THANATOLOGY

The field called thanatology (the science or study of death) emerged quite suddenly at the end of the 1960s. There is little doubt that the most important contribution to this emergence was the book On Death and Dying, by Elisabeth Kübler-Ross. By the end of the 20th century the field of thanatology largely consisted of footnotes to Kübler-Ross's work. Thanatology principally attracts practitioners in psychology and counseling.

The other important contribution to the field's birth came from historians. Here the work of the maverick historian Philippe Ariés was particularly important. He amassed data on the shifting attitudes toward death throughout Western history. Many other historical studies of death in ancient and modern worlds contributed to thanatology. Most important in the United States were the detailed studies of death in Puritan society.

Thanatology has incorporated philosophical considerations regarding ethical issues in the care of the dying. It has tended to avoid a serious encounter with religion. Caregivers are cautioned not to push religion upon the dying. If dying people are religious, however, their beliefs are to be tolerated. This attitude of bare neutrality in most textbooks contrasts with Kübler-Ross herself who says that it was through caring for the dying that she became religious. To the extent that thanatology fits itself into the mold of a modern science, discussion of religious mystery or life beyond death is necessarily excluded.

There is no agreed upon division of thanatology. The five subheadings that follow can be found in many textbooks. Some authors consider one or more of these areas to be outside of thanatology. Others might cover all of these topics but divide the material into ten or a dozen subheadings.

Experience of Dying. One of the reasons for the rise of thanatology was the progress of medical technology. When this technology provides an extension of a full, human life, few people would argue with the word "progress." Technology can also extend the act of dying almost interminably, a contribution that strikes most people as decidedly negative. In the ambiguous middle, technology can identify some fatal diseases and predict death months or years in the future. The disease of AIDS is the most dramatic but not the only instance of this long interim for death's preparation.

Those with knowledge of their immanent death often go through a long psychological journey as they prepare to die. Kübler-Ross, working with groups of seminarians in the 1960s, traced a chart of five stages through which most patients go. The author did not say that everyone must go through these five in proper sequence. However, as is almost inevitable with such "stage theories," other people found Kübler-Ross's theory to be attractive for classifying people and for knowing what the next step on the road to dying should be.

Kübler-Ross gave these names to the steps she found in her dying patients: (1) denial; (2) anger; (3) bargaining;(4) depression; (5) acceptance. The categories are neither novel nor surprising; the terms are almost self-explanatory. The power of her book lies in the real-life case histories that illustrate each stage. From a quantitative viewpoint, the author gives much less space to "bargaining" than to the other four. There is no indication in the text, however, that this stage is any less important.

The author does say that the "majority of our patients" reach the fifth stage in the journey. This stage of "acceptance" is perhaps the one that needs clarification. Kübler-Ross has many times been accused of trying to romanticize or glorify death. If acceptance were to mean affirmation, then there might be grounds for the charge. But in On Death and Dying, death is not a kind of prize to reach and celebrate. "Acceptance should not be mistaken for a happy stage," says the author. There can be elements of hope against hope and stubborn resistance to death even to the very end.

The difficulty in grasping her meaning of acceptance raises a larger question about the nature of stages and the image of sequence. Instead of there being five stages strung along an arrow, it would be more helpful to think of these stages as a dialectic of no or yes. The number five is less important than the fact of an odd number. A series of yes or no answers finally issues in a stage that says yes and no. That is, acceptance is not the acceptance of death so much as the final, simple recognition that the acceptance of living has always included the reality of dying. Only when one is close to death does it become unavoidably clear that yes and no belong together.

Care of the Dying. Here again a quite drastic change in medical technology is the urgent reason for discussion of ethical problems in the care of the dying. What kind of treatment should be used? Who should decide about its use? How long should treatment be continued when the case is evidently hopeless? Modern ethics and its recent subdivision "medical ethics" are not at all certain where to find answers. There is no authoritative text in this area. Discussion spills out into popular magazines and newspaper stories.

The underlying problem is that modern ethics was conceived as a flight from death. The founding fathers (Hobbes, Locke, and others) established ethics on the basis of the possession of "rights." Each person is the owner of property starting with the closest property, his or her life. Other rights such as liberty or the pursuit of happiness are consequent upon the right to life. Nearly everyone in the modern world speaks this language, nowhere more so than in the United States.

