The Way We Die Now

by Seamus O'Mahony

  *

  Ivan Illich, in his fifties, developed a facial cancer, for which he typically refused treatment, or even investigation; he believed in ‘the liberty to die without a diagnosis’. The cancer slowly advanced, causing considerable pain and disfigurement, and eventually killed him in 2002 at the age of seventy-six. His obituary reported:

  As the tumour on his cheek became more prominent and painful and subject to epileptic attacks, he refused to accept the diagnosis imposed by the doctors. ‘I am not ill, it’s not an illness’, he declared. ‘It is something completely different – a very complicated relationship.’

  All four of these thanatologists are dead now. Ariès died aged sixty-nine; I hope his funeral was traditionally conducted and well attended, and that his family observed a suitable period of mourning. Gorer lived to eighty, and died in his manor house in Sussex, where he had cultivated his prize-winning rhododendrons. His closest friends – Orwell, Auden and Mead – predeceased him. I trust his relatives went into formal mourning.

  RITUAL AND MOURNING

  The bleakest funeral I ever attended was that of my friend, S. He died in Amsterdam in 2000, at the age of only forty-seven. He had lived in Holland for many years, where he worked in construction, and had married a Dutch woman, with whom he had two teenage children. He had become unwell, complaining of pains in his left arm and shoulder. Although he was a smoker with a strong family history of heart disease, his doctor thought these pains were muscular. He died suddenly of a heart attack. I travelled from Leeds (where I was living at the time) to Amsterdam for the funeral. My friend had emigrated from his native west Cork more than twenty-five years before, and left behind all those things about Ireland that he regarded as backward, such as religion. His funeral, therefore, was a singularly secular event.

  I got a taxi from the airport to a huge cemetery in the suburbs of Amsterdam, and met my friend’s three brothers at the entrance. They greeted me ruefully and thanked me for travelling. His widowed mother did not travel; the furthest she had ever ventured from their small farm was to the city of Cork. A business-like undertaker took control of the proceedings, and we followed him and the coffin – no ‘open coffin’ here – in the rain to the recently dug grave. The coffin was lowered into the ground and we few mourners simply walked away – without prayers or words of any kind. We gathered in a public room attached to the cemetery and were given coffee. The undertaker asked in a desultory fashion if anyone wanted to say a few words. The three brothers looked at each other and shook their heads: this was a task for a priest. But there was no priest, only the brusque Dutch funeral director. After a long and painful silence, one of my friend’s Dutch workmates stepped shyly forward and gave a short speech – mainly in Dutch – concluding ‘he was a good guy’. A CD of some folk songs that the dead man had loved was played. And that was it.

  I got a taxi back to Schiphol airport where I had several hours to think about the importance of ritual in dealing with death. My friend’s three brothers, reared in the Catholic tradition, were literally dumbstruck by this secular event: the banality of it was heart-breaking.

  Years later, I was deeply impressed by how Catholic ritual – after the deaths of my great-uncle (March 2013) and father-in-law (October 2013) – guided the bereaved during the days immediately following their deaths. Ritual helps the dying too: in Ireland, the sacrament of anointing the sick carries a powerful significance even for those with little or no religious belief. This is not something a lay hospital chaplain can do. Karen Armstrong, the historian of religion, has argued that religion is about practice, rather than belief; about doing, not dogma. Our ancestors had a communal knowledge of how to mourn, and ritual was at the core of this knowledge.

  Alain de Botton has suggested in Religion for Atheists that our secular world should cherry-pick some of the good ideas from organized religion and adapt them for our bright, modern secular world, while ditching what he sees as all the superstitious, supernatural nonsense: ‘Many of the problems of the modern soul can successfully be addressed by solutions put forward by religion, once these solutions have been dislodged from the supernatural structure within which they were first conceived.’ De Botton lists many of the positive aspects of organized religion, such as the way it brings people together as a community, the weekly opportunity to simply sit and engage in contemplation, and the comforting rituals around birth, marriage and death.

