There is, nonetheless, a troubling aspect about the contemporary push to make suicide acceptable. It can miss the main point of dying – and living – with dignity. A widespread adoption of “rational suicide” could be dangerous for groups of people whose lives are disabled or who are in any way outside the “normal.” At the least, the human race should go slowly in changing the legal and ethical status of suicide.
Some controlled experiments lasting years or decades should be studied before changing wider social policies. As noted in the previous chapter, the Dutch have been carrying out a useful experiment since the 1980s; it was not until the year 2002 that suicide was completely legalized. A physician is allowed to help a person commit suicide but only under strict conditions. The Netherlands is a small country with a population that is unusually independent and well-educated. Most people die at home rather than as in the United States where eighty percent die in hospitals. The Dutch provide a good testing ground for legalizing suicide but the results are not easily generalized to countries such as the United States.cxxiii
Within the United States the state of Oregon made sense as the first place for experimenting with physician-assisted suicide. It is a relatively small state with a long tradition of independent-minded people. Some important lessons can be taken from Oregon’s experience without either immediate application to the country as a whole or interference by Congress which tried to reverse the law.cxxiv
When Australia initiated legalized suicide, it did so in the Northern Territory. As politicians quickly found out, that was the wrong place to start. The fact that the Northern Territory is twenty-five percent Aboriginal raised special fears. A government report concluded: “It has been expressed to us by a number of individuals that euthanasia is seen by some as a further method of genocide of Aboriginal people.”cxxv The law was revoked after bitter denunciations. The episode was unfortunate, particularly because Australia, with its relatively small population of independent-minded people, seems a good place to experiment withcontrolledsuicide.
Advocates of “dignity promoting suicide” draw the picture of a candidate for suicide as a man who has been diagnosed with a fatal disease and who has nothing to look forward to except complete loss of everything that he values in life. The only reasonable thing seems to be to end his life on his own terms, avoiding the indignities of a failed body and the burden he would place on his relatives. Sherwin Nuland cites the example of Percy Bridgman, a brilliant Harvard professor, who shot himself on August 20, 1961. Nuland calls this suicide “close to being irreproachable.”cxxvi Bridgman left a detailed explanation of why he was ending his life. Here was the case of a man facing his death with his dignity intact. Yet even here, more than a cool, rational choice was involved. He wrote: “It is not decent for society to make a man do this to himself. Probably this is the last day I will be able to do it to myself.”
Most suicides do not resemble Percy Bridgman’s. They run the gamut from murderers who kill themselves after killing others, to the despairing and the sick who are beside themselves with pain. In most of these cases, suicide is a failure of dignity but it may be difficult to say who is at fault.
The suicide/murderer has, for whatever combination of reasons, failed to find a dignity in life or in death. The violent end may be his or her own fault but usually there are environmental factors as well. The desperate wish not to feel the sting of disrespect destroys the very basis of respect and dignity.cxxvii The suicide may be hailed as a hero by other desperate people but such suicide should not be dignified as admirable.
People who are physically dependent on others for ordinary human actions (eating, dressing and cleaning themselves, going to the bathroom) are in a very different situation. Although they are not at fault for whatever they lack, they might be treated with something less than dignity by callous professionals or exhausted family members. The “temporarily abled” have to strive not to be short-sighted.cxxviii As death approaches, nearly everyone moves in the direction of a greater dependence on the surrounding community. If a caring community is absent, then the resulting isolation can pressure the individual toward suicide. Alvarez says that “total loneliness is the precondition of suicidal depression.”cxxix
It seems inevitable that suicide will find widespread legalization. But I think that the Hemlock Society should be restrained in celebrating a victory. At most, the success seems a sad necessity for some people. If considered to be a widespread solution to the increasing cost of health care in the United States – a motive that would never be admitted – the national acceptance of suicide would put great pressure on the elderly, the poor and the sick. A right to commit suicide could quickly become almost a duty to commit suicide. Not only the ninety-year-old who has multiple serious health problems but millions of young and middle-aged adults, who are a net loss to the nation’s economic productivity, may feel a pressure to do the noble thing and stop being a drain on their relatives’ resources. Their suicides would not be a net gain for “death with dignity.” In the coming decades the policies concerning suicide and the practice of suicide may reveal what kind of society we are.
CHAPTER SEVEN: SHOULD MOURNING HAVE AN END
Mourning is to survivors what stages of dying are to the terminally ill. One difference is that we know more, or at least we can know more, about mourning than about dying. The dead are not available to tell us about their experience of dying. But everyone past a fairly young age knows the experience of mourning for someone they loved. A second big difference is that the end of dying is clear and inevitable. Mourning, however, may go on indefinitely with seemingly no direction.
