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The Changing Prole of Social Death

Michael Mulkay and John Ernst

European Journal of Sociology / Volume 32 / Issue 01 / May 1991, pp 172 - 196

DOI: 10.1017/S0003975600006214, Published online: 28 July 2009

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Michael Mulkay and John Ernst (1991). The Changing Prole of Social
Death. European Journal of Sociology, 32, pp 172-196 doi:10.1017/

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THE C A U S E S of human death, the social distribution of death and the

social organization of dying have all changed dramatically during the last
century in the industrialized societies. Since the nineteenth century, the
percentage of deaths arising from short-term infectious diseases has fallen
sharply, whilst the significance of long-term degenerative diseases has
greatly increased (OPCS 1985, Table 5). Whereas, in the last century, the
mortality rate was particularly high among children and continued at
what we would regard as a high level throughout adult life, the incidence
of death is now heavily concentrated among the elderly. Thus average life
expectancy is now much longer. For the great majority of people, death
approaches slowly over years of gradual decline and its final advent is
supervised by qualified personnel in systematically organized settings
where technical facilities for prolonging life are to hand. Similarly,
disposal of the dead, like the process of dying, has also become rationally
organized. Unlike the 1800s when burial was universal and in many areas
posed a serious threat to the health of the living, two thirds of human
corpses in Britain today are hygienically destroyed by burning. To a
considerable degree, death and dying have been taken under human
This brief outline of the changing profile of biological death in our
society is well documented and its main features are unlikely to be
challenged. There is, however, another hidden profile of social death
which is more difficult to observe and is less frequently discussed.
Biological death and social death resemble the famous drawing of the
'pretty young woman' which, if you look at it in a particular way,
transforms itself into a representation of an 'old crone'. In this article, we
will try to reveal the hidden profile of social death that is buried within
the customary picture of cumulative improvement in the pattern of
human mortality *.
Like the 'old crone' initially unnoticed in the Gestalt drawing, the
profile of social death that we will sketch below is in some respects less
appealing than the picture of progressive demographic change in the

* Edgar MORIN, L'homme et la mort devant Vhistoire (Paris, Correa, 1951), version
revisee et augmentee sous le titre L'homme et la mort (Paris, Seuil, 1976); B. G.
GLASER & A. L. STRAUSS, Awareness of Dying (Chicago, Aldine, 1965); ID. Time for
Dying (Chicago, Aldine, 1968); G. GORER, Death, Grief and Mourning in Contem-
porary Britain (London, The Cresset Press, 1965); Philippe ARIES, La mort inversee.
Le changement des attitudes devant la mort dans les societes occidentales, Archives
europeennes de sociologie, VIII (1967), 169-195 ; ID. The Hour of our Death (London,
Allen Lane, 1981) [transl. from French]; Anne-Marie GUILLEMARD, La retraite, une
mort sociale : sociologie des conduites en situation de retraite (Paris/La Haye, Mouton,
1973); Louis-Vincent THOMAS, Anthropologie de la mort (Paris, Payot, 1975);
L. PRIOR, The Social Organization of Death (Basingstoke, Macmillan, 1989).

Arch, europ. sociol., XXXII (1991), 172-196. — 0003-9756/91/0000-591 $02.50 ^) 1991 A.E.S.

economically advanced nations with which we began. But it is perhaps

even more important. For changes in our biological existence are
significant for us only in so far as they affect our consciousness, our
experiences and our conduct. Of course our social death, that is, the
termination of our social existence, is linked to our biological cessation
and to broader structures of human mortality. But biological death and
social death are not identical. Because the two are connected, the pro-
found demographic developments summarized above have brought about
extensive alterations to the profile of social death. However, because the
two are partly independent and because social death is a contingent
cultural response to demographic change, the pattern of social death has
come to be redrawn in certain unexpected ways. .
In later sections, we will examine the evolving profile of social death
with special reference to the basic categories of age and gender. We will
be mainly concerned in this discussion with the situation in Britain. But,
throughout this analysis, wherever suitable British material is lacking, we
will refer to the extensive American research literature on death. In the
section which follows, we will try to clarify the meaning of 'social death'
by examining two influential American studies in which this concept was
first employed for purposes of sociological interpretation. More recent
work has shown that the conclusions of these studies have considerable
relevance for present day Britain (Field 1989).

The concept of 'social death'

During the 1960s, two major ethnographies of death and dying were
carried out in the U.S.; namely, that by Sudnow (1967) and that by
Glaser and Strauss (1965; 1968). These studies examined the social
definition of death and the process of dying in American hospitals where
'most people in the United States now die' (Glaser and Strauss 1965,
viii). By the 1980s, the proportion dying in American hospitals had risen
to 80 % (Turner 1984, 127) whilst in Britain 70 % had come to die by
this time in hospitals or in similar settings (OPCS 1989, Series DHI). In
both ethnographies, social death is distinguished from clinical or bio-
logical death and special attention is given to the former. In the words of
Glaser and Strauss: 'Our intent was, above all, to ask whether people can
die socially before they die biologically, and what this means for human
relationships' (1965, x). Sudnow confirms Glaser and Strauss's sugges-
tion that hospital patients can, and indeed frequently do, die socially
before they have been defined as biologically dead (1967, 74).
Like Glaser and Strauss, Sudnow cites Goffman's concept of the
'non-person' as a source for the notion of 'social death'. Goffman defines
'non-persons' as 'standard categories of persons who are sometimes
treated in their presence as if they were not there' (1959, 152). He gives as


examples, servants, slaves, the very old, the very young and the sick.
Goffman does not explore this concept in depth. Nevertheless, he seems
to imply that the application of the category 'non-person' by participants
is implicit rather than explicit and that it normally involves no more than
a passing and contextually specific denial of another's social existence.
These kinds of social actors, he maintains in the quotation above, are only
sometimes treated as if they did not exist. In other words, the young, the
old and the sick are not uniformly ignored in all contexts; and on some
occasions their individuality, that is, their existence as persons, may be
recognized by others. Even slaves, whose exclusion from the social world
of their masters is most enduring and most complete, are able to create a
fuller social life among themselves (Patterson 1982, 6).
Goffman's essential insight is that our social existence is not neces-
sarily continuous. As we come to occupy certain social roles, we may
temporarily drop out of the social world that is being created around us.
Furthermore, Goffman's examples indicate that this process of social
deconstruction may often be related in some way to people's biological
condition; for instance, to their age or to their state of health. In certain
circumstances, human beings can come to be regarded as living biological
organisms without social attributes. Glaser and Strauss, and Sudnow,
develop this idea in the context of the modern American hospital. The
concept of 'social death' is designed to express their observation that a
hospital patient can become implicitly a permanent non-person whilst
still alive, as other people foresee the patient's biological death and
change their conduct with the patient's biological termination in mind.
Social death, then, in the hospital setting, grows out of the recognition
that a patient is dying clinically. Sudnow, in particular, emphasises that
the term 'dying' is an 'essentially predictive term [...] Seeing " dying " is
seeing the likelihood of [clinical] death within some temporal perspective
[...]' (1967, 64). Similarly, Glaser and Strauss show that 'death expec-
tations are a key determinant in how everyone acts during the dying
sequence' (1968, 13). In other words, when subjects are seen to be dying,
those with whom they come into contact respond by seeking to impose a
special frame of reference in terms of which further interaction is to be
organized (Sudnow 1967, 68-9). These interpretative frames can vary
considerably. In some instances, as death approaches, the subject's social
life may become more intense and long dormant personal relationships
may be briefly revitalized. But the two ethnographies show clearly that
the more usual situation in the modern hospital is that the patient's
involvement in social life is increasingly restricted by the progressive
withdrawal of other parties. The sequence of physical decline which we
call 'dying' is accompanied by a sequence of social decline which occurs
as other people begin to grieve, to reduce the frequency of personal
contact, to avoid 'difficult' topics, and so on, in anticipation of the
patient's expected demise (Glaser and Strauss 1968, 25). This process is


