By Joanne Tippett

Meaning and Symbol, Soicology 308

"In every society, the dominant idea of death determines the prevalent concept of health. " (Illich 1976 :174).

There is an intimate connection between a society's conception of death and that of its conception of illness. This in turn colours conceptions of health. Many of these links can be seen in funeral rites and the way in which a society deals with death. In this essay, I will look at the way in which contemporary British and American society deals with death, the medicalization of death and health and the links between a reductionist scientific world view and disconnection between people and processes of decay and how this affects people's ability to construct a healthy lifestyle and to take responsibility for their own health. I will explore possible links between gardening, ritual, sex and creativity, as I feel these can be positively related to the way in which people deal with death.

Conceptions of Death in Western Society

In modern Western society #, there is a great medicalization of death, "when hospitals draft all those who are in critical condition, they impose on society a new form of dying. " (Illich 1976 : 42). Most deaths occur in hospitals and are under the control of physicians who are conferred the power to decide when a person is dead and in what manner they will die, whether they will be given pain killers, what forms of technology may be used to help keep people alive for longer. (Illich 1976). There is also a corresponding medicalization of life, "society has transferred to physicians the exclusive right to determine what constitutes sickness, who is or might become sick, and what shall be done to such people" (Illich 1976 : 6).

(#Note : in order to avoid lengthy descriptions of what I mean each time I mention contemporary British society,I will use the words 'our society' and 'Western society' in this text, basically in reference to contemporary British and American society (I feel some ambiguity in my own cultural makeup between these two countries). I also wish to state a disclaimer that I am not speaking for all people in a culture, indeed, the very idea of a homogeneous culture which could be discussed in a text such as this is problematic in itself, especially if one were to take into account possible cross-gender and ethnic differences in interpretation., It is outside the scope of this paper to delve too deeply into these complex issues, but I am aware of a problem in even trying to talk about a thing such as modern Western or British culture.)

Medical science has been conferred a moral neutral ground, which has been "defended on the grounds that medical categories, unlike those of law and religion, rest on scientific foundations exempt from moral evaluations' (Illich 1976 :47). As Shiva has suggested, "modern science is projected as a value-free system of knowledge which has displaced all other belief and knowledge systems by its universality and value neutrality" (Shiva 1989 : 15). Thus science and the medical profession have infiltrated our conceptions of life and death and given power to determine the way in which we live our lives. Illich suggest that medicine has taken the place of traditional rites of passage in our society. "The ritualization of stages of life is nothing new, what is new is their intense medicalization. (Illich 1976 :89).

One of the effects of this medicalization of the life cycle is that "people are turned into patients without being sick. " (Illich 1976 :89). Illich has called this the medicalization of prevention and cites examples such as the medicalization and treatment of birth and old age in hospitals. Medicine determines how a baby is to be born, whether or not it will be deemed as healthy or in requirement of treatment, and towards the end of the life cycle, medicine decides whether or not an old person can be allowed to die, or whether they will be treated for what is an essentially un-curable condition, the process of aging. Through life, people are subjected to routine testing, and physicians have the power to place them in categories determined by their clinical procedures. Such testing "transforms people who feel healthy into patients feeling anxious for their verdict. " (Illich 1976 :92). Illich also suggests that many studies show this testing does not increase life expectancy, it only creates categories of ill people.

According to Illich, we demand a high-tech care of our bodies, relegating control to the medical profession , as we feel "a deep seated need for the engineering of miracles. Intensive care is but the culmination of a public worship organized around a medical priesthood struggling against death." (Illich 1976 :106).

Hockey suggests that one characteristic of contemporary British society is an inability to deal with death. "The living are seen to have no direct relationship with death. It stands apart, separated off by boundaries...medical, social and conceptual" (Hockey 1990 : 27). Hockey suggests that separation of the living from the dying and from death is done in spatial and temporal terms, there is a distinct boundary which is maintained by the medical profession as well as through the creation of distinct categories of people and of groups which are perceived as marginal, such as the elderly and the diseased, which are kept distinct from normal society. (Hockey 1990 : 36). One example of this creation of boundaries which Hockey cites is the separation of elderly people into the spatial construction of an old people's home, conceptually at the margin of society. This is seen as "a way of controlling and distancing physical deterioration which falls outside the powerful curative scope of the medical model. " (Hockey 1990 : 155).

