Summary:

This is a comprehensive social history of European (or "Western") attitudes toward death and dying over the last thousand years. Ariès organizes his history into five sequential cultural constructs, each of which conveys the meaning of death to the individual and community, as well as the social institutions around death and dying, during a different period of Western history, beginning in the Middle Ages.

Cultural responses to death must begin by acknowledging that death is mysterious and overwhelming; a wild beast; a meaningless monster. Death lurks at the edge of our consciousness, ready to destroy us and demolish whatever meaning we attribute to our lives. In medieval Europe Christianity had domesticated this monster by establishing a comprehensive set of beliefs and practices that Ariès calls the "tame death." Death was merely a transition to eternal life. The individual was understood as an integral part of the community and not as autonomous and isolated. Therefore, death and dying were communal events, supported by specific prayers and practices (i.e. ars moriendi) that "tamed" the unknown.

In the centuries that followed, Ariès's "tame death" evolved through five stages into the radically different cultural conception of death that characterizes Western society--especially in its American form--today. These changes result largely from the gradual replacement of community-oriented personal identity with today's radical individualism; and the gradual sequestration of death to a position behind the scenes, so that dying and death become remote from ordinary experience.

In today's world we encounter "invisible death," a somewhat paradoxical name because its invisibility allows the savage beast free rein. Death is no longer "tame" because we deny its existence so effectively we no longer develop personal and communal resources to give it meaning. Death's invisibility enhances its terror; our culture's loss of spirituality enhances death's meaninglessness.

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This slim volume dips into "quotable quotes" drawn from literature and historical writings dating back several centuries. The quotes are put forth by physicians, patients, observers of medical issues, and writers of fiction as well as essayists. Each quote is but a few lines. The author, the source, and the date (when known) are provided for each quotation.

Many of these quotations will be familiar to persons who are widely read or who study the literature by and about medicine. Some of the quotes are scatological in the sense that they address issues of bodily parts and functions; others are simply amusing, while many are profound observations. The range is wide and the selections eclectic.

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Professor Sandra Bertman founded the Medical Humanities Program at the University of Massachusetts Medical Center and holds certificates in grief counseling and death education. This handbook outlines how she uses the visual and literary arts to "improve our professional abilities to deal with death and dying." Her premise is that the arts provide a valuable vehicle for exploring and making bearable the prospect and fact of death.

Bertman illustrates her presentation technique (Chapter 2) of juxtaposing dual images around six central themes, here abbreviated: the chosen death; death and afterlife; existential aloneness; loss of control, unmentionable feelings, grief; the land of the sick vs. the land of the well; the moment of death. The book offers dozens of paintings, sketches, and photographs (reproduced in black and white), as well as many literary excerpts. Classic works are represented (David's painting, The Death of Socrates; Michelangelo's sculpture, "Pieta"; Tolstoy's novel, The Death of Ivan Ilyich) but there are many unusual representations as well--greeting card messages, epitaphs, cartoons.

In addition, some groups with whom she works (for example, medical students studying Gross Anatomy) have submitted their own drawings and commentary. These are shown in Chapter 3, along with written responses to a follow-up Death Attitude Questionnaire. Responses are from junior and senior high school students; college students; medical students; graduate nurses; hospice volunteers.

Chapter 4 gives suggestions for how to use images and texts and for how to approach discussions of loss and grief. The course syllabus for "Dissection, Dying, and Death," taught with Gross Anatomy, is appended, and there is an extensive bibliography.

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This is a collection of two dozen case studies, written for non-medical readers, of patients with right-brain disorders. The chapters are divided into four groups: "Losses," dealing with loss of memory, cognition, and proprioceptive sense; "Excesses," with tics and other cases of overabundance; "Transports," with seizures and various "dreamy states," and "The World of the Simple," concerning mental retardation. In every case, Sacks focuses on the interior or existential world of the patient as the foundation of diagnosis and treatment. Sacks argues that this approach is appropriate for the right hemisphere, which compared to the left is less dedicated to specific skills and more dedicated to a "neurology of identity."

Sacks openly proposes these studies as a corrective to the field of neurology, which has tended to focus on the left hemisphere and therefore, he argues, has wound up treating patients solely in terms of specific deficits, often to their detriment. In "the higher reaches of neurology," and in psychology, Sacks argues, disease and identity must be studied together, and thus he recommends that neurologists "restore the human subject at the centre" of the case study. Sacks warmly recommends music, story-telling, and prayer as therapies that work by ignoring physiological defects and speaking to the patient's spirit or soul.

