As members of a society we may play a major role in its death system as core participants. Our participation may occur on a more or less continuous basis or we may be 'peripheral players'. A very small percentage of the members of a society are 'core' members of it's death system. Funeral Directors, Morgue Attendants, and Cemetery workers are the first to come to mind and are easily identified as members of any death system. What about the sales persons, accountants, receptionists, copy writers, real estate brokers, developers and construction firms, who owe their existence to the decision to make a financial investment in the inevitable fact of dying by purchasing life insurance? However indirectly, these people are part of a 'death system'.
Kastenbaum points out that occupations such as florists and lawyers, may have a direct role to play in the death system as do workers in the food industry who are responsible for raising, slaughtering and processing other animals for food, leather, clothing, and footwear. Animals are 'sacrificed' in the pursuit of medical cures and prevention for a host of diseases - someone must kill the animal on our behalf.
In earlier agricultural societies individuals were familiar with death and did their own killing. A chicken dinner did not appear ready cooked with all the trimmings from the local chicken diner. A chick was hatched and encouraged to grow to maturity. It was guarded against the fox, eagle, and other predators. On the appointed day someone held it by the feet, lay its stretched neck out across a chopping block and cut off its head with an axe then held on tight to keep the meat from bruising as the chicken died in a flurry of beating wings and spurting blood. Cleaning a chicken wasn't 'clean' at all. Today, as 'civilized' urban dwellers, we hire others to do this work for us.
Think of how many people may be involved in a restaurant dinner. The waiter, cook, and dishwasher are most visible and killing and processing the chicken obviously involved people in the death system. What about the truck driver who delivered the meat and the mechanic who maintained the truck? Account executives and advertising agencies, bookkeepers, cleaning staff, and window washers benefit to some extent from the 'death system'.
Health professionals, clergy, scientists, engineers, all take an active role in and derive benefit from our death system.

2.0 Places:

Places are part of our death system. Cemeteries, crematoriums and funeral homes are a well defined part of our death system but sometimes a place attains lasting social, political or spiritual power simply by chance. Battlefields, chosen in the midst of war as sites of death and destruction, become regarded as national and historic treasures. We set aside the homes and castles of a societies once powerful and influential, but now dead, people as memorials to their achievements or infamy. And, what makes a 'haunted house' haunted?

3.0 Times:

In Canada, Remembrance Day, the eleventh hour of the eleventh day of the eleventh month, November 11, is set aside as a day of National Mourning for those who have died in war and in peace while providing service to Canada and the world. The church celebrates it's Saints and Martyrs Days. In Mexico, the Day of the Dead, is in integral part of that societies death system. We set aside specific days according to our religious affiliation be it Christian, Jewish or Shinto.
Special times are a part of our mourning. 'Anniversary re-actions' refer to the upswelling of grief that occurs on days that we closely associate with a loved one who has died. Their birthdate, wedding anniversary, date of death, are formal, expected times as are Christmas, Easter and Thanksgiving. We are usually not prepared for the grief that accompanies the memory of first dates, first kiss, vacations - those private special times we shared that come to mind in the first year following the death of a loved one.

4.0 Objects:

The hearse that carries away our mortal remains and the headstone put on our graves are 'death objects' as are the coffin or casket. Other objects are identified and referred to in ways that recognize their significant role in our societies death system.

5.0 Symbols:

Objects may also serve as symbols. Cigarettes are referred to as 'coffin nails', an automobile or aircraft past its prime or not properly maintained is called a 'flying coffin'. In the Victorian Era black arm bands for men and black or dark purple dresses for women signaled their status as mourners. Letters sent by someone in mourning were 'edged in black'. I have a photo of my great grandfather Joseph showing him wearing a necklace and small jewel stone around his neck. I discovered that during the late 1800's, it was common for the middle classes, academics and clergy to wear a 'mourning stone'. Reading my grandfather's journals, I discovered that he was wearing it in remembrance of his sister.
Music is symbolic. Our attitudes towards death are reflected in our choice of a New Orleans Jazz Funeral or the playing of Beethoven's Fifth Symphony. We use 'symbolic reference' to death in our daily speech through the use of euphemisms.

