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In his The Encheiridion or "Handbook," stoic philosopher
Epictetus speaks repeatedly of the importance of keeping death and dying
in one's consciousness. Being aware of the reality of death is
emphasized by Epictetus, who suggests that the individual, "Let
death and exile and everything that is terrible appear before your eyes
every day, especially death," as doing so will prevent
"anything contemptible in your thoughts," as well as
"craving anything excessively." (p.16) The philosopher does
not, however, reserve his discourse only for the matter of when death is
contemplated, but also offers advice on how such contemplation should
take place. He states:
Did your child die? It was given back. Did your wife die? She was
given back. How does the way the giver asked for it back concern you? As
long as he gives it, take care of it as something that is not your own,
just as the travelers treat an inn. (p.14)
In suggesting the use of "given back" as a metaphor for
death, Epictetus brings to light several points regarding the nature of
our conception of death and dying, which neither he, nor other
investigators of death, seem to have taken any further: he recognizes
the role of metaphor in providing a foundation for our understanding of
the "unknown"; he recognizes these metaphors as culturally
constructed, and culturally reinforced; finally, and perhaps most
importantly, he realizes that these metaphors, since they are our own
creations, may be replaced when they no longer offer us the increased
understanding, or at least reduced perplexity, which they are intended
to provide.
Epictetus was on to something. However, it would appear that he, as
well as much of the world's thinkers on death and dying, have not
pursued his discovery further. In doing so it appears that they may have
abandoned a critical factor in our personal and cultural understanding
of death. They confuse, as in the ancient Zen saying, "A finger
pointing at the moon for the moon itself."
The Name of Death - A Rose By Any Other Name
"Death is a displaced name for a linguistic predicament."
- Paul de Man (1919Y-83)
In his essay, "The Information Environment," cultural
critic Neil Postman asserts: "The means by which people communicate
comprise an environment just as real and influential as the terrain on
which they live." (p.29) Perhaps this is a reason why many of the
most prominent researchers/writers on the subject of death and dying
have touched on the role of communication in the dying process. However,
much of this discussion is limited to an interpersonal context,
involving the family or caregivers in communication with the dying
person. Researchers on death, or "thanatologists," often look
to Elizabeth Kubler-Ross as a critical pioneer in advancing cultural
acceptance of, and intellectual inquiry into, the nature of death and
dying. In her groundbreaking work, On Death and Dying, Dr. Kubler-Ross
is quite clear in her assessment of our culture's reservations when
discussing mortality in general. This practice of refusing to discuss
the topic of our own mortality may be symptomatic of our culture's
overall discomfort with the topic as whole. "In a society where
death is regarded as a taboo," asserts Dr. Kubler-Ross,
"discussion of it is regarded as morbid, and children are excluded
with the presumption and pretext that it would be 'too much'
for them." (p.6) One cannot help but speculate that regardless of
the prevailing attitudes which underlie such a semantic condition, the
results of it are surely predictable. What is not discussed, and instead
denied or avoided, is quickly removed or at the very least diminished,
from our cultural consciousness. Whichever came first, the denial of
death, or the refusal to speak of it freely, the situation we find
ourselves in remains much the same.
Perhaps the most notable recent "ground breaking" addition
to the field of thanatology has been the 1995 publication of Dr. Sherwin
Nuland's How We Die. Nuland, much like Kubler-Ross, observed in his
medical practice the generalized denial and fear of death so prevalent
in our culture. In assessing the role of communication in remedying this
problem, Dr. Nuland is quite clear: "Only by a flank discussion of
the very details of dying can we best deal with those aspects that
frighten us the most. It is by knowing the truth and being prepared for
it that we rid ourselves of that fear of the 'terra incognita'
of death that leads to self-deception and disillusions." (p.17) Dr.
Nuland, like Dr. Kubler-Ross, agrees that an "increase" in the
"frank discussion" of death and dying would raise our cultural
comfort level regarding this topic.
