American Behavioral History: An Introduction

7 American Death

7 American Death Peter N. Stearns Three points are clear about the reception of death in contemporary American society, in even a crude historical context. First, death is always a complex preoccupation for humankind, which means that many problems visible today are not necessarily new. But second, massive changes in death and death practices have occurred over the past century or century and a half (some debate here), and current society is unquestionably, if sometimes unwittingly, still adjusting. So, third: there are some problems and blind spots in contemporary approaches to death that are both untraditional and troubling. Behavioral history, exploring the second point but with an eye to the third, can explicitly help us understand where we are concerning death reception, why we are where we are, and whether there are important adjustments to consider.1 Points 2 and 3 used to add up to a ringing indictment of contemporary society for distancing itself from some of the traditional solaces concerning death, for turning into a destructively death-denying culture with real costs to the dying and to those around them.2 Some of this indictment still holds, but we know a bit more now about some successful adaptations that followed the 20th-century watersheds concerning death. Some aspects of death are handled better than others in contemporary life, so that a blanket condemnation of contemporary death-as-taboo misses the mark. Previous historical work, from the 1960s, actually played some role in leading to partial reconsiderations, though not reversals, of the dominant contemporary approach. Behavioral history can and should now work in these complexities. Contemporary death practices and experiences have been criticized from various angles, some of them contradictory (particularly, in this re-  gard, a long campaign against excessive expense on funerals versus a belief that contemporaries have inadequate rituals and grief outlets). Almost always , there is at least passing juxtaposition to superior values and practices in the past—a judgment that accurately captures huge changes but sometimes overdoes the resulting contrast in the quality of encounters with death. As against the blanket condemnation approach, two facets stand out for particular concern. Most dramatic, confirmed by a 2003 study, is the fear and isolation in which large numbers of Americans face their own death. Though understudied, especially since the classic formulations of Elisabeth Kübler-Ross of forty years ago, this is undoubtedly the most troubling feature of contemporary death, one that does contrast with premodern experience. The Institute of Medicine report, while calling for more research, notes explicitly that “a significant number of people experience needless suffering and distress at the end of life.” Simple facts confirm: a vast majority of people wish to die at home but a vast majority do not do so. Forty percent of all dying individuals are isolated in intensive care for more than ten days. Despite modest improvements, discussed below, endof -life care is “still a roulette wheel, with only slightly better odds now.”3 But the receptivity for grief at the death of others, particularly grief that is unusually expressive or prolonged, comes next on this list. This can be closely associated with great tensions experienced on the deaths of children . This is a tragic encounter that more often than not splits a marriage because of the diffuse blame and unresolved grief, in contrast to the frequent tightening of family ties around a shared grief experience just a century or so ago. Victorian practices of a century and a half past also made extreme grief more manageable or easier to conceal, or both, than is true in the contemporary United States.4 Other aspects of contemporary death reactions, though different from those of either Victorian or more traditional society, seem, however, to work fairly well for most people. We’re dealing with a differentiated experience , in which some adjustments to change, though considerable, have proved functional while other categories are badly served. One final preliminary approach, analytically interesting though not central to a behavioral history, focuses on explanation of current patterns: historians of death, though not a huge breed, have generated one important debate over when the “contemporary” begins. Some note that nineteenth -century culture began to lose confidence in traditional death formulas , which themselves were not unchanging. Death began to become       .        more unacceptable. Certainly, Victorians painfully accepted guilt whenever children died, even though the mortality rate at this point remained high. More elaborate...