The Functions of a Death System.

1. Warnings and Predictions

Every day we come across some sort of warning against or a prediction of death. Kastenbaum notes that they can be based on:

These warning can be:

As individuals or societies we have the choice to either:

In order to 'navigate' through this warning system we must have some means of prioritizing and assigning value to the warnings. Our daily weather reports contain storm, hurricane and tornado warnings. Small Craft warnings are common for populations close to major waterways. Ecological warnings or predictions of pollution, environmental hazards, and galactic catastrophe, hold so prominent a place in the human psyche that they have become subject matter for the entertainment industry with movies depicting tidal waves, earthquakes, volcanic eruptions, meteor showers and infectious diseases. Our response to the warnings depends on our belief in:

2. Prevention System

Physicians and workers in the health care system are our first line of defense in our 'war on death'. Backed by research scientists and billions of dollars in technical innovation every year the system fights to keep us alive, sometimes at any cost. Police and Fire fighting systems recruit individuals willing to face the danger of imminent death in order to keep others safe. Highway maintenance crews, part of our transportation system, reduce the chance of accident and death by keeping highways in a constantly safe state.
Advertising campaigns reminding us to 'drive safe' and 'work carefully' are daily fare. In Ontario, the introduction of graduated licensing was a direct attempt to reduce highway deaths involving novice, and usually young, drivers. What is the not so subtle message from the automobile brake and tire advertisements that prominently portray children and babies as the real reason for purchasing a particular brand of merchandise or service?

3. Care of the Dying

As our population ages the tasks of caring for our dying continues to emerge as a priority of our death system. When do we move from cure mode of thinking and care to a comfort mode of palliation in the face of inevitable decline and death? Who makes the decisions and sets out the parameters that define 'quality of life'? Kastenbaum (pg 66) suggests that the move from preventative to palliative health care is complicated by inadequate patterns of communication between patient, family and caregivers.
At first glance, this appears to be true, however, patterns of communication and the means to communicate are not synonymous. Our ability to 'hear', that is, our ability to understand the value and meaning being expressed by the dying is distorted by our own values and meaning systems as living entities. As a helper and caregiver, my understanding of the dying persons needs is coloured by the fact that I am not dying. I can try to empathize, understand, and even sympathize, but I cannot 'know'.
Societal attitudes, according to Kastenbaum, continue to change, making both the decision and the means of implementing that decision tenuous. But that raises the question of 'cause and effect' an integral part of any open system. Are means developed in response to attitudes or are our attitudes shaped by the means at our disposal?

4. Disposing of the Dead

Methods of disposing of a corpse differ between and within societies. The 'funeral' or 'last rite' is the community expression of its relationship to the dead. The dead have a place and role in our death system. In 1993 the Mississippi River flooded the town of Hardin and washed away much of the local cemetery. Considerable energy and resources were allocated to the recovery, identification and re-internment of the bodies. Large numbers of volunteers from other communities helped with the process. Kastenbaum observed that "The living still felt connected to their dead. The dead are considered "at rest" when their identities are clear and they reside in their own proper graves. The dead are conceived of as somehow distressed or violated when they remain nameless, adrift, unburied".
This belief has been expressed by war veterans who remain troubled by the image of friends and comrades lying on the battlefield in positions of death. Part of the pilgrimage made by many former combatants to military cemeteries is to assure themselves that the dead have received proper care and burial. In one case, I journeyed to the military cemetery at Dieppe, while in France and placed a wreath on the grave of a soldier who had died in my father's arms. The photo of that well tended grave with its marker and flowers brought considerable comfort to my father. I suspect that one grave was symbolic for the 262 men of my fathers regiment who died that day.

5. Social Consolidation after death

Death can shatter our assumptive world. That is, what we normally expect to be true, may no longer even be relevant. The bereaved are faced with the challenges or re-defining their new assumptive world and integrating themselves with it. The death system either fosters or thwarts this integration. If the system functions well, it provides emotional and practical support.
Emotional support, in the form of consolation, encouragement and empathy and practical support, the doing of tasks and provision of services, creates an environment conducive to the re-establishment and defining of personhood. The giving of information and feedback allows the bereaved to engage in reality testing as part of the process of testing, modifying and establishing new cognitions, expectations, behaviours, and appropriate emotions congruent with their new role in the world.