  His case is well argued, but it seems to me that religion has developed and refined these rituals over millennia, so why bother inventing new ones? Why build new Temples to ‘Perspective’ and ‘Reflection’ when we already have the great cathedrals, temples and mosques? De Botton describes one such doomed attempt to invent a godless religion, namely the French philosopher Auguste Comte’s ‘religion for humanity’. I wonder if we should simply be content with belonging, and stop being so worried about believing. Evangelical atheism has accelerated the flight from religion, leaving us even more adrift, more atomized, and unsure of how to behave when faced with the great events of our lives.

  So we have to fashion our own ars moriendi. It has been said that death hasn’t quite come out of the closet, but its toe is sticking out. Any priest will tell you that funerals have become increasingly informal, and are now more representative of the individual than the community. Up until very recently, traditional Irish Catholics thought it vulgar to talk about the deceased, personally and specifically, from the altar during the funeral mass; now, the eulogy has become a central part of the occasion. Coffins are commonly draped with mementos such as mobile phones and replica sports jerseys. The deceased is celebrated as a wacky individualist. In crematoria, the coffin often disappears to the tune of ‘My Way’ or ‘Always look on the bright side of life’. Ariès’s ‘tame death’ may have been ‘tame’ in the sense that it was acknowledged and accepted, but it was still awesome, terrible and grand. Now, we strive to make death tame again by a kind of studied frivolousness.

  I lived in Britain for fourteen years. My wife is Scottish, and my two children were born in Yorkshire. Coming from Ireland and a Catholic upbringing, I found British mourning practices very alien. An English colleague of mine died relatively young – in her early sixties – from cancer. A mutual friend, a senior doctor at the hospital, had been closely associated professionally with the dead woman for more than two decades. I was surprised, therefore, not to see him at the funeral service. I mentioned this a few days later to him, and he told me that unfortunately the funeral had coincided with a professional meeting which he was unable to reschedule. In Ireland, this would have been unthinkable. I was similarly surprised when, after the death of my father-in-law, his next-door neighbours called to the house to commiserate. We invited them in and gave them tea. When asked if they would like to see the dead man, they recoiled, saying they would like to remember him as he was.

  The Irish, for all our many failings, still – just – do mourning well. The old ritualistic Catholic sequence – first the rosary, then the removal, and finally the funeral mass and burial, still survives. Rural folk still hold a ‘month’s mind’ mass, a month after the death. The formulaic words – ‘sorry for your trouble’ – are still intact. Since returning to Ireland in 2001, I have been to countless removals. Funeral-going in Ireland can be excessive: I have felt obliged to attend the removals or funerals of people I have never even met − usually the parents and relatives of work colleagues. The queues are sometimes so long that it can take more than an hour to reach the top: queue-jumping at removals is a regular sight.

  One of my great-uncles was a notably enthusiastic funeral-goer. Irish funerals are famously sociable events, with much food and drink provided; if the deceased is very old, the atmosphere is light-hearted, almost celebratory. In his retirement, this great-uncle travelled all over County Cork and beyond, to attend the funerals of persons with whom he often had only the most tangential and remote connection. The death notices of the Cork Examiner constituted his only reading materia
l. Had he survived into the age of the Internet, he would have been an avid user of the website RIP.ie.

  In the cities, however, these rituals and codes are slowly dying; in the space of a single generation, Ireland has gone from a country with near-universal church attendance to a secular society in which weekly worship is now a minority activity.

  One of the few books I inherited from my father was Irish Wake Amusements by Seán Ó Súilleabháin. This slim volume, originally written in Irish as Caitheamh Aimsire ar Thórraimh, is a scholarly account of wake customs in rural Ireland in the eighteenth and nineteenth centuries, with detailed descriptions of the rituals, games and drinking which occurred at these events:

  Storytelling; singing; music and dancing; card- playing; riddles, tongue-twisters; versifying and repetition of Jingles... Contests in strength, agility, dexterity, accuracy of aim, endurance and toughness, hardihood and athletics... Taunting and mocking, booby traps, mischief-making, horse- play, rough games, fights... imitative games, catch games, games of hide, seek and guessing.

