MORTALITY

Most of us like to pretend death won’t ever happen to us. Now the death wellness movement is aiming to change that by encouraging us to talk about it – a lot. They’re bang on point: global trends show a radical rethink in our approach to dying. So... do y

Are you ready to talk about death?

Biting the dust. Kicking the bucket. Pushing up daisies. Giving up the ghost. Shuffling off this mortal coil. Taking a dirt nap. Meeting your maker. And my personal, irreverent favourite: Popping your clogs. Once you start listing the euphemisms for dying, you realise just how many there are – and how uncomfortable we are talking about death. Yet we’re all going to face it.

Growing up, we often used to drive past a desolate little cemetery next to the highway. Without fail, my mother would say, ‘If you bury me here one day, I’m coming back to haunt you.’ As teens, my brother and I leapt at the opportunity to tell her that this was, in fact, exactly what we planned to do. We’d say we had already picked out her plot and the threat of haunting was really more of a perk: we were thrilled that she was planning to visit us in the afterlife.

I know this seems a bit morbid (or even flippant), but it may also be the reason that I know what she does want when she dies one day – which, I’ve come to learn, is quite uncommon. Most people avoid talking about death at all costs, telling their kids the family dog has gone ‘to live on a farm’ – and leaving relatives shocked by the contents of their will when they eventually pass away.

DYING SOLO

Over the years, we’ve become more and more disconnected from death as part of life. In the 19th century, the sick and the dying were typically housebound and tended to by family members. As a result, most people died at home, where the household

Estimates are that the energy required to cremate one body is equal to driving 7 725 km.

would then host the wake and the funeral. (In Victorian times the deceased would be watched over for three days before the burial – to make sure they didn’t suddenly wake from a deep sleep.) These days, however, death has become medicalised, with most people dying in a hospital or nursing home.

‘Too many people die clinical deaths,’ says Beth McGroarty, vice president of research and forecasting for the Global Wellness Summit. In 2019, The Global Wellness Institute, a non-profit organisation dedicated to healthy living, identified ‘death wellness’ (also known as ‘the deathpositive movement’) as an emerging trend worldwide. Besides a growing desire for a more comforting, less sterile passing, the movement also extends to a growing curiosity around death. People want to talk about it, they want to know the details of what happens, they want to look into alternatives to traditional funerals, and they don’t necessarily want to be buried in a coffin, six feet under.

‘Everything around dying is getting radically rethought – from making the experience more humane to mourning and funerals getting reimagined,’ states the ‘2019 Global Wellness Trends Report’.

DEATH DOULAS

According to Odette Green, a Western Cape death doula (we’ll get to that in a minute), her profession is focused on reinstating a traditional way of looking at death. In an interview with CapeTalk host Pippa Hudson, she says, ‘Modern society has taken the dying, put them aside, and gone, “Shhh, you’re sick; you mustn’t be here; you must go and die by yourself.” Whereas, eons ago, dying was cultural – it was villaged. Families did it. The children knew when people were dying. People were not shoved to one side to die alone. Our modern societies have lost touch with the dying.’

Even more alarmingly, an increasing number of people are dying alone, with neighbours or relatives only discovering their bodies weeks later. In Japan, where a large part of the population is advanced in age, this is such a common occurrence that it even has a name. In 2017, a popular Japanese magazine noted that there were 4 000 occurrences of kodokushi (translated as ‘lonely death’) a week.

Today, the process has been outsourced largely to hospital staff, even though doctors are often illequipped to deal with death. They’re trained to prevent it at all costs and to manage pain, not to give end-oflife care.

‘At first glance, physicians’ poor understanding of death and the process of dying is baffling, since they are supposed to be custodians of health across the lifespan,’ writes Dr Junaid Nabi, a physician and medical journalist, in an article for medical media company STAT. ‘Look deeper, though, and it may reflect less the attitudes of physicians themselves and more the system that nurtures them. After all, we train vigorously on how to delay the onset of death, and are judged on how well we do that, but many of us get little training on how to confront death.’