The role of communication issues in our cultural and personal
conception of human mortality is discussed by these, and many other
writers on the topic of death. However, such discourse is limited in its
choice of topics: how to discuss death with our children or how to
discuss death with patients if you are a doctor. The interpersonal
context of our discussion of death is scrutinized in some detail. In
such a generalized scrutiny, however, some of the most critical
subtleties may be excluded.
Metaphors - The Unacknowledged Foundations of Cultural Consciousness
Perhaps one of the most powerful forces in human consciousness, yet
one of the least recognized, is the metaphor. As children, we are taught
that a metaphor (unlike a simile) is a comparison between two things
which does not use the words "like" or "as." Perhaps
like many of you, this marked the end of my formal education on the
topic of metaphor. "Where understanding fails" said Goethe,
"a word comes to take its place." It would be difficult to
find an area where understanding fails so completely, as in the area of
human mortality.
In his book Crazy Talk, Stupid Talk, Neil Postman states: "Every
semantic environment is controlled by metaphors, frequently hidden from
the view of those who have created them, but through which people
interpret the meaning and value of what is happening." (p.132) He
also asserts: "In poetry and science, such metaphors are usually
called to attention. They are, in fact, forced on our awareness by being
placed at the center of what we are to consider, and they may be
rigorously examined. But in everyday speech situations, we are apt to be
unaware of how we are using our metaphors, and therein lies a source of
considerable confusion." (p.125) The origins of metaphors in the
formation of our consciousness is examined in even greater detail by
Christine Nystrom in Human Symbolic Evolution. In chapter 5,
"Metaphor," as she notes, "A metaphor is a way of dealing
with the unfamiliar, the novel, the unknown, by likening it to something
known, that is, to something we have already learned to predict and
control with relative success." (p.81) If Dr. Nystrom is correct,
and the roots of our formation of metaphor do reside in our desire to
perceive control over that which we have little or no actual control of,
it is no surprise that we, as a species, have such an array of metaphors
for mortality.
Thus, as our metaphors are created by our consciousness, so is our
consciousness created by our metaphors. What then is the role of the
metaphor, our most unrecognized perceptual tool, in our cultural and
personal consciousness of dying, the ultimate stage of life? Through
interviews and interaction with individuals who through personal events,
or professional choices are interacting with human mortality, it was my
hope that such metaphors and their functions could be brought to light.
The sheer number of metaphors we use in reference to human mortality
is an index of our cultural discomfort with the topic. In fact, one
would be hard pressed to find a type of reference to death in this
culture which is both frequently used and without metaphoric content.
Rarely is death called by its own name.
The Battle Rages On - Clinical Metaphors For Death and Dying
Although each passing year introduces new illnesses and reminds us of
those we have yet to find cures or prevention for, Western medical
science continues to engage with undiminished vigor in an almost
mythical battle against its sworn nemesis: human mortality. As Dr.
Sherwin Nuland suggests, "We live today in the era not of the art
of dying, but of the art of saving life, and the dilemmas in that are
multitudinous." (p.265)
In Apology, Plato presents Socrates' address to his followers
regarding fear of death:
To fear death, my friends, is only to think ourselves wise, without
being wise: for it is to think that we know what we do not know. For
anything that men can tell, death may be the greatest good that can
happen to them: but they fear it as if they knew quite well that it was
the greatest of evils. And what is this but that shameful ignorance of
thinking that we know what we do not know? (sc.29)
How many times have we heard a physician or surgeon say "I
don't know" in reference to a medical question? In modern
Western culture, the role of the physician is analogous to the role of
the Shaman in Native American culture. He is the one who knows that
which cannot be known by the "common man" regarding the forces
of life and death. It is the job of the physician to "know"
not only that which is not known, but even sometimes that which cannot
be known. Death however, in our current conceptual framework, could be
viewed as the ultimate failure for Western medical science. It is
incurable, it has a 100% fatality rate, and no matter how hard one
studies, practices one's technique, or memorizes related formulas,
it cannot and will not be prevented indefinitely. Perhaps this is why
some of our most frequent and unapologetic uses of metaphor in relation
to death continue to grow and spread unabated, especially in the
antiseptic hallways of our medical institutions.