The trouble arises when one tries to apply this language to the care of the dying. It simply does not fit. Ethicists consequently postulated a "right to die," which, given the history of rights language, is an extraordinary contortion of language. The obsession of such groups as the Hemlock Society with a universal right to suicide is almost a parody of modern ethics. What gets lost in this discussion is the care of the dying, the responsibility of the human community to see that suicide not be a desirable good because the process of living and dying transpires within the love, care, and support of other people.

The original phrase in the discussion was "the right to die with dignity." The emphasis should have been on the last two words of the phrase. Each person has a right to dignity even if he or she is dying. "Dignity" is perhaps one of the few categories that can form a bridge between ancient and modern ethics. Vatican documents bolster this assumption in their stress upon the dignity of the person. Each thing deserves to be treated and cared for in a manner proportionate to its dignity. Insects have a limited call on our care while domestic animals have a definite degree of care due to them. A human being, whatever its condition, deserves respect for its interior life and bodily integrity. The human being's capacity for self-direction should not be violated by other human beings or by human technology.

The Catholic Church has provided much of the practical guidance in this area. Modern secular society, lacking any consistent philosophy, turns to the courts for decisions when something must be done. But even at their wisest, judges are prepared to say only who decides; the moral issues of what and how go begging. The long, consistent tradition of Catholic moral thought has provided a firm basis for a number of documents in this area. As long ago as 1957, Pope Pius XII pointed out that there should be a limit to the means used to extend life. The Vatican document in 1980, "Declaration of Euthanasia," went further in elaborating distinctions. The patient is at the center of the process with family as the first of expanding circles of decision makers. The document allows for a refusal of treatment "that would only secure a precarious and burdensome prolongation of life."

One of the most helpful developments in this area was the hospice movement. The word often refers to a place but it can also mean a way of treating people who are dying, especially in their homes. The modern hospital was established as a place to cure disease, not as a place for people awaiting death. Nonetheless, 80 percent of people in the United States die in hospitals, amid conditions that can be very alienating. The St. Christopher Hospice in London began a movement that spread rapidly in the United States after 1974. In the hospice setting, death is accepted as a reality and each person is cared for and helped to care for her or his own person. The emphasis on dignity means that there is little need for discussion of a right to die.

Near-Death Experiences. Modern technology has had its influence on this aspect of death although the experience itself has probably existed throughout history. What did not exist until recently were research-minded individuals who would search out, collect, and classify the data. The book that dominates this topic is Raymond Moody's Life after Life. Other people, including Kübler-Ross, have, since Moody's book, added their own collection of data to the file.

"Near death" is used to refer to the experience of seeming to have died and then of returning to consciousness. Until Moody's book appeared, individuals who had had this experience were generally reluctant to speak about it. With the assurance that others had a similar experience, many people responded to Moody's case studies by recounting their own. The discussion of near-death experiences become fairly common in the literature of the late 20th century.

In people who had died and then "came back to life," Moody found remarkable similarity in their experiences. Perhaps the most surprising thing is that in nearly all cases the experience was so pleasant that coming back to life was somewhat disappointing. The great exception was the case of attempted suicides where the experience was generally unpleasant. People who have had one or more near-death experiences will usually say that death no longer holds much fear for them.

Moody's original study was based on about 150 cases, of which 50 were studies in detail. At the time, there was no language of the near-death experience so that there was no possibility of people using standard phrases or describing something they might have imagined happened to them although they were in fact remembering someone else's account. The people involved tended to think that no one else had had such an experience.

The isolation of the individual cases made all the more remarkable the similarity in the descriptions. With only slight variation in detail, the description was as follows: at the moment of dying the individuals passed through a tunnel and found themselves outside their bodies, which were often being worked upon by others. The individuals then recognized that they had bodies but of a different sort. Dead friends and relatives met them. And finally there was a great white light before which the individuals appeared. A review of life took place in a pleasant rather than fearful atmosphere. Then the limit was reached and earthly life drew the individuals back despite resistance on their parts. The cases in which someone did wish to come back involved people who felt that they still had responsibilities to fulfill, as was the case with one mother of three small children.

The description did not vary much across religious lines. Christians, however, tended to use a language of God and Christ for the powerful force at the center of the experience. What the descriptions do correlate with to a high degree is the Tibetan Book of the Dead. Moody's case descriptions could have been lifted directly from the first section of that book although none of the interviewees said they had read the book. It should perhaps be noted that in the Tibetan Book of the Dead the journey of the soul becomes unpleasant later on and that the journey of 49 days is somewhat depressing. The journey ends with reentry into the womb for another cycle of life. The near-death accounts do not prove anything about the reality or the nature of afterlife. But they provide an interesting challenge to our literalistic psychology in the West and they provide a comfort to some patients that the moment of death is one of peace and joy rather than terror and agony.

