Category: COVID-19

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This is what ‘tree burials’ are like in Japan due to lack of space in cemeteries

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The families place the ashes on the ground, and plant an endemic species, forming forests in memory of the deceased.

Funeral rituals have accompanied human beings since they have notion of self. The earliest recorded burial is in Kenya, dating back 78,000 years. It is one of the oldest indications we have of a transcendence-oriented thinking: to the possibility that there is something beyond our earthly understanding.

With the advance of urbanization, and the apparently irreversible trend of population growth on the planet, the spaces to deposit the organic remains of the people has been compromised. We no longer fit. Given the situation, burials in Japan have had to take a new direction, which affects less the environment and appeals to a contemplative sense of eternal rest.

Rest in the shade of a tree

Natasha Mikles has dedicated her life to exploring the alternatives that exist to face death in the world. With the climate emergency in tow, the expert in philosophy from the University of Texas considers that the appropriation of physical land in favor of funeral practices it is simply no longer an option.

In recent years, Mikles has focused his study on Buddhist funeral rituals and narratives about the afterlife. In these Asian traditions, death is not understood as an end point. Rather, it is one more phase of the wheel of karma, and a step forward in the path to enlightenment.

Many times, however, the author acknowledges that “environmental needs collide with religious beliefs“, As detailed in his most recent publication for The Conversation. Rest perpetually under the shade of a tree in a public green area it could be an option, as is being seen in burials in Japan today.

A new way to face death

burials in Japan

It is not the first time that burials in Japan have been practiced in this way. Since the 1970s, there has been a record of Japanese public officials fearing for the lack of funeral space for the population, particularly in urban areas. The problem deepened in the 1990s, when more serious alternatives began to be implemented throughout the island.

It was then that Jumokusō was thought of, which translates into Spanish as “tree burials.” In these, the families place the ashes on the ground, and plant an endemic species on site to mark its final resting space. In this way, instead of building more cemeteries, entire forests would be planted in memory of the deceased.

This principle leans from the Shinto tradition, which finds value in all the vital manifestations of the universe. For this reason, the spaces dedicated to this type of funeral rites are considered sacred: there is an intrinsic spiritual value in life that ends to make way for a new.

We suggest: Natural organic reduction: this is what ecological burials are like that turn your body into human compost

Do burials in Japan of this type interfere with traditional practices?

burials in Japan

Many of the families that have implemented this strategy of sacred greening of public spaces they don’t even practice Shintoism, or are affiliated with a specific religious tradition. However, the interest in continuing this type of practice denotes a environmental responsibility extended throughout the population.

Despite this, these burials in Japan also obey an ancient Buddhist principle. Like the plants are considered sentient beings, it is a way to continue the reincarnation cycle for the soul that departed. Seeds embody a living component of this path, and therefore, they must protect themselves with the same honor.

The practice has been so well received that various temples and public cemeteries have adopted it as part of their agenda today. The model has been so successful that some Religious spaces promote it as part of the spiritual life of people. Although they do not necessarily align with the ancient practices originally proposed by Buddhism, they do obey the precept of respect for existing forms of life, which sets the standard for all branches of this spiritual tradition.

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What the Pandemic Taught Us About the End of Life and Grief

Hospice workers, ethicists and therapists say grief is a pathway toward healing

By Vicky Diaz-Camacho

Grief felt “closer” this year for Meagan Howard. It’s the only way she could describe it.

On May 16, her good friend died in a car accident. There was something different about this death. As a Black woman in the mental health field, Howard said she has personally felt the compounding trauma of the pandemic with racial tensions.

That’s why it hit harder.

But as she sat in silence and cried with another friend to mourn their loss, she felt the release.

“That was more healing than someone saying, ‘It’s going to be OK’,” she said.

Meagan Howard
Meagan Howard is transparent about her own difficulty to grapple with grief and now encourages others to find ways to navigate sometimes complex emotions.

Years ago, Howard personally struggled to acknowledge the grieving process when her grandmother died. Now, she works against that to help her own clients who are navigating complex feelings of anger, avoidance and sadness — symptoms of grief — and in her personal life.

She specifically counsels folks with substance use disorders at Midwest Recovery Centers, which can often stem from unresolved trauma and loss.

The pandemic sparked a new kind of uncertainty, ranging from housing and job security to health security. This is why it’s more important now than ever to take a moment to pause and feel, she added.

A paper for the National Institutes of Health (NIH) on preparing palliative care providers explained that “anticipatory grief is the normal mourning that occurs for a patient/family when death is expected.”

That anticipation evaporated in the wake of the public health crisis. Back in March 2020, the number of people infected and dying from complications skyrocketed. This, mental health experts say, caused a mental health whiplash.

“As a society, we’re just kind of told lock it down, keep it moving,” she said.

However, she witnessed a shift this year that ranges between communal trauma to communal grief.

Howard said grieving as a society has been an essential step toward collective healing.

“One of the most powerful things that I saw from the pandemic is this sense of community,” she said. “There is power in being able to share your grief in a community setting with someone else. (It) gives us power when we feel like we don’t have any.”

From a mental health perspective, grief is healthy.

“It’s needed, it’s necessary, it’s essential,” Howard said.

“If we’re not allowing ourselves that grieving process, then almost in a sense we almost start to die internally. And I know that sounds kind of morbid, but that’s what it feels like is happening if we’re not allowing that to come out.”

Researchers at the NIH outlined what they call “context of grief” during the pandemic, which underscored how the public health crisis complicated an already sensitive process.

