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BOOK REVIEW |
University of Wisconsin Oshkosh Oshkosh, WI 54901
On Our Way: The Final Passage Through Life and Death, by Robert Kastenbaum. University of California Press, Berkeley, CA, 2004, 452 pp., $27.50 (cloth).
Students of gerontology today would probably be shocked to learn that many of their professors never took a course on aging. This was certainly true for Robert Kastenbaum. As described in an autobiographical essay (Kastenbaum, 2000), his education in psychology exemplified the discipline's neglect of aging and death until the last quarter of the 20th century. In addition to paying no attention to aging and death, psychology also failed to study time. In Kastenbaum's view, this omission greatly compromised its scientific integrity, for it led to a narrow focus on what he called "hypothetical people who did not age or die" (2000, p. 146). Fortunately for gerontology, early in his career, Kastenbaum encountered a few teachers and situations that encouraged him to engage with "existential issues of meaning and death" (2000, p. 152).
Robert Kastenbaum has now written a book about death that resists attempts to categorize it. The publisher groups On Our Way: The Final Passage Through Life and Death with works on religion, sociology, and anthropology, while the Library of Congress system puts it in a category called "psychology of other special subjects." Thus, Kastenbaum's book appears with other volumes on the psychology of death; these can be found between books on the psychology of color, and the psychology of false alarms, fire, and funerals. Despite its placement in a section on psychology, Kastenbaum's work does not resemble any psychology book being written today. It reads more like a work from the early 20th century, when psychologists felt freer to range widely through history, diverse cultures, philosophy, poetry, art, and drama.
How do you write a new book about death when you have already written several textbooks on the subject, edited an encyclopedia about death, taught countless classes on "Death, Society, and Human Experience," edited the journal Omega, Journal of Death and Dying for many years, and written journal articles, book chapters, plays, and even an opera or two about aging and death? Kastenbaum seems to have made a deliberate decision in writing On Our Way not to regale his readers with research findings, nor to feel obligated to make this work dryly academic by keeping himself, as author, far removed from the vitality of his subject. Rather, this book is at once scholarly and personal. Picture Kastenbaum in the lecture hall—on the stage—relating how human beings across time have understood death, dealt with the dead, imagined the state of "afterdeath," and by doing all of this shaped their individual and communal experiences of life. All of this is delivered with his inimitable humor, honesty, passion, and profound skepticism about how the social sciences reduce "the chill of death anxiety to a 15-item true/false scale" (Kastenbaum, 1994a, p. 169). And, since this is Kastenbaum teaching this course, there are, of course, a few pithy baseball metaphors.
High Noon in Mental Health and Gerontology
In 1974, Kastenbaum published a powerful essay in Geriatrics that later appeared in a book he edited (Kastenbaum, 1981). Titled in the book "... Gone Tomorrow," this essay argued that the "high noon" vision of mental health promulgated by so many psychologists in the latter part of the 20th century contributed to the despair of the old and dying. Mental health defined solely in terms of zest, self-efficacy, competence, and the ability to radiate well-being privileges the young and the healthy; old people who experience prolonged sorrow because of the deaths of people they love may be seen as weak, or worse, deviant. Time and change, which are inevitably interwoven with suffering and loss, threaten the high noon vision. Because the old are associated with death, and because it is socially unacceptable to acknowledge death fear, people avoid admitting fear and thinking about death by avoiding the old. Kastenbaum's observations on how the high noon vision of mental health produces social marginalization are now being confirmed in research on terror management theory and the effects of death fear on ageism (Martens, Goldenberg, & Greenberg, 2005), and reactions to people with disabilities (Hirschberger, Florian, & Mikulincer, 2005).