Bereavement. The phenomenon of bereavement is as old as death. All religious traditions have had a central place for rituals of bereavement (even a tradition such as Buddhism, which protests against wailing or animal sacrifice as disgraceful forms of bereavement). Bereavement has been studied as a universal experience although it is the highly dramatic instances of mass death that make bereavement easier to study. Thus, the Holocaust and Hiroshima have provided the basis for long-term studies of bereavement.

The classic study was Erich Lindemann's 1944 work based on the Coconut Grove fire in Boston. Lindemann uncovered the reality of denied grief and postponed grief. He also discovered what has since been amply confirmed, that the failure to find an outlet for grief does grave physical harm to the body. From a social angle the best study of the topic is Geoffrey Gorer's Death, Grief, and Mourning, which emphasizes the need for ritual and the contemporary absence of ritual for expressing grief. Gorer says that death is to the 20th century what sex was to the 19th; that is, one does not admit to it in public. Without traditional religions to supply ritual for the bereaved, the contemporary world is bewildered by what to do with grief.

One way that the phenomenon of grief is dealt with is by placing it into the larger study of a "psychology of loss." Comparisons can undoubtedly be helpful. The losses of car keys, virginity, hair, a favorite sitting chair, and the life of one's spouse have some characteristics in common. Just as surely, they have differences; grief at the death of a loved person has characteristics all its own. Too casually lumping together grief with any kind of loss can be a way of avoiding the painful reality and distinctive character of death.

As all of the traditional religions have known, there are "stages of bereavement." And at each stage of bereavement there should be social forms that have a degree of flexibility. The grieving individual cannot invent and should not have to invent the ritualized steps after death. Robert Kavanaugh has proposed seven stages of bereavement, which he names: shock, disorganization, volatile emotions, guilt, loss and loneliness, relief, and reestablishment. Kavanaugh has consciously modeled his description on Kübler-Ross's stages of dying. What might be simpler to say is that dying and bereavement are the same process experienced from different poles. The individual who grieves has to go through the same steps as the dying person.

What is most important is not the number seven but the odd number of stages. Bereavement is a dialectic of no to death followed by a yes to death. The yes that follows death requires a symbolic no to life. After some days or months of struggling with yes or no to life, the bereaved person is ready to say a yes that includes accepting death. The person who emerges from bereavement does not go back to life as before but to a life inclusive of death. The psychological wisdom embodied in religion is nowhere more apparent than in rituals surrounding bereavement.

Death Education. With death as a topic of intense concern, it could be expected that death education would not trail far behind. During the late 20th century courses were instituted in many colleges. The popularity of these courses was indicated by the flourishing textbook industry with titles such as Deathing, The Last Dance, and Dying Dignified. Many students took these courses in search of therapy; either someone close to them had died or else their own deaths pressed at the edge of consciousness. And in the wake of the September 11, 2001 tragedy in New York City, more students became aware of the threat of terrorism and its potential to end life randomly.

The case has been increasingly made that courses in death are necessary. Children should deal with death in high school, or even in elementary school. The comparison is often made to sex education and, indeed, sex and death have had a long, intimate relation. Neither sex nor death should be hidden, denied, or made into a disgusting subject matter. Attempting to shield children from any experience of death is one of the worst things adults can do to children. There is abundant evidence that children can handle death if the adult community does not go to pieces. Thus, a young child needs "education" in death but that should not be equated with courses in school. A few honest words in the classroom would help, but the child's education here, as with sex, is mainly in familial experiences.

Kavanaugh suggests the need for death courses to develop a "folk language of death." As with sex, and perhaps even worse than with sex, young people lack a richly humane language to talk about death. The school's job is not to explain death but to demystify some aspects of it (for example, the funeral industry) and reduce the embarrassment surrounding death. The school could be a place for admitting in public that, in contrast to television and movie exploitation of the subject, real people suffer difficult deaths that cause painful sorrow. That kind of death education would reduce rather than increase young people's obsession with death. Robert Neal's The Art of Dying remains a model of healthy attitudes and practical exercises for college age and beyond. Neal allows religion into the discussion, which textbook makers are wary of doing.

The interest in high school courses has been spurred by the concern with teenage suicide. The rate of suicide among young people has risen dramatically since 1950. No one is sure of the cause and no one can guarantee a remedy. "Suicidology" is a whole field of its own these days, exemplified by the work of Edwin Shneidman. Much in the tradition of Durkheim's turn-of-the-century study of suicide, researchers assemble statistics on various groups and track down possible causes and conditions of suicide. That approach may be useful to the management of social agencies, but it is of doubtful use in the education of young people.

