Book Review
A Social History of Dying
Allan Kellahear
ISBN: 0-52116942-9-9; 2007; 297 pages; Cambridge University Press;
Norelle Lickiss
University of Sydney; Sydney Institute of Palliative Medicine, Royal Prince Alfred Hospital, NSW
Allan Kellahear, now Professor of Sociology at Bath, is a prolific writer on matters related to dying and death, viewed through the prism of sociology. Over the last decades his focus has broadened from the experiences of an individual in the last year of life, to various aspects of dying in Australia, to now incorporate a global, all-recorded time perspective. In this book he documents sociological aspects of dying from The Stone Age (where dying was perceived as an other-world journey), through The Pastoral Age, The Age of the City, to The Cosmopolitan Age (where ‘the cosmopolitan mentality has turned dying on its head', with dying occurring often in situations of dislocation, unconnectedness and radical aloneness). He highlights and analyses the (regrettable) features of a Shameful Death which is characterised by the:
a) erosion of awareness of dying
b) erosion of support for dying, and
c) problem of stigma (after Goffman).
Attention is given also to the increasing concern about dying ‘at the right time': not too early nor too late. The emphasis in this book is understandably on Western history but there is evidence of awareness of other strands. The author alludes to (and criticises) the work of others, such as Philippe Aries (At the Hour of Our Death 1981).
The author notes that ‘behind the fragile and temporary images of our individual selves that appear on its surface exist suggestions of less familiar company: strange tides of history, cultural undertows that sweep in and out of our lives' (2007: 1). He advises that ‘this book is an attempt to stand back from these images of ourselves, to take a wide-angle view of the human condition story of endings, and to identify and describe the major patterns of dying throughout our history' (2007: 1), and also to offer a ‘broad historical storyline' to help launch new debates about the meaning of dying and to offer a vantage point from which to reflect upon our common fate.
These two objectives indicate potential complexity, if not difficulty, in a short volume.
This book is difficult to read and appraise, not only because of the subject matter and the fact of 100% mortality rate in store for all readers and reviewers. It is of course laudable that an attempt has been made in our time to give an account of the fact of human dying in the complex context of human history. This reviewer cannot appraise the accuracy, adequacy or balance of the historical resources used, but there is such extensive documentation of facts from a wide variety of sources that it is sometimes hard to keep the ‘broad historical storyline' in focus. There is also considerable repetition of ideas, and a distillation of the core concepts and content of this book could make it more useful (and maybe more acceptable) to a wider readership. The documentation, undoubtedly evidence of diligence and scholarship, is accompanied by comments reflecting personal views which may be somewhat contentious: not necessarily a fault, and in accord with the stated aims of the writing, but the intrusiveness of the comments do detract from clarity.
It is clearly wise to encourage recognition of the fact that exploration of the human condition requires the perspectives of many disciplines; in particular, it is critical to recall that dying is radically a personal (and therefore social) act and not a therapeutic failure. Nevertheless, medicine is a social influence deserving a high (higher?) profile in a consideration of the shaping of our dying. At the individual level, influences of relevance for good are the quality of clinical decision-making, the competent and appropriate application of sound strategies for prolonging life (at an acceptable price), for relief of major symptoms especially pain, and for the just mobilisation of resources for care. At the community level, the ethical stance of the medical profession has profound influence on policy. Dying need not be shameful, and the inequities, global and local, are truly an ethical stain which should be intolerable for this generation.
Kellahear is right: a fresh look is justified at the total human context, and this book may stimulate it. But one might hope that the focus could be stronger on dying as part of living (even limited to this world, for not all hold for an afterlife), and even allow raging, on occasions at the dying of the light, as well as welcoming the coming dark. On finishing reading the book, if one does, there may be need for a toast to life.
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