In some ways, the essay on mental health presaged Kastenbaum's critique of "gerotranscendence" in the afterword of a book on religion, spirituality, and aging edited by Gene Thomas and Susan Eisenhandler. In that piece, he commented that some gerontologists seem to want old people to be serenely spiritual, with the "anxious, restless and noisy souls" (Kastenbaum, 1999, p. 207) labeled as difficult and lacking "life satisfaction" and "well-being." The research evidence accumulated in the last quarter century about religion and various indicators of health, both mental and physical, is voluminous, for the most part scientifically sound, and now widely accepted in the field. However, when gerontologists today talk about religion and well-being, they are probably not envisioning the old men Gene Thomas (1999) described as shaking their fists at God, nor the folks Kastenbaum (1994b) once depicted as "saints, sages, and sons of bitches." Kastenbaum has little patience for the kind of consumer-driven spirituality that would encourage a bereaved elder to light scented candles, share a few light-hearted stories about a loved one, and get right back to "productive aging" or "sexy aging" or even "conscious aging." More likely, he would quietly sympathize with Joan Didion's (2005) rage and anguish in her year of magical thinking, a year when she encountered the "divide" over which her husband passed into what Kastenbaum calls simply the "absence."
Has gerontology purposefully or inadvertently promoted a high noon vision of late-life well-being? This vision rushes to "closure" on suffering, fails to grasp the admixture of joy and sorrow in older people's lives, splits "successful aging" from frailty, and conspires to keep death in the last chapter of textbooks—the chapter often omitted or only briefly addressed as another exhausting semester comes to an end. The question of whether this vision is deliberately embraced by gerontologists would undoubtedly stimulate a spirited debate in a hotel bar after a day of Gerontological Society of America meetings; what cannot be debated, however, is the hold of the high noon vision on the general public. People who worry about this have their own high noon stories. For example, I once walked into a famous bookstore on the West Coast, followed the map to the section on aging, and found not one book addressing dementia. Those were located in the neurology area. A clergy friend to whom I related this story told me his version. He was asked to help a church-related continuing-care facility write a mission statement. Among its many strengths, he cited how it was a place where people could "be safe and supported in humane ways until death" (Robinson, 2006, p. 200). Needless to say, his suggestion did not appear in the mission statement; the final version contained no reference to death, but instead boasted how the facility promotes "active living."
Rituals in Life and Death
On Our Way begins in ordinary time, not with big thoughts about life and death. It opens by inviting readers to think about distinctions between the routines and rituals of daily life. Both order life, but rituals connect people to a meaning system and, through it, to one another. Whether they are the small, "maintenance rituals" of everyday life or the grand rituals that religions construct for major life transitions, rituals have the power to "hold back the anxieties, the doubts, and, of course, the irrational forces that seize and destroy even our finest achievements, even our most innocent or gifted comrades" (p. 23). This conviction about the significance of rituals echoes through the entire book. In the first chapter, Kastenbaum moves from considering morning coffee routines, and the ritual of touching a mezuzah when entering or leaving a home, to reminding us about the rituals of remembering September 11. He then turns to a vivid description of a visit to the catacombs under St. Stephansdom cathedral in Vienna where the bones of 15,000 victims of the 1679 plague lie in dusty piles. The contrast is stark in time and memory between the horror we knew recently and the horror experienced so long ago. The old dry bones still produce chills in intrepid tourists, but their presence in the catacombs has been separated by centuries from rituals that once conferred meaning and order on a time of vast disorder.
After the rising crescendo of the first chapter, Kastenbaum settles into a quieter theme as the second chapter opens. He begins by talking about the importance of bedtime rituals and the ways they enable the child, and the adult, to trust in life enough to settle into sleep. He claims these rituals are a way of practicing death and that parents need them every bit as much as the children with whom they share a story or recite a prayer. Though he does not go to the other end of the life cycle, his discussion of bedtime rituals evokes images of the evening hours in nursing homes. What comforts can be given to residents by harried staff who must prepare so many for the transition to sleep? Do residents endure perfunctory bedtime routines or does another person confer meaning on the day and on life itself by offering a ritual. Kastenbaum believes that rituals, whether small or grand, are a kind of blessing. There are many heroic CNAs who somehow find the time and energy to confer blessings upon the residents for whom they care.
Kastenbaum suggests that people who have not known the daily comfort of rituals, whose lives are more characterized by chaos and unpredictability than order and meaning, may be at a complete loss for knowing how to journey through the passage of life to death. Although he does not spend a lot of time examining early 21st century funeral practices in Western societies, he does express concern over the ways that they have been trivialized and compressed to fit into people's busy schedules. No longer does one see a funeral cortege slowly winding its way toward the cemetery. Hurried people on their way to conduct all the important business of their lives would not tolerate such delays. The sacred space of cemeteries is increasingly threatened by the demand for land to build enormous houses and big box retail stores. Kastenbaum argues that societies that disrespect the dead may experience a dangerous loss of moral restraint in valuing the living. He reminds us that some societies treat the dead well out of fear that they will haunt the living; for a modern, secular society, the haunting may come in forms other than revenants and midnight mischief.