Teenage suicide requires some broader response than a school course directed at suicide prevention. There can be no more direct a challenge to the entire process of education than young people killing themselves. The most profound exploration of the subject in recent decades is James Hillman's Suicide and the Soul. Hillman analyzes suicide as a cry to die and be reborn, not a premature death but a delayed transformation. Instead of trying to prevent suicide, the friend or counselor has to help the person to find a different path to rebirth. Once again here, religion is unavoidable in discussing suicide. Unless religion can be admitted into the conversation, the genuine mystery of suicide is likely to remain an impenetrable problem.

Bibliography: p. ariÉs, The Hour of Our Death (New York 1981). h. wass, ed., Death Education II: An Annotated Resource Guide (New York 1986). g. gorer, Death, Grief, and Mourning (Garden City, NY 1965). j. hillman, Suicide and the Soul (New York 1964). r. kavanaugh, Facing Death (New York 1972). e. kÜbler-ross, On Death and Dying (New York 1969). e. lindemann, "Symptomatology and Management of Acute Grief," American Journal of Psychiatry 101 (1944) 141–148. r. moody, Life after Life (Atlanta, GA 1978). r. neale, The Art of Dying (New York 1973). e. shneidman and n. farberow, eds., Clues to Suicide (New York 1957).

[g. moran]

Thanatology

Thanatology is the study of dying, death, and grief. This study encompasses thoughts, feelings, attitudes, and events. Contributors to the growing knowledge of death-related phenomena include social, behavioral, and biomedical researchers as well as economists, health-care providers, historians, literary critics, philosophers, and theologians.

The word thanatology is derived from Greek mythology. Thanatos (death) and Hypnos (sleep) were twin deities. It was not until 1903 that distinguished scientist Elie Metchnikoff called for the establishment of a scientific discipline devoted to the study of death. He suggested that the life sciences would not be complete unless systematic attention was also given to death. Nevertheless, only a few scholars and educators followed his lead. Medical students had their obligatory encounters with cadavers but received almost no instruction in care for the dying, nor was death included in the curriculum for students of other professions and sciences.

The situation started to change following World War II, with its many casualties and haunted memories. Existential philosophers redirected attention to life-and-death issues. Researchers such as Herman Feifel challenged Western society's taboo on death, opening the way for improved communication. An international suicide-prevention effort responded to the anguish both of people contemplating self-destruction and their family and friends. The hospice movement introduced improved means of caring for dying people, and grief-support groups provided comfort to many who had been alone in their distress. Death education overcame early resistance to become a significant resource in both formal and informal settings. Thantological challenges in the twenty-first century include the emerging issues of physician-assisted death, children's rights, and lifestyle behaviors such as excessive drinking, use of tobacco products, and unsafe operation of motor vehicles that contribute to more than a million deaths a year in the United States.

See also: Anthropological Perspective; Cadaver Experiences; Children and Their Rights in Life and Death Situations; Death Education; Feifel, Herman; Hospice Option; Psychology; Saunders, Cicely; Suicide Types: Physician-Assisted Suicide

Bibliography

Feifel, Herman. The Meaning of Death. New York: McGraw-Hill, 1959.

McGinnis, J. M., and W. H. Foege. "Actual Causes of Death in the United States." Journal of the American Medical Associations 270 (1993):2207-2212.

Metchnikoff, Elie. The Nature of Man. New York: G. P. Putnam and Sons, 1959.

ROBERT KASTENBAUM

Thanatology

The formal study of the nature of death and dying. Prior to the demarkation of thanatology as a new area of specialization, the study of various aspects of death had been included in psychology and parapsychology. Parapsychological research has concentrated on three human experiences that seem to be part of the death experience: 1) the sensation of floating out of the body; 2) feelings of peace or wholeness; and 3) meetings with someone who has died previously. Studies of what today is called the near-death experience have been made by psychical researchers since the nineteenth century, often under the label death-bed experiences.

Significant in defining the new field of thanatology has been the work of physician Elisabeth Kübler-Ross, author of the book On Death and Dying (1970), whose work began with a concern for the grief process she frequently encountered in counseling with dying patients. Her continued interest led her to questions of survival of death, traditionally an area of psychical studies. She is the founder of Shanti Nilaya, a healing and growth center in Virginia. Among the leading centers focused on research in thanatology are the International Institute for the Study of Death in Florida and the International Association for Near-Death Studies.