Hockey suggests that people in Western society stress death as the end point, at which a limit which cannot be surpassed has been reached. She sets this in contrast to societies which emphasize continuance and transcendence in relationship to death, where death symbolism is often included in rites of passage which mark changes in state during the life cycle. (Hockey 1990 :39).

This conception of the creation of boundaries has a deep significance in Western society. "Modern medical science....(has) been held to contribute to a fragmentation of the unity of the person." (Martin 1987 : 19). We tend to have a compartmentalized thinking, which is loath to see connections, but rather sees entities as discreet in their own right. Capra suggests that conceptions in modern physics and natural sciences influences more than simply technology, they extend "to the realm of thought and culture" (Capra 1983 :21). This conception covers both the human body and nature, perceived as separate from the body. Shiva suggests that these divisions and "the reductionist and universalizing tendencies of such 'science' become inherently violent and destructive in a world which is inherently interrelated and diverse." (Shiva 1989 : 14).

One of the ways in the violence of separation of thought and reduction as opposed to holistic, integrative thought can be exemplified is through our attitude to death. Metcalf and Huntington describe an American (and I would suggest by extension, a British) attitude to death as an "endless shying away from confrontation with mortality". (Metcalf and Huntington 1991 : 201).This has many far-reaching consequences. "When we deny death's inevitable role in our lives, it saturates our sense of being as a threat to life. " (Lawlor 1991 : 364).

Conceptions of Illness in Western Society

Conceptions of death permeate the meaning which a society give to the idea of illness, as Sontag has said, "part of the denial of death in this culture is a vast expansion of the category of illness as such." (Sontag 1977 :56). Conceptions of illness, and by contrast, health, are never simple categories. Modern science would have us believe that illness is identifiable, with causes which can be isolated as a system and treated. I would suggest, however, that ideas of health and illness are culturally constructed and yield to many different interpretations, which can have far reaching effects in the way in which a society is organized. One example of the way in which conceptions of health are affected by cultural systems in the West is the use of metaphor in description of illness.

Lakoff and Johnson have identified the way in which metaphor can "structure the way we think, talk and act". (Martin 1987 : 76).Sontag describes the way in which metaphor is used to describe and make meanings of tuberculosis, cancer and AIDS She says that in Western society, "Disease is seen as an invasion of alien organisms, to which the body responds by its own military operations, such as the mobilizing of immunological "defenses". Sontag 1989 : 95). She suggest that the main use of metaphor in describing cancer are drawn from the realms of warfare, "Thus cancer cells do not simply multiply, they are "invasive".... Treatment also has a military flavour. Radiotherapy uses the metaphors of aerial warfare; patients are "bombarded" (Sontag 1977 : 64 - 65).

Sontag links the metaphors used to describe illness with society's current fears and concerns. This can be seen in two examples of the metaphorical associations given to cancer and AIDS, "fear of sexuality is the new, disease sponsored register of fear in which everyone now lives. Cancer phobia taught us fear of a polluting environment; now we have the fear of polluting people that AIDS anxiety inevitably communicates" (Sontag 1989 : 159).

Funeral Rites, Connections and Sex

In Western society, we tend to be very little connected to the rites in funeral practises. We are not invited to participate, but rather relegate the handling of death over to experts, to the doctor at the onset of death, to the mortician to deal with the body and to the church to organise a ritual which we are to attend in a passive role. Indeed, many Americans are so thoroughly sealed off from death, they have never seen a corpse.(Metcalf and Huntington 1991 : 26). Bodies are embalmed, this process prevents the necessity of a confrontation between mourners and "the processes of putrescence in the corpse...this horror of corruption may be seen as a special case of (a) general aversion to bodily processes (in American society)." (Metcalf and Huntington 1991 : 198).

By contrast, in Malagasy society, death and death ritual are seen as all pervasive forces in the social life of the community. Tombs are very elaborate and predominant on the landscape. Funerals are expensive affairs, in which there is much social and religious significance. (Metcalf and Huntington 1991 : 110).

