SC. Sci. Med. Vol. 18, No. 9, pp.

713723,
Printed in Great Britain

1984

0277-9536/84 $3.00 + 0.00

Pergamon Press Ltd

ARE WE A DEATH-DENYING
SOCIETY?
A SOCIOLOGICAL REVIEW
ALLAN KELLEHEAR
School of Sociology, University of New South Wales, Australia 2033
Abstract-There
exists in much social science literature on death and dying the traditionally held view
that modern societies are death-denying. In some cases this has been a throw away line of minimal
importance. Other times, the thesis that we are a death-denying society has taken on the appearance of
serious sociological argument. In still other cases, there exists another body of literature which supports
this thesis by offering examples of death denial rather than cogent argument. This has amounted to a
significant, albeit fragmented, sociological theory of the background of our principle death related
behaviours. This paper gives that quasi-theory a systematic review by examining the central terms of
reference, argument and examples of death denial in the literature. The main arguments and examples
of this thesis, that we are a death-denying society, are evaluated according to their sociological content.
Subsequently, the ability of the thesis to explain the principle areas of our death related behaviour as
discussed by it, has been assessed. This paper argues that Western societies are not death-denying by
any of the major criteria posed in the literature on the subject. To say that our contemporary societies
are death-denying has no theoretical or practical explanatory value.

INTRODUCTION
Are Western industrial societies death-denying?.
Becker [l] regards all societies as fundamentally
death-denying. Since the fear of death is universal
and the denial of death is the major way of coping
with this, the social construction of reality is founded
solely on this principle. Aries [2] and Illich [3] see our
society as death-denying and attribute this mainly to
the medicalisation of death and the crisis of individualism in the twentieth century. Dumont and Foss [4]
argue that, at least in the United States, death is both
denied and accepted. Contradictory
attitudes exist
side by side-sometimes
in the same group or indivual. This is the case with so many subjects that the
authors are surprised that its association with death
attitudes has not been readily seen. Freud [5], Fiefel
[6], Raphael and Maddison
[A, Weisman [8],
Kastenbaum and Aisenberg [9] and Germain [lo] are
among the other chief proponents of the view that we
are a death-denying society.
Although serious reservations have been expressed
over the uncritical use of the term [l 1,8] and the
concept as a whole [12, 131, its theoretical circulation
continues unchecked and unexplained. With the possible exception of Dumont and Foss [4] there has
been no sociological and systematic attempt to critically review the theoretical foundations
of the
death-denying society thesis. And yet this short
phrase claims to be the central sociological background and stage for the bulk of our death related
behaviour. The importance of this claim requires its
examination. The major components of the deathdenying society thesis will be analysed in terms of
their sociological content and evaluated in terms of
its effective explanatory capability.
This paper argues that the sociological content in
the death denying society view is minimal. Consequently, its ability to explain the many contemporary examples of death-related behaviour is found
to be severely wanting in several important respects.

The central theoretical components of the thesis that

we are a death-denying society are five in all. They
will be discussed under the following general headings: the use of the term denial; the fear of death
argument; the medicalisation of death argument; the
twentieth century crisis of individualism argument;
and the principle examples of death-denying social
practices. The last point deals with only examples,
which are sometimes put forward instead of any
arguments, and are offered as proofs.
THE USE OF THE TERM DENIAL

According to Weisman [8, p. 601, the concept of

denial was originally formulated within psychoanalytic circles by Anna Freud (1948) in the work
The Ego and The Mechanism of Defense. It was a
unifying concept describing a general affect from a
combination
of psychic strategies. The generalisations were describing a total process and not just
a mechanism of response to a psychosocial situation.
These descriptions were confined to childrens modes
of relating and covered only the interactional areas of
psychoanalysis-its
social psychology.
Today, denial is used indiscriminately to refer to
any avoidance of reality-particularly
the reality of
the labelling observer. Its interactional meaning has
been generally lost to the reductionist tendency to
generalise about the individual without his social
context. This has led to the critical observation that
denial exists only in the mind of the beholder
(M. A. Simpson, quoted in [lo]). As a label, denial
becomes not only an explanation but an explanation
of why evidence for the original explanation is not
readily forthcoming. As a theoretical construct it has
the best of both worlds-valid
with and even more
valid without-any
evidence. As Taylor [12] has
pointed out of attitude research in the area of death,
three propositions are widely held: (a) death creates
fear; (b) respondents often profess little fear and
therefore, (c) are denying their fear of death.

