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Editorial: Death, dying, and bereavement
  1. Gillie Bolton
  1. Medicine and the Arts, King’s College London University, Department of English, Strand, London WC2R 2LS, UK; gillie.boltonkcl.ac.uk

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    Death, dying, and bereavement are dark threads running through all literature. Not only are they life’s sole certainties, along with birth; they are also the biggest mysteries of biological science. What is gained in conception and birth, and what leaves the body at death? “The body dead is our world’s great secret … it’s our condition to not know.”1 Death, dying, and bereavement are written about in many ways: with personal anguish or clinical detachment, spiritually, practically, dramatically, horrifically, violently, lovingly, and gently. A large proportion of all poetry is devoted to these subjects (along with love of course). Fiction often hinges upon a death or a birth.

    Medicine and health care pay increasing attention to the way death is managed. Reading is a way of listening and reflecting deeply on the vital experiences of others. This seemingly second hand knowledge can stand a clinician in good stead. Experiences of bereavement, death, and dying are intense and vital to those concerned; it is impossible to correct shortcomings of judgment, compassion or understanding later.

    Death, and its associated suffering, is feared in our culture partly because it does not have a role in our everyday lives. The processes of dying, and dealing with a body between death and funeral, are tidied away. Our experience can be widened by reading about the experiences around death and dying: the vast and bewilderingly altering emotions, complex family disruptions and passions, tortuous legal and practical issues, responsibilities and cares, unexpected freedoms. There are many texts for children dealing with death, for example, written and published with an overtly educative function. Death is also feared for its mystery. We belong to a culture which has difficulty in accepting, as Doty does, that it is our condition not to know.

    Expressive and explorative writing also have a vital part to play when the writer, or one close to them, is dying. Such writing—for example, a journal, or poetry—can help towards gaining clarity and understanding. The certainties of life are often stripped away by death, dying, and bereavement. Writing can enable the sufferer to question and begin to find some sort of a route to answering, for example: who am I, where am I going, what am I leaving behind, what do I want to say to whom? It can also help them to celebrate the life that has been lived.

    Opening the word hoard is edited by Gillie Bolton. Items should be sent to her at the address at the end of her editorial.

    Such writing can help the bereaved, the dying, and also clinicians involved in the care of the dying, to take more responsibility for the stories of their own lives. Stories of our lives are constructed by us, and by others about us; some tend to take more responsibility than others. The wife of an elderly man I knew claimed to “know him better than he knows himself”; some children allow their parents to take such responsibility for their story. It can be helpful to such people to be supported to take more responsibility for their own life stories, particularly at the end of life; and those with a negative focus to their plotline might be helped to rewrite in a more positive mode. Galen Strawson asserts that there is no necessity for those who do not naturally construct their own stories of their lives to do so.2 If life goes right, I am sure this is so; but it does not always go right, particularly around a death.

    A hitherto accepted life story may be disrupted by the death or dying; there may be aspects of this new phase of life which do not work or are difficult to connect with previous aspects of life. A young breast cancer patient I worked with wrote a letter to her husband days before her death, telling him that whatever her pain, she still wanted cuddling.3 She could not manage to SAY this to him. She got her cuddles, but sadly, he told me after her death, he did not realise he could write back; so many things he wanted to say were left unsaid.

    Working with literature, writing, and narrative can be helpful to clinical staff in helping patients to understand and relate to their own lives better. Strawson2 ridicules the narrative programme at Columbia University as only restating the truism that doctors should listen to their patients.4 What, as a philosophy academic, he does not seem to realise is that we need strategies for enabling and encouraging doctors to be able to listen to their patients more effectively. Narrative understanding is just such a route.

    The processes of writing offer so much: the story form with its fictive completeness of beginning, middle, and end; the illuminative strength of metaphor and image; the soothing and calming order of rhythm and rhyme; the release of expressing and effectively communicating powerful experiences and emotions: “Give sorrow words: the grief, that does not speak, /Whispers the o’er fraught heart, and bids it break”.5 There are no more powerful words to support the “o’er fraught heart” than written ones.

    Remembered intensities associated with death, bereavement, and birth also present themselves as appropriate writing subjects. When I ask clinicians to write about a vital experience in their lives (reflective practice for professional development), both men and women often write about a death, or the birth of their first child. Dealing with death encompasses the clinical areas most likely to lead to anxiety and burnout.

    The two pieces below concern death in very different ways. Judy Clinton writes about the harrowing suicide of her son: the result of no crime, yet society and obstetric medicine were clearly at fault. The clarity and poignancy of the writing are an education to those of us who thankfully will never suffer such blows. Juliet Carpenter writes about a patient’s death with reflective understanding and sensitivity. The writing explains and celebrates her full responsibility for her actions. (Readers might also like to reread John Graham Pole’s Consent and consensus, about the death of a child patient.6)

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