November/December 2006

journey in health

Death and Dying:
Amazing grace across cultures

BY ROZ BROWN

I suppose it’s ironic that I would be writing about death and dying at the same time my mother has returned to a nursing home for the second time. Suffering from severe osteoporosis, she is trying to recover yet again from a procedure to relieve intense back pain. At age 81, this can’t go on indefinitely.

My mother was a life-long Lutheran, and I know that her eventual funeral will be relatively traditional with familiar hymns, a long ride to the cemetery, casseroles and quiet conversation with neighbors and friends. Once they’re gone, it will also include whisky around the kitchen table and hours of storytelling.

From previous experience, I know that all of this will be more difficult for me than for my brothers, who have lived within a few miles of my parents their entire adult lives. In their small Midwest farming community, there’s a funeral every few weeks for someone they’ve known for 30 or 40 years. They often serve as pallbearers and spend countless hours drinking weak coffee in church basements. It’s not that they’re immune to grief, but based on their geography they’re closer to the birth and death process, and from what I’ve observed, more centered about the inevitable.

More than 145,000 people died today and another 145,000 will die tomorrow. But unless that loss is personal, death will not likely be part of our consciousness if it can be avoided. And yet that’s exactly what the ancient and not-so-ancient sages instructed.
Ancestral Advice

“The best life is spent preparing for death,” declared philosopher Plato in ancient Greece. In the 11th century, Tibetan sage Drakpa Gyaltsen offered a similar observation when he said, “Humans prepare for the future all their lives, yet meet the next life totally unprepared.” In Italy, the original Renaissance man, Leonardo Da Vinci, again captured the essence when he said, “All the time I thought I was learning how to live, I was actually learning how to die.” And in Hollywood, Woody Allen summed it up for most Americans when he said, “I am not afraid of death. I just don’t want to be there when it happens.”

“The time of death can be chaotic, and when things are chaotic, we want guidelines,” says Kim Mooney, director of the Grief and Education Center for Hospice of Boulder. “But it’s really about what any particular family wants. We encourage people to come face-to-face with death and discuss everyone’s needs.”

She tells a story about a rancher in Montana who knew he was dying and built his own coffin. “His sons were ranchers too, and each put his own cattle brand on dad’s coffin,” she says. “But when it came time for dad to put his own brand on the coffin, he was too weak. So they all helped dad by hold the branding iron. Symbolically, they all helped him meet his own death.”
In our culture, many people felt they finally had permission to broach the topic of death and dying in normal conversation only after Elisabeth Kubler-Ross began writing on the topic in the 1980s. “For those who seek to understand it, death is a highly creative force,” said Kubler-Ross. “The highest spiritual values of life can originate from the thought and study of death.”

One of the latest efforts in that direction is the “ethical will” movement. The website of the same name, www.ethcialwill.com, says ethical wills are a way to preserve your legacy and values, to be shared with your family after you’re gone. It’s not a new concept; ethical wills were first described 3000 years ago in the Hebrew Bible and again in the Christian Bible. Initially an oral tradition, they evolved into written documents usually meant to be shared with family and the community when the writer is still alive.

Nonetheless, some of us find the topic of death morbid, and only want to undertake such conversation when our own death or the death of a loved one is imminent. Western culture is often called a “death-defying” rather than “death-affirming” society. We use euphemisms such as “passed on” or “taken from us” or “gone to the other side” to keep death at arm’s length. When death is viewed as the “enemy,” we fight illness and live by the words of Dylan Thomas to “not go gentle into the good night.”

“Too often Americans act like death is an option,” says Mooney. “They’re insulted by it. Of course a hospice setting is blessed because people wouldn’t be there if they were in denial about their pending death. But when it comes to death, you still need to meet people where they are. An important question to ask is, “What does respect at the end of life look like for you?”

Cultural Customs
Different cultures possess a vast variety of ways to demonstrate respect for the dead. For example, sorrowful songs and dark clothing are nearly foreign to Latin American people. The annual celebration of the Day of the Dead in Mexico, in fact, symbolizes a belief that life and death are a continuous cycle; mourning and celebration are not separate, but rather go hand-in-hand.
In Mexican traditions, said Kubler-Ross, “They go and visit the graves. They bring food, they talk to them, they have a feast. There are lots of cultures who have much less of a hang-up. The old, old, old cultures are also much more natural.”

In ancient Egypt, the deceased were expected to begin a new journey to another world immediately, and families paid vast amounts of money to preserve their loved ones’ bodies, placing in the grave all the things needed for a new life, including ample food and provisions.

Hindus believe a person dies and is reborn into a new identity, a circular pattern of life and death occurring many times. Not surprisingly then, some studies have shown that Hindus also have the least anxiety about death. Christians, on the other hand, express some of the highest anxiety about death, based on their belief that death occurs only once, to be followed by heaven or hell based on earthly behavior.