"Coded"
In medical school, you don't learn anything about human beings.
It's incredibly clinical. A great deal of what people say or do is
simply passed down, from person to person, within an institution.
Doctors, and most other medical staff in hospitals, are not likely to
refer to someone's death as "they died." Usually they are
referred to as having "coded." Like, "How's the old
woman in 4B?" "Oh, she coded last night." It's
really curious to me because "coding" is a procedure, not an
event. When we discuss someone's bypass surgery you don't ever
hear someone say, "He bypassed yesterday." - Dr. G
(Cardiologist)
The term "code," unshockingly enough, was born in the
clinical setting of the hospital or medical center. A "code"
was a term used on hospital PA systems, in order to alert medical staff
that an important and usually life-threatening event was occurring
(e.g., Code Blue - Heart Attack, Code Yellow - Fire in Hospital).
Medical staff are assigned to the "code team," and responsible
for measures such as CPR on clients who have "coded." How the
term became a reference to the death of a patient is unclear. As noted
in the interview with Dr. G, a prominent cardiologist who has worked at
a variety of city hospitals, as well as a major heart center, the fact
that the procedure of a "code" has come to refer to the event
of a death is curious. That it is one of the few examples of this kind
of referential shift in medical terminology could be indicative of a
need for a "medical metaphor." "Code" is clinical in
its tone, but still not completely honest.
"Lost"
The most common metaphor I hear clinicians use when speaking to
nonmedical personnel and families is "lost." "We lost the
patient," or "We attempted resuscitation, but lost him
anyway." When I first came to this country this struck me as rather
odd. I wanted to say, "Well, we didn't really lose your
husband. We know where he is, it's just ... he's not breathing
there anymore." - Dr. Y (Oncologist)
When discussing death with medical personnel, undoubtedly the most
common metaphor is "lost." We are all familiar with this
metaphor. From the "I am sorry for your loss" found so
frequently on Hallmark sympathy cards, to "after a massive
arrhythmia we lost the patient," this metaphor deeply pervades our
cultural consciousness. But, how many of us have really ever considered
the implications of this word choice. Why is the primary metaphor for
death one which has such a wide range of meanings, all with somewhat
dismal connotations? The American Heritage Dictionary (Third Edition)
defines "lost" as: "To be unsuccessful in retaining
possession of; to be deprived of ownership as by negligence, accident or
theft; to fail to win." In a matter as inevitable as human
mortality, how did we come to inject this oppositional tone? Does this
metaphor perhaps reflect the almost mythic battle between the forces of
Western Medicine and its sworn nemesis, the "grim reaper"? A
battle which, if death marks the reaper's triumph, we are destined
to "lose" every time.
"PBAB" and "Circling"
Most people, if they understood the codes we mask it in, would
probably be really offended by the kind of morbid humor that goes on
between medical staff. It's not that we're callous people, or
evil, it's just that we have to find some way of coping with these
emotional events. Humor is one way that we can do that. When we refer to
a patient as PBAB, the medical staff involved know what it means, but it
is hidden to everyone else involved, since physicians use so many
acronyms anyway. - Dr. G (Cardiologist)
If people ever came into these offices when the doors are closed, and
it's just the team, they would think we were really sick people. We
have this tendency to joke about things that we all know aren't
funny, but it lightens things up a bit, and probably prevents us from
breaking down weeping every hour or so. - Ms. R (Hospice Administrator)
The necessity of humor in coping with stressful situations would
appear to be a natural human response, not limited to any one
profession. However, the sworn enemies of human mortality, the medical
profession, seem the most reluctant to admit their own tendency to use
humor as a coping mechanism. In interview after interview, each medical
professional (from physicians and surgeons to nurses) admitted, with a
low whisper, that many of the common metaphors for mortality were a sort
of "black comedy," which they understood the necessity of, but
believed those outside the profession would misunderstand. From
referring to imminently dying individuals as "PBAB" (Pine Box
At Bedside), to entering the offices of the hospice team asking "So
... who's circling today?" (a reference to the image of
vultures circling the dying individual), the use of humorous metaphor
abounds. There appears, among the medical professionals interviewed, a
common acknowledgment, yet a common tone of guilt, over the need for
these metaphors. In a culture where "humorous" metaphors for
death abound (e.g., "kicked the bucket," "croaked")
why does this group feel more reluctant to admit to this use?