further accentuated by the bureaucratic management of the death

sequence (Sudnow 1967, 84-6). In many cases, although the patient's
basic physiological requirements continue to be met by the medical staff,
he or she ceases to exist for them as an active, individual agent some time
before biological termination takes place.
Because so many deaths are now caused by degenerative diseases and
because modern medicine is able to delay and divert so many life-
threatening processes, the typical death sequence today is much more
prolonged than in the past and many different parties are likely to become
involved. As the death sequence proceeds, patients become caught up in a
series of potentially independent movements toward social termination in
their dealings with doctors, nurses, relatives, friends and others. Because
each social category may employ dissimilar interpretative frameworks,
these social death sequences can develop differently and may move at
varying rates. For instance, a comatose patient may be socially dead for
the nursing staff, but not for the spouse (Glaser and Strauss 1965, 109).
This variability of social definitions is acknowledged and documented by
Glaser and Strauss and by Sudnow. But its implications are not fully
explored, mainly because both studies focus too narrowly on the social
context of the hospital where the definitions adopted by medical per-
sonnel are dominant.
Glaser and Strauss stress that they are concerned, as sociological
analysts, with the varying ways in which patients, doctors and others
understand and experience the dying trajectories in which they become
involved. Social death sequences are, therefore, to be regarded as 'per-
ceived courses of dying rather than the actual courses' (1968, 6). The
authors never make entirely clear what they mean by 'actual courses of
dying', but it seems to be implied that a patient's actual course is the
sequence of dying as understood medically by properly qualified pro-
fessionals. Thus Glaser and Strauss implicitly treat doctor's views of the
death sequence as interpretatively privileged. Of course, from doctor's
professional perspective, the death sequence necessarily ends with cli-
nical/biological death. As a result, Glaser and Strauss also come to
assume that the death sequence ceases at this medically defined juncture.
In their own words: 'The patient's trajectory ends with his [biological]
death' (1968, 206).
The ethnographers provide ample evidence showing that, in the view
of the great majority of medical staff, biological death forms the ultimate
point of termination. Most modern hospitals are socially and technically
organized to prevent death and their practitioners are concerned
exclusively with the needs of the living. Once death has taken place,
doctors are likely to lose interest quickly and to turn their attention
elsewhere (Sudnow 1967, 81). Similarly, when death has occurred, nurses
typically strive to forget the patient. They create a state of collective
amnesia concerning those who have died, which helps them to con-


centrate on those who are still alive (Glaser and Strauss 1965, 249-53).
All of this is well documented in both studies. Nevertheless, we must not,
as analysts, adopt unquestioningly the limited perspective of the medical
staff. We must remember that other parties are normally involved in the
death sequence and that they may well see the process differently.
Furthermore, death sequences are seldom wholly confined to the medical
setting, even in cases where the person dies in hospital. It seems advi-
sable, therefore, to consider the possibility that, for some participants,
social existence may be taken to persist after biological death, and that, in
other settings, the biologically dead may continue to contribute actively
to social life.
Glaser and Strauss themselves describe instances where patients'
social existence seems to continue, at least fleetingly, after death, even in
the hospital setting. They report, for example, that relatives often speak
to and/or caress a patient who has just died. However, the analysts
dismiss this behaviour as abnormal and as requiring a special type of
explanation. They comment that the 'deceased person's awareness is thus
taken into account, in a strange way, by the living, even though, rea-
listically, that problem should disappear after the patient has died' (1965,
114). In other words, Glaser and Strauss treat the living participants as
having made a mistake when they continue to include a dead person
within their social world. Glaser and Strauss suggest that people find it
difficult to adjust to the transition from life to death and that they make
this mistake because they forget momentarily that they are now dealing
with a corpse. Yet, Glaser and Strauss provide no independent evidence
to support this interpretation; and such evidence is particularly necessary
because this is the only point in their analysis where they override and
explain away what appears to be participants' definition of the situation.
In contrast, Sudnow is willing to accept without reservation that social
death my occur 'well after " biological " or " clinical " death' (1967, 75).
Furthermore, he attempts to furnish empirical support for this claim.
Sudnow's evidence, however, is rather weak and unconvincing. In the
first place, the examples he gives are all very short term, involving
minutes, or at most hours, of 'social life' after clinical death. More
critically, all of Sudnow's illustrations contain an element of pretence.
Thus, in some instances, staff reassure anxious relatives that the patient is
still alive when they know that the patient has actually died—for example,
on the operating table. In situations of this kind, the patient clearly
continues to live for those relatives who accept the staff's assurances. Yet
this continued existence is based on an illusion created by others and is,
in this respect, similar to what Glaser and Strauss regard as the 'mistake'
of talking to a corpse. In addition, this form of 'social life' is necessarily
brief and can only last while the pretence of the patient's clinical survival
can~be maintained.