The study identified three specific changes during COVID-19: spread of the disease; social distancing and the increase of deaths; and hospitalizations and overburdened hospital systems. It outlined the financial, emotional, social and mental toll this would take on society at large.

Among the recommendations was to address grief head-on:

“Approach difficult conversations directly and do not shy away from discussing emotions, grief, and overall patient and family distress during advance care planning conversations.”

Trauma and loss experts have long advised families to begin conversations early about advance care planning. The idea is to ease ourselves into more comfortable conversations about what to do when someone we love dies. More importantly, these conversations serve as an emotional buffer.

Caring Conversations

Life unexpectedly changed, leaving communities unsure how to grapple with uncertainty and at the same time inciting communal trauma of seeing folks die from COVID-19.

This brought to the surface ethical considerations that impact the grieving process. How do families broach the subject of advance care planning or Do Not Resuscitate (DNR) orders?

That’s where Terry Rosell comes in. Rosell is an ethics consultant at the Center for Practical Bioethics — one of the only three centers of its kind in the United States.

(Disclosure: the author’s spouse recently accepted a job at the center. The interview was arranged and conducted without their involvement.)

Rosell, who is also a faith leader, works closely with medical professionals and has seen firsthand how COVID-19 changed the way in which families and their doctors approach life and death discussions.

Terry Rosell
Terry Rosell is an ethics consultant and educator for the Kansas City University of Medicine and Biosciences and the University of Kansas Medical Center. He also was a theology professor.

“It’s hard enough to die. It’s hard enough to deal with our loved ones dying. So we ought to make it better,” he said.

End-of-life care is also known as hospice and palliative care, which emphasizes keeping the person comfortable while they’re dying. This is part of what Rosell teaches when he presents to physicians and hospital staff.

“The first ethics matter around end-of-life care is taking care of these patients. Just because they’re no longer curative, just because they’re no longer receiving aggressive care, we still have a duty to care for them,” he said. “We ought not to abandon dying patients, right?”

Another part of his job is educating on advance care planning, which ensures a person’s wishes are fulfilled. To some extent, this practice can curb the anxieties that come with anticipating loss.

But not everyone may know what hospice care or advanced care planning entails, which brings to the forefront the lack of visibility of end-of-life services. What the pandemic revealed was the need to address these conversations earlier on.

This helps with the processing part of loss, Rosell explained. Death is a part of life and grief follows suit.

“Any kind of significant loss has a grief response. It’s just part of being human,” he said.

Part of being human is finding comfort in some sort of routine, whether that be spiritual or a ritual. To that end, Rosell added: “Don’t give up on the grief rituals during COVID times. It helps us”

‘I don’t know who I am anymore’

For Oscar Orozco, being vulnerable is part of his job.

Orozco was a former medical social worker for Children’s Mercy, where he helped at-risk children. Today, he works as a grief counselor at Kansas City Hospice and Palliative Care. He echoes Rosell’s points on advance care directives to reduce the added stressors of planning while someone is on the decline.

Oscar Orozco
Oscar Orozco, a grief counselor at Kansas City Hospice and Palliative Care, sees grief as an unpredictable wave.

Even though he’s been in his new role for a short few months, the need for counseling folks through the process has never been more clear.

This year hardly anyone has been able to catch their breath. Orozco said he has talked to health care workers who are friends or clients and they said: “I can’t do this. It’s too much.”

Why?

“(There’s) death and traumatic death, and it’s different. This is not death that people could see coming,” Orozco explained.

Another piece of complex trauma is identity and how folks have struggled to come to terms with the absence of their loved ones.

“In our grief work, what I hear almost often is, ‘I don’t know who I am anymore’,” he said. “People don’t realize that it’s much more than just the death of that person, but it’s the death of … routines, of day-to-day activities and memories and parts of our lives really that died with that person.”

He sees grief like an ocean. It’s unpredictable but sooner or later it’s easy to know when the waves are coming. Managing grief is like swimming, he explained, and sooner or later, we learn how to stay afloat.

Oscar Orozco with his grandparents
Oscar Orozco (middle) lost his grandfather a few months ago. He’s since learned how to process the loss by channeling his grandfather’s love of food into his own life.

That’s how he feels about the recent death of his grandfather. He channels his emotions into cooking, which is how his grandfather expressed his love for the family. This physical act helps him emotionally recover and process.

Processing is key, he said, but that’s been on the back burner for so many during the pandemic. So he advises folks who have experienced loss to be active and deliberate in the grief journey. That could mean going to their burial site for a visit, or it could be to buy their favorite meal from their favorite restaurant.

Grief is an individual process. Orozco advises people to embrace the emotion whether it be by crying, journaling, hiking or traveling.

“You know, whatever it is that comes out naturally to express, but never cast it aside because we’re afraid of where it might lead,” he added.

“We need to talk about this. We need to have those conversations because as uncomfortable as they might be, they could be lifesavers for (us) to continue to live our lives in a meaningful way.”