If, as it is often said, death is hidden in our culture, then one should not be surprised that mourning is, too. The dying cannot help what is happening to them. They stir up sympathy for their plight. The mourner is more likely to generate impatience and resentment. “Get on with your life” is the frequent advice given to the mourner. When mourning is hidden or suppressed, it does not go away; it operates quietly but endlessly. Similar to a patient who is on life-support seemingly without end, millions of people can mourn with no end in sight.
A few distinctions in the use of terms would help in setting out the problem and getting some bearings in the use of resources. Grief, mourning, and bereavement are the terms most often used in referring to a response to death in the lives of survivors. “Grief” is a feeling of sorrow that follows a loss; most commonly the word is used as a noun. Grief connotes a burden that a person carries when someone who had shared the burdens of life is now gone. Grief is the territory for psychologists and “grief counselors” who try to unlock the feelings the griever.
“Mourning” might be helpfully distinguished from grief as its outward expression. Most commonly, mourning is used as a verb; to mourn is the activity of expressing grief. An individual mourns as a community member, that is, the main actor is a community or a group, while the individual both gives and receives as part of the process of mourning. This community of mourning can be a whole nation, at a time when the nation has lost a leader and occasionally when a nation has lost its soul. Psychologists know much about mourning but they are not the final experts. Every community has wise adults who have learned both to comfort and to mourn.
“Bereavement” is a state or condition in which mourners exist. The adjective “bereft” is not used much in English but it still carries the powerful image of feeling deprived and desolate. The noun “bereavement” is also not very common because a set period for mourning is no longer in vogue. People are supposedly freer to express their grief as they wish and for as long as they need to do so. But a bereavement having form and length survives among some religious groups and might be more supportive of personal freedom. Bereavement involves both senses of end: a fixed purpose and a termination point. Thus, the good thing about bereavement is that it actually ends.
Freud has a helpful essay on the difference between mourning and melancholy.cxxx Both are feelings of loss but melancholy is without end. The sad person who is afflicted with melancholy, says Freud, loses his or her own life and becomes impoverished emotionally. In contrast, the mourner “bit by bit, under great expense of time and ...energy returns to reality.” The existence of the lost “object” remains in mind. In the grip of mourning, the world becomes poor and empty; in melancholy it is the ego itself that is emptied. The absence of joy in one’s life may paradoxically be due to an inability to mourn.
The main contention of this chapter is that mourning is a personal and communal act that can only be understood as a relational response. If there is no community with rituals for mourning, then feelings of grief cannot be accepted and dealt with in a healthy way. What we increasingly have is a dichotomy: on the one hand, intense private mourning that saps bodily and spiritual strength, and on the other hand, an ostentatious public mourning that promises what it cannot deliver. Public displays of mourning, such as the new practice of victims confronting criminals at a court sentencing, supposedly bring “closure,” but more often they interfere with people coming to terms with their grief. Similarly, each time the nation relives some national calamity we simply repeat the grief.
Once again there is a comparison to be made between sex and death. Geoffrey Gorer in his 1960's study compared mourning in the twentieth century to sex in the nineteenth century.cxxxi Everyone is known to do it in private but one should not speak about it in public. Things have changed in the decades since Gorer’s study but perhaps not as much as the surface would suggest. The place of sex was changed by adding public displays to the main activities that remain intensely private. Mourning, too, has acquired splashy public displays but feelings of grief are likely to remain bottled up in a private sphere.
Public mourning lacks a form of “public” that is not entirely cut off from the private. The bridge between private and public spheres is rituals of community life that sustain interpersonal relations. Rituals of their nature are conservative; they connect us to the past. They are always vulnerable to being attacked as outdated and irrelevant. But at the most intense moments of life humans need to be buoyed by routine gestures that hold the world together until new and reasonable actions can function again. Rituals have to grow organically; they cannot simply be invented. The best rituals are hundreds or thousands of years old. The funeral, with all its cultural variations, seems to have emerged at the very beginning of humanity.
Rituals can change without losing their effectiveness provided the change slowly emerges out of past experience. What can be especially corruptive of rituals surrounding death is the exploitation of tender feelings for the sake of profit. The “commodification of grief,” including books, workshops, and chat rooms has been booming.
