The Craft of Dying, 40th Anniversary Edition

Lofland, Lyn H.

Introduction

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But the 1970s was also a decade when end - of - life issues extended all the way to the White House and bookended politically tumultuous times. In 1971 President Richard Nixon announced his War on Cancer, and in 1979 President Jimmy Carter formed the President’s Commission for the Study of Ethical Problems in Medicine and Biomedical Behavioral Research, which later published its landmark 1981 report Defining Death : A Report on the Medical, Legal, and Ethical Issues in the Determination of Death during the Reagan administration. Carter’s group would eventually become known as the President’s Council on Bioethics and advise all future Presidents on a wide array of issues, including, but not limited to, death and dying.

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I found myself directly confronting Lofland’s newly articulated experience of death and dying, as discussed in part II, when my younger sister, Julie Troyer, died from terminal brain cancer on July 29, 2018. Watching my sister die made me reflect quite heavily on The Craft of Dying’s key assertions, and in very unexpected ways that accidentally (albeit sadly) coincided with writing this introduction. The MIT Press expressed interest in republishing The Craft of Dying while my sister was dying, but I started writing the introduction after she was dead — an interval of approximately one - month. My father, Ron Troyer, a long - time grief and bereavement support - group facilitator and retired American Funeral Director, best summed up my death interval experience in very Loflandian language : it is one thing to publically say, “Julie is dying,” it’s an entirely different experience to state, “Julie is dead.” The former felt active, the latter inert.

Preface

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In the essay that follows I want to try to make some sociological sense of some of these kinds of activities; to view a portion of these death - related doings with the “sociological eye.” My focus will be on the what and how of all this collective bustle. I am concerned, that is, with such questions as : What are the important elements of the modern “face of death” ? What are the important components of a modern “craft of dying” ? How do the dying construct a dying role or identity for themselves ? How do varying conditions intrude on the freedom of that construction ? Put more generally, I will be analyzing what modern death and dying are like and how contemporary humans — individually and collectively — are dealing with them.

I The Situation of Modern Dying: Problems and Potentials

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Like the prolonged helplessness of its young, like bisexual reproduction, the inevitable fact of death provides one of the great parameters of the human condition. It can neither be “believed” nor “magicked” nor “scienced” away.

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Critics of modern death orientations frequently evoke an idealized past in which death is said to have been “accepted.” 14 Given human impotence relative to its control, one could as well speak of “fatalism” and “passivity.”

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What little evidence there is, 15 suggests that like Távana Vahine, most humans admitted to the dying category throughout human history and prehistory have probably been “sick unto death.” The absence of medical gadgetry, the absence of a well - developed complex medical establishment, the absence of theories of living and dying that would promote attempts at “early diagnosis,” the absence of bureaucratic control of large populations, all contributed to the likelihood that diseases or potentially fatal conditions would be “identified” rather late in the dying - to - death trajectory, and this would be even more true of those who died from what are now conceived as chronic or degenerative diseases than of those who died from the more typical maladies. [ condition (2) ] Thus, whether a person was “dying” or not was, in the premodern world, probably minimally problematic.

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If the dying situation of the premodern human can be likened to an encounter, the dying situation for more and more modern humans is best viewed as a full - blown affair.

II Individual Constructions: Styling and Controlling the Dying Role

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Before proceeding to an analysis of the more activist matters of shaping (or styling) and managing (or controlling) the dying role or identity, however, we need to consider three matters of a more structural or “given” character : the aspects of singularity, entry, and phases.

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Leaving aside questions of exhaustive topographic mapping, let me point up three ways in which “dying” is singular. As a way of “being” in the modern world, dying is (1) transitional, (2) irreversible, and (3) characterized by an absence of “graduates.”

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Once they have generated a category of kind of person or being in the world, social groups tend also to generate accompanying conceptions or “cultural scripts” that provide some specification for how one is to act when one is “in” the category. 10 Speaking ideal - typically, among traditional groups, such scripts tended to be singular and specific. For many, in fact, what to do when dying seems to have been quite thoroughly scripted. Of course, since dying, as we have seen, was usually a short - term way of being, it is understandable that what one was supposed to “do” while in the category were not things anyone could do for any prolonged period of time.