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ALLAN KELLEHEAR

Donaldson [1 1, p. 2861 argues that denial is not a

meaningful scientific category because it has no conceptual status other than a snappy descriptive term
of unknown accuracy. Given the definitional problems of the term-its
unknown accuracy-denial
is
still seen as either problematic [14] or helpful [15] in
the area of patient care. All this points up the
problem of inappropriately
using psychiatric concepts to fit sociological problems. But within the
border zones of a social psychology it is still not clear
that the various students of denial are even talking
about the same thing. Becker [l] and Freud [5], for
instance, emphasise the aspect of repression in the
concept of denying death. Dumont and Foss [4]
concentrate their attentions on a use of the term
denial as a culturally sanctioned form of selfdeceit.
Weisman [8] reintroduces the interactional complexities to the concept while retaining the view that the
locus of the functional significance is psychological.
Although Weisman does the concept justice in psychological terms, he does not sketch the sociological
parameters which would supply a causal hypothesis
for explaining the behaviour. All have in common the
view that denial means, in the broadest sense, avoidance of something.
The objects of avoidance are different too. Although all authors speak of the denial of death, the
avoidance of the realities of death, each selects
different realities as objects of that avoidance.
Becker and Freud discuss death denial as an avoidance of the prospect of annihilation of the ego. This
meaning of death they take as fact. Dumont and Foss
discuss death denial as an avoidance of the prospect
of separation. Weisman speaks of death denial as a
functional avoidance of ambiguous social relations.
Fear of death attitude research reveals that what
many people understand as fear of death is their fear
of the dying process. Denial of death in this sense
would be avoidance of certain images of dying.
In addition to the above problem is the further
difficulty in using a value laden term such as denial
in the first place. Terms such as denial, happiness,
guilt etc., tend to beg a polarity in subsequent
discussion. In psychoanalysis, the possibilities may be
fruitful, but in sociological analysis such divisions are
artificial and anthropomorphic.
Although human
beings may be happy or aggressive or denying,
societies are structured in historical ways so as to
encourage, discourage, emphasise or de-emphasise
certain of these traits. Situations are set aside for their
dramatic expression or to reinforce their continual
absence. This is the sociological meaning of culture.
The tendency to have theoretical polarity is best seen
in the dubious debate over the denial vs acceptance
of death. This type of discussion is exemplified in
Dumont and Foss [4], whilst a sociological example
is observed by Donaldson [1 I].
If we agree with Weisman [8, p. 33) that the mere
absence of fear does not necessarily mean denial, let
us add sociologically, that the presence of denial does
not lead to the conclusion that this is a central
response of our society to death. In addition to the
polarity of discussion immediately raised by the term
denial, is the issue that such terms encourage further
personalising, psychologistic descriptions. If societies
are not death denying or accepting then perhaps

they are apathetic [16] or prude [ 171 or even

defiant [18]. The use of psychiatric or psychological
terms in describing sociological phenomena-such
as society-necessarily
leads to anthropomorphism.
Society is personalised in its structure and function
if personalised concepts are used to describe it.
In summary, the key concept of the sociologically
intended phrase death-denying society is psychiatric
in origin and implication. Denial is an unsuitably
sociological concept because of its epistemological
tendency to personalise social systems, in artificial
ways. Durkheim [19] has argued the problems with
this in general and Malinowski [20] has discussed
some of the specific problems with this tendency in
psychoanalytic work. In any case, the term itself is
ill-defined, its meaning too broad and various for
specific application, accurate description and general
usage. Unless stated otherwise, the term denial as
used in this paper will illustrate this point by using the
popular meaning of avoidance of the reality of
death.
The specific reality of death that each section will
be concerned with will be discussed in that section.

THE FEAR OF DEATH

ARGUMENT

One of the more common arguments in favour of

the death-denying society thesis is that the fear of
death is universal and that the most efficient way of
coping with this is denial. The universality of the fear
of death has been discussed by among others-Lester
[21], Freud [S], Hocart [22], Riley [23] and Vernon
[24]. Its best known advocate is Becker [1] who
attributes this most basic of all existential anxiety
with the creation of Human Cultures. There are
several serious problems with both the view that (a)
the fear of death is universal, and (b) denial will be
the chief response to that fear.
The basic problems with this view are the foilowing:
(a) Fear of death is not universal because not
everyone has this fear;
(b) Of those who report a fear of death, both the
type of fear and the image of death feared tend to
vary markedly.
(c) So many fears of areas in ordinary life are
included under the canopy of fear of death that such
a fear can arguably be read as a fear of life;
(d) Finally, a description of the complex individual
psychodynamics does not lead to an understanding of
organisational
dynamics and the relationship between the two. Discussion about fears provide several
insights into the psychology of death, but leave
explanations of group and institutional behaviour
severely wanting.
Taking each point separately, the first problem
with the argument is that the fear of death does not
appear to be universal. According to Watson [25],
fear of death belongs mainly to adults. Nagy [26] and
Kastenbaum and Aisenberg [9, p. 181 support this
view and observe that fear of death in children is
learnt. Fear of death is diminished and sometimes
replaced in some cases of the aged who fear dependency and disability more than death itself