  When this book was first published in 1961, the author (correctly) assumed the religious beliefs of his readership:

  As Christians, it is difficult for us to imagine how people in pagan times regarded Death and what might follow it. They knew by experience that Death ended the normal way of life which the deceased had known. Still, they believed that, in some way or another, ‘life’ of some kind continued beyond the grave. Christianity taught them gradually about the existence of the human soul which was not ended by Death; nevertheless, they felt that the dead were still involved in some way in human affairs, still continuing in some kind of human form which was rather like that held during life.

  Ó Súilleabháin here writes about ‘the existence of the human soul’ as if its discovery was a scientific fact, akin to a sub-atomic particle. He viewed these wake practices as ‘pagan’ in origin, and ‘certain aspects of traditional wakes’ were eventually stamped out by the clergy, using pulpit denunciation and various synodal decrees. ‘Certain aspects of traditional wakes’ or ‘wake abuses’ almost certainly involved sex and alcohol, but Ó Súilleabháin could not go into any great detail about this when he wrote his book. Nor could he have foreseen how Ireland would shortly and dramatically shed its Christianity.

  Wakes are now rare, even in Ireland, and tame events compared to the Dionysian extravaganzas described in Irish Wake Amusements. The last wake I attended was that of an old neighbour, the wife of the man from our street who had dropped dead at forty. She had more than forty years of widowhood, and had died a great-grandmother. It was held in the little house where she had raised her six children and she was laid out in the front parlour – the ‘good room’; neighbours arrived in a regular stream and remarked how beautiful she looked. I sat next to the open coffin, and had tea and cake with her family. It was a happy, creaturely gathering and there was something about it that was intimate and serene – the fine old woman, the modest room. That which caused revulsion in Dumfries, in Cork was companionable and easy.

  *

  My aunt, a nun in the Bon Secours order, died in 2010 after many years of severe dementia. During these years, she had been cared for in the convent infirmary with a love and attentiveness that was the most persuasive argument for Christianity that I have encountered. When she died, her fellow sisters gathered in the small sitting- room of the nuns’ infirmary, where she was laid out. After the recitation of the rosary, they sang hymns; the sound of these old women’s voices had a strange grandeur and pathos.

  *

  Death has become fashionable as a topic of public discussion, but, despite all the celebrity memoirs and earnest newspaper articles, it is still largely hidden. In Europe, the process of secularization has advanced so far that we will never see a return to Philippe Ariès’s ‘tame death’. Could we fashion a secular version of tame death? I doubt it: death is tamed by ritual, and ritual is primarily a religious phenomenon. We will never go back to a pre-Enlightenment Christianity in Europe, and secular rituals will not emerge.

  Perhaps it is impossible for us, afflicted by a lethal combination of secularism and individualism, to see inside the minds of our ancestors. In our atomized world, death is far more shocking for us because we cannot imagine anything beyond this self, this life.

  CHAPTER 3

  A Hesitation to be Brave

  When Philippe Ariès described how ‘tame death’ gradually became ‘hidden death’, he called it ‘the beginning of the lie’, and used Tolstoy’s novella The Death of Ivan Ilyich (1886) as a key text to illustrate this dramatic shift in human behaviour. Ilyich is a successful judge in his forties. His life is devoted to advancing his career and maintaining the proprieties of his bourgeois life. He has grown distant from his vain, superficial wife, and concerns himself with house furnishings and card-games. He is taken ill with a vague pain in his abdomen, which is diagnosed by various doctors as ‘appendicitis’ and a ‘loose kidney’. His pain gradually gets worse, and it eventually becomes clear that he is dying. His family and the doctors try to hide the awful truth from him:

  Ivan Ilyich’s great misery was due to the deception that for some reason or other everyone kept up with him – that he was simply ill, and not dying, and that he need only keep quiet and follow the doctor’s orders, and then some great change for the better would be the result. He knew that whatever they might do, there would be no result except more agonizing sufferings and death. And he was made miserable by this lie, made miserable at their refusing to acknowledge what they all knew and he knew, by their persisting in lying over him about his awful position, and in forcing him too to take part in this lie. Lying, lying, this lying carried on over him on the eve of his death, and destined to bring that terrible solemn act of his death down to the level of all their visits, curtains, sturgeons for dinner... was a horrible agony for Ivan Ilyich. And, strange to say, many times when they had been going through the regular performance over him, he had been within a hair’s breadth of screaming at them: ‘Cease your lying! You know, and I know, that I’m dying; so do, at least, give over lying!’ But he never had the spirit to do this. The terrible, awful act of his dying was, he saw, by all those about him, brought down to the level of a casual, unpleasant, and to some extent indecorous, incident (somewhat as they would behave with a person who should enter a drawing-room smelling unpleasant). It was brought down to this level by that very decorum to which he had been enslaved all his life.

  Towards the end, Ilyich realizes that he had ‘not lived as one ought’, that his death, like his life, was full of lies. ‘From that moment’, writes Tolstoy, ‘there began the scream that never ceased for three days, and was so awful that through two closed doors one could not hear it without horror.’ Only at the very end does Ilyich experience any peace, when his young son takes his hand, and the dying man feels tenderness and forgiveness for his family.

  Ivan Ilyich’s agony is an example of what Cicely Saunders, the founder of the hospice movement in Britain, called ‘total pain’. By this she meant a kind of suffering beyond physical pain, marked by hopelessness, loneliness and existential despair. In my view, The Death of Ivan Ilyich is the most powerful, the most true, depiction of dying in fiction. The novella has had a strange afterlife: ivans xtc. (2002), a film loosely based on the story, is an account of the final days of an amoral Hollywood agent who is dying of cancer. Nowadays, ‘the scream that never ceased for three days’ would have been drowned out by the syringe-driver, but The Lie is alive and well.

  In 1923, Dr Felix Deutsch examined his patient, the sixty-seven-year-old Sigmund Freud, and found that he had an oral cancer. Deutsch confided in six of Freud’s closest associates, and it was decided that the great man must not be told. Later, when Ernest Jones – psychoanalyst and author of the first major biography of Freud – admitted to Freud that the truth had been kept from him, the great man demanded, ‘Mit welchem Recht?’ (‘With what right?’). Deutsch resigned as Freud’s personal physici
an and was replaced by a young doctor called Max Schur. At their first meeting, Freud told Schur what he considered the two most important elements of the doctor–patient relationship: first, that they always tell each other the truth, and second, ‘that when the time comes, you won’t let me suffer unnecessarily’.

  John McGahern wrote about his mother’s death in Memoir. (McGahern himself was sickening when he wrote this book, and mortally ill by the time of publication.) She had been diagnosed with breast cancer during pregnancy, and went to the Mater Hospital in Dublin for treatment: ‘When we asked about her we were warned not to ask but to pray to God. To veil everything in secrecy and darkness was natural to my father, and it turned out that my mother was far from happy with this secrecy.’

  Meanwhile her husband, McGahern’s monstrous police sergeant father, was secretly corresponding with his wife’s surgeon: ‘Dear Sir,... Would you, therefore be good enough to advise me on the following: 1. Should my wife give up teaching? 2. What is your opinion of her chances of recovery? 3. What roughly are the percentages of recovery from her disease taken at this stage she was operated on?’

  The surgeon duly replied: ‘She probably has a 30% chance of complete recovery.’ Clearly, patient confidentiality was not greatly observed in 1940s Ireland. McGahern observed: ‘He communicated neither this nor the previous report to my mother or to anybody else...’ McGahern’s mother died, attended only by her sister and a nurse. Her husband was stationed in the police barracks of another town. The children were taken away before the end to the barracks and their father, and his world of secrecy and evasion. His mother’s death was ‘hidden’:

  Those who are dying are marked not only by themselves but by the world they are losing. They have become the other people who die and threaten the illusion of endless continuity. Life goes on, but not for the dying, and this must be hidden or obscured or denied... My mother’s faith must have been a strength, but even this was used against her when my father accused her of losing her faith in God. No matter how strong that faith was, it could hardly alleviate the human pain of losing everyone who depended on her whom she loved and held dear. She had no one to communicate this to after her forty-two years in a world where many loved her.