By the late nineteenth century, the people of Europe and North America were living longer and in societies of rapidly increasing size. A transformation of unprecedented proportions had brought industrialisation, urbanisation, geographic mobility, the rise of scientific rationalities, political and ideological upheaval, and a growing questioning of religious values. The population of Europe had doubled in the course of the century, from two hundred million to four hundred million. Mortality rates were falling and the prospects of living into old age began to increase for many people. But with the benefits of longevity and the diminished threat of early death came particular consequences. The predominant causes of death had started to shift —from sudden demise brought on by infection, disaster, and plague, to protracted dying associated with the emerging diseases of the modern era, not the least of which were cancer and tuberculosis. Whereas in the Middle Ages in Europe the death that came too swiftly was something abhorrent and to be guarded against, now fears began to grow about lengthy dying, and the suffering which it might entail.
The changing social world of dying and death
Popular Victorian culture presented idealised images of a slow and controlled farewell to the world, with family members gathered around and confidence in a passage to another and better world—the good death as a sign of coming salvation. Margarete Holubetz’s scathing critique of deathbed scenes in Victorian literature captures this practice and makes interesting use of the term ‘palliation’.
For it is not the Victorian belief in immortality which we object to but the very earthly paradise many nineteenth century novelists set before us; it is not the Victorian family scene of adieu we find ridiculous, but the attempt to glorify it with exalted emotions; it is not the encounter with death we shrink from, but the morbid ways of rendering it harmless by sentimental palliation, which deprive it of its true mystery. (p34)[i]
But by the later years of the century, anxieties were emerging about the precise manner of dying—now coming to be seen not only as a social and cultural event, but also as a medical process. Strict rules existed for how to behave after a death occurred. Yet there appeared to be less confidence in the agreed dispositions towards dying. The changing personnel around the deathbed, a new secrecy about the imminence of death, as well as the desire to quell the threat of pain and suffering—all reveal a growing anxiety about the dying process. That in turn opened up a space for medical intervention that first took hold towards the end of the nineteenth century but was to have repercussions for more than a hundred years thereafter, indeed right up to the present day.
For the French historian Phillipe Ariès, the nineteenth century was associated with the emergence of sentimental orientations to death that reflected major changes within the culture and structure of family life.[ii],[iii] He argued that as the meaning of family relationships deepened and became more nuanced, so parting with a dying relative—and the subsequent grief following that loss—became increasingly emotional and expressive. A growing emphasis fell on the personal pain of separation and on keeping the dead alive in memory, enhanced by new developments in photography that enabled carefully staged post-mortem images to be captured and preserved for posterity. It also meant elaborate rituals of mourning and funeral observance and the emergence of the cult of the grave as a family resting place. Undoubtedly it led to new representations of the deathbed itself. The wider romantic movement contributed to notions of the ‘beautiful death’, to la mort de toi (‘thy death’), personified in the death of a loved one.
Ariès also shows that in the nineteenth century the rise of modern science brought challenges to religious authority and, specifically in this context, to the necessity of dying in the presence of the official representatives of formal religion. Medical men began to replace priests, clergy, and ministers at the bedsides of the dying. But this created new dilemmas. For if the role of medicine was to focus on the technical preoccupations of attending to the relief of pain and the easing of physical distress, who was to address the fears of the dying, the distress of the bereaved, and the achievement of the ‘good death’? Using this point of reference, we might see this as the period in which dying was drained of meaning by science and medicine forcing its retreat from public and family dimensions into the sequestered spaces of hospitals and, ultimately, homes for the terminally ill. For Ariès, the mid-nineteenth century was also the origin of ‘the lie’ wherein the gravity of the dying person’s situation was kept from them. Death was on the way to becoming ‘shameful and forbidden’.
Later historians and sociologists have questioned Ariès’ linear conceptualisations. There are assertions that he relies on superficial readings of material relating mainly to the upper and middle class elite, and that the experiences of working class families and communities are misrepresented or obscured in his grand narrative. He is also accused of romanticising a past era and somehow caricaturing death in the twentieth century as anonymous, repressed, and pathological. From the perspective of Ariès’ critics, there was no golden age of grief that was subsequently ‘ruined’ by the scientific and medical discourses of modernity.[iv] As Julie-Marie Strange puts it, ‘the Victorian culture of death is a myth of our own making’.[v] Perhaps therefore it is better to regard those living and dying in the nineteenth century as no more and no less skilled than their forebears or successors in dealing with the experiences of dying, death, and bereavement.
Cultural framing of death
The encounter with death is universal—as human beings we all know that we must die. But in every age and culture there will be variations in how we experience our mortality. At times there may be tendencies towards personal adjustment and the framing of death as a uniquely personal experience for both the dying and the bereaved. Other discourses lay a strong emphasis on the place of death in society, its impact on social cohesion, and the legal, public, and policy consequences of dying and bereavement. In some contexts discourses of religion may dominate; in others the perspectives of science and humanism may hold greater sway. Using this approach, historians have argued for understanding death through the cultural values that shape how we describe it, rather than seeking to uncover any particular ‘truths’ about how we experience it. This is an important consideration.
There are incontrovertible ways in which our ability to care for dying people has improved and become more sophisticated in the period since the late nineteenth century. But we should beware the assumption that this means there can be wholesale improvement on the management of death in the past. The shift of dying from the social, community, and family realm to become the preserve of specialists, professional carers, and service providers of various types should not mask the fact that death remains a profoundly social experience. Reforming the social component is a far more challenging goal than, for example, improving the technologies of pain relief. When death becomes a matter of public debate, dissension is not far away. Death in the contemporary world has become a contested space, in which the interventions of palliative care are only one set of forces at play.
[i] Holubetz M (1986). Death-bed scenes in Victorian fiction. English Studies. 1986;67(1):14–34.
[ii] Ariès P (1976). Western Attitudes Towards Death: From the Middle Ages to the Present. Baltimore and London: Johns Hopkins University Press.
[iii] Ariès P (1981) The Hour of Our Death. London: Allen Lane.
[iv] Walter T (1993). Sociologist never die. British sociology and death. In: Clark D. (ed.). The Sociology of Death, p. 286. Oxford: Blackwell, .
[v] Strange J-M (2005). Death, Grief, and Poverty in Britain, 1870–1914. Cambridge: Cambridge University Press: 20. [AU: UK or NJ?]