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Death and Dying

Death describes the cessation of life, and dying speaks to the manner in which death occurs. Although these are simple concepts to understand intellectually, the realms of personal experience and counseling to which they refer are quite complex. As noted by Schneidman, death entails many contradictions given the various ways in which it may be perceived. For some death is the destroyer, for others it is a redeemer. Similarly, it may be seen as both the greatest cruelty and as a means of release. Whereas fear of death tends to be universal, there are those who actively pursue it. Despite the reality that all are subject to death, each person's experience is unique. We live with the fact of our death from the moment of birth and yet have little knowledge of the phenomenon. We thus tend to be fascinated by the subject even as we fear it.

Societal Perceptions

During the 19th century, the worlds of the living and of the dead generally were closely intertwined, with meaning flowing freely between them. However, as advances in medical technology and health care during the 20th century led to dramatic improvements in birth survival rates and exponential increases in life expectancy, a hope that death might eventually be conquered evolved. In the West, this hope gave birth to a culture that, until very recently, was reluctant to embrace death as either an integral part of life or a phenomenon to be studied and understood. Ours has been described as a death-denying society, with fear the norm and perceptions of death so negative that it is a topic studiously to be avoided.

Many explanations have been offered regarding the desire to bypass conversations about death. These include the fear that talking about death will encourage or bring it forth and the related thought that avoiding the subject will preclude its appearance. Additionally, most have great concerns about the dying process as well as the inevitable unanswered questions about what happens after they die and distress at the thought of losing the one life we are given. Awareness of a lack of meaning in our lives, negative associations around the decay of our bodies, apprehension about judgment, dread of the unknown, and fear that nothing awaits us on the other side of death all lead to a general sense of trepidation. Despite such pervasive attitudes, however, within the mental health professions the topic of death and dying has become an important area for consideration.

Professional Developments

The late 1960s and early 1970s were a highly volatile era in our social history, characterized by significant growth in awareness of and responses to the previously unmet needs of those who were dying. The concepts of hospice and palliative care were pioneered in England by Dr. Cecily Saunders, and in the United States, Dr. Elisabeth Kiibler-Ross was at the forefront of the field of thanatology. The evolution of a new movement was marked by the first meeting, in 1974, of what eventually became the International Work Group on Death, Dying and Bereavement. In 1976, in response to the needs of a growing number of professionals involved in this work, the Forum for Death Education and Counseling, subsequently renamed the Association for Death Education and Counseling, was created. Today, many books, journals, conferences, and training opportunities on the many aspects of death and dying are available, and a variety of research investigations have shed a great deal of light on this subject.

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