Another example given by Sudnow of 'social life' continuing after

biological death occurs when ward staff 'pretend that the patient has not
died, and [...] try to camouflage his death by making him look alive'
(1967, 82). The orderlies' aim here is to pass on the corpse to the next
shift in order to avoid the unpleasant task of wrapping the body and
handling it in an intimate manner. Once again, this is a poor example of
'social life'. For the ward personnel are merely trying to create an illusion
of organic function, which will be revealed as false the moment somebody
approaches the corpse and attempts to interact with it.
Sudnow, and Glaser and Strauss, manage to provide a strong case
when they argue that the social existence of dying patients is often
markedly reduced in the hospital owing to other parties' physical,
emotional and communicative withdrawal. They show clearly that this
process of social redefinition frequently leads to the occurrence of sub-
jects' social death before their biological termination. The ethnographers
are much less successful, however, as we have just seen, when they
consider whether social death can occur after, and indeed in Sudnow's
words 'well after', the cessation of biological function.
One obvious difficulty that we face in pursuing this possibility is that
it implies that we must regard the social person as able to exist in
'disembodied' form (Turner 1984). The idea of social life after biological
death requires us to conceive of social actors as separable from their
bodies. This conception is especially difficult to sustain in the hospital
setting, where the human body is the centre of attention and where the
dominant worldview is emphatically physicalist in character (Prior 1989).
But in other contexts, the social world is construed quite differently.
Thus the idea of disembodied social action may be essential if we are to
remain true to the basic sociological premise that participants respond to
what they take to be real, not to some other reality to which the analyst is
In various non-medical settings, as several studies have shown, par-
ticipants seem to be able to maintain long term relationships with the
dead (Lloyd Warner 1959; Kearl 1989). Let us give one simple illus-
tration in order to clarify what it means to say that social death is often
delayed until well after biological death. In a study entitled 'The hal-
lucinations of widowhood' carried out in the late 1960s, W. Dewi Rees
interviewed 227 widows and 66 widowers 'to determine the extent to
which they had hallucinatory experiences of their dead spouse' (1971,
37). This sample comprised 80 % of all widowed people within a denned
area of mid-Wales. Rees found that 137 of these people had what he
called 'post-bereavement hallucinations'; that is, they felt the presence of
their dead spouse and/or saw, spoke to, listened to or were touched by
their dead partner. These experiences were not confined to special
occasions or to the period immediately following the death. In numerous
cases, they persisted over many years. A large proportion of the people


interviewed by Rees appeared to sustain a lasting, personal relationship

which affected the course of their daily lives with an individual whom
they knew to be dead (1971, 39).
Rees, a medical practitioner, refers to these relationships as 'hallu-
cinations'. In this respect, he resembles Glaser and Strauss in treating
participants' continuing experiences with the dead as unreal. But the
word 'hallucination' does not seem to have been used by the bereaved
themselves. For the latter, their contact with their partner was taken to be
real and was real in its consequences. They were well aware that their
spouse was dead; that is, that his or her body had ceased to function and
had been destroyed or was undergoing dissolution. Yet, their spouse
continued to exist for them and continued to play a part in their lives.
The dead were experienced and addressed symbolically by the living, and
they influenced the conduct of the living. In these respects, the
disembodied dead continued to participate in the observable social world
as that world was understood by their surviving partners.
Rees's study, combined with the work of the hospital ethnographers,
serves to confirm that the elimination of social beings is only loosely
linked to their biological cessation and that the social death sequence
must be conceived of as an interactional process which extends poten-
tially to both sides of 'the grave'. Any particular sequence comes to an
end when an actor's actual or impending biological or clinical death is
taken as grounds for treating that actor as a non-person. By 'non-person'
we mean that the actor ceases to exist as an active individual agent in the
ongoing social world of some other party. When social death has
occurred, other people no longer seek to communicate with that person
nor take that person directly into account in carrying out their own
actions. Thus social death may precede clinical death; for example, when
a 'hopelessly comatose' patient is treated as 'merely a body' (Glaser and
Strauss 1965, 108). Alternatively, social existence may continue long after
death; for example, when distraught parents regularly visit the grave of a
dead child and talk and write to that child about their previous life
together and about the reunion to come (Clegg 1988, 65).
The denning feature of social death is the cessation of the individual
person as an active agent in others' lives. As we stressed above, indi-
viduals can be involved in numerous death sequences and may be, at the
same time, dead for some parties yet socially alive for others. Social life is
the obverse of social death and depends on the social continuation of the
particular person, whether or not that person is biologically living.
Accordingly, neither the persistence of socially defined categories nor the
implementation of generalized rights after biological death are, in
themselves, evidence of continuing social existence. For instance, both
Sudnow, and Glaser and Strauss, indicate that rules exist in hospitals
which prescribe that corpses should be handled with respect (Glaser and
Strauss 1965, 114). One routine feature of this respectful treatment of the


dead is the physical separation of men from women. Sudnow points out
that the 'sexual segregation of body care found in the handling of dead
bodies is thus similar to that which governs some aspects of the care of
live ones' (1967, 78). However, these socially denned and socially
differentiated forms of handling do not constitute social life in the sense
with which we are employing this term. For the hospital rules do not
define the corpses as active agents. On the contrary, the rules for
handling corpses are general procedures which deal with a broad dis-
tinction between male and female bodies and which involve no necessary
recognition of the individuality of any specific corpse. They are intended,
in the hospital context, to regulate the conduct of the living, not to
articulate a social relationship in which the dead themselves participate.
Similar considerations apply in relation to the 'right to proper burial'
or the 'right to rest in peace'. Assertions of such rights may grow out of a
continuing relationship between living persons and dead individuals.
They may, therefore, be used by the living to defend or, in some other
way, give expression to that relationship. But neither recognition of these
rights, nor acceptance of the obligations they entail, necessarily implies
involvement in such a relationship. In other words, it is possible to fulfil
these obligations and to implement these rights without attributing to the
dead any vestige of social existence. Social life, then, depends, not on the
existence of procedural rules or general obligations concerning treatment
of the dead by the living, but on the continuation of individual actors in
the experiences and activities of the living. Social death consists of the
cessation of these experiences and activities.
This completes our preparatory examination of the concept of 'social
death'. Sudnow, in the course of his analysis, warns against the temp-
tation to define this phenomenon in too loose a fashion, so that it becomes
equivalent to 'any instance of radically asocial treatment of a person'
(1967, 75). He prefers to avoid such a usage because it is bound to be
'analytically ambiguous'. We have attempted, to some degree, to follow
Sudnow's advice. We have tried to be careful and reasonably precise in
our claims and to restrict the scope of our definition of 'social death'. We
do not imagine, however, that we have managed completely to avoid
'analytical ambiguity'. It is comforting to note, therefore, that Sudnow
himself, within the same paragraph as his warning, admits that his own
analysis is not entirely free from this defect (1967, 75). In our view,
fruitful investigation often requires a degree of conceptual looseness.
Thus Patterson's (1982) imaginative extension of the concept 'social
death' to the topic of slavery has shown that a more flexible use of this
idea can help to elucidate a much wider range of social activities than
Sudnow's narrowly ethnographic approach was able to envisage.
Nevertheless, we have, like Sudnow, linked our notion of 'social death'
firmly to participants' recognition of 'biological and/or clinical death'. We


will now try to show that our revised conception of 'social death' can be
used to throw new light on social responses to the changing pattern of
biological death in modern society.