Enter the death doula. The term doula (from the Greek for ‘servant’ or ‘helper’) is usually associated with someone who helps a woman give birth – but in 2003, the concept of a death doula was, er, born. Frustrated by the lack of care medical staff were able to give dying patients and their families, New York City hospice social worker Henry Fersko-Weiss created the first professional training programme for so-called death doulas, also known as ‘end-of-life midwives’, ‘transition guides’ or ‘end-of-life integrative nurses’. The International End of Life Doula Association (Inelda) offers online programmes and weekend workshops, and in 2017, the Larner College of Medicine at the University of Vermont started its End-of-life Doula Professional Certificate programme. ‘We can’t keep up with our waiting list,’ says programme director Francesca Arnoldy. ‘The last time we opened up registration, the applicants crashed our system.’

Here in South Africa, similar training programmes have also started cropping up.

So what exactly does a death doula do? In another interview on CapeTalk, Vivienne Katz of Doulagivers SA explains: ‘The death doula is a non-medical person who assists somebody going through end-of-life stages. They support them physically, emotionally as well as spiritually. We all have to end our lives on this physical earth, and we spend a lot of time welcoming in new life. But we really neglect people on their last few days on this earth. People tend to avoid them, they don’t want to visit them, and many people die a very lonely death either at home or in a hospital, not surrounded by loved ones.’

Having worked as an intensivecare nurse for many years, Katz says her occupation is ‘definitely a calling’. ‘It appealed to me to help people get closure of this life – to be complete with their journeys and to have a wonderful death. I had many friends whose family and parents were diagnosed with a terminal illness, and often their deaths were so fraught with pain and anger and sorrow and incompleteness that it shocked me.

‘We don’t have the capacity in this country for medical professionals to be doing this and, quite frankly, I don’t think they’re trained how to do it. I worked in a hospital for many years and we certainly had very little training. Hospices have training but they don’t have the resources to spend all their time with you. So a death doula is somebody in the community who sits with you and helps you. They help you prepare: How do you want to be remembered? How do you want your funeral to be? I know it sounds macabre, but when you help a person to have closure it’s neither scary or distasteful.’ The process, says Katz, can even be joyful.

‘Generally, people who are dying know they are dying,’ says Green, ‘and they want to have those conversations. It’s the people around them who don’t want to have those conversations. [The dying] want their lives to count. They want their stories to mean something.’

‘Death doulas are also superfocused on helping the dying create living legacy projects so they take a creative role in the stories they leave behind,’ writes Beth McGroarty in the trends report. ‘They help them create artistic things, such as memory books and boxes, audio and video recordings, letters, interviews, collages and scrapbooks, so they can review and process, and leave behind who they really are. They often serve as scribes and communicators, from helping the dying make amends with estranged friends and family members to writing letters to loved ones to be read at a future wedding day or birthday.’

Once a ‘client’ dies, a doula would also stick around to support the family. ‘Family and friends are not left devastated. They are left with peace in their hearts,’ Katz says.

CAKE AND DEATH

Another emerging trend is the need to talk about death. Festivals, gatherings, podcasts and YouTube videos are stripping away some of the mysteries around death – and getting people to discuss their fears, ask questions and engage with something that is usually kept hush-hush.

In San Francisco, you can attend a festival called Reimagine End of Life, a week-long event that delves into the topic through the arts, design and performances. Ask a Mortician is a very popular YouTube series, hosted by Los Angeles celebrity mortician Caitlin Doughty, that delves into nitty-gritty topics like how corpses decompose. A non-profit called Death Over Dinner facilitates conversations about death and dying over some roast chicken, and there are Death Salons that explore ways to ‘prepare a death-phobic culture for its inevitable mortality’.

You could also pop into your nearest Death Café, a non-profit programme that encourages strangers to gather to ‘eat cake, drink tea and discuss death’. And it’s not as creepy as it sounds. In her 2018 memoir Self-helpless, journalist and author Rebecca Davis describes her experience at a Death Café in Cape Town. Seated at a table with four to five strangers, participants were encouraged to talk about their fears and tell their stories. One woman’s parents both committed suicide, and as a result nobody had ever wanted to talk to her about death. Another spoke about the sudden death of a family member at 35, and how awful his funeral was.

One man voiced his secret fear that he hadn’t experienced the death of a loved one yet – he worried that he was ‘somehow amassing a tidal wave of overdue death to be unleashed at some moment in the future’.

Others are more practical. ‘One man told us that every time his parents amend their will, they email it openly to all family members. It’s not just to prevent squabbles about inheritance, he said, but also a reminder that they know they are going to die and have planned for it.’

