Denial of Death

Visiting a rural cemetery that contains 18th- or 19th-century tombstones reminds us of the then high mortality rates of infants and children. Before the advent of hospitalization of the sick and dying, death was a normal part of family life. Birth and death were realities seen in every household, both among farm animals and people. Death was an important event in the life of a family, but it happened frequently enough that it was seen as something that happens to everyone, not as a significant catastrophe. Philippe Ariès suggests that death simply reflected a normative life span experience, in his words, a collective notion of destiny. As humanity lived through the Industrial Revolution, urbanization, globalization through two world wars, the isolation of nuclear family mobility, and [Page 351]the medicalization of all maladies, there has been an increase in anxiety and angst around the end of life. Young people are increasingly removed from any exposure to, or experience with, the elderly and the end of life. Death is viewed as an inconvenient enemy. Particularly in the 20th century, denial as the dominant coping response became common. Ariès traces this new attitude as having begun in the United States and since spread to Europe and all of Western culture. Today, the denial of death is frequently linked with youthoriented culture, but this reflects only one perspective of the denial of death. The denial of death can be understood as a cultural phenomenon, a personal coping strategy, and also a life span issue. From these three vantage points this entry takes on different issues.

Cultural Phenomenon

The death-denying attitude in American culture became pervasive during the latter half of the 20th century. In the early 1900s, most deaths occurred at home, as the result of accident, trauma, or acute infection. One hundred years later, most deaths occur in hospitals and skilled nursing facilities, as a result of long-term chronic conditions including heart disease, cancer, and dementias. Medical breakthroughs in diagnosis, technology, and biological agents, including antibiotics, have revolutionized medical care and reinforced the myth that death can be defeated. In the Experience of Dying, E. Mansell Pattison notes that the care of persons who are dying has been handed over to physicians and hospitals. However, when surveyed, physicians are more likely to be more uncomfortable around death than are most other health care professionals, seeing it as a failure in their expertise rather than a natural part of life. The denial of death is seen in medical settings when staff avoid the dying patient or adopt a noton-my-shift mentality. Care is relegated to the intensive care unit where the family is marginalized and the dependence on technology is reinforced. Most health care dollars are spent in the last 6 months of life. Death is understood to be giving up or failing rather than completing the life course. It is seen even more dramatically in longterm care facilities, when the death of a patient is noted only by the removal of personal things and an empty bed. Returning to work and finding one's patient has died and the bed has already been filled by another resident is a common experience for nursing home staff. One nursing home had an old elevator at the back of the building that was too old to be used by residents, but because it went directly to an area near the back door, it was used to move bodies so that they could be picked up by a funeral home. The noise of this old elevator was the only sign to the residents that someone had died. The denial of death has, at times, resulted in institutions either not wanting to offend or wanting to protect residents and staff from grief. However, by denying death, a new form of fear is created, the fear that one will die and no one will notice.

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