Social death and the elderly

We have seen that social death is the final event in a sequence of

declining social involvement that is set in motion either by participants'
collective preparation for, or by their collective reaction to, the advent of
biological death. In order to understand this sequence, it is necessary to
consider at what point in people's life cycle this process normally begins.
It is, of course, true, as Sudnow emphasises, that we are all in a way
dying from birth (1967, 61). It is also clear that, from an early age, we
anticipate, in some general sense, our own and others' eventual demise
(Kuykendall 1989). However, because the attribute of mortality is uni-
versal, it does not, in itself, lead to variations in social conduct; that is, we
do not behave in any special way when we interact with someone who is
going to die at some point in the future which is at present quite
unknown. In contrast, when the fact of another's mortality becomes more
concrete, more imminent, more predictable, we begin to attend to that
person's forthcoming death and our conduct alters accordingly. Simi-
larly, when we come to see the occasion of our own death as part of a
tangible, soon to be experienced future, we begin to behave differently
with that bounded future in mind. It is these new forms of conduct
which, when death is foreseen, mark the beginning of the death sequence.
To ask about the start of the death sequence in our society, therefore,
is to ask at what juncture does people's participation in social life begin to
change and, in particular, to diminish significantly, quite apart from
personal variations in state of health, owing to the socially recognized
imminence of death? In modern Britain and the U.S., this major tran-
sition typically occurs, particularly for men, at the time of retirement
from work (Anderson 1985). In Turner's words: 'Where there is
compulsory retirement current levels of life expectancy will mean that
many old people experience a significant proportion of their life in
isolation' (1984, 129). The death sequence begins structurally at this
point because retirement typically produces a major reduction in the level
of people's social participation and because, as people are well aware,
their removal from full involvement in social life is directly linked to the
increasing probability of their biological death. Thus in England and
Wales, in 1987, 74 % of male deaths occurred among those who had lived
beyond the age of retirement (cso 1989).
As a result of the significant increase in life expectancy during this
century, the number of people reaching this age in Britain has grown
from 2.2 million in 1901 to 9.7 million in 1981 (Falkingham 1989). In


1980, 88 % of men in this age group were actually retired from work
(Turner 1984). One consequence of this situation has been the formation
of an elderly population whose members are socially and economically
disadvantaged (Turner 1984, 117). Not only are the elderly largely
excluded from the workforce, they are also denied full participation in the
family life of their own descendants and in the wider community (Turner
1984). As an indication of the social isolation of the elderly, we can
consider the extent to which they are visited by friends and relatives. In
Greater London, for example, in the 1970s, only a quarter of elderly
people received a visit more than once a week; and one in six were never
visited at all. Even in less urban areas such as Yorkshire, only four out of
ten elderly people were visited more than once a week (Hunt 1979).
The general situation, then, is that as people become older and the
likelihood of their entering a medically denned dying sequence increases,
they are formally retired from paid employment and the social contacts of
their mature years are severed. Retirement from work means reduction of
income, often to very low levels, which in turn further restricts their
social activities. Family and communal involvement is reduced and
elderly people are likely to find themselves increasingly subject to a
general sense of physical aversion which is akin, in a milder form, to the
revulsion caused by dead bodies. From the time of retirement, elderly
people in Britain and the U.S. are channelled collectively away from the
main areas of social activity and their social ties with the wider society are
progressively weakened in anticipation of their biological end.
As we grow old we are gradually marginalized within the community and begin to
lose a number of personal contacts, which takes the form of a personal or psychologi-
cal contraction (dying) from social relations. Through the process of dying our social
contacts are gradually diminished and we find ourselves socially isolated. Finally, this
process is terminated by a biological death which brings to a conclusion the long
history of our personal disengagement. We can therefore regard dying like aging as a
gradual attrition of social relations combined with increasing dependency often on
institutions which are somewhat anonymous and bureaucratic (Turner 1984, 125-6).

The death sequence in which elderly people are enmeshed within

society at large parallels and provides the background for the death
sequences observed by the hospital ethnographers. This is particularly
evident in Sudnow's study. Sudnow reports that, in County Hospital,
patients are treated by staff as 'dying' only if they are deemed to be 'likely
to die on this admission' (1967, 69). He notes, however, that there is
another sense in which staff deal with all their elderly patients in a special
way which follows from the latter's proximity, as elderly persons, to
biological death. For the hospital physicians and other staff, the absence
of a future for old people is taken utterly for granted in routine inter-
action (1967, 68-9). Thus dealings with the elderly need not be specially
modified at County Hospital when they enter the medical death sequence
'in so far as the things one normally discusses with them are not premised


on, or take their meaning from, any understanding of a long term future'
(1967, 70-1). In other words, the death sequences that come to envelop
elderly people within the hospital setting are accentuated versions of a
broader social death sequence within which such people are already
In England today, over 60 % of elderly people die in hospitals (OPCS
Series DHI no. 2) where the bureaucratic 'neglect of the patient as a
person' (Field 1989, 147) converges, to varying degrees, with the phy-
sical, emotional and communicative withdrawal of the living from those
on the death sequence. A smaller, but significant, proportion of the
elderly end their days in residential and nursing homes. In 1987, 8 % of
all deaths among the elderly in England and Wales occurred in such
homes; in the case of women, the proportion was 11 % (OPCS Series DHI
no. 2). These 'homes' provide an institutionalized form for the final
separation of people on the death sequence from 'ordinary' social actors.
They are the culmination of the process whereby the elderly are pro-
gressively excluded from the ongoing social world.
Residential homes have become an increasingly important location for
the enactment of the death sequence among the elderly. During the last
decade or so, recourse to residential care has become common practice for
people over 85 years, and amongst those who are defined as having 'high
dependency' needs. Between 1977-87, the number of elderly persons
living in non-hospital institutional care increased by 41 %. This growth
seems likely to continue for the foreseeable future (Sinclair 1988; Health
and Personal Social Services Statistics for England 1989). In short, the
bureaucratic management of the death sequence is still expanding.
Despite the changing structure of residential care in England—with
greater numbers of recipients, higher levels of government finance, and a
marked increase in private, commercial forms of provision—there is little
indication that institutional regimes are appreciably different from the
'impersonal, dehumanising and controlling model' of elderly residential
care first identified by Goffman and Townsend in the 1960s (Hughes and
Wilkin 1987, 420). Although physical conditions have generally improved
since then, treatment in many contemporary homes for the elderly is still
designed to suppress residents' individuality, initiative and social enga-
gement (Booth 1985; Wilkin, Hughes and Jolley 1985; Hughes and
Wilkin 1987; Sinclair 1988). Whereas in some pre-literate societies the
unwanted old are buried alive (Goody 1962, 44), in our society they are
immured in residential homes where, out of sight and largely out of
mind, they can be left whilst the process of biological decline takes its
inevitable course.
When elderly people enter a residential or nursing home, all those
involved are aware that the entrants are most unlikely to come out alive
(Hockey 1985). As Glaser and Strauss report, when geriatric patients are
sent to an age-segregated institution, they know that 'it is all over but the


