The American Way of Death Revisited

by Jessica Mitford

  In this, I was somewhat disappointed. The discussions seemed inconclusive, and the funeral spokesmen themselves often appeared to be unclear about the points they were making.

  My first interview was with Dr. Charles H. Nichols, a Ph.D. in education from Northwestern University, who became the educational director of the National Foundation of Funeral Service. Among his published works are “The Psychology of Selling Vaults” and “Selling Vaults,” which appeared in the Vault Merchandiser in 1954 and 1956 respectively. His duties at the foundation include lecturing to undertakers at the School of Management on such subjects as “Counseling in Bereavement.”

  Dr. Nichols readily volunteered the information that embalming has made an enormous contribution to public health and sanitation, that if done properly it can disinfect the dead body so thoroughly that it is no longer a source of contamination. “But is a dead body a source of infection?” I asked. Dr. Nichols replied that he didn’t know. “What about foreign countries where they do not as a rule embalm; is much illness caused by failure to do so?” Dr. Nichols said he didn’t know.

  Mr. Wilber Krieger was an important figure in funeral circles, for he was not only managing director of an influential trade association, National Selected Morticians, but also director of the National Foundation of Funeral Service. To my question “Why is embalming universally practiced in the United States?” he answered that there is a public health factor: germs do not die with the host, and embalming disinfects. I told him of my conversation with Dr. Jesse Carr, and of my own surprise at learning that even in typhoid cases, embalming is ineffective as a safety measure against contagion; upon which he burst out with, “That’s a typical pathologist’s answer! That’s the sort of thing you hear from so many of them.” Pressed for specific cases of illness caused by failure to embalm, Mr. Krieger recalled the death from smallpox of a prominent citizen in a small Southern community where embalming was not practiced. Hundreds went to the funeral to pay their respects, and as a result a large number of them came down with smallpox. Unfortunately, Mr. Krieger had forgotten the name of the prominent citizen, the town, and the date of this occurrence. I asked him if he would check on these details and furnish me with the facts; however, he has not yet done so.

  I had no better luck in a subsequent conversation with Mr. Howard C. Raether, executive secretary of the National Funeral Directors Association (to which the great majority of funeral directors belong), and Mr. Bruce Hotchkiss, vice president of that organization and himself a practicing undertaker. In this case, our conversation was recorded on tape. I asked what health hazard is presented by a dead body which has not been opened up, for purposes of either autopsy or embalming.

  MR. RAETHER: Well, as an embalmer, Bruce, aren’t there certain discharges that come from the body without it having been opened up?

  MR. HOTCHKISS: Yes, most assuredly from—orally—depending upon the mode or condition preceding death.

  Then I asked, “Can you give any place, then, where the public health has been endangered—give us the place and the time?”

  They could not. We talked around the point for several minutes, but these two leaders of an industry built on the embalming process were unable to produce a single fact to support their major justification for the procedure. I told them what Dr. Carr had said about embalming and public health. “Do you have any comment on that?” I asked. Mr. Raether answered, “No; but we can take a look-see and try to give you some instances.”

  When the results of the look-see arrived, eight weeks later, in the form of an impressive-looking document titled “Public Health and Embalming,” I was surprised to find that it was the work not of a medical expert but of Mr. Raether (who is a lawyer) himself. The approach was curiously oblique:

  I confronted some teachers in colleges of mortuary science with the opinion of your San Francisco pathologist that embalming in no way lessens the spread of communicable disease. Their first reaction was “who is he, what is his proof?” And, rightly so. Then they add that it is not contended embalming destroys all microbes.

  What is contended? We are not told. An authority is cited that seems vaguely irrelevant. It is recommended that I read Public Health in Boston, 1630–1822; I am assured that the dean of the American Academy of Funeral Service “has documented proof,” but no further evidence is offered. This reminds me of the old trial lawyers’ maxim: “When the law is against you, argue the facts; when the facts are against you, argue the law; when the law and the facts are against you, give the opposing counsel hell.”

  A health officer, in the single reference to a source outside the funeral industry, is quoted as advancing a startlingly novel argument for embalming. It is efficacious, he declares, not only from a public health standpoint but “from the standpoint of man’s ages-long concern with life after death,” a proposition that is hard to argue against.

  The only specific information offered Mr. Raether by spokesmen for the National Funeral Directors Association (NFDA)—to support the contention that embalming has value as a sanitary measure—concerned “the procedures followed at the famous Mayo Clinic, where they have a standing rule that no autopsy shall be conducted on a body unless that body is embalmed—unless they need tissue immediately. This is a standing rule for the protection of doctors and pathologists who might be working with the body.”

  Unversed though I am in the procedures of doctors and pathologists, this sounded very strange to me. I wrote to the clinic in question to ask if it was true. Their answer: “Unfortunately, it appears that Mr. Raether has been misinformed concerning the attitude of the Mayo Clinic toward the embalming of bodies. We have no rule which requires that bodies be embalmed before an autopsy is performed. It is true that frequently bodies are embalmed prior to the performance of an autopsy, but this is done more for the convenience of the funeral directors than because of any insistence on our part.”

