happened’.
Gorer concluded that, compared to their grandparents, ‘...the majority of British people are today without adequate guidance as to how to treat death and bereavement and without social help in living through and coming to terms with the grief and mourning which are the inevitable responses in human beings to the death of someone they have loved.’ ‘The Pornography of Death’ concluded with a plea: ‘...then we must give back to death – natural death – its parade and publicity, re-admit grief and mourning’.
ERNEST BECKER:
THE DENIAL OF DEATH
The death taboo reached its zenith (or nadir) in the US in the late twentieth century. Perhaps America, which had conquered the world, subconsciously believed that it could conquer death too. Richard Nixon famously declared ‘War on Cancer’ in 1971. Three years later, Ernest Becker (1924–74), an obscure cultural anthropologist, won the Pulitzer Prize posthumously for his 1973 book The Denial of Death. It is difficult to believe that it was widely read, since the prose is in places impenetrable, his argument conveyed through the prism of classical psychoanalytical theory (‘the meaning of anality’) and heavily influenced by the work of Otto Rank, a disciple of Freud’s. In Woody Allen’s Annie Hall (1977), Allen’s character, the death-phobic, psychoanalysis-obsessed Alvy Singer, gives Annie (Diane Keaton) a copy of The Denial of Death.
The book, however, has a certain potency because Becker was dying from cancer when he wrote it, and succumbed in 1974, aged forty-nine. If Freud taught that sex was the basic motivation for human behaviour, Becker argued instead that it is our fear of death:
...the idea of death, the fear of it, haunts the human animal like nothing else; it is the mainspring of human activity – activity designed largely to avoid the fatality of death, to overcome it by denying in some
way that it is the final destiny for man... This is the terror: to have emerged from nothing, to have a name, consciousness of self, deep inner feelings, an excruciating inner yearning for life and self-expression – and with all this yet to die.
Becker, like his contemporary Philippe Ariès, thought that the Enlightenment and scientific ‘progress’ had come with a heavy price-tag:
The man of knowledge in our time is bowed down under a burden he never imagined he would ever have: the overproduction of truth that cannot be consumed. For centuries man lived in the belief that truth was slim and elusive and that once he found it the troubles of mankind would be over. And here we are in the closing decades of the 20th century, choking on truth...
Becker went a step further than Ariès and Gorer, and argued that we sublimate our fear of extinction into what he called ‘heroic projects’, designed to transcend death. These projects included organized religion and the great political movements of the twentieth century: communism and fascism. The philosopher Sam Keen, in the Foreword to a new edition of The Denial of Death, wrote that Becker had discovered ‘a science of evil’. Keen summarized Becker’s ideas:
The first strand. The world is terrifying... The second strand. The basic motivation for human behaviour is our biological need to control our basic anxiety, to deny the terror of death... The third strand. Since the terror of death is so overwhelming we conspire to keep it unconscious... The fourth strand. Our heroic projects that are aimed at destroying evil have the paradoxical effect of bringing more evil into the world.
It is not difficult to see how Woody Allen/Alvy Singer would be attracted to Becker’s pessimism: ‘Creation is a nightmare spectacular taking place on a planet that has been soaked for hundreds of millions of years in the blood of all its creatures.’
The contemporary writer and philosopher John Gray, whose work is also characterized by a bracing pessimism, has clearly been influenced by Becker: ‘Those who struggle to change the world see themselves as noble, even tragic figures,’ Gray writes, ‘Yet most of those who work for world betterment are not rebels against the scheme of things. They seek consolation for a truth they are too weak to bear. At bottom, their faith that the world can be transformed by human will is a denial of their own mortality.’
Becker’s work inspired a whole new school of experimental psychology called terror management theory (TMT). TMT argues that the clash of our desire to live with our awareness of the inevitability of death creates the potential for terror. Tom Pyszczynski, one of the founders of TMT, wrote: ‘Cultural worldviews manage existential terror by providing a meaningful, orderly, and comforting conception of the world that helps us come to grips with the problem of death.’ Pyszczynski and others have carried out a series of controlled experiments which show that when people are given reminders of their mortality, they are more likely to be critical of, and punitive towards, those who oppose their beliefs. TMT enthusiasts saw 9/11 as a vast natural experiment designed to test this theory. They concluded that Americans behaved in the aftermath of this disaster exactly as TMT would have predicted, with increased nationalism, intolerance of dissent, hostility towards those who are different, desire for revenge, a need for heroes, a desire to help.
Flight from Death: The Quest for Immortality, a documentary film based on the ideas of Ernest Becker and TMT, was an unlikely international success in 2003. Perhaps it is not so surprising; TMT is a sort of Grand Unified Theory of human behaviour and evil.