In western society, it would be deemed improper and inappropriate to mention sexual activity in the context of a funeral. Traditionally, widows were required to wear black and go into mourning for many years, a compete negation of their lives as sexual beings. Stringent mourning requirements were relaxed during the World Wars, due to the high number of deaths and therefore widows. (Metcalf and Huntington 1991). Funerals are still, however, solemn affairs. Hushed tones and quiet demeanor are considered to be appropriate behaviour. There is a de-emphasis on processes of decay and decomposition, and there is little reference to the rotting of the body to return fertility to the ground. This has not always been the case in Western society, Illich describes the battle which the early Church fought with pagan death rituals in Europe, "from the fourth century onwards, the Church struggled against a pagan tradition in which crowds, naked, frenzied and brandishing swords, danced on the tombs in the churchyard. ...Death was an occasion for the renewal of life. Dancing with the dead on their tombs was an occasion for affirming the joy of being alive and a source of many erotic songs and poems. " (Illich 1976 :176).

We can also see alternative views of funeral behaviour in different cultures. Metcalf and Huntington describe Malagasy funerals, where : death, "social order, fertility and all that these entail are naturally and positively related ... The combination of themes of death and sexuality contains little of the antisocial power that these themes evoke in our cultural tradition". (Metcalf and Huntington 1991 : 111). Funeral rites include drunken and rowdy behaviour, believed to be necessary as the newly dead will be lonely and in need of entertainment. There is much food and music as a type of orgy ensues, with sexual activities which would be outside of societal norms at other times. There is a lot of noise and songs with sexual themes are sung. (Metcalf and Huntington 1991 : 112, 117). There is a deliberate serving of rum in order to generate rowdy behaviour. (Metcalf and Huntington 1991 : 128). Metaphors of sex and birth are played out in the actual burial. The men capture the coffin from the women's house, and run to the mountain, followed by the girls with disheveled hair and clothes. There is a physical struggle between the two groups involving tug of war, which eventually culminates in the men having to barge through a barrier of girls using the coffin as a sort of battering ram, in a metaphor of sexual penetration. The body is buried head first, as if being birthed like a foetus. (Metcalf and Huntington 1991 : 128).

Death, Decomposition and Gardening

I would make a link between an attempt to create rigid boundaries between life and death to a dissociation of Westerners from processes of decay, fertility of the soil and the growth of plants.

Our rubbish is removed and put out of sight and mind, it is a linear flow from use to waste product. Sewage is flushed away and disappears, it is usually not conceived of as a source of fertility, but rather of pollution. Berry has suggested that this division between people and decomposition can have very harmful consequences and suggests that the divisions we create between rotting and fertility have sexual and ecological implications. "It is apparently the nature of division sooner or later to destroy what is divided; the principle of durability is unity.. The divisions flowing from the division of body and soil are first sexual and then ecological." (Berry 1991 : 36).

Adams has argued that in South East Asia there are "strong parallels between certain manufacturing processes and mortuary rites" (1977 in Metcalf and Huntington 1991 : 72). In our society, we tend to buy food prepackaged and prepared, with very little idea of where it has come from and very little physical involvement with the processes of growth. In a similar way, we often treat corpses as elaborate packages which are meant to be preserved in a state of beauty in a funeral parlour. (Metcalf and Huntington 1991 : 26).

We are also very separated from the processes of producing the goods we use in our daily lives. This can be contrasted to the making of indigo dye and hemp fiber in South East Asia. Indigo is prepared as a dye stuff by the fermenting of the plant in pits in the earth, hemp fiber is allowed to rot in pits in order to separate the fibres, then is beaten and twisted into rope. The interesting element about many of these processes is that they all involve "decomposition to produces useful things." (Metcalf and Huntington 1991 : 73). In these societies, such as the Berawan, there is a formal symmetry between the preparation of fermented food and products and the treatment of the corpse. This involves three processes, those of preparation, decomposition and extraction. (Metcalf and Huntington 1991 : 73). "Rotting does not have the wholly negative connotations that it does for us. Consequently, there may be a radically different set of attitudes to the decomposition of corpses than those found in the West." (Metcalf and Huntington 1991 : 74).

The Western fear and avoidance of processes of rotting and decay of the corpse can be set in contrast to the view of the Melpa in the New Guinea Highlands,"the flesh is not lost. It goes down into the earth and contributes to the earth and contributes to the earth's 'grease' or 'fertility' (kopong). In turn, plants grow from the soil, people eat these, and the cycles are continued." (Strathern in Bloch and Parry 1982 : 118).The tendency of corpses to rot is "seen as entirely correct for by this means flesh returns to the earth" (Strathern in Bloch and Parry 1982 : 121).