5 Tips on Navigating Grief

  1. Grief can be complicated and hard to pinpoint. That’s OK. Acknowledge the feeling or sensation (it could be a stomach ache, fatigue, lack of focus or emotions such as profound sadness or anger) as a first step. Experts say there are several kinds of grief:
    1. Complicated grief: When loved ones ruminate about the cause of death, worry about the consequences, feel guilty and display avoidant behaviors, such as denial. Around 7% of bereaved people will experience this kind of grief.
    2. Disenfranchised grief: When a loved one loses a person or child. It “can occur when families are unable to grieve with normal practices of social support and rituals in burial and funeral services,” according to the NIH.
  2. Asking for help to begin the grieving process is OK. “Grief counseling can help,” said Terry Rosell at the Center for Practical Bioethics. “Ministers, clergy, rabbis, priests, there are a lot of people who can help with grief counseling (for free).” You can find grief counselors at your local hospice organizations and mental health professionals who specialize in loss — for good reason. One example is the Solace House Center for Grief and Healing.
  3. Communication is powerful. Talk openly with family members, chosen family or biological relatives, or friends about their wishes before death — sick or not. Studies on the psychological impact of meaningful conversations — or saying “goodbye” — among family members of cancer patients show it helps with depression and complicated grief.
  4. Engage in activities that remind you of your loved one. This can also be characterized as play therapy if your loved one was an artist, which eases the transition from grief to acceptance. “I very much believe that spiritual practices or just rituals is how we get in tune with what our body is telling us about the loss we experienced,” said therapist Meagan Howard.
  5. Cry. Therapists advise sitting in a safe, quiet place or with a support network to embrace the feeling and release. This is good both physically and psychologically. Crying is the body’s “release valve,” according to Dr. Judith Orloff, who wrote: “After crying, our breathing, and heart rate decrease, and we enter into a calmer biological and emotional state.”

Complete Article ↪HERE↩!

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How The Pandemic Has Exposed The Gap In Bereavement Support

By Katie Lynch

Workplace well-being and employer benefit packages have been expanded and highlighted in recent months in light of current events and as companies look to attract talent and build loyalty within their organizations. While vacation time, remote and flexible working, paid parental leave and other wellness perks are often touted as part of a progressive company culture, bereavement leave and grief support still remain a gaping hole in the employee value proposition, leaving people scared to share or ask for help during difficult life events at work.

Even in the wake of Covid-19, I find the conversation around grief and loss in the workplace lacking. Few companies have truly publicly acknowledged the devastating loss of this past year and its impact on employees. As of this writing, the death rate from Covid-19 in the U.S. has surpassed 580,000 Americans, leaving an estimated5.2 million Americans grieving (according to a recent calculation that for every person lost to Covid-19, nine close family members are left to grieve). It is undeniable that this pandemic has affected each one of us, so suffice it to say that all Americans have experienced grief and loss this past year. Why then are companies not talking about its impact on their employees and offering more support?

Companies that strive for empathetic and inclusive cultures need to acknowledge these issues and remove the stigma associated with grief and death in the workplace. According to the Society of Human Resource Management’s (SHRM) 2019 survey, 89% of employers were providing some form of bereavement leave to their employees. However, traditional bereavement leave lasts just one to four days, depending on the employee’s relationship to the deceased. Not only are some companies still not providing leave, but those that do provide it often fail to provide an adequate amount of time away and lack ongoing support for employees dealing with a grief event. When a company only provides employees with one day off following the loss of a loved one, it signals a lack of empathy and support from leadership.

Something that may be contributing to the lack of discussion about grief in the workplace is the lack of any federal or state legislation requiring companies to provide paid leave to their employees. Currently, there is no federal requirement to provide paid leave even for a funeral, let alone time to grieve one’s loss. The fact that the U.S. Department of Labor calls this “funeral leave” and not even bereavement leave shows how antiquated our view of bereavement remains. In an encouraging turn of events, President Biden recently announced the American Families Plan, which would immediately guarantee three days of paid bereavement leave if passed. As of today, though, Oregon is the only state to sanction the overarching need to support grieving employees with a law requiring bereavement leave for employees, with California hoping to follow suit as legislators consider a similar bill.

While some companies are investing in programs to help employees in need, there is room for further support. Having spent years working with people through challenging life transitions, I know firsthand that dealing with grief and loss is not just a single moment in time, and it almost always requires ongoing guidance, education and specialized support.

In 2017, two years after the tragic death of her husband, Facebook COO Sheryl Sandberg famously placed the company at the forefront of the bereavement discussion by championing the need for expanded bereavement leave policies for employees and recognizing that employers need to support their people throughout these situations. Yet, little has changed outside of a select few companies, including Facebook and SurveyMonkey, both supplying bereavement leave of 20 days for immediate family members and 10 days for extended family members. Mastercard, Zillow and New York Life Insurance Company have all in recent years adopted bereavement leave policies of 10 to 20 paid days, depending on who passed away.

While there were great hopes that 2020 would usher in a new era of discussing grief and loss in the workplace and providing employees with adequate leave and support, either internally or with the help of a third party, many companies have failed to take this crucial step. What is so shocking is that even before Covid-19 wreaked havoc on our world, it was reported that grief costs employers an estimated $75 billion each year in lost productivity alone. This number has most certainly skyrocketed in the past 14 months. What we are experiencing now is not new, but it has been worsened. If the risks and costs to businesses are so severe, why do companies not invest more heavily in supporting these employees?

Moving Forward

We need to use the momentum from Covid-19 to do better for our employees. With this mission helping to drive my company and me, we are having these difficult conversations with clients and are providing their employees with proper support in this area. We are hopeful that moving forward, more companies will recognize their responsibility to promote conversations in the workplace on dealing with grief and loss as well as training managers and employees on how to support colleagues following a grief event.