IVAN ILLICH:
MEDICALIZING DEATH
‘Doctors are the new mediums, the decoders of the psychological mysteries of their time,’ wrote Philippe Ariès, but it could just as easily have been written by Ivan Illich. Illich (1926–2002) was a singular figure. Born in Vienna to a Croatian Catholic father and a German Jewish mother, he spoke over a dozen languages fluently and often remarked that he had no mother tongue. His family had to leave Vienna after the Anschluss in 1938. Illich initially studied science (histology and crystallography), but switched to philosophy, history and theology, taking a doctorate in History at Salzburg, and studied for the priesthood at the Gregorian University in Rome. He was ordained a priest in 1950 and moved to New York, where he ministered to the Puerto Rican community. In 1956, aged just thirty, he was appointed vice-rector of the Catholic University in Ponce, Puerto Rico. Illich became a radical ‘anti-imperialist’ and his anti-American views led to clashes with the Catholic hierarchy, which culminated in a recall to New York in 1960.
In 1961, with the support of the American Catholic hierarchy, he established a centre in Cuernavaca in Mexico called the Centre for Cultural Information, or Centro Intercultural de Formación (CIF). The purpose of this centre was to prepare North American missionaries for work in Latin America and to provide intensive courses in Spanish. Illich began to question the entire missionary enterprise in South America and effectively sabotaged the programme by openly discouraging would-be missionaries and writing incendiary articles attacking the American mission. CIF evolved into CIDOC (Centro Intercultural de Documentación), a sort of informal university and radical think tank. In 1968, Illich was called to the Vatican to answer charges of heresy; although no formal charges were made, he resigned from the public duties of the priesthood. Nevertheless, he continued to regard himself as a priest for the rest of his life.
It is difficult to categorize Illich: he was a medieval historian, a social theorist, a philosopher, a theologian and an educationalist. His core thesis, which he developed at CIDOC, and which has a whiff of Rousseau, was that industrialization and urbanization had robbed people in developed countries of their freedom and their spirituality. One of his best-known works, Medical Nemesis (1975) opens with the famous assertion: ‘The medical establishment has become a major threat to health.’ In this radical polemic, Illich argued that modern medicine had hubristically taken on a mission to eradicate pain, sickness, and even death. These were, he argued, eternal human realities, with which we must learn to cope: in fact, coping with these verities is what it means to be ‘healthy’. Although I don’t think Illich coined the word ‘iatrogenesis’ – meaning the harm done by doctors – he certainly popularized it. He described three types of iatrogenesis: clinical, or the direct harm done by various medical treatments; social, or the medicalization of ordinary life; and cultural, the loss of traditional ways of dealing with suffering: medicine ‘constitutes a prolific bureaucratic program based on the denial of each man’s need to deal with pain, sickness and death’. This medicalization of death, he argued, caused us to lose our ability to accept death and suffering as aspects of life, and to devalue our traditional rituals around death and dying. He went further: medicalization is a form of social control, in which a rejection of ‘patienthood’ is viewed as a form of deviance.
Illich’s prose is dense and difficult; his use of footnotes is greater even than the late David Foster Wallace. His scholarship, however, is unarguable. Illich’s arguments were not taken seriously enough at the time because he overstated his case, and proposed no practical solutions. The medical establishment dismissed him as a crank and moved on. Illich himself became an increasingly marginal figure. Although disowned by the church, he held visiting professorships in several European universities, after closing CIDOC in 1976. Illich himself had something of the ancient Greek philosopher Diogenes about him: he never wore a watch, which he called a ‘gauge’, and which he believed forced an artificial structure on daily life, yet he frequently asked the time from ‘gauge bearers’. He spent most of his later life living in a mud hut just outside Mexico City, ‘aristocratically aloof, austere, absorbed but happy’, according to his obituary in The Times. There was more than a touch of the Old Testament prophet in Illich’s public persona; indeed, he was frequently dismissed by critics in ad hominem attacks as a ‘Jeremiah’.
It is tempting to dismiss Illich as just another historical footnote to the counter-culture of the 1960s and 1970s, and yet, nearly forty years on, much of what he warned against
has come to pass. Since the publication of Medical Nemesis, US spending on health care as a percentage of GDP has doubled. Illich would have been wryly amused by the invention of new diseases, such as social anxiety disorder (shyness), male-pattern alopecia (baldness) and erectile dysfunction (impotence), all of which can now be medicated. The ever-increasing venality of the pharmaceutical industry would not have surprised him. How he would have loved to attack the sacred cow that is ‘evidence-based medicine’. Illich wrote: ‘Through the medicalization of death, health care has become a monolithic world religion... the struggle against death, which dominates the life-style of the rich, is translated by development agencies into a set of rules by which the poor of the earth shall be forced to conduct themselves.’
Illich believed that there is a profound difference between pain and suffering. Pain, he argued, is a sensation, but suffering is a practice. Pain could be borne with dignity by ‘duty, love, fascination, routines, prayer and compassion’. Cultural iatrogenesis has robbed people in Western countries of their ability to suffer. Medicine, which convinced people that all pain is curable, has made pain unendurable. He predicted that this medicalization might eventually lead to assisted suicide being seen as a human right: ‘The patient’s unwillingness to die on his own makes him pathetically dependent. He has now lost faith in his ability to die, the terminal shape that health can take, and has made the right to be professionally killed into a major issue.’
‘Dying’, wrote Illich, ‘has become the ultimate form of consumer resistance.’
The Way We Die Now Page 4