Are we a death-denying
[27,28]. Even reported fear of death in adults is often
absent depending on the circumstances, which may
not be conducive to thinking about death [12].
Secondly, on a deeper methodological level, people
tend to fear what they feel death means. Fear of
actual death-that
point of loss of consciousnessmay be rare. This may be because this particular
image of death may not be a commonly held one. It
is more fruitful as Kastenbaum and Aisenberg [9] and
Weisman and Hacket [29] observe, to differentiate
fear of dying from fear of death. Fear of dying is
usually the critical source of images for people when
discussing their fear of death. Weisman and Hacket
[29, p. 3151 make the observation that condemned
men have attempted suicide in order to avert either
dying in general (the waiting), dying a certain type of
death or perhaps dying without absolute control over
the circumstances. They fear, in any case, the dying
process apparently more than death itself.
The third point to be made is that there are so
many images of death feared that it becomes increasingly difficult to separate out this particular fear
from a general fear of life. Freuds approach is of
interest here. Freud [5, p. 2891 asserted that the fear
of death is so strong that it results in an inability to
imagine it. We cannot, according to Freud, conceive
of our own death, we are convinced of our immortality. But Vernon [24] rightly observes that we can
never know what it is to be anything else either. This
inability to know the essential experience of otherness does not logically lead to, nor does it result
from, fear. This is because we do not, indeed cannot,
fear the unknown, by definition. Only the images we
use to fill these conceptual gaps become the objects
of our fears. These images then, are not purely
existential ones but historical and often culture
bound ones. We may fear the violence and deprivation brought by the war images of destruction
and suffering [30]. We may fear the isolation and
contamination
of the medical images of incurable
disease and aged disability [31]. Fear of dying is said
to take many forms [29, p. 3141, including hypochondriasis and fear of insanity and images of dying
vary from burial and punishment to pain and the fear
of ghosts [24, p. 1811.
Generally though, we may fear the prospect of
death.because we fear all prospects of separation in
a culture where social support remains low. Our
so-called fear of death then, is basically our main
fear of life [32] and at present, may be confused with
it. In contemporary terms, this dread may turn out to
be a rationally based fear of social isolation [33],
meaninglessness [34] and anomy [35], so characteristic of social life in the twentieth century.
Finally, granted that most, if not all, fears are
learnt, the public expressions or responses to these
must be understood organisationally. This is because
public situations arouse different emotional and social responses to private ones. The psychodynamic
realities of denial, not withstanding its conceptual
shortcomings. is even more inadequate as an explanation of institutional responses. This is simply because its central focus is on the I, tending to omit
the primacy of the thou as a locus for behaviour
when in group situations. It is the presence of the
other which modifies individual behaviour when in

society?

715

public. Any analysis of group behaviour which overlooks this critical point oversimplifies that analysis.
The next section discussing the medicalisation of
death will. cover this point in more detail.
In summary, people do fear death but this fear is
not universal. Psychologically, much of this fear of
death may be more accurately understood as a fear
of dying and this is determined by the predominant
images of dying. These are culture-bound and hence
these are not universal either. Not remarkably,
people fear death more when the personal prospect is
closer and they fear death less or not at all when they
do not feel personally threatened. In any case, fear
of death relates to certain groups over others in
society as a whple-possibly
to adults mainly, who
feel they may die or be killed through disease or war
because they are close to one or the other. The fear
may be greater the more they feel they have to lose
and so fear may be greater, or present in greater
numbers, in the middle and upper-middle to upperclasses. Class is a sociological factor that needs more
vigorous investigation in relation to fear of death and
dying. It is one factor that has been largely overlooked. Aries [2] has argued, the higher the social
position of people the less likely that they will be
exposed or aware of death and its approach. They
will be more dependent on others for this awareness
and therefore its personal impact and consequences
will be greater. Sociologically however, much of what
we call fear of death may be. deathly fear of certain
aspects or even the whole of life in todays social
systems.
In some individuals,
this fear may lead to
psychiatrically describably forms of repression and
denial. Sociologically, it may lead to higher levels of
social and physical violence and a subsequent increase and development of various forms of social
control. In times of economic recession it may.lead to
an expansion in the institutions of entertainment,
leisure and religion-complementing
the desire for
distraction, group activity and orthodoxy. In boom
periods, times of economic growth and expansion for
many people, this same fear may lead to radical
questioning of the larger structures in our society.
This may be precipitated by a disenchantment with
orthodox religious and political institutions complementing a drive for the assertion of individual
autonomy and freedom. But whatever the outcome,
in whatever period, society will cope with all fears,
not psychodynamically,
but organisationally.
THE MEDICALISATION

OF DEATH ARGUMENT

It is now inappropriate
to speak of the taboo
placed on death in modern society [36], particularly
in professional health-welfare arenas. Today there is
an increasing proliferation of literature indicating our
rediscovery of death. Indeed Pollack [37] argues that
it is becoming increasingly difficult to hide from
information about death and dying. The issue of
disclosure of terminality to patients by their doctors
has just about turned full circle since the 1950s.
Doctors now tend to tell their patients if they are
dying [38]. But all this is very recent. The argument
that we have medicalised death to the point of
confusing it with disease and therefore denied its