Ritual and Creativity

"Ritual focuses attention by framing: it enlivens the memory and links the present with the relevant past. In all this is aids perception. ...It can permit knowledge of what would otherwise not be known at all. ...There are some things which we can not experience without ritual" (Douglas 1966 : 64). Ritual processes can play an important part in a society's ways of knowing and perceiving, "when framed within ritual time and space, the revealing of the normally veiled, literal grounding of conceptual systems poetically reanimates or revitalizes those systems in their capacity to describe or interpret the world" (Hockey 1990 :87). I would suggest that part of the violence of an exclusively Western scientific approach to learning is that it excludes any other way of knowing, in the process denigrating and trivializing the perceptions possible in ritual.

Ritual processes, intimately tied to social processes, inevitably concern themes of life and death, with the themes often intertwined and seen as complimentary processes. Metcalf and Huntington state that ethnographers from all areas in the world report "symbols occurring in rites to promote fertility and the preservation of life" (Metcalf and Huntington 1991 : 75). Van Gennep undertook a survey of death rituals through out the world and found a preponderance of symbols of "regeneration and growth, expressed in symbols of agriculture and human fertility". (Metcalf and Huntington 1991 : 33).

Van Gennep identified three states in rites of passage, the first being the tearing of the initiate out of normal social structures, in order to enter a state he called liminality, which occurs in ritual time and space, then reintegration into the normal conditions in society with a change in state or status following the ritual.

It is the stage of liminality which I wish to explore in greater detail, in particular with reference to creativity and rotting. "Liminality is a condition which is essentially unstructured, a realm of pure possibility whence novel configurations of ideas and relations may arise" (Turner, 1967 : 97). There is a release from the constraints of everyday social structures and cultural units can be recombined in often bizarre ways. It is possible for new thought patterns and ways of perceiving to arise, thus liminality can be described both as : "a stage of reflection" (Turner, 1967 : 105) and "settings in which new symbols, models and paradigms arise- as the seed-bed of cultural creativity" (Turner 1985 : 9)." (Tippett 1993). .

In Turner's view, the process' "of rotting, of dissolution of form..provide the metaphor of social and moral transition." (Metcalf and Huntington 1991 : 71-72). I would suggest that this idea of rotting is often distanced in Western society, and this can be a block for creative ideas in culture and in the way in which we structure our lives.

Morris criticizes Turner's conception that "religion and ritual are liberating aspects of human culture, associated with equality and fraternity, creativity and human well being. " (Morris 1987 : 259.), as he feels that Turner does not allow for any sense of equality and liberation in secular life, "Outside the ritual context, Turner would seem to suggest, there are no 'human', personal relationships" (Morris 1987 :259).

One of the problems with Turner's formulation is that it effectively separates any notion of fraternity and reciprocity from secular activities at the same time as denying the role of hierarchy structure and equality at work within religion. "For Turner...humanity only seems to flourish in ritual "(Morris 1987 :263).

By incorporating this criticism of Turner, it is possible to broaden his concept of liminality to include non-sacred aspects of life. Schechner would argue that there is no longer a tight distinction between ritual and other, secular aspects of life. "This understanding of ritual, as a process applying to a great range of human activities, rather than as something tethered to religion, is a very important development" (Schechner 1993 : 20).

One of the aspects of ritual which Turner concentrates on is that of communitas, which is described by Morris as "a 'sentiment for humanity' of which Hume speaks, representing a desire for total, unmediated relationship between person and person" (Turner in Morris 1987 : 258). In my opinion, the most important aspect of Turner's ideas in relationship to our conceptions of death and relationship between the body and the earth, is that of liminality, not so much of communitas. It is this betwixt and between state which I feel holds much potential for changing the way in which we live our lives and create our conceptions of health, and thus are able to integrate the sacred into every day activities.

I would suggest that the idea of liminality could be applied to the processes of life, the growing of food, cooking, making objects for daily use. Turner seems to see liminality as coming into play more outside of these daily activities, whereas I could see a very fruitful connection between ideas of dissolving boundaries, and allowing for creative flow within daily processes and our relationship to the environment.

Turner has show that the stage of liminality tends to contain many symbols "drawn from the biology of sexuality and fertility" (Metcalf and Huntington 1991 : 38). It would seem wise to question what happens in a society when there is little emotional involvement in integrative rites of passage, where such rites tend to be medicalized, with the symbols of sexuality, death, decay, regeneration and growth carefully expunged to leave a clinical, scientifically explained reality which serves to further fragment the body into mechanical pieces separate from soul and soil.

