The Dying Process

Excerpted from
Death, Grief and Mourning: Individual and Social Realities
By John S. Stephenson, Ph.D.

The individual who is dying is in a state of transition between the living and the dead. Being in the stage of life known as "dying" has ramifications for both the individual and the larger society. In studying the dying process, we will focus on both the psychological and sociological dimensions of dying. Historical studies of dying provide us with an understanding of the social and psychological meanings placed upon dying at different times and in different social contexts.

Normative ways of behaving not only demonstrate a society's values, but in turn reinforce those values through traditional legitimation. Dying is a human activity which is carried out in a normative manner. The individual learns the meaning of death and what are considered to be proper or "good" ways of dying from the larger society. One hopes to die what one's society considers a good death. At the same time, dying "well" reinforces certain values within the society itself.

The historian Philippe Aries, in his study, Western Attitudes Toward Death, describes dying as it existed for 1000 years before the twelfth century in Western civilization as being "tamed." One had a foreknowledge of his own death, and was therefore able to prepare himself for death. There were ritual gestures and customs which the individual was ideally supposed to act out. The person who was aware of his imminent death first took it upon himself to express his regrets over the end of his life. This was followed by a pardoning of those who were important to him for any wrongs that they might have committed against him. At that point, the individual shifted his attention away from this world, and onto his God. He confessed his sins, and gave his soul over to God. If possible, he received absolution from a priest, and then waited in silence for death.

Note that the individual who was dying was the center of the process. He organized it, decided what was important, and carried it out in a public ceremony. It was not a theatrical, maudlin, or emotional act, but was instead a simple, meaningful ritual. Aries states that death, which was "both familiar and near, evoking no great fear or awe," was met as "a familiar resignation to the collective destiny."

Beginning in the eleventh and twelfth centuries, Aries sees a shift from the former "tamed death" to a style of dying he calls "One's Own Death." The gathering at the death bed became an emotional scene, as the judgment of the individual by God took place at this time. Still, the individual controlled his dying. No longer the passive, fatalistic person of the former style of dying, the individual now cherished his life. Individual existence was becoming more important. As we saw in our examination of the history of American attitudes toward death, this judgmental dying was predominant among the early settlers of New England.

Aries's work describes the influence of society upon what was considered the proper way to die at various times throughout history. Earlier, we examined the attitudes and values which have affected the changing American image of death. In this chapter, we will examine contemporary American thinking and research on the dying process.

The Living-Dying and Terminal Intervals

In contemporary times, one no longer relies upon an inner conviction such as Aries described that he or she is dying. Most usually, that definition is arrived at by a medical analysis of one's physical condition. One may enter the doctor's office with a minor complaint, only to learn that the condition is a symptom of a terminal illness. A person is considered to be dying when death is no longer the inevitable abstraction that it is to us all, but has become a very real, time-bound condition. I would prefer to use Pattison's term, the "living-dying interval" for this period of time. This term allows for the fact that a person may, at least at the time of entering the living-dying interval, be doing more living than dying, and that his or her physical debility or symptoms are not yet at a point where the individual is to be considered as being controlled by his or her ailment. For example, a friend of mine was told of his diagnosis of leukemia as a result of a blood test for his marriage license. The only difference in his condition initially was a psychological change when he was told of his illness. He had not consulted a doctor about any symptoms, nor did he feel ill. Suddenly, he was given information which was to drastically change his life and his social identity. However, he had no physical feelings of illness at that time, only information from his physician that he was not well. As the individual continues in the living-dying phase, eventually the term "dying" becomes a more apt description than does "living." Within the living-dying interval, Pattison describes three distinct phases: the acute crisis phase, where the person tries to cope with the knowledge of impending death; the chronic living-dying phase, during which the person works through the fears and anticipatory grief; and the terminal phase, wherein the individual begins to close off his or her emotional investment in life, and prepares for death.

As the individual enters the status of being in the living-dying interval, his or her status in society changes as well. Typically, when his or her condition is known to others his or her definition as a member of society is modified. The clarity of terminality produces marked changes in the ways in which the rest of society relates to the individual. Typically, the person in the living-dying interval is isolated from his or her everyday world and the people in it.