dying' (1968, 52). For those left behind, the symbolic significance of this
transition is so evident that in many cases they engage in what Fulton and
Fulton (1971) call 'anticipatory grief. In such circumstances, persons are
mourned as if they were biologically dead, even though they may
continue to live on in the home for years. Such pre-emptive mourning
helps those outside the home to deal with the crisis of separation. It
enables them to begin to adjust in advance so that, by the time death
comes, they are already 'grieved out' (Glaser and Strauss 1968, 151-4).
As a result of this process, however, they become more distanced from
the person in the home, who is pushed further along the social death
sequence as his or her past relationships are disrupted and lose their
meaning. Outsiders will often, of course, try to maintain contact with
elderly residents. But the symbolic divide between the full social actors
on the outside and the physically and socially segregated insiders makes
such relationships little more than pretence. For, from the outside, the
residents are, owing to their inability to perform meaningful social action,
already dead in social terms.
This does not mean that, internally, residential homes for the elderly
are completely devoid of social life. What may often happen in such
settings is that the limited range of activities available to residents
becomes socially structured in relation to a basic distinction between
those who are deemed to be close to death and those for whom death is
not thought to be imminent. In situations of this kind, the more active
residents strive to re-establish the meaning of their own existence by
separating themselves physically and symbolically from other residents.
This is well documented in Hockey's (1985) study of a residential home
in North Eastern England.
In this home, the 'fit' residents were distinguished by staff and by
other residents from the 'frail'. These two categories of residents were
kept apart spatially and were treated in quite different ways. In parti-
cular, in their dealings with the 'fit', staff stressed their liveliness and
employed a linguistic repertoire which denied the immediate relevance of
death. In contrast, in their treatment of the 'frail', staff presumed the
imminence of biological death and used language forms which referred to
death directly as well as by implication. These categories were main-
tained despite the fact that the 'fit' often died unexpectedly and the 'frail'
sometimes lived on well beyond their allotted span.
For the staff, the distinction between the 'frail' and the 'fit' enabled
them to focus their attention on the former and, thereby, to sustain a
sense that the home was more than a 'house of death'. Although, from the
outside, such homes are seen as locales for the socially dead, on the
inside, residents may be defined in ways which emphasise the conti-
nuation of social life. This is particularly important for the newer and
'fitter' residents who are even more committed than staff to the spatial
and social segregation of the 'frail'. The consequence for the 'fit' is that


they can, in this way, retain some vestigial sense of personal worth and
social significance. The consequence for the 'frail' of this collusion
between the 'fit' and the staff is, of course, that they cease to exist as
social actors. The ultimate outcome for the 'frail' is that they are sys-
tematically prevented from participating in this last, culturally impov-
erished setting in much the same way that the elderly in general are
excluded from the wider society. For other participants, the 'frail' tend to
become invisible. 'As a result, the final transition of a " frail " resident to
sick bay and to the mortuary often goes by unremarked. A much earlier
separation ensures that their name and identity is unknown and of little
significance' (Hockey 1985, 42).
How far Hockey's conclusions apply in detail to other residential
homes is not yet clear; although the findings of other, more general
studies suggest that the regime observed by Hockey is unexceptional
(Hughes and Wilkin 1987). In so far as her study is representative, it
shows that, within our residential homes for the elderly, the death
sequence of society at large is repeated in microcosm. It is ironic that,
even inside these institutions which exist to cater for the socially dead,
participants find it necessary to deny death's presence (Aries 1981) and,
in so doing, to condemn others, and in due course themselves, to yet
another manifestation of social death.

Women and social death

Between the early 1900s and the early 1980s, the life expectancy of
females born in England increased by 25.3 years, compared to an increase
of 23.3 years for males (McPherson and Coleman 1988). In the U.S.,
over the same period, the difference between the life expectancy of white
males and white females increased from 2.1 years to 6.9 years (Kearl
1989, 132). Thus women have benefited rather more than men from the
great expansion in the length of human life that has occurred during this
century. Furthermore, not only do women now experience a greatly
extended lifespan, but they also spend, on average, much less of their
lives than in the past bearing and giving birth to children (Turner 1984).
In modern Britain, the vast majority of these children will survive to
adulthood and will, indeed, outlive their parents. Throughout the 1800s,
in contrast, a large proportion of children were destined to die during
infancy. Thus in Liverpool, in 1899, the number of children dying before
the age of five was 136 per 1,000 in the more prosperous wards of the
city. 'In the poorer areas it stood at 274 and in the meanest of streets, it
was a catastrophic 509 per 1,000' (Walvin 1983, 23). Since then, infant
mortality has been reduced to a remarkably low level. In England and
Wales, for example, the number of children dying in their first year
has fallen dramatically from 154 per 1,000 live births in 1900 to 9 per


i,ooo live births in 1985 (Mitchell 1982; Halsey 1988). The consequence
for British women has been that, unlike their Victorian counterparts, they
are very unlikely to spend a significant part of their child-bearing years
dealing with the deaths of their own children.
In addition, the general increase in life expectancy means that the
deaths of parents and of other close relatives are now likely to occur much
later in a woman's life cycle than in the past (Jalland and Hooper 1986).
As a result, during the main years of their maturity, women are now
much less involved with death as a normal part of family life. This is, of
course, also the case for men. But the social impact of these demographic
changes has been much greater for women owing to their central role in
domestic activities, including those ritual activities associated with death.
In the last century, both children and adults almost always died at home
in the family setting (Walvin 1986). For example, in 1851 only 15.5 % of
deaths occurred in public institutions (Registrar General 1855). Within
the domestic setting, the rituals of bereavement were overwhelmingly the
responsibility of women and it was on women 'that the external signs of
grief were hung' (Morley 1971, 63).
Men passed almost the whole burden of mourning to their womenfolk,
who were required to mourn relations by marriage in the same manner as
relations of blood. In what we may loosely call the 'Victorian middle
class', the wife would be expected to mourn an aunt or uncle for three
months, a grandparent for nine months, and a son or daughter for one
year. The most lengthy and elaborate of all mourning sequences was that
of a wife for a husband. Mourning dress of an exaggerated severity was
worn for the first two years as a sign of 'inner desolation'. Black,
light-absorbing crape was used to express the widow's grief and her
withdrawal from the world. For the first year of bereavement, the widow
could undertake no social activity outside the home. After this she could,
if she wished, gradually resume her place in society. It was not unknown,
however, for the bereaved woman to remain, like Queen Victoria herself,
in more or less permanent seclusion (Gorer 1965, 79; Morley 1971, 68).
When close relatives and particularly when her husband died, the
middle class Victorian woman was required to enter a formal social death
sequence; that is, the range of her conduct was drastically curtailed, she
was excluded from many of her normal social activities, and indeed she
continued to exist only in the most distant fashion for many of the people
in her customary social world. The conventional response of the Vic-
torian woman to death in her immediate family was a kind of surrogate
death of her own. It is interesting to note that servants, those prototypical
non-persons mentioned by Goffman, were also put into mourning when a
member of the family died (Morley 1971, 72). But the adult women of the
family suffered a much more complete restriction of their social being.
Given the high adult and infant mortality rates of the time, the great
majority of middle class women would have spent many years, in total,