6. Making Sense of Death

The question I am most often asked by the bereaved is "Why?". The need to make sense of death, to discover some reason or purpose that was served by the death is often paramount. This urgent need to make sense of death is most intense when death is traumatic:

This need to discover a rational explanation for death is experienced and observed at a superficial level when we use phrases like "When your dead, your dead" or "Nobody lives forever".
The more urgent and demanding questions involve our quest for the meaning of life and our understanding of our purpose in living in the face of death. The 'sense' we make of death may be individual or an acceptance of a universal truth. In the end, it is the act of having re-integrated into the social group as evidenced by the ability to proclaim "This is what I believe. It is what we believe."

7. Killing

In the discussion on 'People' we noted the web of individuals connected to death, either through employment or the hiring of others to perform death related tasks. Society condones killing of humans in specific circumstances by appointed individuals in distinct roles. The police forces in Canada have a mandate to protect the lives of their members and the lives of the members of the community they serve. As such, they are issued weapons of lethal violence and trained in their use. They are not given free reign. Their activities are closely monitored and regulated. Our armed forces have a similar mandate but are equipped and trained on weapons capable of inflicting multiple deaths.
Euthanasia, if legalized, will be the commissioning of individuals in a society to kill other human beings in a given set of circumstance. What those circumstance entail at this time is not clear.

Kastenbaum's model does give us a way of understanding not only our society, but our role within that society when faced with death in its many and varied forms. An historical examination of death attitudes and practices is plagued with difficulties that cannot be met using only historical, social, or empirical methods. Kastenbaum's model may help us understand not only our own death systems but those of historical societies before us.

Additional Reading:

© Howard R. Gorle (2000)

Historical Approaches to Death and Dying

Philip Aries, a French historian, spent almost twenty years investigating the changing attitudes towards death in Western Civilization, and the forces behind those changes. His scholarship was exacting. He began with the period 500 to 1100 AD, which he called "Tamed Death". The label does not mean that death itself was ‘tame’ but refers to the human response to the arrival or occurrence of death in their individual lives. Grief at the loss of a loved one was real as was individual mourning. What Aries was referring to was the attitude towards death of a person ‘facing death’.

Death was familiar for several reasons; life was harsh and cruel, medical standards were low, infant mortality was extremely high by todays standard, life expectancy hovered at around 40 years. As a result, death was a common occurrence, witnessed by everyone in the community on a regular basis and expected. A warning of coming death; a chest cold, festering wound, injury, gave an individual time to prepare for death in a manner that was familiar to him and the society in which he lived.

Having first made arrangements for the dispensation of his worldly goods and calling those to whom he was indebted or were indebted to him to his bedside to settle debts and forgive outstanding grievances, he summoned a priest to his bedside and requested the rites of the church. Seeing the priest the people joined the procession to the bedside where they took their part in the service from memory having participated from early childhood. Having received the sacraments, the dying man lay with his head to the east, and either crossed his arms on his chest or spread them out to the side in the configuration of a cross and waited for death. Dying was simple and occurred in the home. The primary concern was the well being of the community.

Religious belief was that the dead were merely asleep and waiting for the second coming of Christ. The human body was not considered sacred or revered in any way. The common resting place was an unmarked charnel house or common grave outside the walls of a church.

Change occurred slowly but around 1100 AD Christian belief began to focus on the individual soul as the prize in an ongoing cosmic struggle in which Satan and St. Peter struggled for the soul of man. Aries called this era that of ‘My Death’. What was considered important was how one died which influenced one’s future afterlife. Thus the ‘dying well’ or ‘Ars Moriendi’ came to primacy as one faced their own demise.What was then important was how the dying faced death. Several books on the subject were made available and great attention was paid to preparing for death. Cadavers rose in import and were interred inside church walls, that is, inside the walls surrounding the church grounds, and were sometimes marked with a single stone. Members of the aristocracy and clergy might be buried inside the church proper.