  Kenneth V. Iserson is a professor of surgery and director of the bioethics program at the Medical School of the University of Arizona. After twenty years in practice treating dying patients and counseling professionals and families about sudden death, he realized, when preparing an ethics paper on teaching with donated remains, that there were huge gaps in his knowledge about what happened to dead bodies. He was prompted to investigate, and the results of his exploration were published as Death to Dust: What Happens to Dead Bodies? (Galen Press, 1994).

  Dr. Iserson’s massive, comprehensive volume is easily the best work on the subject that has appeared in recent years, and it is written with a fluency that makes it accessible to the lay reader as well as the professional.

  He was initially stymied by what he felt was a cover-up by a funeral industry that systematically conceals its methods. He says now, in words which have a familiar ring to me, “At the time I was writing, I had to work with several Deep Throats.”

  Like Dr. Carr, Dr. Iserson has no patience with the argument that embalming is necessary because of the health hazard posed by unembalmed bodies. He quotes with approval Dr. Carr’s discussion with me, adding that the Arizona Auditor General’s Office, in a review of funeral industry practices, concluded that “the public health risks associated with the disposal of human remains are minimal”; also, a Canadian health minister, “Embalming serves no useful purpose in preventing the transmission of communicable disease.”

  The clincher for Dr. Iserson is the acknowledged failure of embalmers universally to apply measures for their own protection. If embalmers are not concerned about protecting themselves, he reasons, what message does that send to the public about the claim that embalming is necessary as a public health measure? The true purpose of embalming, he suggests, is to facilitate an open-casket funeral—with the emphasis on casket. Embalming, he suggests, is a procedure that boils down to sales and profits.

  The only “authoritative” voice the industry has been able to produce in rebuttal belongs to one John Kroshus, identified only as having a connection with the University of M
innesota’s program of mortuary science. Mr. Kroshus is quoted in Funeral Monitor (April 1996) as denouncing “the book” (again a phrase familiar to me) by posing the question: “If embalming is taken out of the funeral, then viewing the body will also be lost. If viewing is lost, then the body itself will not be central to the funeral. If the body is taken out of the funeral, then what does the funeral director have to sell?”

  I could not have put it better.

  In a curious, perhaps inevitable, reversal, the decades spent persuading the public that embalming is a sound public health measure have come back to haunt the funeral folk. Angrily protesting new Occupational Safety and Health Administration (OSHA) regulations that end the practice of dumping bodily wastes and embalming fluids down drains or in Dumpsters, one mortician, according to Mortuary Management, ridiculed the “illogic of it all.” It seems, he claims, “that waste from dead people is now deemed to be more dangerous than that which comes from the living.” He goes on to protest that not one case of infection has been reported as resulting from the longstanding practice of dumping bodily wastes and embalming fluids down sewers.

  If the public health benefits of embalming are elusive, ten times more so is the role of “grief therapy,” which is fast becoming a favorite with the funeral men. Trying to pin down the meaning of this phrase is like trying to pick up quicksilver with a fork, for it apparently has no meaning outside funeral trade circles. Although it sounds like a term picked up from the vocabulary of psychiatry, psychiatrists of whom I inquired were unable to enlighten me because they had never heard of it.

  “Grief therapy” is most commonly used by funeral men to describe the mental and emotional solace which, they claim, is achieved for the bereaved family as a result of being able to “view” the embalmed and restored deceased.

  The total absence of authoritative sources on the subject does not stop the undertakers and their spokesmen from donning the mantle of the psychiatrist when it suits their purposes. As an embalming textbook says, “In his care of each subject the embalmer has a heavy responsibility, for his skill and interest will largely determine the degree of permanent mental trauma to be suffered by all those closely associated with the deceased.”

  Lately, the meaning of “grief therapy” has been expanded to cover not only the Beautiful Memory Picture but any number of aspects of the funeral. Within the trade, it has become a catchall phrase, its meaning conveniently elastic enough to provide justification for all of its dealings and procedures. Phrases like “therapy of mourning” and “grief syndrome” trip readily from industry tongues. The most “therapeutic” funeral, it seems, is the one that conforms to their pattern, that is to say, the one arranged under circumstances guaranteeing a maximum profit.

  I had a long discussion with Mr. Raether about “grief therapy,” in which I sought to know what medical or psychiatric backing he could produce to substantiate the funeral industry theory that viewing the restored and embalmed body has psychotherapeutic value. He spoke of grief and ceremony; he mentioned some clergymen of his acquaintance who thought viewing the body was a valuable experience; but no qualified psychiatric reference was forthcoming.

