Finnur Magnússon
University of Lund, Department of European Ethnology
Finngatan 8, S-223 62 Lund, Sweden

Why is it so that death seems to organize so much of our discourse in "now" and "then"? Death's metaphorical strength of polarizing seems endless. Death is constantly spoken of within different discourses being shaped into narratives. These narratives as the author treats them in this essay are found on two different levels. First, within the abstract assumptions of scientific theories; second, in informal as well as formal storytelling among people actually working in Swedish clinics and hospitals where dying patients are being cared for.

Pathological Death

Thoughts of modern death and dying are mirrored within several different social theories and assumptions. On a general level we encounter the idea that modern man has been deprived of the right to his or her own death. Death has become a matter of medical technology and is enclosed in medical institutions. This view is found among several scholars, for instance Zygmunt Bauman, who pinpoints modern death as a deconstruction (Bauman 1992). He claims that modernity seeks to deconstruct mortality. This does not of course imply that death does not exist in contemporary society. In contemporary society death has rather become the Other. Death has certainly always been the Other, but in modern society this Other has gained a specific meaning. Some of the supposed features of modernity as hope, faith and reflexivity, control of body and mind, etc., are according to Bauman threatened by the sheer knowledge of our own mortality. The deconstruction of mortality does not involve the denial of death as much as resisting the causes of death. The deconstruction of death means a pathologization that has turned death into an illness which can be cured. This is what makes death so frightening. Death has always been frightening and will always remain so. But modern fear of death differs from that of previous eras in its character of being a rational fear. It is rational in the sense that fighting or resisting the causes of death becomes the main project of our life, so when death finally occurs, it is seen as being a failure. Therefore one can say that medical ambitions, taking care of one's own health and body, keeping fit, eating proper food, and not smoking and drinking are only subtitute solutions of insoluble problems.

As the main task of the medical establishment is to preserve life, the dying patient becomes a reminder of the failure of medical care(cf Certeau 1984: 191ff). Placing this statement within a contemporary discussion of modernity, death has become a threat to some of the main features of modernity: rationality, the ability to transcend, the control of one's body and soul, the creation of self-identity and reflexivity (Melucci 1989, Giddens 1991, Mellor 1993).

To summarize this discussion which outlines some central topics in the scolarly discussion of modern death and dying, the following facts may be stated. Death and dying seem to have become the problems to be solved by an individual, instead of being a collective matter as it was in earlier stages of history. Further on, death and dying have developed into medical phenomena treated by the help of experts. Finally, death in its modern shape is believed to threaten some of the grand values of our society, and therefore it has been thrust into the realms of institutions separated from the rest of society.

However, social and cultural theories of the meaning of death in modern society may focus on general tendencies, but they do not always tell us all that much about how death is actually met and dealt with inside wards and hospitals.

Cultural Construction of Death

In my study of the Swedish old age care, I have touched upon some topics concerning the care for aging and dying patients. The study is based on fieldwork as well as interviews with nurses within different sectors of the medical establishment (Magnússon 1993, 1995, 1996).

One of the purposes has been to outline the ethnography of death where diffent types of narratives are important. These narratives show important changes in dealing with death and dying among the staff. Furthermore, they also function as "seismographic" readers of some social and cultural changes within modern society.

In spite of extensive literature claiming the opposite, a vast quantity of evidence shows that death no longer seems to be a matter of taboo (Ariés 1978, Gorer 1965, Mellor 1993). Today, a nurse working in a clinic where the death of a patient - young or old - is frequent, does not regard death as an exclusively pathological or medical matter. Death and dying are being defined more as cultural or social phenomena. This becomes evident in narratives as well as the carefully woven rituals and habitual behaviour found within everyday care. In working with dying patients, one is bound to cope with emotional difficulties and sometimes crises that are always present. A nurse experiences pain and suffering, she witnesses the decay of human bodies, and she learns to distinguish between different types of deaths, as, for example, death which comes as a relief or a surprise, or death which is beautiful or nasty. She may spend some time establishing relations of friendship with a single patient, and then she suddenly finds this relation being abruptly broken off by death. Furthermore, the nurse may even at some time in her career have witnessed some acts of brutality and ignorance from her colleagues. In other words, she has most likely experienced the double-faced character of care.

Janus-Face of Care

Nurses respond to these experiences of death in many different ways. This leads us to a complicated field of narratives of dying and death among them.

The intertextuality of the narratives is quite clear. They almost always have the character of two-sided retrospection. By remembering and narrating examples of different patients and their death, the nurses emphasize changes in the care for the dying, changes which they regard as progress. Quite frequently nurses use history to give legitimacy to their present situation. They refer to the time when death was a taboo, when death was never really spoken of and when dying patients were ignored and did not always get proper care.

This means looking backwards to the Swedish medical institutions of the 1970s. It was during this period that some problems involved in the care for the dying were pointed out. This was especially the case within the geriatric care system. Incidents - like the one when a confused young man murdered at least twelve old people at a geriatric ward in 1979, exposed bad conditions within the care system. This, among other incidents, raised a series of questions by scolars, politicians and media people, all pointing in the same direction: Swedish medical establishment was in a really bad shape, when it came to the care for the aged and for the dying. The critique voiced in the public debate shows signs of the general critique of modern society, being unable to give proper care to dying and disabled patients. The medical establishment became a symbol of the degeneration of modern society.