The beginnings of this grief industry were in the 1840s when the profession of undertaker or funeral director was born. The casket, a word taken from the jewel industry, replaced the plain, wooden coffin. Embalming became a standard practice to keep the corpse “natural” when clearly it is not. The funeral parlor gradually replaced the home as the setting for the mourners to gather. Reformers have periodically attacked the funeral industry for its callousness, pretentiousness and greed. Jessica Mitford’s book, The American Way of Death, is perhaps the best known of these books.cxxxii But practices around death change very slowly. Until recently, most people trusted their local undertaker whose family had been in the business for generations.
A significant change occurred in the 1990s. For a long while, the big corporations had not seemed to notice how profitable the funeral business could be. When bad economic times come, many businesses suffer. Funerals provide steady and predictable income. Several corporations began buying up all the little, family-owned funeral parlors. The biggest entrepreneurs, Service Corporation International (SCI) and the Loewen Group, bought up one-fifth of the market. They expected to make millions of dollars. Surprisingly, a combination of greed and ignorance led instead to financial disaster. Between 1998 and 1999 both of these empires collapsed. SCI stock lost ninety-four percent of its value; Loewen filed for bankruptcy.
What has since been emerging is a new funeral industry which one can hope has learned from mistakes made by the big corporations. What should have been learned is that there is a limit to how far business can go in making grief just one more impersonal object that can be subjected to “economies of scale” for maximum profit. The profession to be successful has to reacquire some of the better characteristics it had in the past as a family-owned business. The mourner was dealing with a neighbor who had deep roots in the community and had other interests besides making money.
The students in today’s fifty-two mortuary schools are generally interested in providing a service to a community rather than being a sales manager in a big company. About half the students in these schools are women (as opposed to five percent in 1971); almost a third are African-American. George Connick, executive director of the American Board of Funeral Services Education, has said: “The business has opened up. It’s brought people into the field who have stronger academic backgrounds and stronger backgrounds in working with people. I think the quality of service will improve over time.”cxxxiii
The Jessica Mitfords of the country will remain suspicious of such lofty rhetoric but there does seem to be an opportunity for improvement. Nevertheless, one cannot expect a funeral industry to reflect better attitudes toward death than does the culture as a whole. Death education is not primarily a matter for mortuary schools, or even for schools. It starts with the way parents provide an example of mourning to their children, and the education continues by way of the many groups and organizations in which people participate. This education can include civic rituals that sometimes connect with genuine personal grief.
Television, now joined with the Internet, is one of the great variables in the modern expression of grief. Television is now old enough to have its own rituals. It can be an unsurpassable bond at moments of great sorrow. It can also be an instrument for the manipulation of mostly manufactured emotions.
When John Kennedy was killed in 1963, rituals on television and the ritual of television itself were relatively new. The assassination of a president, who had projected youth and vigorous action, came as a genuine shock to the nation and the world. Television provided a calming effect. The funeral was elegantly designed with admirable restraint in its form. For four days the nation stopped its business and felt the reality of death.
The event of Kennedy’s death and funeral quickly became part of the national memory “Where were you when...?” The Kennedy image became inflated into a legend. A brief and not so successful presidency was turned into a glorious achievement. Airports, highways and schools were named for the fallen leader, a way to keep the memory alive. The grave site of Kennedy became a chief attraction for Washington tourists. Less helpfully, Dealey Plaza in Dallas became a kind of shrine where one could relive the horror of Nov. 22, 1963. Still, when one looks back at the event, John Kennedy’s funeral provides a fairly good standard for how national tragedies might be handled.
It probably was not possible that television could ever repeat this simple and restrained approach to the need for national mourning. Just five years later, the deaths of Robert Kennedy and Martin Luther King, Jr. evoked some of the same feelings as did the assassination of John Kennedy. But the country’s mood was much different and television could not heal the divisions that these deaths embodied. The artificiality of television’s grief was evident. Since then, the deaths of famous people – rock stars, movie actresses, athletes – sets the grief machine in motion.
The death of Princess Diana in 1997 offers comparison to both the Kennedy proceedings and to the treatment of the glamorous celebrities in recent decades. Diana’s funeral did create a bond of feeling in England, where she was not quite a national leader. The reaction was so intense and so widespread that many people predicted that the event would change the English character. England would now wear its emotions, especially grief, on its sleeve.
By the first anniversary of Diana’s death, when the crowds failed to show up at the burial site, the predictions appeared exaggerated if not embarrassing. National character does not change drastically with one outpouring of emotion. In this case, as in many others since the 1990s, international television and twenty-four hour news channels have created mass outpourings of feelings.