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ALLAN KELLEHEAR

reality, stands on an interpretation of medical history. The following is a short summary of that
history.
For centuries in the Western world, from the
beginning of the Middle Ages up until the Industrial
Revolution, men viewed death with equanimity [39].
Death was familiar and when, as recently as the
nineteenth century this familiarity turned to contempt, it did not radically alter the basic epidemiological facts. Death from high infant mortality,
bad hygiene inherent in living conditions and battle
wounds from War in the Middle Ages or the factories
of the Industrial Revolution, put the average age of
death for the labouring classes at 22 [40]. Poverty and
death were constant companions as they have always
been. What was significantly new was the arrival and
expansion in the nineteenth century of an a&tent
middle class of farmers and landlords. This group
imitated the gentry in all manners of possession,
custom and expectations. Prominent in this triangle
of imitation was the desire for old age and the chance
this gave to its owners of leisure and spending that
had been minimised in their lifelong pursuit of
financial security. This chance was seen to be increased by regular visits to the physician, whose
power, wealth and influence began to steadily improve with his popularity. As Illich [3, p. 1981 observed, medical care became a mark of distinction
and privilege.
The nineteenth century fight against plagues of
consumption and pestilence and the twentieth century image of medicine battling specific diseases
gradually suggested a war against death itself. Gradually, death became confused with incurable disease
[2, 31 and still more recently with cancer [32, p. 741.
The impact of these changes on our view of death
led to radical alterations in the way which we viewed
life and deaths role in it. Death became, as it still is,
an interruption to life rather than the unpredictable
end of the whole. Now deaths, more than perhaps
ever before, can be viewed as premature or meaningless if they do not occur in old age. And people
expect to live to see their old age [41, 421 and when
they reach that old age sometimes expect life to go on
even longer [43]. Death and disease have been removed and institutionalised
from popular view in
hospitals. Until very recently death was a forbidden
subject in medical circles. So death now comes in old
age, unless it comes prematurely in an accident or
in the form of cancer. Death is unnatural unless it
is proximate to senility and timely if it intercedes
mercifully before it.
There are two important points in support of the
death denying society thesis which stem directly from
the preceding description of the medicalisation of
death. One refers to an idea and the other to its
practical expression. If death as an idea, has been
confused with disease and old age then death, with
these images in mind, may be stereotypically viewed
as contaminating [44, p. 55; 8, p. 61, dirty [42, p. 3831
and embarrassing [45, p. 2831. Consequently, death
represents a loss of control but also the hope of
treatment. The high-sense of risk, repulsion and the
realities of the medical hopelessness of terminal care
lead to the psychological protection of denial. The
practical expression of this theory is the transposed,

insulated, technologised and decontextualised situation of death in hospitals described by Kastenbaum

and Aisenberg 19, p. 2051. This makes hospitals-our
main place of dying in todays society [38]-an arena
for denial.
The overall situation which looks to support the
contention that we are a death-denying society is
thus the following: since hospitals are the central set
aside areas for dying in our society, and since these
areas are denying situations, then that society is
death-denying.
The major sociological problem with the above
argument is that it does not describe any organisational consequences of this image of death on
interactions in that hospital. This means that the
above explanation has failed to notice that although
many people might respond psychologically with
denial they will nevertheless behave according to the
value prescriptions of the institution. These value
prescriptions are learnt partly by learning explicit
social rules, but mainly by fitting in behaviour.
Fitting in consists in imitating senior members of
the institution and using their value systems as a
criterion for ones own behaviour. Without a description of the interpersonal features in an organisational
response to death, denial must be seen as only a
limited explanation. To use denial as a total explanation is too simplistic and reductionist.
Despite the fact that patients who die in hospitals
come from a wide range and variety of backgrounds,
it is still asserted that denial is a common response to
dying. Although it is true that standardised environments transform individuality into uniformity [8, p.
1501, it does so most efficiently when that standardised environment
is most active in the transformation. The most important aspects of the standardised environment of the hospital and hence the
phenomenon called denial, are the medical staff.
Medical education has not in the past prepared
medical students for their experiences with death and
dying, and yet they do experience an astronomical
amount of this compared with the average nonmedical person [46]. They often are reported to fear
death (with all the implications this means as previously discussed) more than the average person [4].
This is possibly because, according to Dumont and
Foss [4, p. 211, medicine may attract this type. On the
other hand, because doctors are regularly exposed to
death, perhaps they are constantly reminded of their
own. Finally, since death means loss of control,
dependence, goals, authority and material things,
doctors may fear death more because they have a lot
more of those things to lose.
So, denial, even in its heydey before the recent
volte-face of attitudes may have been predominantly
the influence of medical personnel. In other words,
behaviour related to the aversion of death and then
the subsequent interpretation
of this behaviour in
relation to their patients may be related to medical
behaviour
and medical attitude
to death. In
psychiatric terms, the long-standing view of the dying
as denying may in fact be a projection of denial by
medical people. In sociological terms, the medical
myth may not be in accordance with the patient
reality.
Benin [ 151and Weisman [8] have noted the primary