Companies that want to lead with empathy and be at the forefront of this movement will need to model their programs after progressive examples and invest in programs offering robust and ongoing support to employees following a loss. They will also need to create policies that are more inclusive, ensuring that bereavement leave is not just given for the death of a parent, spouse or child, but any family member to whom the person was close. This should also include miscarriage. In addition to leave, companies should also provide employees with ongoing and more robust emotional, administrative and logistical support.

Lastly, the topics of death and grief must become part of the conversation in the office, and managers and leaders need to get comfortable with the uncomfortable. The results will be seen in both better business outcomes and profits as well as a happier and healthier workforce overall.

Complete Article ↪HERE↩!

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The Grief Crisis Is Coming

For each person who dies of Covid-19, experts say there are at least nine newly bereaved. We must begin to address the toll.

By Allison Gilbert

The end of the Covid-19 crisis in the United States is in sight, thanks to effective vaccines being deployed on a massive scale. But the still growing death toll will leave behind millions of bereaved people, wracked by the suffering that the loss of a loved one can bring. This is a public health crisis with consequences that may last generations, which we do not currently have the policy tools or resources to address.

We first need to get a sense of the scope of our national grief. Researchers are just beginning to count the bereaved, and while current estimates suggest five million Americans have lost a loved one to Covid-19, the final tally is likely to be much larger.

Ashton Verdery, an associate professor of sociology and demography at Pennsylvania State University, recently led a study that introduced the Covid-19 Bereavement Multiplier. By his team’s calculus, for every person who dies of Covid-19, nine loved ones are left behind.

To arrive at that number, the researchers included the losses of spouses, siblings, parents, children and grandparents. If other relatives — like nieces, nephews, aunts, uncles, stepparents — and friends are taken into account, “you may get 10 times or more” people in grief, Mr. Verdery said.

I know, from losing my parents at a young age, that grief plays out in waves across one’s life and has no clear ending. We should be prepared for another health catastrophe; while the Covid-19 vaccines can put a cap on the burden, they can’t halt or alleviate the pain. A recent study found that at least 37,000 children in the United States have lost a parent to Covid-19 so far.

Experts and grief organizations are asking American leaders to address this growing crisis. Evermore, one of the nonprofits that I have collaborated with in the past, is calling for the Biden administration to establish the first White House office of bereavement care to respond to the emotional and financial needs of grieving people after tragedy.

Another coalition of national bereavement organizations and grief researchers recently wrote to President Biden urging him to fund grief intervention services, including training to educate the public and professionals such as social workers, psychologists, teachers and clergy on how to assist the grieving.

Grass-roots groups like Covid Survivors for Change and Marked by Covid have lobbied at the state and federal levels for accountability to relatives of victims, including public and online spaces for mourning and remembrance, and compensation for families of people lost to Covid-19.

The effects of grief can be as physical as the symptoms of any disease. The short- and long-term impacts are well studied and include trouble sleeping, higher blood pressure, depression and anxiety. Studies have found that people who lose a spouse die earlier than their married peers. Children who experience loss of a parent may suffer lasting consequences, including lower grades and failing in school, as well as increased experimentation with drugs and alcohol.

The social effects can be drastic as well. Nearly 90 percent of young people in the juvenile justice system report having experienced the death of at least one loved one. And although grief is a universal experience, it can contribute to lifelong racial inequality, as Black Americans experience the loss of loved ones far more frequently and earlier in life than white Americans, contributing to differences in mental and physical health outcomes.

“Grief should be investigated the same way we examine other public health indicators like obesity, smoking and drinking,” said Dr. Toni Miles, a professor of epidemiology and biostatistics at the College of Public Health at the University of Georgia.

After conducting a statewide health survey three years ago, Dr. Miles discovered that 45 percent of Georgia residents over 18 indicated they were newly bereaved. The findings suggested that grief was far more prevalent than the other three risk factors, she said.

Viewing grief as a threat to overall health could pave the way for prevention efforts — including financial assistance — that help individuals navigate life-altering changes, such as shifts in family income and housing. “We need systemic change to protect those who are left behind,” Dr. Miles told me.

A White House office of bereavement care is a necessary start, and could benefit families who have lost loved ones to other causes, such as gun violence. There are early signs that this administration could be the one to embrace bereavement care. Starting on Monday, people who paid for the funeral and burial expenses of someone who died from Covid-19 can apply for up to $9,000 in reimbursement, the Federal Emergency Management Agency recently announced.

Mr. Biden has spoken frequently from experience about the scars that grief can leave, and what it’s like to face the “empty chair around the kitchen table.” He has the chance to reduce the toll that loss takes on its victims and on all of us.

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Questions of Life and Death During the Coronavirus Pandemic

— A Medical Anthropologist’s View

By Isono Maho 

Cultural anthropologist Isono Maho left academia last year and set out as an independent-minded commentator to question the conventional wisdom influencing views on to living and dying. We spoke to her about the competing priorities of “saving lives” and social connections during the COVID-19 pandemic and the importance of listening to the reservations many people feel about the impersonal approach of modern medicine.

The Right to Say Goodbye

As the coronavirus pandemic has raged around the world, how many people have died alone in isolated hospital wards, separated from their loved ones? How many people have suffered the anguish of not being allowed to visit a family member to share a few last moments together? Most people have accepted this tragedy as an unavoidable aspect of the ongoing crisis. But is it really necessary or desirable to prioritize the risk of infection ahead of all other concerns?