  Eventually he referred me to an article by Stanford University professor Edmund H. Volkart which had appeared in Explorations in Social Psychiatry and which allegedly supported the proposition that “viewing” was therapeutically valuable to the bereaved. Since Professor Volkart’s article was the only authoritative published work cited by Mr. Raether, it seemed advisable to check with him. Professor Volkart, who was at the time director of Stanford’s program in medicine and the behavioral sciences, wrote to me as follows:

  I know of no evidence to support the view that “public” viewing of an embalmed body is somehow “therapeutic” to the bereaved. Certainly there are no statistics known to me comparing the outcomes of such a process in the United States with the outcomes of England where public viewing is seldom done. Indeed, since the public viewing of the corpse is part and parcel of a whole complex of events surrounding funerals, it would be difficult, if not impossible, to ascertain either its therapeutic or contra-therapeutic effect.

  The phrase “grief therapy” is not in common usage in psychiatry, so far as I know. That the loss of any loved object frequently leads to depressions and malfunctioning of the organism is, of course, well known; what is not well known or understood are the conditions under which some kind of intervention should be made, or even the nature of the intervention. My general feeling is that the phenomena of grief and mourning have appeared in human life long before there were “experts” of any kind (psychiatric, clerical, etc.) and somehow most, if not all, of the bereaved managed to survive. The interesting problem to me is why it should be that so many modern Americans seem more incapable of managing loss and/or grief than other peoples, and why we have such reliance upon specialists. My own hunch is that morbid problems of grief arise only when the relevant laypersons (family members, friends, children, etc.) somehow fail to perform their normal therapeutic roles for the bereaved—or may it be that the bereaved often break down because they simply do not know how to behave under the circumstances? Very few of us, I think, would be capable of managing sustained, ambiguous situations.

  Demonstrably flimsy and absurd as the justifications for universal embalming and “viewing” may have been, these patently fraudulent claims of undertakers for their product remained immune from government intervention until 1984, when the Federal Trade Commission’s funeral rules were adopted. These provided, among other things, that:

  It is a deceptive act or practice for a funeral provider to:

  • Represent that state or local law requires that a deceased person be embalmed when such is not the case;

  • Fail to disclose that embalming is not required by law except in certain special cases.

  The rule went on to provide that prior approval for embalming must be obtained from a family member.

  The howls of dismay that greeted these seemingly innocuous rulings were pitiful to behold. They echoed, indeed, the eruption, five years earlier, that followed the introduction of a similar requirement at a meeting of California’s State Board of Funeral Directors and Embalmers. I had special reason to take note of it at the time, because the proposer was my husband, Bob Treuhaft, who had been appointed to the board by then governor Jerry Brown.

  The proposed regulation required that a responsible party confirm that he or she understood that:

  Arterial embalming requires cutting into an artery and draining the blood, which is replaced by chemical preservatives for the temporary preservation of the body while awaiting interment. I understand that embalming is not required by law.

  Bud Noakes, an editor of Mortuary Management, responded emotionally in a leading editorial:

  I thought I had reached a time of life at which I do not shock easily, but I realize now I had not fully plumbed the depths to which Mr. Treuhaft is capable of descending. I was shocked that an individual, who is sworn to act in the best interest of California, could be so wholly insensitive to the emotional state of bereaved families.

  Anyone who wants to know how embalming is accomplished can easily find out simply by asking funeral directors. But the answer will be given in a tactful and diplomatic manner, and in consideration of the emotional state of the person making the inquiry. For anyone to assume that the same explanation could be given to everyone under any and all circumstances is to confess abysmal ignorance of the tender sensitivities of people in a state of bereavement.

  There follows a call to action. There will be a hearing at the state capitol (date and address given) to vote on the proposal. “It is incumbent upon all funeral directors to take immediate action to protect the best interests of the bereaved public we are dedicated to serving.”

  So the brethren rallied, and the lobbyists lobbied, and the proposal was defeated. Dead, yes, but destined to be reincarnated five years later in the Federal Trade Commission’s Funeral Rule.
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  The funeral folk soon had another opportunity to show their tender concern for the feelings of those in bereavement. When, in the early eighties, the outbreak of AIDS became a matter of public anxiety, there was panic on the part of funeral directors and embalmers for their own safety. Most mortuaries refused to accept cases where it was believed that the deceased had been exposed to the HIV virus; those that did accept AIDS victims refused to wash, dress, or embalm the victim.

  The New York State Funeral Directors Association (NYSFDA), on June 17, 1983, advised members to institute a moratorium on the embalming of AIDS victims. Reaction was quick.

  Peter Slocum, a spokesman for the State Department of Health, said that funeral directors had previously been advised to handle the bodies of victims of AIDS as they handle victims of hepatitis B—that is, to wear latex gloves, a procedure that had already been prescribed to prevent spread of any contagious disease and required for health care workers under all circumstances when working with dead bodies. “We have not seen anything that suggests that there needs to be any precautions beyond that.”

  Governor Mario Cuomo introduced a bill in the state legislature which would make funeral directors liable to loss of license if they refused to embalm AIDS victims, saying, “We must not permit AIDS sufferers and their families to be subjected to irrational and unscientific behavior born out of fear, not fact.” One week later, the NYSFDA lifted its moratorium on embalming, and the bill died in committee.