In the 1700’s a noticeable shift occurred with importance being placed on ‘the death of the other’ which Aries labeled ‘Thy Death’. Death still occurred in the home in the company and care of loved ones and came to be romanticized as a separation of loved ones from each other. A cult of ‘beautification’ developed that saw the introduction of mourning clothes and prescribed periods of mourning for each sex. Women came to wear black for one year followed by dark purple for another two. Men wore black or a black armband. Church graveyards had become crowded and often unsanitary. Civic cemeteries were created in park like areas. Ornamentation on grave stones became symbolic and often complex. It became common to commission an artist to design and sculpt a unique marker that reflected the social standing and wealth of the individual while professing the love of the community.

In the 1900’s, particularly after the first world war (1914 - 1918) death attitudes changed again to what Aries refers to as the era of ‘Death Denied’ or Invisible Death’. The causalities of war strained the ability of society to provide elaborate individual funeral services and there simply was no time to mourn in the urgency of war. This period saw the development of embalming and the slow evolution of carpenters and horsemen to professional ‘morticians’. Care and burial of the body was entrusted to others in the new ‘death industry’.

Health care began to rise and traditional causes of death began a slow change that accelerated in mid century as childhood diseases came under control and antibiotics were developed. Advances in medical technology, particularly the development of the respirator, meant that death could now be delayed and occurred in hospital following a ‘great war against death’.

Changes in demography resulted in families being separated, children were no longer the first to die, degenerative diseases slowly attacked the aged. The concept of ‘mass death and destruction’ brought about by the threat of nuclear, chemical and biological warfare tended to desensitize individuals to death as did the rise in violence in entertainment. Death occurred in silence, almost in secret as ‘a dirty thing’ or ‘medical defeat’, something to be ashamed of and avoided rather than a natural occurrence. Cemeteries became ‘Memorial Gardens’ where upright monuments were prohibited in place of flat headstones.

Internment has been replaced with cremation by up to 80% in some parts of the world (London, England) and ‘Memorial Services’, sometimes held several weeks after the death, have become more common. Wakes or ‘receptions’ in the family home have been moved to ‘reception centers’ run by funeral homes and catered by professionals. ‘Direct Disposal’ is a service offered that provides transportation of the body directly from the place of death, usually a hospital of infirmary, to a crematorium. No religious or spiritual service occurs. Death is now invisible and we are in the era Aries refers to as ‘Invisible Death’.

Think of the changes occurring in your community today. Notice the increase in funeral advertising as individual family owned establishments are taken over or ‘acquired’ by multinational corporations in expectation of high profits generated by the death of members of the ‘baby boom’ generation. (The ‘big three’ establishments in North America are; Service Corporation International’, Louwen Group, and Arbour Care).

Dr. John Morgan of Kings College has done extensive work in this area. The following is a paper he published on the internet at:

http://www.wwdc.com/death/attitude.htm

ATTITUDES TOWARD DEATH

Dr. John Morgan, Ph.D.

Although death is a fact, something that happens to all, dying and grieving are activities in which one engages according to the attitudes one holds about them. An attitude about death, dying, and bereavement, a more or less enduring readiness to behave in a characteristic way, does not differ from other attitudes. One is socialized into it by a culture.

A DEATH ATTITUDE SYSTEM

The set of attitudes by which one lives dying and grieving has been called a "death system" (Kastenbaum and Aisenberg). A death attitude system is cognitive, affective, and behavioral, that is, it teaches what to think about death, how to feel about it, and what to do regarding it. In other words, it is the total picture of questions related to death, dying, bereavement, suicide, and euthanasia in a given culture at a given time.

Attitudes contain feelings about dependency, pain, indignity, isolation, separation, possible rejection, leaving loved ones, afterlife, finality of death, facing the unknown, and the fate of the body. One may be very open about death and bereavement on a verbal level but quite anxious below the level of consciousness or at the fantasy level.

Whatever the contemporary attitudes toward death, there are other ways of looking at death, dying and bereavement than the ones prominent in the West. Though these are found in the West today to a modest degree, they are not dominant, but they have been dominant at other times, and are still dominant in other settings.