Medical anthropologist Isono Maho argues that medical authorities have been far too ready to ban hospital visits for patients in extremis. She admits there are good reasons why a hospital might restrict visits to coronavirus patients, not least of which is the risk of a Covid cluster breaking out. “Visitors will likely want to talk to and touch their loved one,” she explains. “This increases the likelihood the infection will spread, and it’s understandable why hospitals have chosen to ban visitations.” Even so, she questions whether it is appropriate for the same restrictions to be placed on patients not suffering from the coronavirus. “It raises the question whether the risk really justifies keeping each and every dying patient from their family members and forcing them to spend their last days alone without a chance to say goodbye.”

Isono argues family members have a right to be close to relatives who are approaching the end of life, and that current medical practices unnecessarily deprive people of the opportunity to gather and say farewell to loved ones in their final days.

“Words often fail when a family member is approaching the end of their life,” Isono observes. “Instead, communication becomes tactile. It doesn’t happen overnight, though, but is a gradual process, taking families time to develop a sense of how it will work for them. She notes that even if family members are allowed to visit in the last few days before a person dies, the separation up to then has deprived them of the chance to observe and process the physical changes in their loved one. “To be suddenly confronted by these can be overwhelming. In many cases, such final visits are extremely upsetting and can even hamper the mourning process.”

Families have generally accepted the restrictions on visitations during the pandemic, seeing them as unavoidable. Still, Isono stresses that people only have one chance to say goodbye to a dying family member. “We have to ask whether it is really right for hospitals to deprive families of this important rite. Does the objective of preventing further infections really take precedence over everything? My feeling is that there is still room for debate.”

Isono says that such restrictive measures to minimize COVID-19 infections have been framed as necessary to “save lives,” a correlation she is uncomfortable with. “It’s become akin to a moral doctrine that no one is even allowed to question.”

Modern Medicine and Death

Isono started out studying exercise physiology with the aim of becoming a physical trainer, but says she struggled to come to terms with the approach to human health in the natural sciences, which she found treated people as mere things to be studied. “The tendency is to reduce the human body to numerical data,” she argues. “Just more grist for the analytic mill.” Despite her doubts, she traveled to the United States for further studies. It was there that she discovered cultural anthropology. “I think the main appeal of the field for me was the way it tries to find deep, philosophical explanations for complex phenomena in what seem to be insignificant everyday events.”

What made the field fundamentally different to her is its grounding in fieldwork. “A lot of other academic disciplines use abstract ideas from the outset,” she says. “Cultural anthropology, on the other hand, seeks to develop ideas about life based on observations of mundane, everyday phenomena.” She points to people in Japan rushing out to buy toilet paper and basic foodstuffs before the government declared the first state of emergency in April 2020 as an example. “What social factors and what kind of information that was available drove that behavior? I think just about anyone would find the field fascinating—the questions it asks are so closely connected to daily life.”

Attitudes to life and death are one of the major focuses of cultural anthropology. The field also provides rich resources that can serve as “tools” for helping Isono to articulate her misgivings about modern science and medicine, another major reason why she chose to change the focus of her studies.

“The field has built up a vast storehouse of information on how different cultures and ethnic groups deal with death,” she explains. “In many cultures, a so-called good death is not simply a matter of living as long as possible. It is seen instead as part of the cycle of life and determined by connections between the living and the dead. There is a kind of universality in ideas like this. By contrast, modern medicine tends to prioritize longevity as something desirable in its own right. The value of life is converted into numbers and ‘evidence.’ My misgivings about this approach stem in part from the tendency to discount all the many cosmologies devised by diverse ethnic groups that connect the living and the dead.”

Blaming Everything on the Pandemic

One focus of Isono’s research is the clinical settings where healthcare is provided. She has interviewed numerous doctors, nurses, and caregivers in an attempt to understand the opinions of front-line healthcare workers—particularly those whose roles might go unrecognized. By talking to these people, Isono wanted to learn more about how healthcare provisions actually work and how they might be improved.

“Many of the individuals I spoke with expressed reservations about the way things are run,” states Isono. “For instance, they might see an elderly patient, bed-ridden and hooked to an artificial respirator for weeks on end, and wonder about the tendency of modern medicine to prioritize life support above all else.” She points out that many healthcare workers struggle with these doubts, but typically keep them to themselves. “My focus is tapping into the potential of cultural anthropology to recognize the value in these doubts and put them to positive use.”

Isono says that the close proximity of medical workers and caregivers to their patients can lead to uncomfortable feelings regarding the way that treatment plans are decided according to the convenience of the hospitals and other authorities. “I think their misgivings about this approach to medical care contain the seeds of a new perspective that can bring us closer to the real concerns of patients and their families, potentially leading to a better way of doing things.”

During the pandemic, it has become common for the media to highlight the harsh conditions healthcare workers labor under. Isono, however, says that not all medical workers like the image being portrayed of them as heroes risking their lives to help others. “Quite a few of people have their doubts about at least some aspects of the narrative,” says Isono. “They say they don’t really need illuminations of landmarks like the Tokyo SkyTree or fly-overs by the Blue Wave fighter planes as ways of showing appreciation and support. And quite a few people are uncomfortable with the way in which everything seems to center on preventing infection at all costs.”

Isono is skeptical about the tendency to blame the structural problems of the Japanese healthcare system for worsening the coronavirus crisis. The media is quick to pounce on issues like bed shortages for COVID-19 patients and the large numbers of nurses quitting their jobs. These problems, she stresses, are nothing new. “Poor coordination among hospitals and clinics and chronic staff shortages, including large numbers of nurses leaving the profession, predate the current crisis. I think the media should take more care in pointing this out to people. Misunderstanding the situation and blaming everything on the pandemic will only make it more difficult to improve the areas that need fixing. If we’re not careful, nothing will change and the problems will still be here after the current crisis is over.”

