The Natural Death Handbook, Fifth Edition

A thoroughly updated and revised edition of the Natural Death Centre‘s celebrated handbook. Now presented alongside a new collection of essays on death, dying and funeral practices by doctors, historians, authors, poets, theologians and artists including Richard Barnett, David Jay Brown, Dr Sheila Cassidy, Charles Cowling, Bill Drummond, Stephen Grasso, Maggi Hambling, Graham Harvey, Gary Lachman, Nick Reynolds, and Dignity in Dying.

It’s out in May 2012!

First published in the New York Times by SIDDHARTHA MUKHERJEE

It had rained heavily the night before. The steep stone steps of the ghat are slick and slippery, and when my father pulls me onto the boat, the water feels more stable than the ground. The boatman rows out toward the open river, and the city of Varanasi swings into full view.

On the bank, wrestlers are performing calisthenics; a vendor is selling marigolds; a man is throwing birdseed at pigeons. The river moves sluggishly at first — but then a current forces the boat around the bend, and we are floating silently by the Manikarnika ghat, where the dead are burned.

I am 8 or 9 years old. Save a distant uncle who has died of renal failure, I have had no personal experience of death. I imagine it as little more than a corporeal exit from the world.

It is an unforgettable sight: row upon row of burning bodies on wooden pyres by the river’s edge. There are dozens of pyres lighted at the ghat, like lanterns along the river. Around them, a circus of death unfolds. There are sons waiting for a professional barber to shave their heads. Men carry the bodies down to the water.

The bodies, swathed in white cloth and strewn with flowers, are bathed, washed and then taken onto a bedlike pile of wood and set alight. The fires burn sometimes for hours. When the flames begin to sputter, the priest shovels the ashes, still smoldering, into the river. The melodrama of the scene is nearly perfectly offset by the glum, mechanical matter-of-factness of its participants. Mounds of ash and marigold and wood chips are floating all around the boat.

There is a man standing by one of the fires and facing the boat, with his arms still taut, as if holding the body — except he is holding air. I bury my face in my father’s lap, but curiosity, literally morbid, forces me to look and to look again, as we drift past. The scene on the bank is mesmerizing. Then the boat rounds another bend, the haunted tableau vanishes, and we debark at another ghat.

Decades later, having trained as an oncologist in Boston, I attend the funeral service of a woman who has died after a long battle with cancer. I remember approaching the coffin, and then registering something odd: the woman has been coiffed and dressed up, and there is the faintest blush of lipstick — lipstick? — on her mouth.

The eulogies at the service are moving and emotional. But the funeral itself seems cleansed and sanitized into a clinical, nearly forensic, ethereality. There are children in dark suits sitting on the aisles looking like miniature adults. I wonder if any of them will be haunted by this funeral, or dream often about it, as I did after that disorienting vision decades ago.

At medical rounds a few days later, I ask some residents and interns about death: how many have carried the body of a parent? What does the weight feel like? And what about the ritual of bathing and cleansing?

In the United States, most terminally ill men and women die in hospitals or nursing homes. The death is typically “pronounced” by an intern on call. The body is lifted out of its bed by an attendant and wheeled to a morgue by another shift worker in scrubs. Undertakers clean and dress it.

Before a cadre of professionals took over the job, people of many faiths took part in the care of the bodies of the dead. Early Christians typically prepared their dead for burial themselves. The novelist Catherine Madsen writes about the Tahara, a Judaic rite in which bathing the body in warm water is accompanied by the reading of ecstatic love poetry to the dead man or woman. If the ritual were revived today, Madsen predicted that “there would be nervous giggling about . . . necrophilia; the plan would be . . . declared inappropriate and quietly dropped.”

Indeed, when I recount Madsen’s description to the residents, it makes them nervous. Our experience of death has become disembodied. The corpus has vanished from the most corporeal of our rituals — and we are left standing with our hands outstretched and taut but with no counterweight to bear, like the man on the riverbank holding air.

 

Siddhartha Mukherjee is an assistant professor of medicine in the division of medical oncology at Columbia University. He is the author of “The Emperor of All Maladies: A Biography of Cancer.”

Hat-tip to Beth Knox of Crossings

In his excellent book Curtains, Tom Jokinen quotes US undertaker BT Hathaway on the subject of home funerals. Hathaway reckons a home funeral suits “the 5 per cent who have money, time, resources, education and political and emotional will.” With preconditions like these, how come it ever got as high as 5 per cent? Hathaway concludes: “It’s poetic, but the truth is, I don’t know that many poetic families.”

Poetic? I’m not sure about this elegant disparagement. Jokinen draws his own wrong conclusion: “This is of course the same argument for why people eat at Pizza Hut instead of milling their own wheat and breeding their own pepperoni cattle.” Here we have an overstatement. You don’t have to grow a tree to make the coffin, neither do you have to plant your own jute to make the lining.

But convenience is a seductive thing. And time is of the essence. A dead body is potentially a chaotic, eruptively ugly thing; it makes a lot of sense to call the experts in and keep a safe distance. And we reflect here that, when people die, those who loved them urgently want the body back from wherever in the world it conked out. They want this with a fervour which arguably defies reason. This may be not so pronounced in the UK, where dead soldiers were buried where they fell as late as the Falklands war. But in the US the historic clamour to have the body returned led to a stream of dug-up coffins coming back, once hostilities were over, from the battlefields of the first and second world wars.

So: distance matters. The body must come home. Propinquity is good. But closing the distance and engaging with that body? NO!  At the last, we need our cordon sanitaire, cowards that we are. Here we record the loss of the lesson of the teachings of all the great religions that the dead body should be treated as an object of veneration.

At the end of his book Jokinen begins to reap the harvest of his experiences as an undertaker’s understrapper. Here’s what he says:

“Instead of deflecting a confrontation with death through commerce, you face it, fill the hole by hand, and then get on with the hard work of mourning, knowing that instead of passively choosing an object from a catalogue and subcontracting the ritual to someone else, you’ve acted, taken a stand, not against dirt, in fact, but in favour of it. An act with a meaning.”

Later the same day he meets his wife for supper. “I have seen the future,” I tell her. “And it’s Jewish.”

In other words, he finds the middle ground between doing it all (the home funeral) and doing nothing: giving in to “the impulse to fix grief through shopping.”

A lot of religious law has to do with physical and emotional health. Much law relating to diet has been rendered obsolete by simple advances in hygiene. Leviticus is for that reason looking decidedly old hat these days, and pigs unfairly deprecated. But a number of Jewish practices, however ritualised, retain their (thank you, Mr Hathaway) poetic value because they promote healthy grieving.

Sitting shiva, for example. Taking yourself out of the loop, telling your employer to get stuffed and staying at home for either seven or three days after the burial. Time exclusively spent getting your head around it but, importantly, time which is bounded. Got to be good.

And then there’s the work of the chevra kadisha, the little community team that performs the tahara – the ritual preparation of Jews for burial. This involves the right prayers, of course, and also the washing and dressing of the body with immense respect, concluding with an apology to it should anything done have offended it.

I’m not making a pitch here for the return of the splendid and formidable laying-out woman. All I would observe is that, if a dead body is held precious, then it makes good emotional sense to play a part, under the eye of experts, in getting it ready for burial.

There’s a very good little video film which talks about the work of the chevra kadisha and shows the tahara performed in a funeral director’s mortuary. I’d embed it if I had the skills. If you want to skip straight to the tahara, start 6 ½ minutes in.

Click here.