In the United States, the event that bears closest comparison to John Kennedy’s death is the bombings on Sept. 11, 2001. The date itself became an immediate marker of anger, grief, self-pity and insecurity. The spontaneous shrines that appeared in Union Square Park and Washington Square Park in Manhattan represented genuine grief and the need to mourn in an appropriately public way. Television’s part was a mixture of the best and the worst. For the first few days, a cadre of television reporters who were close to the scene delivered graphic and calming reports. But television’s voracious appetite for news has no built-in restraints.
Some of the memorials at political, athletic and educational gatherings during subsequent weeks were appropriate. The well-attended funerals of fire fighters and police officers gave mourning a visible and solemn form. However, the attempt to make Sept. 11, 2002 the greatest memorial ceremony in history reflected the nation’s tendency to overdo its self-absorption. After listening to a thousand renditions of “God Bless America,” many nations that had shared in the immediate grief reached the limit of their sympathy. It was time for the United States to put its grief in world perspective, which is not to forget the event but to situate it in a way that is helpful for itself and for other nations.
Washington D.C., which Philippe Aries described as a city of monuments to the dead, has one memorial that is different.cxxxiv The Vietnam memorial, a plain dark wall with 58,235 names on it, has done as much as any one thing to heal the division caused by that disastrous war in Southeast Asia.cxxxv The young designer, Maya Lin, accomplished a near miracle in getting the monument built. “I had an impulse to cut open the earth,” wrote Lin, then a twenty-one year old student at Yale. “The grass would grow back, but the cut would remain.”cxxxvi
Any doubts about the memorial’s effectiveness were quickly erased not just by the size of the crowds but by the genuine emotion that the memorial elicited. A Veterans Day editorial aptly describes the usual scene: “They walk as if on hallowed ground. They touch the stone and speak with the dead. They come to mourn and to remember – an old ritual made new, creating in this time another timeless moment....As the long polished panels reflect those that move before them, the names of the past become etched on the faces of the present and, for a moment, the living and the dead are one.”cxxxvii
National monuments seldom carry such power because mourning (in contrast to grief) requires interaction. People rather than stones are the ordinary basis for interacting. The genius of Maya Lin’s design is that, unlike so many recent memorials that merely relive the past horror, the Vietnam memorial has a narrative, a powerful story that begins with the grim facts but then moves the visitor beyond the grave. One walks down until one is literally overwhelmed by the dead but then one walks up and out.cxxxviii Perhaps the only comparable memorial in Washington is the Holocaust museum, filled as it is with the ordinary stuff of life and the extraordinary means of death. The museum is most powerful for Jewish people but, as the crowds of visitors indicate, its stark simplicity crosses both ethnic and generational lines.
For most people most of the time, mourning is possible because there are a few people who are physically present to share the grief. The correlative term of “to mourn” is “to comfort,” a word that means to bring strength. The comforter brings strength mainly by being there. To comfort and to mourn are reciprocal actions; they can move back and forth in exchanges between mourner and comforter. Often the mourner ends up comforting the one who has come to offer support. No matter; the comforter and the mourner share the burden of grief and also share the healing that comes from genuine human encounter in dark times.
Words are important in such moments, although exactly what words are spoken is not so important. Religious rituals contain formulas that everyone in the community knows well. Such fixed formulas can be criticized as clichés or empty formalism. But in the midst of profound grief, few people are able to come up with fresh and brilliant insights that fit the situation. It is the strength of ritual sayings that they carry people through their sorrow. The standard Roman Catholic practice at wakes was to say the rosary (“a decade of the beads”), the repetition of a prayer formula without much thought to the words. Jewish religion probably has the most precisely specified gestures and words from the moment of death to the departure from the cemetery and for the week that follows.cxxxix
For people attending a funeral service, the uppermost question often is: What do I say? However, once they have suffered the loss of someone close to them they usually realize that one need not worry about what to say. In the United States the funeral service still has enough ritual about it to provide help in what to say and do.
The same is seldom true of the mourning period that follows. Widows complain that their friends and associates shun them for months and then pretend that nothing has happened. Writing a letter of condolence is something of a lost art but cards and letters are still an important form of comforting during the weeks and months after a death. Whether the card comes three days or six months later it is always welcome. Today’s e-mail lacks some of the desired formality but it does have the advantage of providing easy access to world-wide communication. Harold Kushner’s book, When Bad Things Happen to Good People, emerged from the author’s own experience of mourning and the book offered helpful advice to comforters. When one tries to comfort it is difficult to know what to say. It is easier to list what not to say, such as anything critical of the mourner, anything that tries to minimize the mourner’s pain, or anything that asks the mourner to disguise his or her feelings.cxl It is particularly important not to say to children: “Don’t feel bad. God took your mother because he needed her more than you did.”