WESTERN ATTITUDES IN HISTORY

The French historian Philippe Ariès postulated that attitudes to death over the centuries are indications of the person's awareness of himself or herself, and of his or her degree of individuality. In other words, attitudes about death and bereavement differ because of differing conceptions of what it is to be a person, and the relationship of the person to his or her community, to the world, and to God. Ariès groups these attitudes historically around four basic orientations that he calls "tamed death," "the death of the self," "the death of the other," and "death denied."

Ariès characterizes as "the unchronicled death throughout the long ages of the most ancient history" the orientation he calls tamed death, which dominated until the Middle Ages. Since life was, as Thomas Hobbes wrote, "solitary, poor, nasty, brutish and short", one was constantly exposed to, and therefore familiar with, death as "a knife at our throat or a scourge at our child's bedside." The effects of this "uncontrolled mortality" was that since child and maternal deaths were common, one did not spend much time in preparation for adulthood: courtships were short, relationships were understood to be limited, education was minimal.

In the second historical period, which Ariès dates from approximately the twelfth to the fifteenth century, the individual became aware of himself or herself as distinct from the community. Whereas the earlier period emphasized familiarity with death, the second orientation, called "my death," emphasized the termination of one's own life, one's personal death. Death was the last act of a personal drama. This is the period of the Ars moriendi genre, manuals on dying that were meant to guide the reader's behavior as he or she faced of the end of life. Elaborate tombs memorializing the life became common, as did placing these tombs in churches of various sizes.

In the nineteenth century, the ideas of "death as a neighbor" and "death as the personal end" declined in favor of a third orientation, "death of the other." Life was viewed as having meaning primarily through relationships, thus death was perceived of as the loss of that relationship. Death was no longer as public, since privacy had become necessary for these relationships to develop. Dying was not mourned as the loss of community, as the end of life, or as judgment, but as physical separation from the beloved. The image of the beyond in the earlier periods, which had ranged from eternal sleep to a glorious heaven or damned hell, become in the nineteenth century the scene of the reunion of those whom death had separated. Wills became less common for had put his or her physical and spiritual affairs in the trust of the beloved without the necessity of a written document.

CONTEMPORARY WESTERN DEATH ATTITUDES

Present Western death culture differs significantly from those that preceded it. Ariès names the twentieth century the period of "death denied." To understand this designation, one must look at the parameters of contemporary death attitudes. They differ among cultures because of four major factors: exposure to death, life expectancy, perceived control over the forces of nature, and the understanding of what it is to be a human being.

Exposure to Death. Exposure to death and bereavement is the first element in an understanding of death. If one has little experience of the loss of significant others, death attitudes will be limited by that inexperience. Earthquakes in Mexico, volcanic eruptions in the Philippines and Central America, and chemical and nuclear disasters in India and Russia indicate that even the twentieth century is subject to uncontrolled mortality. However, these events create headlines precisely because they are unusual. In most Western settings, children grow up protected from death. In other parts of the world, the young are exposed to death quite early through war and starvation. Even in the West, exposure varies. Persons living in inner cities, especially those of African descent, may have an awareness of death vastly different from that of most suburbanites. The child whose parents die early, or the child of a funeral director or an emergency room physician, grows up with a greater exposure to death than does the average North American.

Life Expectancy. Exposure to death is related to life expectancy. Most babies born in North America can be expected to live to their late seventies. The latter part of the twentieth century is a period of increased longevity and predictable age specific death rates due to fewer neonatal and maternal deaths, better sanitation and food supplies, and improved medical care. The discovery that contagious diseases could be prevented through inoculation neutralized diseases that sometimes killed whole populations in earlier times. Consequently, in developed countries, it is today reasonable to assume that most mothers will not die from infections contracted as a result of childbirth and that most children will live to maturity.

Around the turn of the twentieth century, the death rate was approximately 17 per thousand live population in the United States, whereas in the 1990s the figure is less than 8 per thousand live population. The very old constitute the fastest-growing segment of the population; 10 percent of those over sixty-five years of age have a child who is also over sixty-five. As the population ages, the rate of death will increase, especially because the birth rate is too low to replace those taken by these additional deaths. Women outlive men, as they have always. The age-adjusted mortality rate in the United States, which was reduced by 26 percent for elderly males between 1940 and 1980, was reduced by 48 percent for elderly females in the same period.