enclosed within the ritual death sequences through which expression was
given to the collective bereavement of their families.
Among poorer people, for obvious economic reasons, this extended
ritual confinement and symbolic adornment of women was impossible
(Walvin 1986). For many Victorian women, the labours required to
maintain a daily subsistence for the living had to take precedence over
ritual labours for the dead. Nevertheless, the middle class pattern of
activity in relation to death 'percolated to the lower classes' (Morley
1971, 17) and furnished a model of proper conduct to which many less
wealthy people aspired. Thus, members of the labouring classes put aside
more money for 'decent burial' than for any other purpose (Morley 1971;
Walvin 1986). The essential feature of such burial, as opposed to disposal
in a pauper's grave, was that it provided an identifiable site for the dead
person which could be the focus for communal and family mourning. As
in the case of the middle class, the responsibility for such mourning lay
heavily upon the women of the working class.
The central involvement of women in mourning and the partial social
death of bereaved women required by the rules of Victorian etiquette was
not only a symbolic expression of loss. It also served as a mechanism
whereby the social existence of deceased family members was extended.
For one of the primary tasks of bereaved women was to keep alive the
memory of the family dead by means of regular prayers, by continuing to
celebrate their birthdays and other anniversaries, by visiting their graves,
and so on (Morley 1971; Walvin 1986). These activities were given
significance for the great majority of women by belief in an afterlife and
by hope of reunion in a world beyond the grave. 'The hopes of all,
whether unsophisticated, or sophisticated, were fixed on Heaven' (Morley
1971, 102). Women were required to spend so much of their lives in the
borderland between life and death because they were responsible, within
the family setting, for maintaining strong social bonds between the living
and the constantly increasing number of the dead.
Most of this now, of course, has gone. Belief in the afterlife has greatly
declined and with it the rituals of mourning and the other forms of
associated conduct (Gorer 1965; Morley 1971; Turner 1983). In these
respects, modern women may appear to live both longer and freer lives
that are less oppressed by the deaths of others. Yet social death is still a
more significant feature of women's lives than of the lives of men;
although its form now is very different. Because women outlive men, on
average, by a considerable margin, most married women alive today are
destined to become widows (Kearl 1989). Rees's study of a rural
community, in which the ratio of widows to widowers was more than
three to one, is not unrepresentative. Thus men are much less likely than
women to be left alone as biological death draws near. This suggests that
the most extreme form of social death for the majority of women in
present day society, as in Victorian times, is likely to occur after the death


of their husband. Rees's study showed that many of the widows in his
population during the 1960s did maintain some kind of social life with
their dead partners. But these 'hallucinations of widowhood' experienced
in private by elderly, isolated women are no more than pale shadows of
the socially supported relationships with the dead that gave meaning to
widowhood in the Victorian era.
We observed in the previous section that retirement from paid
employment is a major transition in men's lives and that this enforced
social disengagement marks for men the beginning of the death sequence.
This change in men's status is of considerable importance for their wives,
who in many instances will also retire from the official workforce as the
family cycle runs its course. Thus both women and men experience more
or less together the marked restriction of social activities that is charac-
teristic of all social death sequences. However, the change is less dramatic
and less consequential in the short run for married women owing to the
fact that, with few exceptions, their unpaid labour in the home continues
undiminished after their husband's or their own retirement. Accordingly,
women's entry to the death sequence will normally involve less dis-
ruption to the established pattern of their lives and a less significant
reduction in their social activities.
Given that caring for their menfolk provides a central focus for the
daily activities of elderly women, the character of the death sequence
changes most significantly for them when their partner dies. Referring to
that generation of American women who are now very old, Kearl writes
that: 'So totally dependent are their identities on those of their spouses
that when their husbands die these females lose a significant portion of
their very self-concept' (1989, 485). With the advent of widowhood
comes a radical alteration in women's social existence and, in many cases,
a great acceleration in their move toward social death. It may well be that,
for many women, this is where the social death sequence really begins.
Modern widows, of course, are not necessarily old. Nonetheless, the
concentration of biological death among the elderly means that widows
today will be significantly older collectively than in Victorian times. Yet,
owing to their greater longevity, they will often have many more years to
live. Writing about the American situation, Kearl estimates that the
average duration of widowhood may now be close to twenty years.
These long years of widowhood are not subject to the strict control
which drastically limited women's social activities in the last century, yet
which, at the same time, gave them social significance. They are, rather,
likely to be years of increasing personal emptiness and declining social
involvement. It may be that, for a proportion of the women now
approaching this major change in social status, the consequent reduction
in social participation will be less complete and less personally damaging
than in the past. 'For more recent cohorts of women [...] individuals may
have more anticipatory socializations for widowhood because of earlier


divorces and may be less devastated by their spouses' deaths as their

identities are more likely to derive from their work' (Kearl 1989, 485).
However, this is speculation about the future rather than description of a
present reality. In Britain today, the majority of elderly widows are well
along the social death sequence, with many thousands isolated in their
own homes or experiencing the social deprivation generated within the
bureaucratic institutions for the aged. Of the elderly women who died in
England and Wales in 1987, 77 % ended their days in an institutional
setting (OPCS 1989, Table 5). What this means in personal terms was
made clear in the previous section.
During the last century, then, the profile of social death for women
has changed considerably, at least partly in response to alterations in the
distribution of biological death by age and sex. In the nineteenth century,
women's ritual involvement in social death was a recurring feature of
their adult lives. It narrowly restricted the scope of their social activities
over extended periods, particularly among the middle class. Yet this
continual exclusion from full participation in the social life of their time
was not entirely negative. For it entailed important responsibilities in the
domestic setting and in the wider network of family relations. In
addition, women's conduct in the ritual sequence of social death was seen
to have personal and social relevance as a means of contact between the
living and the dead.
In the present century, as biological death has become less widely
distributed across the generations and more predictably located among
the elderly, sustained ritual mourning has virtually disappeared. This has
enabled women, on the whole, to put off their entry into the death
sequence until relatively late in life. Nevertheless, women's economic and
social dependence on men still condemns them, in large numbers, to
spend many years on the modern version of the sequence of social death.
Unlike the nineteenth century, women's social exclusion is not spread
throughout their mature years, but is concentrated into the final decades
of elderly decline. Indeed, a large proportion of the extra years gained
during this century by increases in life expectancy are spent by women,
in growing isolation, on the death sequence. In our world, however, this
sequence brings with it no active responsibilities and has no wider
significance. It has become simply that period in which old women wait
for their personal extinction.