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This book contains six medical case studies in which hope, or lack of it, played a role in the outcome. Five stories are of Groopman's cancer patients, the sixth the story of his own recovery from severe chronic lower back pain. The book concludes with an account of Groopman's search for scientific answers to the questions that inspired the book: How is the cognitive-emotional complex of hope formed in the mind? How might that complex affect the chemistry of the brain? And how might that, in turn, affect the physiology of the body in a way that would be relevant to healing?

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An automobile accident left Mary Swander nearly paralyzed and coping with chronic pain. After several incorrect diagnoses, she saw a neurosurgeon who told her that a disk in her neck ruptured "at C6 and punched a hole in the spinal cord. The flu virus went into the cord and infected it." She had central cord syndrome (which can paralyze arms) and myelitis (which can paralyze legs).

Other than traction, the doctors said they could not do anything more for her. She went to New Mexico where herbal medicines of a curandera and spiritual healing by a Russian Orthodox monk helped her. She now walks without a cane.

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A stray bull has been grazing on Mrs. May's farm for several days. She is outraged that her tenant/farmhand, Mr. Greenleaf, hasn't chased the bull away; and her outrage only grows stronger when she learns that the bull belongs to the tenant's sons, who have settled not far away with their French wives and bilingual children.

Mrs. May is a widow lady whose two sons, both in their mid-30s, live on the farm with her, but have no interest in farming. One sells life insurance to black folks; the other is an intellectual. Mrs. May thinks she knows how to "handle" Mr. Greenleaf; she has employed him for 15 years despite his stupidity and shiftlessness. His wife is a religious fanatic and faith healer. His twin sons, unlike Mrs. May's, went away to the war in Europe, rose in the ranks, came home with European wives, and now each had a piece of good land and three children in a convent school. They also have a bull that escaped, but they evidently don't it want back.

Mrs. May becomes more and more obsessed with the bull that is eating her out of house and home. Finally, she demands that Mr. Greenleaf shoot it and insists on accompanying him to make sure the deed is done. When the bull escapes to the woods, Greenleaf follows it. Shortly thereafter, it comes charging out of the wood directly toward Mrs. May. Mr. Greenleaf finally shoots the bull just after it has gored Mrs. May in the chest and killed her.

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In the fall of 1983, Treya Killam was about to be married to Ken Wilber, a prominent theorist in the field of transpersonal psychology, when she was diagnosed with a particularly virulent form of breast cancer. This is Ken Wilber's story, with much of it told through his wife Treya's journals and letters, of their five-year battle against her cancer, a long roller-coaster ride that ended in her death by euthanasia in 1988. The narrative includes details of several conventional and unconventional cancer therapies.

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It is 1905, and a young doctor just out of internship in Chicago has decided to head for the southwest to seek his fortune. He finds himself on a slow train in southern New Mexico, sitting across from a Sister of Mercy "in her black robes, skirts and sleeves, and heavy starch." When the train stops, the doctor inquires about a group of men huddled on the platform. They surround a severely ill Mexican worker, who turns out to have appendicitis. The doctor insists that only an immediate operation will save his life, but the Mexicans are violently opposed to surgery. Eventually, the doctor enlists the nun’s help to persuade them.

In the blistering heat, they carry the man to a shed where the doctor performs an appendectomy with instruments in his black bag, including morphine and chloroform. For the next 24 hours, he and the nun watch over the man, and then carry him to the nearest town on the next train. He survives, which is good because otherwise the Mexicans have threatened to kill the doctor. The nun, who throughout has been cool toward the doctor because of his use of "rough" language, proceeds on her way to Texas.

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Old Chuan and his wife, the proprietors of a small tea shop, save their money to buy a folk medicine cure for their son, Young Chuan, who is dying of tuberculosis. The story opens with Old Chuan leaving their shop and going to the home of the person selling the cure, a "roll of steamed bread, from which crimson drops were dripping to the ground." The crimson drops, we soon learn, are blood from a young man recently executed, apparently for revolutionary activities.

The cure does not work and the mother of Young Chuan meets the mother of the executed revolutionary in the cemetery. Here they both behold a mysterious wreath on the revolutionary's grave, a wreath that Lu Hsun, in his introduction to this collection (which he entitled A Call to Arms), describes as one of his "innuendoes" to "those fighters who are galloping on in loneliness, so that they do not lose heart." (p. 5)

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