Control over the Forces of Nature. Attitudes toward death are particularly shaped by one's view of the world and one's place in, and perceived control of it. One who believes that persons are entirely subject to the "laws" of nature will have a death attitude different from one whose view is that he or she has significant control over the forces of nature. In the West the dominant attitude is that nature exists to be used and controlled. Other cultures do not share that view. Those who live on the floodplain of Bangladesh or in the shadow of Mount Pinatubo in the Philippines have a different perception of their relationship to nature than do those who move about in climate-controlled cars and reside in air-conditioned and insulated offices and homes. Persons who believe they can be "protected" from nature have less respect for the power of nature over life.

Sense of the Individual Person. The most important element in the development of attitudes toward death is the perception of what it is to be a person. Most people in the West today believe that the person is unique, what Ernest Becker refers to as "the ache of cosmic specialness." In a culture that emphasises the individual and individual rights, persons will have a different orientation toward death than will members of a culture that perceives each individual as having meaning primarily as a part of the whole, whether religious or political, or perhaps as not having any meaning at all. Those who believe that each life is unique will perceive the end of that life as a different order of loss than those who perceive that a life has meaning only within a whole.

William James wrote that the word "good" fundamentally means "destined to survive." When an individual says that something is good, he or she implicitly affirms that the thing ought to exist. The effect of this self-awareness is the following enigma: "I am. I am good. Yet I shall die." This awareness is, in the words of William James, "the worm at the core of our pretensions to happiness." Death ultimately is the proof that no matter what powers humans have or develop, they still are not God. If James is right that good means "destined to survive," then death is nature's way of saying that humans are not absolutely good.

One indication of the death denial of contemporary North Americans can be found in the media coverage of the Gulf War (Operation Desert Storm). The public has a stake in denying that death occurs in a war. The words "death," "die," and "kill" rarely appeared in media reports, euphemisms for death were used instead. The contemporary view of death in the West is that every death is contingent, a matter of chance, and that, in principle, there is no reason why any particular injury or disease cannot be overcome.

EFFECTS OF THE DEATH ATTITUDE SYSTEM

While everyone is affected by, and in turn affects, the death system, it is instructive to focus on the effects that death attitudes have on those most immediately involved: the dying, the bereaved, and health care workers.

Effects on the Dying. Although the culture as a whole denies the importance or reality of death, the dying and the bereaved cannot do so. The effect of this situation is to alienate the dying and the bereaved from the support they have a right to expect. Most dying patients do not expect "miracles" to reverse their biological condition. What is essential is care and concern. The hospice movement has shown that when the physical and emotional needs of dying patients are attended to, there is less depression, blaming, and guilt for the patient and for the family, and death is the death of a person rather than an illness. Most persons arrive at some sense of acceptance: a realization that time is limited, that one's work is complete, and that one's life has been good.

Effects on the Bereaved. Although bereavement is one of life's greatest stressors, most of the bereaved have found that within one year of the death, the death of loved one has been an opportunity for growth. The main goal of the bereaved is to seek a meaning in the death. The discovery of the meaning of the death, as well as the sense of purpose in their own lives, is the major factor that brings a satisfactory adjustment.

Effects on Health-Care Professionals. Medicine and religion have much in common. Both address the fears of humanity and the meaning of events surrounding life and death. Religion has responded to these needs by constructing theologies; medicine, by providing a scientific theory of health and sickness. Labelling a biological state as a disease is akin to declaring that there is an evil that ought to be eliminated. The rescue fantasy, that one can "snatch the patient away from the jaws of death", is an important part of medical culture and the popular folklore about physicians.

As Becker has pointed out, all power is ultimately viewed as power over death; thus the conceptions of the physician's powers flow from the view that medicine is a priesthood with power over evil. Cardiopulmonary resuscitation is an example of the rescue fantasy becoming a reality. Cardiopulmonary resuscitation was developed for a select group of patients with temporary cardiac arrhythmias who would die without resuscitation. The procedure became standard practice and now the presumption is that no one should be allowed to die in a hospital without an attempt at resuscitation even though less than 20 percent survive.