Are we a death-denying

function of apparent denial in dying patients in

hospitals. Denial, they argue, helps the dying not just
avoid but prevent the loss of significant relationships.
The relationship with their doctor is understandably
a very significant one. Patients will ask about their
illness and survival chances to non-significant people
(such.as nurse and ward aids, medical students etc.),
but rarely those in authority or intimate friends and
family. According to Kastenbaum and Aisenberg [9,
p. 2141, denial in hospitals is evidenced by patients
dismissing or playing down symptoms. In addition to
this, dying patients might place a little too much trust
in their doctor. But if patients are to help legitimate
the health care role of their. doctor (both of them
ignorant of any dying care role [14]), they must play
down the symptoms and reinstate, possibly restate,
their trust in their doctor.
Interactionally,
the sick role is preferable to the
dying role because to be sick there is no-one to blame
and relationships are workable. When dying, the
doctor has failed to cure, the patient becomes stigmatised through the medicalised view of death. Social
relations become as ambiguous as the prevailing
image of death dictates. There is no denial here-at
least not in the sense of not confronting the image of
death and dying. In its place, there exists an old
interactional ritual between stigmatised and so-called
normal people [47]. Because non-stigmatised people
have their own problems, people with stigma feel
generally that they are expected to be outgoing and
cheerful [47, p. 1411, not bitter or resentful. If they
perform this way they are labelled as denying when
in fact they are motivated by precisely the opposite
mental frame of mind. Embarrassment
is a mismanagement of impressions and is to be avoided [48].
Since the medicalisation of death, dying has become
an embarrassing business, a situation of awkwardness, not because of denial, but because of the
prevalent image of death widely accepted.
Finally, the medicalisation of death has not encouraged denial in the psychodynamic sense, but an
interactional ritual which has characterised organisationally: (a) problems of poor communication
between the modern doctor and his patient and (b)
the spread of stigma to death as another form of
medical handicap which creates an ambiguous social
status for its holder.
Far from encouraging denial, medicalising death
has encouraged periodic medical check-ups which
remind people of the increasing vulnerability of their
bodies. Widespread ageing has led to dying in well
defined stages [37, p. 741. This makes dying more than
ever a national experience. Looks deteriorate; children grow up and leave or the chances of having any
fade; friends and relatives begin dying; job prospects
decline and jobs are lost through retirement. All this
in turn leads to a decline in purchasing power and a
loss of social status as the roles of ageing and dying
come closer to each other. More than ever before in
the past, the medicalisation of death has given a new
meaning to the idea of the public death. Age has now
become the measure of our dying.
The major sociological shift of the dying role, this
century in contrast to all others, is this. Today, the
dying are second class citizens alongside drug addicts,
convicts, alcoholics and disliked ethnic groups [31].

society?

717

And even though this situation improves every year,

the only denial still involved is one that means
depriving the dying of their former economic and
social status. We do not, as a society, deny in the
sense of avoiding the facts of dying. In other words,
the medicahsation of death has not transformed our
general view of death into one that denies its impact,
or its existence, or its sting as it were. Medicalising
death has meant the transformation of the dying role
into a low status, technology intensive and potentially contaminating
situation in need of sanitising.
Death has been re-interpreted but the new interpretation is not denial.
THE TWENTIETH CENTURY CRISIS OF lNDIVlDUALISM
ARGUMENT

There is another way in which the term denial as

a concept is employed in the assertion that we are a
death-denying society. Illich [3] and Aries [2] for
instance, mean that people are denied, in the sense of
deprived, of a good death rather than the facts
of death. In a good death [2, p. 142) mans fear and
image of death was tamed [39, pp. 7-l 1] by a series
of preparations and rituals designed to give the dying
control over this process. The dying individual presided over his own death. Today, this good death
has been supplanted by a concept of the natural
death-a
death which comes under medical care
and finds us in good health and old age [3, p. 1801.
In the natural death, it is argued, the individual
power of decision making and control, formerly
invested in the dying person, is to be found in medical
and hospital stafI. This deprivation is supposed to be
a measure of the diminished independence and autonomy experienced by the twentieth century citizen
today in all things. This is described by Aries as a
crisis of individualism.
There are three main points to this argument, all
of which are problematic sociologically. The first is
the assumption of a crisis of individualism characterised by critically diminished levels of individual independence and autonomy. The second is the assumption that the way an individual dies is in some way
a measure of the diminished levels of independence
they experienced in life. The third point is the observation that modem man is not presiding over his own
death. Each of these will be questioned in their
respective order.
Firstly, granted that a crisis of individualism is
occuring in the twentieth century this crisis would
seem to be the crisis of its ever increasing presence
and expansion rather than its decline. The problem
would seem to be a tendency for individualism as a
social philosophy to contribute to the conflict and
disruption of institutional
pressures towards conformity. Consider the present situation of dying and
the issue of individuality.
Today death is decontextualised [9, p. 2051 meaning that since there is no death ideology individuals
are faced with more choices and decisions about their
deaths than ever before. Additionally the shift from
acute to chronic types of disablement and legal
pressures regarding consent in medical treatment has
meant a shift and sharing of knowledge and responsibility from doctor to patient [38]. And by