"Gone"
Although mentioned less frequently by actual medical personnel, the
term "gone" seems the most widespread metaphor for death,
according to television and film. On how many television programs have
we seen the surgeon, nurse, or family member with blood stained clothing
stop CPR, or close the patient's eyes, and say, "He's
gone"?
The use of "gone" presents an interesting dilemma, however.
If the primary function of terms of reference regarding death and dying
is to provide an analogous framework for understanding that which cannot
be understood, why would we use a term as ambiguous as the name of
"death" itself? Where has the deceased "gone" to?
When should we expect them back? To be "gone" somewhere,
without a destination, and without expectation of return, is incredibly
ambiguous. If we are comfortable with this ambiguity, why then do we not
simply use the name we have chosen for the phenomenon itself? Why is he
"gone" instead of "dead"?
Our Eternal Rest - Sleep Metaphors
The way that most people seem comfortable looking at the cemetery as
a place where their loved one's body is "laid to rest" or
"put to rest." Not a place where the body deteriorates, or the
"worms get you." Sometimes though the whole thing gets taken
to almost humorous extremes, when people's perception is so fixed
on the "rest" of their loved one. People ask for spots under
trees, so that they aren't directly exposed to the sun, and have
some shade. I had a woman tell me that she didn't want her husband
in a plot near the end of the land, as there was a road nearby, and the
sound of the cars would disturb him. I asked about his hobbies, and was
told that he enjoyed exercise. So I told her that "I bet he would
enjoy seeing the joggers that run along the road." She agreed with
this, and picked a plot right alongside the roadway. - Mr. H (Cemetery
Director)
It never surprises me when children in this culture are afraid to go
to sleep. So many times, we use references like "Grandma went to
sleep, and didn't wake up," or "Grandma is resting
now." In fact it amazes me that children ever go to sleep at all
after hearing things like that. But really, it's just the most
common thing I hear parents tell their children. - Ms. C (Hospice Social
Worker)
The number of metaphors for human mortality that in some way relate
it to sleep is too great to be coincidental. It is not difficult to
imagine how this phenomenon began. Perhaps to our prehistoric ancestors,
the total cessation of bodily function, which we now know as death, only
appeared to be an unending sleep. Not realizing that an absence of
breathing and heartbeat are the most reliable indicators of death, they
must have judged the death by the other absences that come with it -
cessation of speech and of movement "symptoms" which are
present virtually every 24 hours when we sleep. However, in the
"modern" era, when we are much more dearly aware of the
differences between sleep and death, why do the two remain so closely
intertwined?
In The Hour of Our Death, his comprehensive and well researched
historical examination of death in a cultural context, author Philip
Aries encounters this metaphor repeatedly. "The belief that the
dead are asleep is both ancient and constant," states Aries. He
supports this point with a discussion of the stoning to death of St.
Stephen, the martyr who is described as obdormivit in Domino, or
"asleep in the lord" in the Acts of the Apostles. The
inscriptions found on grave areas, now commonly replaced by "here
lies," is revealed by Aries to in fact be derivative of hic pausat,
hic requiescit, hic dormit or requiescit in isto tumolo, translatable as
"here rests," "here sleeps," or "in this grave
rests." (p.23)
The human tendency to compare that which we do not understand to that
which is more familiar to us, is nothing new. Marshall McLuhan dubbed
this mental and linguistic habit the "rear-view mirror
effect." Talking about a train as an "iron horse" or the
television as a "radio with pictures" can make for convenient
thought, but can blur important differences in the characteristics of
the two items compared. In discussing death and sleep, this could not be
more true.