By the end, Davis marvelled at the depth of the conversations they had. ‘Later, it struck me that our hunger for these conversations is not just the result of a longstanding cultural block on discussions of death. It is also about something broader: the loss of a sense of community in urban life, the lack of secular spaces to discuss issues of meaning, and the scarcity of moments of real human connection in the modern world.

‘There is an undeniable sense of relief in understanding that you are not alone in these fears, and simply sharing them aloud provided a window of real catharsis. But what will keep me going back is something different, though just as profound. I will return to the Death Café for the vanishingly rare chance of authentic, unguarded communication with other humans – and the reminder that we really are all in this together.’

If you are Muslim, Jewish or Catholic, there are specific rituals related to funerals, such as bathing the body, shrouding it in white cloth, sitting shiva or having last rites administered. Others are choosing different paths. Living funerals –

celebrating a person’s life while they’re still alive – are becoming popular. And many people now have funerals at home, with personalised tributes, music and far-flung relatives attending via Skype. Destination funerals are on the rise too – if Gran wants to be laid to rest in Tahiti, who are you to deny her that?

OUTSIDE THE BOX

We tend to think of cremation or burial as the two main options when it comes to laying a body to rest, but some cultures have other, more unconventional methods. In Tibet, bodies are left on mountaintops to be picked clean by birds of prey

– a practice known as ‘sky burial’. The Caviteño of the Philippines inter their dead in hollowed-out tree trunks.

In North America, bodies are typically embalmed and buried in concrete or steel vaults in graves. But cemeteries are running out of space, and there’s a growing awareness of the ecological impact, as documented in the trends report: ‘Every year in North America, 800 000 gallons [about 3 million litres] of carcinogenic and contaminating formaldehyde are dumped into the soil, along with 115 million tons of casket steel, 2.3 billion tons of concrete, and nondegradable hardwood for caskets that equals four million acres of forest – all of which take centuries to degrade. Cremation is relatively less environmentally destructive, but estimates are that the energy required to cremate one body is equal to driving 4 800 miles [7 725 km] – and cremation still spews toxic carbon dioxide, dioxin and mercury into the atmosphere.’

As a result, green burials are on the rise: the body is placed directly in the ground, or is first wrapped in a biodegradable shroud, or is interred in a biodegradable coffin.

If you’re set on cremation, there are more earthfriendly options too: so-called ‘wet cremation’ (resomation or alkaline hydrolysis) makes use of a water-and-saltbased solution to break down human remains. It releases no chemicals and uses 80% less energy than regular cremation.

There are alternatives that are more out-there. You could, for example, buy a mushroom burial suit lined with flesh-eating fungi that would speed up the decomposition process. You could become part of an ocean reef, or invest in an egg-shaped burial pod that would effectively use your remains to fertilise a tree planted above it. Or you could turn your body into a family heirloom – in 2017, the Cremation Association of North America predicted that blue ‘memorial diamonds’ made from human remains would make up more than half of all body disposals by 2020. (A bit of a reach, that one.)

If you find all this disturbing, consider that, according to mental health experts, denying or fearing death causes serious issues. The more you talk about it, the better off you are. Greek philosopher Epictetus, for instance, believed an awareness of one’s impending death was a guiding light of sorts. ‘Keep death before your eyes each day… and you’ll never have a base thought or excessive desire.’

In Bhutan, meditating on death on a daily basis is advocated as a path to happiness. There’s even an app for that: some notifications include facts and quotes about dying, but for the most part all the WeCroak app does is send you five daily reminders that you’re going to die.

Archbishop Emeritus Desmond Tutu, meanwhile, believes death should be met with a sense of awe. ‘[It is] the wonder of someone going to meet their maker, returning to their source of life. In some ways, death is like a birth; it is the transition to a new life.’ On a more practical note, his advice is simple: accept that it’s inevitable, talk to your loved ones about it, make amends and, if you can, say your goodbyes.

‘We have to die,’ Tutu says. ‘The earth cannot sustain us and the millions of people who came before us. We have to make way for those who are yet to be born. And since dying is part of life, talking about it shouldn’t be taboo. People should die a decent death. For me, that means having had the conversations with those I have crossed in life and being at peace. It means being able to say goodbye to loved ones – if possible, at home.

You could also pop into your nearest Death Café, a nonprofit programme that encourages strangers to gather to ‘eat cake, drink tea and discuss death’.