TOWARD AN APPROPRIATE DEATH ATTITUDE SYSTEM

Death becomes acceptable, according to Daniel Callahan, when it comes at the point in a life when (1) further efforts to deter dying are likely to deform the process of dying, or (2) there is a good fit between the biological inevitability of death in general and the particular timing and circumstances of that death in the life of an individual. The achievement of such an peaceful death should be the goal of life, and therefore of medicine. The process of dying is deformed when it is extended unduly by medical interventions or when there is an extended period of loss of consciousness well before one is actually dead.

An integrated death system would enable individuals to achieve such an acceptable death by thinking, feeling, and behaving with respect to death in ways that they might consider effective and appropriate. Avery Weisman outlined what he considered the parameters of an appropriate death. They include (1) relative freedom from pain, (2) control of social and emotional impoverishment, (3) resolution of residual conflicts, (4) satisfaction of those ego ideals consistent with the dying person's present condition, (5) the yielding of control to others, and (6) maintaining or severing key relationships. In judging the helpfulness of attitudes to death, one should ask if this death attitude system promotes the type of death that Weisman describes.

John D. Morgan

King's College

266 Epworth Avenue

Bibliography

Ariès, Philippe. 1981. The Hour of Our Death. New York: Knopf.

Becker, Ernest. 1973. The Denial of Death. New York: Free Press.

Brody, Howard. 1992. The Healer's Power. New Haven, Conn.: Yale University Press.

Callahan, Daniel. 1993. The Troubled Dream of Life: Living With Mortality. New York: Simon and Schuster.

Kastenbaum, Robert., and Aisenberg, Ruth. 1972. The Psychology of Death. New York: Springer.

Weisman, Avery. 1978. "An Appropriate Death." In Death and Dying: Challenge and Change. Edited by Robert Fulton, Eric Markusen, Greg Owen, and Jane L. Scheiber. 193:194. Reading, Mass.: Addison-Wesley.

© Howard R. Gorle (2000)

What is Complicated Grief?

When life issues are unexpressed or un-acknowledged, they become locked in "frozen blocks of time".

These frozen blocks of time stop the normal grief process denying the child the ability to grieve.   It can feel as if life stops and time stands still. The natural flow of feelings is inhibited. There is no movement forward until the issues are resolved and the feelings released. Suicide, homicide, AIDS, abuse, and violence are familiar examples of situations that lead to complicated grief.

The grief process is normal and natural after a loss. When children become stuck in this frozen block of time, they are denied access to this normal and natural flowing process. Overwhelmed by frozen feelings, the grief process seems to be "on hold" or nonexistent. The child is not in touch with his or her feelings of grief, or those feelings are ambivalent and in conflict with each other.

In complicated grief, it is as if an unexpressed or unresolved important life issue - a frozenblock of time - has created a wall of ice between the child and his or her grief. Our job is to help melt that wall.

Breaking the Silence (1996)

Categories That Contribute to Complicated Grief

1. Sudden or traumatic death

Sudden or traumatic death can include murder, suicide, fatal accidents, or a sudden fatal illness. Immediately an unstable environment is created in the child's home. Children feel confusion over these kinds of death. Desire for revenge is often experienced after a murder of fatal accident. Rage and/or guilt emerges against the person who has committed suicide. Terror of violence and death unfolds, and the child feels shock and disbelief that suddenly this death has occurred.

2. Social stigma of death

Social stigma and shame frequently accompany deaths related to AIDS, suicide, and homicide. Children as well as adults often feel too embarrassed to speak of these issues. They remain silent out of fear of being ridiculed or ostracized. These suppressed feelings get inwardly projected towards themselves in the form of self hatred. Often times these kids feel lonely and isolated. They cannot grieve normally because they have not separated the loss of the deceased.

3. Multiple losses

Multiple losses can produce a deep fear of abandonment and self-doubt in children. The death of a single parent is a good example of a multiple loss. When the only remaining parent of a child dies, the death can cause this child to be forced to move from the home, the rest of his or her family and friends, the school, and the community. The child is shocked at this sudden and complete change of lifestyle and surroundings, and may withdraw or become terrified of future abandonment. Nightmares and/or bedwetting could appear.