Correctly Assessing Risk

Over the past year or more, the numbers of new coronavirus cases and fatalities have become a fixture on the daily news. Isono points out that Japan is one of only a few countries that has managed to keep the number of infections relatively low—even though the government has not introduced any impressive policy measures, or used extraordinary legal powers to contain the crisis.

In terms of overall fatalities, the number of deaths from all causes actually fell in 2020 for the first time in 11 years. “In this sense, it’s fair to say that lives are being protected,” says Isono. “But the public and the media typically don’t pay much attention to this fact. They prefer to dwell on the risks of infection and the problems with government policies. The fear of the virus is leading some households to forego support services for seniors and others, including visits from nurses and caregivers. Often, the result is that the rest of the family becomes exhausted, exacerbating the frailty of the person requiring care.”

Isono points out that the unfamiliarity of the pandemic has meant that people are easily swayed by misleading information that fans anxieties about the risk of infection. “Take the flu as an example,” she says. “Most people have personal experience of the illness and know if they’re sick or not. If they come down with the flu, they might take a week or two off work to recuperate. At schools, classes might be cancelled for a few days if too many students get sick. But with the coronavirus, people lack the real-life context that would enable them to assess the risk accurately.” She notes that the constant barrage of news reports telling the public how quickly case numbers are escalating distorts the situation. “In reality, the overwhelming majority of people have not been infected. and the number of serious cases is even smaller still. But there is so much negative information that it becomes difficult for people to respond in a level-headed manner.”

Isono admits that even with vaccinations, the risk of infection and infecting others will not go away completely. “We will probably have to learn to live with the coronavirus for a long time to come. This makes it important to work to control excessive fear and panic over this one particular disease—both on the part of the media and of the people consuming news.” She hopes that society will move in a direction that helps people to mitigate their risk of contracting the disease while permitting individuals to carry on with their lives in a fashion that allows for other important considerations.

Learning to Live with Uncertainty

No one denies the importance of taking reasonable efforts to avoid falling ill. But Isono says that the public needs broaden its focus from trying to live as long as possible to think more deeply about life and death.

“All of us will die one day,” she declares. “Even so, we try to avoid thinking seriously about death. As social animals, we humans see connections with other people as an important part of life. However, individuals are giving up the spiritual nourishment they get from social contacts out of a fear that they might catch the virus.”

She says that living in a community means recognizing other’s individuality and accepting unpredictability into our lives. These uncertainties increase as a person approaches death, and it is family and friends who take on the responsibility of accompanying them in their final days. “In an environment of excessive risk control, though, people are stripped of the opportunity to face up to uncertainties and deal with them together. Their chance to find a way to come to terms with them is taken away from the start.”

Isono warns that there is a risk that even our imaginations might be controlled by a constant flood of information. “I sometimes worry that the deluge of information is affecting our emotional state. I’m terrified by the idea of people being so overwhelmed by the information that is broadcast at them that even their imaginations fall victim to it. Being moved and touched by something is personal—these things should be left to the freedom of the individual.” She says she would like people to think more about the manipulative structure of a system that feeds information to the public in a very one-directional way. “I think we need to think more about the intentions of those who are broadcasting this information, and what it means for us on the receiving end.”

Broadening Shared Spaces

The tendency to prioritize preventive medicine is only likely to increase after the current crisis subsides, which is why Isono says she intends to continue using a cultural anthropology approach to questioning accepted views.

“I think we are entering an age in which statistics-based ethics and value systems that prizes longevity for its own sake will become even more dominant. Life’s choices will be boiled down to the health risks involved and everything will be shown in figures.” She warns that this presents a slippery slope for humanity. “I think more than a few people are uncomfortable with such an approach, lay people as well as healthcare workers. I want to get a message out to such people and help create a platform for thinking together about what it means to live our lives, based on real-life examples that are easy to relate to.”

Isono feels strongly that people should not let go of their right to decide for themselves about what it means to live. “One recent trend in medicine is the practice known as social prescribing, whereby doctors refer patients who are cut off from society to a range of non-medical social services. Of course, it’s only proper for a doctor to notice if a person might be struggling with loneliness and isolation and try to do something to alleviate that situation. But I think those of us outside the medical system also have a right to express our doubts about the way it is done. Have we really reached a stage where we can’t forge social connections without a prescription from a specialist? I can’t help feeling uncomfortable with the expectation that we should simply sit back and gratefully endorse the idea of outsourcing even our social connections to experts.”

In 2020, Isono left her post as an associate professor and launched a series of online seminars on the subject of exchanges with others. Around 300 people of all ages and backgrounds, including medical and social workers as well as teachers and students, have participated. Participants say the thought-provoking discussions and the opportunity to exchange views with people from different walks of life deepened their understanding of issues. In June 2021, a second series of seminars will start under the theme of developing the power to listen.

“Cultural anthropology has a power to push back against conventional wisdom,” Isono asserts. “There is a version of what is correct and acceptable that is put out by people in authority that everyone is supposed to go along with. We still need to question this accepted wisdom and ask if it leads us in a direction we want to go. The discipline can encourage people to express their doubts and perhaps put a brake on the tendency to go along with the loudest voice in the discussion. At the same time, it’s not caught up in making easy judgements about right and wrong. In that sense, I think the field can help to widen the space that we share with others. Through my activities, I want to do what I can in my own little way to bring this attractive side of the field to as many people as I can. That’s my ambition.”