A section of the book in which Kastenbaum describes the "inconvenient dead" (p. 184) should be required reading for people who administer in long-term care facilities. In many facilities, dead residents are efficiently whisked away with no recognition that staff and the remaining residents might need some kind of affirmation ritual of that person's life. Kastenbaum relates a tragic story from his own experience at a state-run geriatric facility where efficiency dictated that residents behave as if a dead roommate or table buddy had never existed. One old man inferred that his friend had died merely from the silence of staff and not from anyone actually telling him about a death. He grieved privately, and then was shocked to learn that his friend had been transferred to a different part of the facility, a fact that none of the overworked staff had bothered to tell him. Later, he heard that his friend had actually died, though someone else whispered that that was not true. Indeed, death had come, but not before this one lonely elder had been forced to experience tremendous emotional pain. Institutional routine had effectively maimed the human spirit.
Fortunately, some long-term care facilities are embracing a new culture of care that adopts a very different approach to the passage of residents from life into death. Writing in the newsletter of the Pioneer Network, an organization that promotes culture change in long-term care, Julie Berndt, the former chaplain of Fairport Baptist Homes, described the situation she encountered when she first went to work there in 1988 (Berndt, 2003). It was much like that of the facility where Kastenbaum worked 20 years earlier. When a resident died, all the other residents were removed from public areas so that they did not have to see the funeral director arrive. They were not told what had happened, and staff was instructed to "clean up" as quickly as possible. Fairport Baptist Homes was a leader in the early culture change movement, and Berndt tells how this changed the way the facility dealt with death. Families of residents coming to the end of life now can be there at all hours. Rituals have been developed for welcoming families and creating a sacred space as they attend to their loved one. When death comes, a bedside prayer service is offered for staff and other residents. Before the service begins, a bell is rung three times and the resident's name is quietly announced over the public address system. When the body is taken out of the facility, it is covered with a flag, quilt, or some other meaningful object; the gurney is moved to an exit on the main floor and families, staff, and residents are allowed to accompany it.
This is the kind of respect for the dying and dead that Kastenbaum fears is being increasingly threatened in our time. He argues that there are serious consequences for individuals and societies that trivialize or even eliminate death rituals. In one paragraph of the last chapter of the book, he condemns both the medicalized, dehumanized deaths of too many people as well as the empty rituals that are "taken off the shelf" (p. 396) and have no real meaning for those who mourn. By no means does he argue that these rituals must reflect traditional religious liturgies, but he does suggest that purely secular memorial services—some that even approach the category of "roast" in our time—fail to guide people through "the miseries of life and the mysteries of death" (p. 398).
Good Deaths, Bad Deaths, and Too Many Deaths
Kastenbaum devotes two chapters to good deaths and bad deaths. As in much of the rest of the book, he approaches this topic by addressing it in the least threatening way by describing cultures that are radically different from the ones likely to be inhabited by readers of the book. For example, we learn a great deal about how the Lugbara people of Uganda and the Democratic Republic of the Congo view death as a kind of performance, with the dying person expected to "do it right" in terms of lines spoken and gestures made. Deaths that are sudden and unexpected, or that take place far from home, are bad deaths because they produce frantic, wandering spirits that endanger the living. From Africa, we move quickly to the Kaliai of Papua, New Guinea, people who view death more as a complex process that unfolds within a network of social relationships. The point of all this is that the way a person dies has important implications for the community; the good death protects the community, while the bad death threatens it. Good death passes through ritual; bad death lies outside of ritual.