4. Past relationship to the deceased

When a child has been abused, neglected, or abandoned by a loved one, there are often ambivalent feelings when the loved one's death occurs. A five-year-old girl whose alcoholic father sexually abused her felt great conflict when that parent died. Part of her may have felt relieved, even glad, to be rid of the abuse yet ashamed to say those feelings out loud. She may carry the secret of the abuse and become locked into that memory and be unable to grieve. Children often feel guilt, fear, abandonment, or depression if grief of a loved one is complicated by an unresolved past relationship.

5. Grief process of the surviving parent or caretaker

If the surviving parent is not able to mourn, there is no role model for the child. A closed environment stops the grief process. Many times the surviving parent finds it too difficult to watch his or her child grieve. They may be unable to grieve themselves, or unwilling to recognize their child's pain. Feelings become denied and expression of these feelings withheld. The surviving parent might well become and absentee parent because of his or her own overwhelming grief, producing feelings of abandonment and isolation in the child. Children often fear something will happen to this parent or to themselves and as a result become overprotective of the parent and other loved ones.

Breaking the Silence (1996)

Activities to help young children with complicated grief

1. Read stories to children that allow them to project their feelings onto the story characters. This opens a dialogue with a child in a way that is not threatening.

2. Allow children to visualize their hurt, fear or pain. Then can then draw, make use clay, or imagine these symbolic feelings being able to talk. If the hurt could talk, eight year old Nancy explained, it would say "Why me?" Nancy had experienced multiple losses, including the death of her younger sister. Feelings of having bad luck or being punished began to emerge.

3. Invite children to make a Loss Timeline, filling it in with people and dates in chronological order according to when they died. This Loss Timeline becomes a concrete representation of all the losses one has experienced.

4. Create with children a geneogram of family tree using a circle and square to represent those people still living and those people who have died in their life. Kids can not only see the extent of the losses they've had, but the support system of the people that are still remaining.

By helping children put their feelings outside of themselves we can facilitate their healing. Sharing feelings diminishes the hurt.

Breaking the Silence (1996)

The Story of Star

Star was Tom's pet dog. He was hit by a car and severly injured with no chance of recovery while Tom was in school in second grade. He came home and his dog was gone. He needed to understand why. His mom tell him, "Star was put to sleep." Tom imagines he will wake up soon and Star will be back. Mom says, "No, he's gone forever." Tom begins to worry that if he goes to sleep he too might not come back.

It's O.K. for him to see his mom crying because she saw Star's favorite ball. She loved him too. Kids need explainations of what is happening so that the missing pieces won't be filled in with their own imagination and interpretation.

Give young children the simplest information possible while still sharing needed facts for their growth. "How did Star die? What did the vet do? Who took him to the vet? Did he cry? Where was he buried? Can I see him?" All of these questions need to be answered. Finally we need to say, "Star won't be back. We won't see him again. His body has stopped working. It is very sad and we will miss him very much." We can give him a funeral and say goodbye to Star.

Life & Loss (2000)

Tommy needs to work through the various feelings associated with mourning. He needs to:

1. Understand that the loss is real
2. Feel the hurt
3. Learn to live life without the lost object
4. Transform the emotional energy of grief into life again

Let Kids Know: "Star won't be in your daily life, but he will be in your memory."

Let Kids Talk: "I'm sad, angry, or frightened about what happened to Star. I feel so lonely without him."

Let Kids Participate: Tom can choose what to do with Star's toys, his bowl, or his collar. Where to put his pictures? What kind of a ceremony would he like to have? Who would he like to invite?

Let Kids Be Unique: Each child is different and so is his grief. Tommy wants to build a dog house where Star is buried. It's his own way of remembering him.

Tom can commemorate Star's death informally or with a real ceremony. As long as he is involved, if he wants to be, he will be able to work through his grief. In this way, he can affirm the value of the life that was Star's. Tommy decided to invite his family, neighborhood friends, and two pet dogs in the neighborhood. He put a picture of Star by his bed to help remember