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How the light gets in

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When palliative care doctor Rachel Clarke looked back over her notes typed hastily pre-dawn in the midst of a global pandemic, she expected to find only darkness—an unrelenting stream of death and despair. To her surprise, her insomniac’s diary was “illuminated by pinpricks of light”. “People began to organise, street by street, village by village, to make sure that their most vulnerable neighbours…were safe and fed and kept from harm”, writes Clarke. Rainbows appeared in windows up and down the country in support of key workers, volunteers set to work sewing masks and manufacturing visors, and a retired British Army officer approaching his 100th birthday united a divided nation by walking laps of his garden to raise money for the National Health Service (NHS).

Clarke, who embarked on a career as a current affairs journalist before beginning medical training, has since punctuated her medical career with writing—from Your Life in My Hands, charting her experiences as a newly qualified doctor, to Dear Life, exploring death, grief, and the things that truly matter at the end of life. Her latest work, Breathtaking: Inside the NHS in a Time of Pandemic, spans the 4 months from New Year’s Day 2020 to the end of April that same year—a fleeting snapshot of a time during which life in the UK changed immeasurably.

“Pacing the kitchen and tapping a keyboard became a kind of nocturnal therapy”, she explains. These notes, typed “fast and furiously” while her family slept, open a window to life in the UK in its darkest hours. Turning the pages of Breathtaking, we relive the angst and uncertainty of those early months. The anguish about personal protective equipment (PPE) and testing, death tolls rising too high to take in, and the sudden, unexplained obsessions with baking bread and accumulating toilet paper that swept the nation. But, for those of us who know COVID-19 in only an abstract sense, following the news from the safety of our homes, Clarke gifts us a unique glimpse of life in the eye of the storm. As the crisis evolved, day by day, week by week, we learn, in real time, what life was truly like for those on the frontlines—those who risked everything, not knowing that they would see the other side. “To us”, she explains, beyond statistics and modelling, “the pandemic is a matter of flesh and blood. It unfolds one human being at a time”. In these darkest of times, Breathtaking shows us that the greatest sources of light came from within the NHS.

Beyond the inestimable challenges of treating a new disease, acquiring knowledge on the run as patients lurched from one physiological crisis to the next, health-care workers fought—through the physical barriers of masks, gowns, and distance—to restore the humanity to their practice that COVID-19 so cruelly stripped. Overnight, hospitals cleared of visitors, carparks emptied. For Clarke, whose work in palliative care has made her all too aware of the power of human connection, seeing patients isolated from their loved ones feels like a psychological assault. “Covid even steals the patients’ names. So great are the risks of communication in PPE that it is safer for the nursing team to use bed numbers to refer to the human beings for whom they care”, she writes. Humanity is restored by any means possible: medical students volunteer to liaise with patients’ families, many of whom are self-isolating and alone; hearts knitted by volunteers are used to symbolise the connection between patients and their families; health-care workers add laminated photos of their faces to their plastic gowns. “Our tools are uncertain and improvised”, she writes. “We use whatever we can to draw people back together and we refuse to settle for despair.”

Clarke’s style is intimate and generous, opening up to us her own home and family life. We join her pacing in her kitchen—glued to her phone—as she watches events unfold, first in Wuhan, then Lombardy, and finally on her doorstep. We watch her conceal her anxiety from her husband, guilty at even an insignificant deception. We feel her exasperation as PPE at the hospice runs perilously low. We feel her overwhelming desire to help, which drives her to volunteer on the frontlines. Misty-eyed, we’re there as she attempts to quell the fears of her 9-year-old daughter, terrified of losing her mother. “How can I possibly tell her I have volunteered, that I want to be the one helping these patients?”, she asks.

Although not yet over, the opportunity to reflect on these early pandemic months is at once cathartic and deeply humbling. Powerful personal stories allow us to grieve the loss we have suffered as a nation, far beyond the statistics, as well as to appreciate the sacrifices made by NHS workers and volunteers who put helping others above all else. Although Clarke cannot conceal her blistering anger at the failings of those in charge, at its core Breathtaking brims with pride and positivity. “Every single day, the grit and devotion of colleagues astounded me”, she writes. “In the 11 years I have practised as a doctor, I have never been prouder of nor more humbled by the NHS and its people.”

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Writing of death is private art and public therapy

Eulogy, newspaper article, novel, poem… the obituary epitomises communal mourning, another aspect of being human that has been wrenched from society by Covid-19 restrictions.

By: Percy Mabandu

At the heart of every culture’s funerary ceremonies lie rites meant to guide ritual accounting of the meaning, in death, of the deceased. The obituary and its cousin, the eulogy, is a literary document clearly conceived to be read out loud. It is often the central aspect of rituals of reckoning for gathering communities of bereaved audiences. The performance that is the reading of an obituary sets the tone for how shared memories of the dead unfold.

The onslaught wrought by the Covid-19 pandemic has occasioned death on a historic scale for humanity. Beyond the massive corporeal loss of life, the coronavirus is marking myriad cultural losses for mankind. This season of industrious dying is ironically denied much of the ritual usually associated with death. The funeral, central in every culture as a ceremony for communal mourning, and perhaps the commencement of a shared acceptance of healing, has been cancelled or at best curtailed by policies meant to curb the virus’ outbreak.