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In contrast, in modern social orders, dying scripts — if they can be said to exist at all — tend to be individualistic, varied, emergent and uncodified. If, therefore “being dying” is relatively problematic to those who take it on, it is not so only because as a kind of prolonged being it is of recent origin. Being dying is relatively problematic also because it is a role in the modern world, and such roles are frequently more akin to improvisational theater than to traditional drama. Parameters of some sort may be “given” (for example, the parameters of entry certification and of the necessity actually to die mentioned above), but within those, the actor has considerable freedom to shape the role’s detailed stylistic enactment as he or she sees fit. 12 Therein lies some of the problem; therein lies some of the potential.

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I should like to suggest that in shaping their dyings, in developing their styles of “passing on,” men and women work with, among other possible construction materials, the dimensions of space, population, knowledge, and stance.

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By space, I refer to the amount of “area” within what we might conceive as the individual’s total “life space” he or she chooses to devote to the dying role. What part of the pie, as it were, is to be labeled “dying”; what proportion of the self is this identity to encompass. Logically, one can imagine gradations all the way from 100 % to 0 %; empirically, it seems meaningful to speak only of centrality or marginality.

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By the dimension of population, I refer to the question of whether the actor chooses to play out the dying role alone or with others who are also playing it out. Given the proportion of persons who die in hospitals (see pp. 33 – 34, above), it seems likely that even those who would prefer to go the whole way alone are often forced into the company of the dying “at the end.” With sufficient resources, however, one can achieve an almost perfectly solo route, as did the “lone eagle,” Charles Lindbergh.

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By knowledge, I refer to the degree to which information about one’s admission to the dying role is shared with others — the dying, the living, or both. One might conceive of the possibilities as a series of outwardly extending circles or zones. In the minimal situation — the small center circle — only the M.D. and the involved actor “know.” In the maximal situation — the furthest and largest circle — the whole world or at least everyone in one’s social order has access to the information.

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By stance, I refer to something more elusive than the three dimensions outlined above. I refer to the character of emotional tone or orientation or personal philosophy that is expressed in the role. 18 Prolonged dying allows persons not only to act in certain ways vis - à - vis their dying but also to color their actions, to provide mood to their “being,” to add demeanor to their doing. Compare, for example, the “tone” conveyed by Ruth Hoffman with that expressed by Margorie Berg.

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Available materials do not permit a fully developed analysis of this important aspect of role construction. But we can, I think, gain some appreciation of the exigencies of control by examining three “dyings” and by making comparisons among them relative to the operation and consequences of four “externals” : (1) the disease process, (2) the social organization and culture of medical practice, (3) available resources, and (4) surrounding others.

III Collective Constructions: The Happy Death Movement

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In a secular age, large numbers of humans confront the modern face of death unarmed with any certainties about what it might mean. A part of the ideological work of the happy death movement is, therefore, the construction of some larger meaning system into which the experiences modern humans are having with death may be placed. While the ideological edifice is at present incomplete, it is still possible, tentatively, to identify three components that may eventually be central to the finished structure. These are immortality, positivity, and expressivity.

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Befitting a movement largely composed of presumably secular upper-middle-class professionals, the immortality claim rests not on revelation but on “research.” That is, Kübler-Ross and others know there is an afterlife not as a consequence of any direct communication with a deity but because of “evidence,” such as the following accounts, provided by the recovered “clinically dead.”

This is a very tall and unusual claim.

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As a component of the ideology of the movement, positivity involves three interrelated assertions : (1) that the dying process may be the occasion for self - improvement and personality “growth” for the dying person; (2) that the dying process and subsequent grieving may be the occasion for self - improvement and personality “growth” for the family and friends of the dying / dead person; and (3) that death itself (the moment of death and what follows) may be blissful, serene, pleasurable, intensely contenting — perhaps even orgastic.