I read this book in the autumn of 2005, in the shadows of Katrina and Rita, devastating hurricanes that produced too many bad deaths. People are still struggling to come to terms with the gravity of what happened along the Gulf Coast and the horrible deaths of over 1,300 people—mostly poor and old. Iconic images have emerged from that dreadful time that years from now will evoke memories of all the bad deaths. One in particular is a photograph of a make-shift grave. A woman has died on the street in New Orleans and someone has covered her with a white sheet, carefully laid stones around her body, erected a cross at her head, and written on the sheet, "Here lies Vera. God help us." In other words, someone, most likely a stranger, tried to salvage for Vera some small measure of human dignity. News stories of that time related how others attempted to build a bulwark of humanity around inhumane circumstances. For example, the people of the Coast Guard recovered many bodies from homes and streets; when they did, they brought along a chaplain to say a prayer before the body was taken to the morgue; another chaplain at the morgue was also on duty to say a prayer as the body—often unidentified—arrived. These small acts represented efforts to preserve some sense of dignity in the midst of too many bad deaths.
The autumn of 2005 also brought numerous news stories of the possibility of too many deaths from avian flu and reminders of the devastation of the influenza pandemic of 1918. We do not yet know whether the H5N1 virus will affect humans in vast numbers, but reading Kastenbaum's descriptions of the plague years of the 14th century, and the social upheaval that all those deaths produced, deepens one's perspective on the latest news story about birds dying in Africa, Asia, and Europe.
In addition to the good death/bad death chapters, Kastenbaum devotes another entire chapter to what he calls "corpsed persons." He offers detailed descriptions of how "corpsed persons have been recruited to serve the needs, ambitions, and caprices of society" (p. 173). Here we learn about the zeal of physicians and scientists in the 18th and 19th centuries who robbed graves for bodies they could dissect and study. We find out where all those spines came from that used to decorate junior high health classrooms in the 20th century. We learn, also, about a new technique in the 21st century called plastination, recently used to assemble 27 human corpses to tour museums in a show called Body Worlds, claimed to be "one of the most highly attended touring exhibitions in the world" (Franklin Institute Online, 2006). Throughout this somewhat grisly discussion, we hear one theme in many variations: our treatment of the dead, whether in war, plague, disaster, or art, is "an opportunity to express whatever humanity we possess" (p. 217).
Who Should Read This Book?
The material covered in this book does not appear in the final chapters of gerontology textbooks. Nevertheless, undergraduate students could gain both knowledge and mature insight from reading Kastenbaum's work. I read this book with an undergraduate student as part of an independent study course; my student told me that she had never thought much about death, had never attended a funeral, and strongly believed all students should take a course on death. She also offered me another perspective on Kastenbaum's jokes. He knows people are anxious about death and he attempts to lighten the discourse for his readers by injecting humor throughout the book. At times, I wondered whether there might be too much humor (for example, one section of a chapter called "Abusing and Eating the Dead" is titled "rituals and victuals"), but my student thought his humor lightened the mood without ruining the message. Humor has always been entwined with tales of death and, by releasing tension, it allows people to laugh at their foibles and fears. Kastenbaum never demeans or devalues his subject. This is no high noon treatment of death. He knows death is disturbing, and so his jokes and dramatic flair for storytelling function as a kind of terror management to encourage his readers to stay with him.
I can imagine groups of older adults reading this book, also. They would find Kastenbaum to be a trustworthy guide through difficult topics. Unfortunately, it might be the middle-aged children of these adults who would object, just as the 40-something daughter of a nursing home resident once berated me for talking with her mother about terminal care planning, a topic her mother was quite eager to discuss. Indeed, Kastenbaum observes that "anxiety about discussing death as death can impair our communication and therefore our relationships" (p. 355).
Gerontologists, too, could learn much from this book. Sometimes we become so invested in promoting the well-being of elders that we do not acknowledge, in the words of Leonard Cohen's wonderful song, that we are all approaching "closing time." Kastenbaum reminds us repeatedly that if we do not connect dying to living, our social and personal lives are impoverished. The circumstances under which people live, and die, today have never been experienced in any other generation. Every gerontologist knows this. We need Robert Kastenbaum's insights more than ever in this time when people live longer, and die longer. We need the teacher who celebrates the "genial perversity in the human spirit that thrives on mocking and rocking its own established order" (p. 2), the order that wants to pretend that death can be controlled and regulated and sanitized. Kastenbaum challenges our facile assumptions about aging and old age, mocks our arrogant and feeble efforts to portray profound human experiences solely in terms of statistics, and teaches us time and again that "life cannot be fully appreciated or understood without somehow taking death and loss into account" (p. 20).
References
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