ALLAN KELLEHEAR

718

patient is meant the individuality of the personality

and the uniqueness of (a) the medical problem, and
(b) its symptomological effects on that personality.
Further important are the controversial but powerfully emergent issues over patient rights, rights of the
aged and the dying and the current broad debate over
euthanasia. All these recent changes and trends are
the expansionary signs of a culturally sanctioned
social philosophy of individualism. It is now making
belated in-roads into an extremely conservative and
authoritarian institution such as medicine and health
care. Dying is part of the current drama of the growth
of individuality in search of its political rights and
right social conditions. But it is not necessarily a
reliable measure of it, and this is because large social
changes are not measured by what happens in only
one institution.
Secondly, dying may be a measure of a peoples
relationship with medicine and professionalism as it
exists today. It may also be a measure of a peoples
relationship with religion and ecclesiasticism as it
existed in the Middle Ages. In these two examples,
the way one dies indicates a pattern of relationships
between the prevailing authorities in regard to death
and those dying. Specifically, it indicates WHO is in
authority in relation to death and how that authority
sometimes expresses itself. It cannot indicate by itself,
a level of a peoples general independence and autonomy.
For example, a Serf may preside over his own
death only after a life described totally in terms of his
bondage to the local Lord or Baron. Independently
presiding over his own death may have been his first
and last truly autonomous act. On the other hand, a
patient today may allow a hospital and its staff all
power in presiding over the passage of his dying. If
this occurs in a totalitarian type society then his death
may be seen as consistent with the general deprivation of his individuality and its rights. If this
occurs in a democratic society, it may be. the first time
that person relinquished his independence in a long
life. The point is this. Because the medicalisation of
death is not a specific outgrowth of any one political
ideology, it is therefore meaningless as a measure of
the independence any political ideology might or
might not give its people. The way a person dies is not
usually related to the political issues of civil freedom,
independence or autonomy.
Thirdly, the observation that modern man does not
preside over his own death, although once completely
true, is now quite dated. Although people do not
usually preside as fully as they once did over their
own deaths, the hospice movement for instance, is
encouraging a deprofessionalising of the situation of
the dying. This late change is related to the first
criticism mentioned in this section. To reiterate, the
social philosophy of individualism is creating a crisis
in present models of medical care which is returning
the option of a good death in either a hospice or at
home. The tide is turning, slowly, against the technology intensive view of death as disease-to-betreated until the end.
*A term used by Glaser and Strauss to denote perceived
courses
[50, p. 61.

of

dying

rather

than

the

actual

courses

In addition to this, there are two recent factors

which are conducive to an evolution of the good
death rather than to its omission. These are the facts
of: (a) increased life expectancy leading to the
increased possibility of lengthy dying [49, p. 91 and
(b) the present widespread willingness of doctors to
inform their patients of their terminal prospects.
This has meant that the preparations and deliberations around the nineteenth century death bed may
still be occurring, but over a longer period of time
and before the illness forces bed rest. In other words,
although death now occurs mostly in hospitals,
the longer part of dying may still be carried on at
home or even at work. Twentieth century man may
yet be discovered to be presiding over his own death
but over an extended period of time involving several
social settings rather than just one. The event of
death in the hospital setting must be seen as only one
sociological component of the dying trajectory*,
rather than the modern symbol for the whole process.
In brief, there is little indication of a theoretical or
empirical nature to believe that we are a deathdenying society in Aries and Illichs terms.
EXAMPLES

OF DEATH-DENYING
PRACTICES

SOCIAL

Sometimes those that claim that we are a deathdenying society do so by offering examples of deathdenying social practices. These countless examples
constantly turn up in any discussion of death denying
behaviour,
sometimes supporting
an argument,
sometimes not. The main source of examples remain
the funeral industry, religion and our reluctance to
speak of death or express open grief. No sociological
review of the death denying society thesis would be
complete without confronting these examples.
Funeral industry
There are four principle examples from the funeral
industry and related practices that supposedly deny
the finality of death. They are the following:
The cc@%. It is said [51] that coffins are so elaborate that they appear to be pieces of furniture that the
deceased recline in. Rather than pointing to the
sombre reality of departure, coffins help create a
picture of lounge room comfort. But although the
coffin, at times, may look like furniture rather than
a disposal box this is merely another example of
aesthetic styles transcending the practical. This is not
an experience confined to either the funeral industry
or death. Omamentalising,
or beautifying if you
like, anything from dusty playgrounds, old cars,
buildings or coffins, help make them more palatable
or acceptable. But in making the objects more acceptable it does not deny its basic function and a coffin
is a box. no matter how adorned, in which corpses are
buried. This is not denial of death.
Embalming. This restorative art has been cited as
being responsible for the practice of creating life-like
corpses [2, 511, another example of death denial.
However, this is structurally a carry over, a logical
continuation, of the cosmetic industry for the living.
The difference does not even lie any more in the
surgical intervention practices for corpses. Cosmetic
surgery now abounds as a fashion option for the