Social death and the young

Social death sequences are likely to precede biological death when

participants believe that death can be foreseen. Thus in our own society,
where the normal process of dying proceeds slowly among a well defined
segment of the population, it is possible for extended social death


sequences to stretch deeply back into people's existence as living organ-

isms. But not all deaths fit this pattern. For instance, accidental deaths
necessarily occur suddenly and unexpectedly. By their very nature, such
deaths cannot be predicted and cannot, therefore, be prepared for in
advance. Other deaths are so comparatively rare and so out of line with
normal expectation that participants experience great difficulty in
constructing a suitable social sequence as the process of biological decline
unfolds. In our society, problems of this kind are particularly likely to be
associated with the deaths of children.
It is only in the present century that children in the industrialized
world have come to be more or less assured of an adult life. In 1987, only
1.3 % of total deaths in England and Wales occurred among children
aged four years or less. Yet as recently as 1900-02, this group furnished
35.6 % of total deaths (OPCS 1989). Throughout the nineteenth century,
as we have noted, infant mortality was high and, in consequence, children
as well as adults needed to be prepared to face death's early arrival. The
children's literature of the time carried out this task by constantly
rehearsing the death of the young in fictional form and by instructing its
readers how to conduct themselves in relation to death in the real world
(Walvin 1986).
Equally important was the fact that children's deaths, like those of
adults, normally took place at home. As a result, children learned how to
cope with the death of others, and by implication with their own, in
essentially the same way that they acquired the more mundane domestic
skills; that is, by observing and taking part in the household's daily
activities. 'The young not only died in large numbers but they also saw
death around them in a fashion and at a proximity which would be
unfamiliar in the modern West [...]' (Walvin 1986, 62). Because the great
majority of childhood deaths were due to infectious diseases, the process
of biological deterioration was usually swift. Nevertheless, the child's
move toward social death was normally controlled in accordance with
ritual practices that were a familiar part of domestic life and which were
based on the assumption that family relationships would continue beyond
the grave.
It would be wrong to infer that the frequency with which children
died or the assurance of life after death meant that death was accepted
without fear by the young or without deep sense of loss by many sur-
viving adults (Jalland and Hooper 1986). However, such deaths were
expected and prepared for in nineteenth century Britain and they took
place in an organized manner as part of the recurring pattern of
communal life (Walvin 1986). The marked reduction in the rate of infant
mortality since then has transformed people's expectations for their
children and this, in turn, has left both adults and children unprepared
for death when it does occur. The fear and distress arising from the death
of the young which were collectively regulated and socially channelled in


Victorian times are now experienced in a society which has yet to develop
a social death sequence that is appropriate to the new demographic
In Britain today, excluding stillbirths and neonatal deaths, accidents
are the most common cause of death among children (Foster and Smith
1987). Such deaths are unexpected, not only in the sense that each
particular death occurs without warning, but also in the sense that
modern parents do not see childhood as a time when death is likely. Thus
parents often react initially with disbelief as well as with shock, anger and
dismay (Foster and Smith 1987). The emotional distress of the bereaved
is so great, partly because the child's firmly anticipated future in this
world is removed instantaneously, but also because expectations of life
after death leading to eventual reunion are either entirely absent or are
held in most cases with less conviction than in the past. In the great
majority of accidental deaths in childhood, the bereaved are deprived of a
graduated social death sequence involving the lost child, either before or
after the child's death, in the course of which they might adjust to their
grief and to the destruction of the personal world in which the child had
played such an important part (Foster and Smith 1987).
We cannot know whether the experiences of parents today upon the
death of a child are any more or less severe than in the last century.
Nevertheless, it is clear that present day parents have no well-established
patterns of social conduct and associated belief to help them through the
traumatic events, centred around and processed by the medical
bureaucracy, which follow the accidental death of a daughter or son.
Acquaintances, friends, even other members of the family network are
likely to respond by pointedly avoiding the topic and also by reducing the
frequency of their contact with the bereaved (Gorer 1965; Foster and
Smith 1987). As a result of the death of child, the social activities of the
parents will tend to become restricted in a way that is analogous to,
though less formalized than, the restrictions imposed on the grieving
Victorian mother. In other words, on the sudden death of a child, parents
today are likely to undergo a form of social death sequence by association.
In the modern world, however, this sequence has no wider symbolic
or social significance. Parents are no longer ritually separated from the
living in order to keep alive the memory of, or to maintain contact with,
the newly dead. They are, rather, set apart to forget, and to prepare to
replace, the dead (Foster and Smith 1987). Their social exclusion is, like
that experienced by the very old, but another expression of the customary
flight from death in our society by those who are not directly affected
(Kearl 1989). The consequence is that the parents, unprepared and
lacking social support, typically respond to their bereavement and to the
unexpected social isolation that follows with bewilderment accompanied
by a devastating sense of personal loss.

I thought there was no way we would get over the dreadful pain and awful hurt


inside, which you can't explain to people. And it was total darkness even in the middle
of the day when there was bright sunshine. In my mind it was just total darkness
(A bereaved parent quoted in Foster and Smith 1987, 18).

One basic feature or such accidents is that death takes the survivors by
surprise. One source of their pain is that they have had no time in which
to readjust their relationship with the child whilst the child was still alive
(Foster and Smith 1987). In the case of deaths from cancer, however,
which is the second most frequent cause of death among the young in
contemporary Britain, time for readjustment is available. Childhood
death from cancer is a comparatively slow process. In this respect, it
resembles the typical death sequence of the elderly. Indeed, as the disease
progresses, children dying from cancer come increasingly to look and act
like the aged.
Dying children are more like the elderly than their own healthy peers—without
futures, worried, often passive, unhappy, burdened with responsibilities for others
and their feelings. They even resemble old people—either bald or dishevelled,
emaciated or bloated, incapacitated, generally sickly, and most of all losing, failing
with time (Bluebond-Langner 1978, 213).

Yet the social context in which these changes occur is crucially

different for children, in that children in our society, unlike the elderly
and unlike the children of past generations, are not expected to die. As a
result, although in the case of a child dying from cancer, the child's
parents and other close relatives have time in which to develop a shared
response to the death to come, their reaction typically takes the form of a
persistent denial of the imminence of death well beyond the point where
the medical prognosis has become unequivocal. In such circumstances,
the clinical death sequence is accompanied, not by a change of conduct in
recognition of the approach of death, but by a collective pretence of
normal social life.
Collective pretence of this kind is not confined in the modern world to
the deaths of children. In the case of older persons, however, such
pretence is likely to give way, in due course, to a more open recognition
that death is finally at hand (Glaser and Strauss 1965). This eventual
openness is especially permissible in relation to the elderly whose
essential social role in our society is to die. It is because the elderly are
properly expected to die that other people are inclined to exclude them
socially from the realm of the living before biological death takes place.
But children are not expected to die. In our world, children are above all
people with a future, to be nurtured, protected, instructed and, when
necessary, cured, with that future in mind (Bluebond-Langner 1978).
Thus adults' normal dealings with children, in direct contrast to their
dealings with the elderly (Sudnow 1968), address the children's future in
innumerable, largely unnoticed ways. Accordingly, when children are


transformed by incurable disease into persons with no future, most adults

experience great difficulty in knowing what to say or do.
In her moving study of children dying in hospital from leukaemia,
Bluebond-Langner (1978) shows that the normal response to this
dilemma is to resort to 'mutual pretence'. Although her ethnography was
carried out in the United States, it seems probable that her main
conclusions apply equally to Britain (Foster and Smith 1987; Sherr
1989). The term 'mutual pretence' is taken from Glaser and Strauss
(1965, 64). It refers to situations where the patient and some other party
believe that the patient is going to die in the near future, but continue to
act toward each other as if the patient were going to live. Bluebond-
Langner establishes that children, including very young children, actively
strive to understand their medical condition and that they normally
succeed in foreseeing their own death, often well in advance.
Parents and medical staff usually try to prevent, or at least to delay,
this realisation by restricting the flow of relevant information to the child
and by refusing to discuss openly the likelihood of the child's death.
Children quickly become aware, however, of adults' reticence in these
topics and respond by pretending not to know what lies in store for them.
The staff was [...] predisposed to keep information from the patients [...] The parents
also [...] volunteered very little information and explained as little as possible. The
children, noting these and other signals of unwillingness to deal with their condition
[...] obeyed them. When they realized they were dying and that people were no more
willing to talk about their condition than they had ever been, the children started to
practice mutual pretence (Bluebond-Langner 1978, 200-01).