At Death’s Door

“There’s no preparation for death except opening to the present,” says Stephen Levine, Buddhist Teacher and author of, A Year to Live: How to Live This Year as If It Were Your Last (Harmony/Bell Tower, 1998). “If you are here now, you’ll be there then.”
Levine spent the year of 1994 living as if it were his last. To prepare for death, he advises doing a review of your life, practicing meditations on forgiveness and gratitude, contemplating beliefs about life after death such as reincarnation, and thinking about what should happen to your corpse upon death.

“We say we are afraid of death,” says Levine, “but more likely we are referring to the travails leading to death: the fear of dying.” He advocates examining death as a way to be more fully alive which can lessen the fear of death as well as attachment to our bodies. In other words, be here now. Stay present. Realize that nobody gets out alive. Live in the awareness of death as a means of preparation.

Addressing the fear of dying, Kubler-Ross identified what she called the five stages of death—denial, anger, bargaining, depression and acceptance—and how they affect not only the person dying but also those around them. A thorough and contemplative reading of her writings can help in understanding the mental processes around dying.

Mooney offers other guidelines to those helping a loved one face death. “This is not a directive process,” she says. “It is what Tibetans call ‘bardo,’ an intermediate state between this life and the next. Don’t back away from then, and don’t impose yourself. Grief is an unfolding process and it’s your job to listen, to act as a witness.” In other words, it’s about being present and available, without needing to fix or change the process.

Grief

And what about those left behind? Experts—including Carlyle Coash, a hospice chaplain and section leader for the Spiritual Caregiving Section of the National Hospice and Palliative Care Organization (NHPCO)—say 13 months is the minimum of time to expect relief when a significant person in your life dies. Coash adds that if the death is a homicide or a suicide, or if traumatic loss occurs repeatedly over a short period of time, it may take several years before an individual ends the grieving process.
Because we’re still such an immature society in terms of preparing for and accepting death, we tend to stop our grief work when we hit the emotional level. “But when you move beyond that and away from denial you can find ways to grieve that are more appropriate,” says Mooney. “You can ‘claim’ your relationship with that person.”

Booming Toward Bardo

If “claiming your relationship with the dead” sounds a little New Agey, blame the baby boomers. “One of the things the Boomer generation has done is redefine some of the ‘dead’ rituals associated with death and dying and transform them into ‘living’ rituals,” says Mooney.

Not surprisingly, a generation of aging hipsters has found salvation in rocket science. Laser technology is used to transfer favorite images onto coffins—anything from the old homestead to their Harley Davidsons. Video captures the A-to-Zs of time spent with Captain Kangaroo, at Woodstock or on Wall Street; music is optional. And if you’re feeling strongly enough about the quality of your video, you can purchase a video-equipped tombstone to let cemetery visitors participate.

Perhaps you’re interested in something more tangible. If so, you can have your cremated remains turned into jewelry, paperweights or Christmas ornaments. Or, for a fee, the Coral Reef Alliance will deposit your cremated remains into the ocean so they eventually become part of a “living” coral reef.

For all that, Mooney says many of the most moving tributes at death are the simplest. “A grandmother who was dying asked her granddaughter to select the dress she would wear at her funeral. The granddaughter picked out the flashiest red dress she could find with heaps of jewelry to match.”

The Last Word
Benjamin Franklin once wrote, “In this world nothing can be said to be certain, except death and taxes.” We can also conclude that death is not predictable, and rarely the dramatic event depicted by television and film. But sometimes even that’s not true. On the last day of his life in 1892, Zen master Tanzan wrote 60 postcards that read: “I am departing from this world. This is my last announcement.” In similar comedic fashion, British author Somerset Maugham kept his distance through the art of sarcasm when he said, “Dying is a very dull, dreary affair. And my advice to you is to have nothing whatever to do with it.”

Kubler-Ross was certainly more sensible in her advice: “It’s only when we truly know and understand that we have a limited time on earth – we will then begin to live each day to the fullest, as if it was the only one we had.” But there will always be those who identify most with actress Bette Davis who, paraphrasing HL Mencken, once said “Old age is no place for sissies.”

For more information, see the following resources:

On Death and Dying, Elisabeth Kubler-Ross, Simon & Schuster, 1969
“On Death and Dying” Interview with Elisabeth Kubler-Ross M.D., HealthWorld Online
A Year to Live: How to Live This Year As If It Were Your Last, Stephen Levine, Harmony/Bell Tower, 1998
Encyclopedia of Spirituality, Information and Inspiration to Transform Your Life, Timothy Frek, Godsfield Press, 2000
www.ethicalwill.com
www.deathonline.net
www.beyondindigo.com

Local:
Deborah Benyik, RN, MPH 03-482-7082; pg 27
Chuck Barr, MA, LPC 303-449-5667; pg 43
Lynne Foote, MA LPC 303-447-2987; pg 43
JoAnn Morris, MA, LPC 303-665-9505; pg 43
Edie Stone, MA, LPC 303-415-3755; pg 43