Are we a death-denying society?

living. It can be argued that face repairs for distressing looking corpses (through a violent traumatising death) are probably more desirable than for
many living persons. Contrary to popular belief,
corpse cosmetics and many other funeral practices
are not a denial of death but an affirmation of normal
capitalist marketing strategy. It is an affirmation of
economic life as we know it all around us. This
accepts death as part of its way of life, but also as a
possible rich source of earthly revenue.
Memorial
gardens.
Luxurious,
parkland-like
memorial gardens-Forest
Lawn being an extreme
but famous example-are
supposed to be further
evidence of death denial. Again, this is only one
possible interpretation put forward at the expense of
all others. For instance, memorial gardens just might
mean what their builders say they are-attempts
to
beautify what was once an area of taboo and superstition. Cemeteries were, in the last century, areas
feared because of their ugliness and barren invitations
to the macabre and religious themes of judgement,
doubt, damnation
and the devil. The attempt to
beautify them is not necessarily to deny death, but
more specifically to prevent entry to this type of
threatening imagery. It belongs to a bygone era and
not the contemporary scene and its new social meanings. In place of these former images are those of
peace, tranquility and rest. These are used perhaps to
encourage the living to return to the cemetery in
contemplation, prayer, or as an ongoing visitation to
facilitate grief work.
Do not misunderstand
my point here. I am not
defending the contemporary
American image of
memorial gardens, or for that matter, embalming
practices. I merely argue that these practices are
normal capitalist market practices. Market manipulation and imagination is everywhere praised and
encouraged
in all other industry-and
some
professions-and
the funeral industry is simply no
exception. Here, they succeed not because they deny
death, but because they recognise the marketable
situation of vulnerability and suggestibility brought
by loss and grief.
Funeraijfowers and wreaths. These too have been
mentioned [7] as examples of death denial. But
flowers are no more a symbol of denial of death at
funerals than they are a denial of sex at marriages or
denial of illness at hospitals. The absurdity of this
proposal should be apparent. The giving of flowers at
funerals was a Middle-Age custom revived in the
Victorian Period and persisting today as a tribute
[40]. This is very much part of the custom of giftgiving [501-a token for the living which is meant to
supplement or replace words of comfort, friendship
or alliance. Of course, gifts have a reciprocal nature
which tends to reinforce the custom even further.
Nevertheless, this custom, like so many others, has a
way of persisting long after the original rationale has
been forgotten.
Religion. An interesting example offered as a deathdenying social practice is religious beliefs and their
practices. Freud [S, p. 2891 and Malinowski [53, p. 471
link a belief in immortality with the denial of death.
Raphael and Maddison [7, p. 61 and Kastenbaum and
Aisenberg [9. p. 2141 connect faith in God or religions
as evidence of death denial. Borkenau [18] and

719

Watson [25] discuss religions as either death denying,

death defying or death accepting. The most important methodological observation in relation to
these claims is the following: despite optimism to the
contrary, the empirical basis for belief in God and
immortality has not been established For or Against
these things. For those with fiery convictions that the
basic foundations
of religion are groundless, or
prickly with evidence, the onus is still on each to show
how this is so. The discussion goes on. Meanwhile,
the authenticity of transcendent religious claims must
be honestly regarded as no more than a hypothesis
which could prove true or false tomorrow. To claim
that religions and beliefs in God and immortality
deny the absolute finality of death is to claim that
the debate is settled when it most certainly is not.
Sociologically however, religions may lend help, support and protection to the bereaved [54] whilst supplying them with a set of images in which to locate
and understand their conflicts. Religions supply a
functional locus for fears, hopes and anxieties and
may be important in preventing these strong emotions from overspilling into other institutions. Religions then, are an important element in the social
control of death sociologically. It is simply an
oversimplification to state that religions are in any
way involved in promoting death denial practices.
Our reluctance to speak of death or show open grief.
Raphael and Maddison [7] discuss the psychiatric
problems related to the widespread reluctance to
speak about death and also to openly express grief.
This reluctance is supposed to be further evidence of
being a death denying society. We shun death by
banning it from conversation and by placing grief in
a straight-jacket.
This concern for conversational
propriety and emotional reserve in relation to death
has been discussed in relation to sex. Corer [17]
argues that this type of behaviour common to sex last
century and death this century is related to prudery.
However this may be so in psychological terms its
explanatory power sociologically is limited. Prudery
is one aspect of social life in a middle class society
partly routinised by the rules of politeness. Politeness
and reserve are customs of increasing value the higher
a person travels in class. The higher the class, the less
emotion expressed for the deceased [55]. The strength
of custom is not in its analytic powers but its ability
or advantage in developing ready responses to the
needs of smooth social discourse. If sex is embarrassing and death is upsetting, then it is sound interpersonal practice to avoid both the subject and the
emotion aroused by it. This can and does encourage
denial in psychiatric terms, but the practice itself does
not stem from death denial but aspirations for
smooth relations and conduct. This may not be
psychiatrically sound practice, but it is a sociologically functional one. Death situations come under
more control and embarrassment
is minimised or
avoided by all. Until our social relationships place a
higher value on tolerance and communication
this
custom of politeness will remain a mechanical substitute for individual responses.
Conversational
propriety and emotional reserve
have been with us for some time and are applied
meaningfully to a range of awkward and ambiguous
topics and situations. When it is found in relation to