Undoubtedly the public critique was justifiable. It pinpointed the dilemma of modern medicine, which has the tendency to regard death in the same terms as Michel Foucault and Zygmunt Baumann put it - as a pathological matter (Foucault 1973, Bauman 1992).

In the narratives we find a firm structure, including repeating comments on bad care, disciplinary punishments of patients and dying patients being left alone, not getting sufficient pain killers or any kind of soothing treatment. When a patient died, it was the hospital's, the doctors' and the nurses' failure. The conditions are commented upon in detailed descriptions. For instance, when morgue attendants were called to pick up dead patients for the removal to the morgue, the calling nurse never mentioned the word 'dead' or 'corpse', instead she said: "We've got this patient to be collected". When the attendant came, the rest of the patients were to stay in their rooms, and the corpse was transported out, using the back door.

There are close connections between the critique voiced in the public debate, and the narratives of experienced nurses. Yet, there are differences to be found. The narratives of the nurses are two-sided. They do not only point out flaws and mistakes, but also comment upon the existence of close ties of friendship actually present in everyday care. In this way the narratives of the nurses point out the tension between the two definitions of the construction of death, the pathological versus the cultural.

On a more general level the narratives of the nurses can even be seen as an expression of the critique coming from inside the medical establishment. They may be seen as moral tales, that is, by looking back you describe a situation which is not only different, but actually less humane or decent than the present one. In this way the narratives express the relation between "good" and "bad", a relation which is one of the foundations of all the care, social or medical (Magnússon 1996c).

The narratives thus enable us to discuss some features of modernity that have to do with the inbuilt mechanisms of sequestration - as well as the transformation of intimacy - seeking for authenticity in social relations (Berman 1982, Mestrovic 1993, Giddens 1992).

Intimacy of Dying

The narratives strive for creating continuity in a world which is characterized by discontinuity frequently caused by the dying of patients. In the relatively slow pace of wardlife, close and intimate relations between the old and the staff are created and these are based on different foundations. This is a topic which is recurrent in interviews with different generations of nurses. You look backwards on your carreer and reminisce about patients to whom you have become attached. In their tales, nurses often comment upon the state of emptiness which frequently follows the death of a dear and beloved patient. When death occurs, a vacuum is bound to arise. Let me quote an interview:

"We once had an old sailor. He used to sit at the same table all day. Then he suddenly died, but in my mind, he is still sitting there. He died a year and a half ago."

Mourning among nurses becomes a natural state of things, as an integral part of everyday care. Memories tend to pop up unexpectedly as, for instance, when noticing the obituary of a patient when reading a newspaper. These memories are collective as well as individual matters. Dead patients worth remembering become legends frequently commented upon. However, death and dying are not only spoken of, changes of attitudes are revealed in practice as well. Narratives and habitual routines, rituals and behaviour become a sort of safety-valve. The ward becomes a place where the power of habits keeps away uncomfortable phenomena to create order in a world of chaos.

The combination of narratives and action even seems to create a picture of nurses as some kind of pioneers within modernity. The nurses seem to be seeking the authentic death, where individual routines and strategies are allowed. This permissive attitude seems to be nearly unlimited. A long list of examples showing permissive attitudes could be made. A nurse has told me of a situation were a Polish immigrant woman demanded that her deceased husband should be dressed up in his old confirmation suit, of course completely unfitting, a certain number of socks and his old cap. In spite of difficulties, the nurses were able to dress the corpse according to the wishes of the widow. The jacket was cut apart at the back and sewed onto the corpse. Parents of stillborn babies are allowed to bring their baby to a nearby lake or a wood, where they just sit holding the child in their arms, engaged in their grief. Corpses are carefully washed, candles lit, the room decorated and nurses pay farewell in a ritual manner, both individually and collectively. The corpse is commented upon in terms such as "nice", "peaceful", "at ease", etc. It has become more and more common that a corpse is actually photographed. For some time it has even been customary that stillborn babies are photographed and their footprints made in plaster.

Seeking the Authentic Death

Thus death and dying within the contemporary Swedish medical establishment, as expressed in narratives as well as in action among nurses, become phenomena that stretch far beyond the limits of medical or biological discourse. In fact, we witness a tendency to sidestep medical discourse in the care for the dying. The task of the doctors and nurses seems no longer to be to preserve life at any cost, but rather to ease pain and suffering. Today the expression 'dignified death' is used - meaning the same as authentic death.

Studying death and dying within the contemporary medical establishment allows us to survey a transformation of intimacy within modern society, as well as the inbuilt force that separates anomalies from the rest of modern society.

Death threatens and frightens and causes thoughts of anxiety among nurses, as it reminds them of their own mortality. But the disturbing thoughts often arising are seldom neglected. In fact, many nurses choose their occupation just because the dilemmas and existential thinking about death and dying give them some sort of satisfaction.

Today people tend to create relationships were the individual is the central issue. This is quite evident in the world of arenas separated from society, such as wards and medical institutions. In the relations to the dying patient the authenticity or purity in social relations - as described by Anthony Giddens - may be found (Giddens 1992). The feeling of loss and emptiness following a patient's death has very little to do with either the failure of the medical system or religious brooding. These feelings of uneasiness are connected with a pure regret at a person's loss. This tendency towards the state of intimacy - where purity or authencity in relations is sought - is to be found at different levels of everyday ward life, but especially concerning the patients' death.

In this way pessimistic prophecies of the denial of death and the alienation of the dying within Swedish modernity seem not to be confirmed in the everyday reality of clinics, wards and hospitals.

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