Closing
Perhaps the whole root of our trouble, the human trouble, is that we
will sacrifice all the beauty of our lives, will imprison ourselves in
totems, taboos, crosses, blood sacrifices, steeples, mosques, races,
armies, flags and nations, in order to deny the fact of death, which is
the only fact we have.
Letter From a Region in My Mind - James Baldwin
We must be particularly cautious when dealing with metaphors of
mortality, because unlike other subjects, death is one which not only is
not understood by our culture, but which does not have the potential to
be understood, no matter the vigor of our inquiry. In general, change is
a difficult experience for the human animal. Metaphors as tools may
assist us in better understanding life's turns into unknown
territory. However, metaphors may also be the bandage which prevents us
from exposing wounds which may on some level require attention.
Metaphors may assist us to a certain extent in coping with the pain of
loss and the fear of dying which we all have or will encounter at some
point. However, they also may alter our perceptions and prevent us from
facing uncertainties which we would do well to face.
The purpose of this inquiry, and the ideas which have grown from it,
is not to suggest that we should discontinue our use of metaphors in
regard to death. In fact, the alteration or elimination of such
perceptual tools may cause us pain that is not needed, particularly at a
time when we are dealing with issues painful enough in and of
themselves. As a culture, we embrace the metaphors of human mortality.
Metaphors offer us comfort in a time when it is sorely needed. They
offer us answers in a time when all of our inquiries are prone to fail.
By identifying the roles these invisible technologies play in our
consciousness, we may increase that which is best in them, and prevent
that which is most dangerous in them. Perhaps simply the process of
identifying our use of these metaphors, and an acknowledgment of their
possible psychological functions is enough. It is not the fact that our
perceptions are altered by our metaphors that makes them potentially
dangerous; it is that we are too often unaware of this alteration. This
then may be our challenge: to become conscious of the words we use in
reference to our own death, and the deaths of those near to us, and then
to realize where these comparisons may lead us. This struggle for
knowledge may be a difficult one at first, but then could it really be
expected to be less? It is after all, a matter of life and death.
WORKS CITED
Aries, Philip. The Hour of Our Death. New York: Oxford University
Press, 1981.
Baldwin, James. "Letter From a Region in My Mind." New
Yorker, Nov. 17, 1962.
Epictetus. The Handbook. Trans. Nicholas P. White. Indianapolis:
Hackett Publishing, 1983.
Kubler-Ross, Elisabeth. On Death and Dying. New York: Collier Books,
1969.
Nuland, Sherwin. How We Die. New York: Vintage Books, 1993.
Nystrom, Christine. Human Symbolic Evolution. New York University,
1997 (Forthcoming).
Postman, Neil. Crazy Talk, Stupid Talk. New York: Delacorte Press,
1976 (Out Of Print).
Postman, Neil. Teaching as a Conserving Activity. New York: Delacorte
Press, 1979.
ACKNOWLEDGMENTS
My sincerest thanks to Julie Jakolat, Neil Postman, Gabe Moran, and
John Zimmerman of New York University for their support and feedback on
this work. Also special credit is due to Noah Sexton and my wife Mary
Jane for listening to my endless theoretical rants. Most especially, my
deepest appreciation to the patients and staff of United Hospice of
Rockland, whose strength and compassion teach me every day.
James Sexton is currently teaching and conducting research at New
York University's Department of Culture and Communication. He also
teaches at Ramapo College of New Jersey. His research interests include
sociological propaganda, thanatology, and the cultural implications of
mass media. He volunteers for a community hospice, and lives in New
Jersey with his wife Mary Jane.