Positive Health and the Medicalization of Society

Modern medicine's contribution to health often negligible,"in contrast to environmental improvement and modern non-professional heath measures, the specifically medical treatment of people is never significantly related to a decline in the compound disease burden or to a rise in life expectancy." (Illich 1976 : 21). It could also be suggested that modern medicine often has a specifically negative effect on health, with invasive clinical procedures and drugs prescribed to alleviate symptoms actually causing much damage. "The pain, dysfunction, disability, and anguish resulting from technical medical intervention now rival the morbidity due to traffic and industrial activities, and even war related activities, and make the impact of medicine one of the most rapidly spreading epidemics of our time. " (Illich 1976 : 26).

I would suggest that the damage done by modern conceptions of medicine go further than the specific damage caused by clinical practises, but also extends into our conceptions of body and of health. There is a tendency to see the body as a machine and to treat the symptoms specifically, without a holistic view of the body and an attempt to return whole health to the patient. "Descartes ..constructed an image of the body in terms of geometry, mechanics, or watchmaking, a machine that could be repaired by an engineer. " (Illich 1976 :150). Health is thus no longer conceived in terms of a holistic state, involving the way in which we live our lives in order to promote positive health, but rather as a state of absence of disease symptoms.

The medicalization of health "tends to mystify and expropriate the power of the individual to heal himself and to shape his or her environment." (Illich 1976 : 9). Illich suggests that our very dependence on the medical profession for our health robs people of the ability to construct a healthy lifestyle. "For more than a century, analysis of these trends has shown that the environment is the primary determinant of the state of general health of any population. " (Illich 1976 : 17). This can be seen to include the water we drink, air we breathe, food we eat, the housing we live in and the way in which we are able to move about. There are many issues of socio-political equity tied up with issues of health. In modern society, we tend consume a cocktail of chemicals from food, water and air, and we have little idea what the cumulative effect of these chemicals will be, both over time and as they act in combinations and produce surprising effects.

Sim Van der Ryn, an architect in California, suggests that our dependence on industrial economy for every aspect of our lives (from provision of housing to the removal of sewage to the provision of health care) does not allow us contact with "the constant cycle of death and decay...with living things" (Sim Van der Ryn in Walter, Arkin, and Crenshaw : 1992 : 65).

What Illich calls the 'de-medicalization of society' could empower people to accept responsibility for their own health and to take the responsibility to shape their environments in such a way as would encourage positive health.

Gardening for food is one of the most important ways in which we can encourage positive health. I would also suggest that this links directly to our conceptions of death as a society. By attempting to create boundaries between death as life and distance ourselves from processes of decay, I feel that we cut ourselves off from process of life, such as the process of growing food, of touching the earth (literally), making compost and the realization that rotting is the precursor of fertility and growth.

One example of the reclaiming of personal responsibility for health being transformed in to an involvement with the growing of food can be seen in Robert Hart's forest garden in Shropshire. He says " In taking over Highwood Hill, I resolved that the creative enterprise of building up a small organic farm was to be a major comprehensive and instructive answer to my own and my family's health problems" (Hart 1991 : 51). He did this through growing a varied and organic diet and through the use of medicinal herbs.

An inclusion of decay and growth in the way in which we live our lives can also be incorporated into ritual forms in our society, especially as it is realized that scientific experimentation does not offer the only valid form of knowing and way of perceiving. Douglas suggests an inclusion of notions of death into social forms can be a powerful force, "When someone embraces freely the symbols of death, or death itself....a great release of power for good should be expected to follow." (Douglas 1966 : 178).

A dissolving of some of the boundaries which we create between ourselves and death and the process of dying, including a reclaiming of death and health from the medical profession, can lead to the idea of death as less of an end point and more of a cyclical transition. "Death is a transition; but it is only the last in a long chain of transitions. The moment of death is related not only to the processes of afterlife, but also to the processes of living, aging and producing progeny. Death is related to life" (Metcalf and Huntington 1991 : 108). A reintegration of death and rotting into life could allow us to see the connections between fertility, sexuality and the earth This understanding could be integrated into funeral rites, in which people are active participants, not merely passive observers.

I feel in the West, a fear of death is damaging to our ability to live fully. If we were to integrate death, decay, and decomposition into our daily lives, we may be able to live more fully and to integrate ourselves with processes of life in the earth.

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