The collective pretence initiated by staff and parents is designed to

sustain an illusion of normality. It is intended to reassure the children
that, despite their poor health at present and despite the periodic deaths
of other sick children, they will in fact recover. Bluebond-Langner
documents the many subtle ways in which this illusion is maintained in
adults' dealings with dying children. She emphasises, however, that it is
inherently precarious and in continual danger of collapse because all
participants, including the children, eventually come to recognize where
the process of biological decline is leading. Furthermore, the collective
pretence of normality, although it is justified as being in the children's
best interests, clearly adds to children's difficulties by creating a situation
in which they are likely to approach death in an atmosphere of avoidance,
prevarication and distrust.
Bluebond-Langner found that a small proportion of parents do try to
talk openly with their children in due course about their death. She
reports, however, that even these exceptional parents are unable to adopt
such an approach consistently and that they continually return to the
dominant pattern of collective pretence (Bluebond-Langner 1978, 221).
This pattern is unavoidable because, in our society, the relationships
between adults and children necessarily presuppose that the latter have a


future. As adults, with relatively few exceptions, we have no alternative

repertoire of conduct which would enable us to interact with children as
'the nearly dead' or which would enable us confidently to displace their
future from this life to the next. Thus, if we are not entirely to abandon
dying children, most of us have no option but to engage in mutual
pretence. Children themselves, argues Bluebond-Langner, implicitly
recognize this dilemma and realise that they must also join in the
deception if they are not to be left to die alone (1978, 229).
By practising the rules of mutual pretence, these children keep the parent/child,
doctor/patient relationship from breaking down. By assuming the role of child or
patient, as adults define it, they allow the parent or doctor to assume the reciprocal
role and all the behavior that follows from it (Bluebond-Langner 1978, 213).

We have seen, then, that the death of young persons in our society
causes special problems, even in situations where the process of dying is
slow and where the eventual outcome is recognized in advance by all
concerned. The underlying reason for this is that the socially organized
death sequences focussing upon the young which were appropriate in a
society characterized by a high mortality rate among children, and which
provided support and compensation for those involved, have disappeared
almost completely as the frequency of such deaths has fallen to remark-
ably low levels. In our society, as the concentration of death among the
elderly has become firmly established and has come to be taken for
granted, so the death of the young has come to be almost unthinkable as
part of the ordinary course of events.
Yet, in a small percentage of young lives, biological death still comes
desperately early. Our customary response when such a death approaches
is akin to constructing a social death sequence in reverse; that is, instead
of initiating an anticipatory process of social decline, we try hard to create
a sense of continuing social involvement for the stricken child. We try to
pretend, for the child but also for ourselves, that the unthinkable is not
happening and to draw the child with us into a world of make-believe
where children never die. In this way, we seek to delay the child's social
death until pretence and denial are no longer possible.

Concluding remarks

We have tried to show that the concept 'social death' can be used to
elucidate major historical developments in society at large. In order to
explore the complex historical changes that have occurred in people's
conduct associated with death and dying, we have employed two kinds of
systematic comparison. First, we have compared demographic profiles of
biological death with profiles of social death. Second, we have compared
the profiles of biological and social death in modern Britain with those of
Victorian times. Although we have furnished much detailed documen-


tation, our wide-ranging analysis has necessarily been general in char-

acter. Our aim has been to provide a broad account of how typical
patterns of death-related conduct have altered over time.
The changes that have taken place in the profile of social death during
this century have been brought about by people's collective responses to
the changing social distribution of biological death, to the changing social
setting of death, and to the changing clinical nature of death. In the last
century, social death sequences were designed to cope with high mor-
tality rates among children, with comparatively modest life expectancy
among those who survived childhood, and with the rapid and unpre-
dictable onset of death from infectious disease. The process of dying in
Victorian society lay beyond the control of the medical profession and
took place overwhelmingly within the domestic setting. In this society,
virtually all members were familiar with death from their earliest years
and regularly participated in social death sequences of varying degrees of
intensity. But women in particular, owing to their subordinate position
within the Victorian household, were mainly responsible for carrying out
the rituals of mourning whereby family members' often brief lives were
continued beyond the grave.
In modern society, biological death has, to a considerable degree, been
tamed. It has become largely predictable and occurs mostly within
organized bureaucratic structures. One of the unanticipated consequences
of this situation is that increasing control over biological death has led to
a growing encroachment by social death upon participants' extended
biological existence. In contrast to the last century, when social death
sequences operated mainly after biological death as a continuation of lives
unpredictably cut short, present day social death sequences work mainly
in advance to reduce and terminate people's social existence in antici-
pation of their biological cessation. Thus in terms of social existence, as
distinct from biological functioning, the difference between Victorian
times and our own is by no means so great as simple variations in
mortality rates seem to suggest. For, in our society, not only are there few
forms of belief or conduct to keep us living in the lives of others after
biological death, but, in addition, a substantial part of those extra years of
biological functioning that have been acquired during this century are
likely to be spent, particularly by women, in a condition closely
approaching social death.
The situation regarding the deaths of children is also less straight-
forward than the dramatic improvement in mortality rates seems to
imply. For this very improvement has changed the context in which
children die and has destroyed the systems of belief and communal
conduct by means of which childhood death was managed in the past. In
our society, where parents reasonably expect all their children to survive
to adulthood, the social death sequence for the young has atrophied and


has been replaced by a process of collective pretence which appears to

exacerbate the emotional and interpersonal difficulties of all concerned.
In the light of these general conclusions and the preceding discussion
on which they are based, two final points seem to us to emerge. The first
is that we can encompass the full historical and cultural variability of
people's conduct in relation to death only if we consistently supplement
the conventional, medically denned concept of 'biological death' with a
sociological concept of 'social death'. Second, we must employ a
conception of 'social death' which is more broadly conceived than that
adopted by the hospital ethnographers and which, indeed, can enable us
to comprehend the death sequences observable in the modern hospital as
facets of much wider social processes. In this paper, we have tried to fulfil
both these requirements.



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