Sources:

Kastenbaum, Robert, ed. Between Life and Death. New York: Springer Publishing, 1979.

Kübler-Ross, Elisabeth. On Death and Dying. New York: Macmillan Co., 1969.

——. To Live Until We Say Goodbye. Englewood Cilffs, N.J.: Prentice-Hall, 1978.

Osis, Karlis, and Erlendur Haraldsson. At the Hour of Death. New York: Avon Books, 1977.

Ring, Kenneth. Heading Toward Omega—In Search of the Meaning of the Near-Death Experience. New York: William Morrow, 1984.

Thanatology

Thanatology is the science that studies the events surrounding death, as well as the social, legal, and psychological aspects of death. The term thanatology originates from the Greek thanatos, meaning death and logos, for study or discourse. Thanatologists may study the cause of deaths, legal implications of death such as the rights and destiny of the remains or requirements for autopsy , and social aspects surrounding death. Grief, customs surrounding burial and remembrance, and other social attitudes about death are frequent subjects of interest for thanatologists.

From the forensic point of view, causes of death may be due to natural causes, such as from lethal disease or advanced age), accidental causes, such as falls, plain crashes, fires, drowning, or automobile accidents , criminal actions, such as murder , neglect, malpractice, or other irresponsible acts by third parties, and finally, suicide. Thanatology also overlaps forensics when it focuses on the changes that occur in the body in the period near death and afterwards.

Some social issues explored by thanatologists, such as euthanasia (the merciful induction of death to stop suffering) and abortion (termination of a pregnancy) are subject to much ethical and legal controversy. These issues are legal in some countries, while considered a crime in other countries. In Brazil, for instance, although outright euthanasia is illegal, patients have the right to refuse medical treatment and artificial life supporting procedures, if they sign a legal statement in advance while of sound mind.

Rights over the corpse of the deceased is also determined by law in most developed countries, as well as burial, cremation, and embalming requirements. Clinical autopsies are generally required in cases of unexplained or violent death, suspicion of suicide, drug overdose, or when requested by the family of the deceased due to suspicion of medical error or when confirmation of certain diseases is sought.

The thanatology community is usually composed of a variety of health professionals including psychiatrists and other physicians such as forensic pathologists, advanced practice nurses, and veterinarians, along with sociologists and psychologists.

see also Assassination; Autopsy; Body marks; Coroner; Death, cause of; Death, mechanism of; Decomposition; Drowning (signs of); Entomology; Ethical issues; Exhumation; Fluids; Medical examiner; Parasitology; Pathogens; Pathology; Saliva; Semen and sperm; Serology; Skeletal analysis; Time of death; Toxicology.

Thanatology

Thanatology is the science that studies the events surrounding death, as well as the social, legal, and psychological aspects of death. The term thanatology originates from the Greek thanatos, meaning death and logos, for study or discourse. Thanatologists may study the cause of deaths, legal implications of death such as the rights and destiny of the remains or requirements for autopsy, and social aspects surrounding death. Grief, customs surrounding burial and remembrance, and other social attitudes about death are frequent subjects of interest for thanatologists.

From the forensic point of view, causes of death may be due to natural causes, such as from lethal disease or advanced age), accidental causes, such as falls, plain crashes, fires, drowning, or automobile accidents, criminal actions, such as murder, neglect, malpractice, or other irresponsible acts by third parties, and finally, suicide. Thanatology also overlaps forensics when it focuses on the changes that occur in the body in the period near death and afterwards.

Some social issues explored by thanatologists, such as euthanasia (the merciful induction of death to stop suffering) and abortion (termination of a pregnancy) are subject to much ethical and legal controversy. These issues are legal in some countries, while considered a crime in other countries. In Brazil, for instance, although

outright euthanasia is illegal, patients have the right to refuse medical treatment and artificial life supporting procedures, if they sign a legal statement in advance while of sound mind.

Rights over the corpse of the deceased is also determined by law in most developed countries, as well as burial, cremation, and embalming requirements. Clinical autopsies are generally required in cases of unexplained or violent death, suspicion of suicide, drug overdose, or when requested by the family of the deceased due to suspicion of medical error or when confirmation of certain diseases is sought.

The thanatology community is usually composed of a variety of health professionals including psychiatrists and other physicians such as forensic pathologists, advanced practice nurses, and veterinarians, along with sociologists and psychologists.

See also Crime scene investigation; Forensic science.

Sandra Galeotti