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A Book Reviews Sandra L. Berrman, Facing Death: Images, Insights, and Interventions: A Handbook for Educators, Healthcare Professionals, and Counselors. New York: Hemisphere PubUshing, 1991. xii + 214 pp. Clothbound, $45.00; paperback , $19.95. An emerging academic field is Uterally a movement, the passage of a shadow composed of the Uves of those who meet and walk for a time together. The rise of the medical humanities is an instance. In the thirty years since the birth of these clinical Uberal arts, the shadows of certain figures have haunted our minds. They have arrested attention briefly, moved us to respond, and then faded from sight—only to return with new variations on their enduring themes. Sandra L. Berrman is one such vivid, recurring presence, and this volume is a condensation of her decades of experience with people attempting to face death yet yearning to turn away from it. The book may fool you. The busy scholar may glance at it briefly and turn to other matters, for the book is seemingly shallow if seen shallowly. It is brief. The pages are sUck. There are so many pictures and one-Uners. Bertman herself describes this small volume as a handbook, a text designed to "support frontline staff" who are working with the dying (p. xi). The book consists of four main chapters. In the first, she attempts to estabüsh a perspective that relates the arts to the experience of terminal illness. The second chapter introduces central themes about dying by means of an unusually rich selection of images from the arts, literature, and popular culture, as well as sketches by students and dying patients. Chapter 3 describes responses of six groups to these images. The final chapter contains suggestions and conclusions derived from group discussions centering on the images presented. In short, Bertman's work can be described at one level as a handbook . But look again. Beneath the straightforward assistance that she offers the dying and their care-givers, Bertman is struggling with a profound hermeneutic issue: the way that human beings can come to understand and interpret threatening experiences of all sorts. Whether it Literature and Medicine 11, no. 2 (Fall 1992) 315-347 © 1992 by The Johns Hopkins University Press 316 BOOK REVIEWS is her intent or not, Bertman's approach addresses our universal need to clarify anxiety-producing events and to convey their meanings to ourselves and others. Her use of the arts is a significant corrective to the lifelong apprenticeships in avoidance that our civiüzation offers. We are masters of techniques for avoiding terror; we are novices in assimilating it. This is especially true when we face the absolute threat of nonbeing in its most personal form. Death is a universal, powerful lens that focuses the realization that we are here both to be and not to be. Our days, however, are punctuated by Uttle dyings, mundane intimations of mortaUty . Therefore, from childhood, we develop a rich repertoire of strategies for retreat: avoidance of dreaded situations and denial of their implications, distraction from painful issues, distortion of statements that are too clear, ideaUzation of human travail, externalization of our own dread, and abstraction from painfully concrete suffering to safer generalizations . Bertman presents symbolically arresting images to suffering people because she intuits that avoidance of circumstances and repression of feeUngs are costly compromises. We purchase spurious comfort at the price of genuineness and creativity. If we need to face dreaded limitations in order to live effectively, most of us have not found effective apprenticeships that foster such learning. How does the author assist us in doing this long-avoided homework ? Her deepest contribution is found in the way that she organizes the material in this book. If the main title, Facing Death, is the problem addressed, then the subtitle, Images, Insights, and Interventions, suggests that brief and fragmentary symboüc encounters are the best initial steps toward a deeper grasp of that problem. She does not build her chapters around such enduring concepts as perspectives, theories, or relationships ; she seems to know that the stronger the anxiety accompanying an experience, the greater our need to move to the parts of the crisis we can control...

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