ALLANKELLEHEAR

720

death. and bereavement its basic meaning does not

automatically become one of denial. It may, however,
function in the service of denial, but for most social
actors the fear of offending is situationally greater
than the fear of mentioning death or expressing grief.
CONCLUSION

We are not a death-denying society. The arguments

and examples to the contrary are unconvincing as
sociological
explanations.
They ignore the organisational considerations
that are basic to any
description of institutional behaviours-whether
this
is in the funeral industry or medicine. They do not
separate out the issues of individual motivations,
from group behaviours, tending to see descriptions of
the former as explanations of the latter. This confusion and projection of private ideas with public
behaviours has led to an oversimplified and reductionist view of the relationships between the individual, society and death. Individuals will and do deny
death as they also will become angry, laugh or feel
sorrow in relation to death. These individuals will, as
far as possible, express these emotions or attitudes in
organisational
settings that permit this. Sometimes
they will be disguised, but always they will be private
expressions.
On the other hand, societies do not deny death but
instead organ& for it and around it; exert forms of
social control through sanctioning different types of
myths and rituals toward it; culturally determine
the conditions, circumstances and sometimes the
nature of death; set in motion processes of conflict,
reintegration and adjustments of roles. It does these
things, despite the rich variety of individual attitudes
and values in relation to death, simply because the
requirements of living together dictate that group
goals take priority over individual ones. This is the
societal response to death, always complex and historically unique. In the Middle Ages the essential
sociological meaning of death was religious. Today
this meaning is medical. There are signs already that
tomorrow this meaning may be a legal one [56, p. 521.
Nevertheless,
sociological
problems,
including
those of death, must be formulated in sociological
terms if decades of misunderstanding
on issues like
the oresent one. are to be avoided.

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COMMENTS
From

DR C. M. PARKES

It is a brave man who denies denial, and Allan

Kellehears
paper provides much food for thought.
His attempt
to sever sociology
from psychology,
however, leads him to some odd conclusions. Thus,

he dismisses denial, happiness and guilt as artificial

and anthropomorphic,
and progresses to the absurd
conclusion that society will cope with all fears, not
psychodynamically,
but organisationally.
In the last analysis all organisation,
be it at a
personal or a societal level, occurs for psychodynamic
reasons, and the sociologist who thinks he can ignore
psychodynamics
makes the same error as the
psychiatrist who thinks he can treat all unhappiness
with antidepressants.
Having said that, I found his main thesis quite
tenable. I see little reason to believe that our society
is more death-denying
than previous ones; it is,
simply, dead ignorant about death. One might argue
that the decline in popular concern about and belief
in a life hereafter is a sign that we are now less
inclined to deny death than our forebears, but this
may only be possible because we no longer confront
it in our daily lives. We have reduced the infant
mortality rate, relocated the dying outside the home
and transformed the dying role into a low status
technology intensive situation in need of sanitising.
Death has become less visible and hence, easier to
ignore.
Age has become the measure of our dying simply
because young people are now more safe from death
than they have ever been before. Yet we have the
paradoxical situation of the safest society the world
has ever known scared to death by its own fantasies!
Out of sight is not out of mind, and the fact that

people in our society are now rarely seen to die does

not mean that there is not a social image of death.
But our social image of death is derived from fiction
and from the more dramatic and horrific forms of
death which make news and appear daily on our
television screens.
If there is nothing you can do about an unpleasant
situation, then it makes sense to ignore it. When
doctors felt they had nothing to offer to the dying,
they were right to offer nothing. Dying patients and
their families took their cue from the doctors and
asked for nothing. But this is no longer the case.
Sociologists, psychologists, psychiatrists and many
others have provided a wealth of advice on the ways
in which we can help the dying to achieve death with
dignity and the dying are beginning to demand these
new ways to a good death. It seems likely that the
death of the future will not be religious, medical or
legal but social psychological.
Department of Psychiatry
The London Hospital Medical
University of London
Turner Street
London El 2AD
EngIand

C. M. PARKES
College

From DR R. WILLIAMS

WHICH

SOCIETY DENIES
ABOUT DEATH?

WHAT

In answer to the question Are we a death-denying

society?, Kellehear has given a resounding No: and
he has threaded his argument with a number of lively
and stimulating suggestions. But in the vigour of his