As a result, many families lose out on the chance to gather and remember their loved and departed members, barred as they are from sharing the crucial ritual of reminiscences.

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The obituary is a form of portrait, the reading of it performance art denied its customary audience by Covid-19 funeral restrictions. Those with means have found a way to connect with physically distanced mourners over social media platforms. The result is a new content regime in which private quarrels generated by grief become larger public spectacles as a result of streaming. In an earlier time, these would have been the preserve of gathered friends and family, at worst gossip fodder for the immediate community.

At the height of the initial strict lockdown, social media gave us an example of this kind of contentious occasion. The Rakgadi meme exploded on to our smartphones after Semati Moedi contradicted decorum at the memorial service for her brother, the tombstone king Lebohang Khitsane. Driven by grief, Rakgadi, the eldest aunt of the family, attacked his widow with accusations of infidelity. The farce and fervour that followed pried open age-old debates about decorum, trauma and the limits of righteous indignation. Close behind were questions about why obituaries always read like sanitised versions of the dead, deviant in life now made darlings after death.

The obituary as newspaper feature

Beyond the funeral gatherings that make theatre of tributes, the obituary exists as a cherished newspaper feature. In this mode, it becomes a potentially polemical memorial. A public letter occasioned by the death of a notable figure to contest crucial social issues.

When larger-than-life American star Little Richard died in May last year, the world went into overdrive with debates about the Black roots of rock and roll, its appropriation by white America and the neglect of the real progenitors of the multibillion-dollar art form, Richard among them. Centrepieces of the debate were defined by the proliferation of newspaper obituaries published globally in the wake of his death.

In Mzansi, Bongani Madondo led the charge against culture vultures. “Richard died last Saturday at the age of 87 and the world lost its marbles. Lord ha’ mercy, what we gonna do? For one, we can all claim we loved him madly. That he was our darling queer avatar,” wrote Madondo, taking issue with the public’s propensity to posture fake care for the dead who suffer neglect in life. At once, the obituary campaigned against pop culture’s social hypocrisies, and dared to settle historic racial scores for the credit of Black creative genius.

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Following the death in 1964 of Sophiatown’s beer-beaten golden boy of letters, Can Temba, his friend and fellow writer Lewis Nkosi sat down to write his obituary. The article was headlined “The will to die” after one of Temba’s short stories. It opens with an epigraph composed of a statement Temba made at an unnamed friend’s funeral: “This son of bitch had no business to die… [sic].” What followed is a study of the horrible state of life in apartheid South Africa. Nkosi highlights the devastation borne by the suicides of creative people such as Nat Nakasa and Ingrid Jonker to understand the death of his friend Temba.

In less lofty instances, the newspaper obituary has been seen as an inconsequential space filler. This point was made by former Sunday Times newspaper editor Ken Owen in a brutal albeit memorable put-down of journalist Chris Barron. The pair were part of a larger media brawl with biographer Ronald Suresh Roberts.

Responding to what was then Barron’s latest op-ed attack against Roberts, Owen took his famous shot: “In his eagerness to smear Ronald Roberts, Barron has misquoted me … He should stick to writing obituaries – the subjects will not complain.”

In this way, Owen shored up the form’s propensity to be inconsequential content. To be balanced, though, Barron’s LinkedIn profile professes that “he turned what was a moribund and largely ignored obituaries section into one of the most eagerly read pages in the newspaper”.

A form and genre

There have been grand moments of glory for the form. The New York Times celebrated the newspaper obit as a genre in 2016 by sharing highlights from its archive. The editors noted proudly that since 1851, more than 200 000 people had been the subjects of obituaries in the paper.

Arguably the most notable was a piece announcing the death of Christopher McCandless. The account of McCandless’ fate stands as a monument to the power of the newspaper obit. McCandless died in the Alaskan wilderness during an ill-fated journey to sever ties with all he had known.

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The first paragraph cloaked him in mystery and tragedy, turning him into a folkloric figure: “No one is yet certain who he was. But his diary and two notes found at the camp tell a wrenching story of his desperate and progressively futile efforts to survive.” It was a short newspaper obituary. But it unleashed an industrious mining for meaning into the life and death of McCandless that would yield further feature articles internationally, at least two bestselling books and a Hollywood biopic called Into the Wild. The film starred Emile Hirsch and Kristen Stewart, with Sean Penn as the director. It was nominated for best editing and best supporting actor awards at the Oscars.

It is doubtful McCandless would have gained this posthumous fame and glory were it not for that compelling newspaper obituary. It launched him as a symbol of youthful renunciation of modernity in search of a lost, liberated, prehistoric purity of man.

The obituary in literature

American novelist Ann Hood published an aptly titled piece of historical fiction, The Obituary Writer, in 2013. Its plot zeroes in on the cathartic benefits of writing obituaries. In part, the book tells the story of Vivien Lowe, an obituary writer, who by telling the stories of the dead not only helps others cope with their grief but also begins to understand the ravages of her own losses.

The Obituary Writer shores up Hood as a discerning novelist who manages to magnify the underlying feature of the obit as a cultural artefact. It converges the needs of the individual with the requirements of community for mutual healing during times of death.

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There are few poets who’ve had to contend with the meaning of death and personal loss like Ted Hughes. His first wife and fellow poet Sylvia Plath killed herself after Hughes left her for another woman, Assia Wevill, who also killed herself along with their four-year-old daughter Shura. The tragedy of Plath’s death, for which Hughes was blamed, would become the subject of one of his most memorable poems. This in part because of the legend that surrounds its discovery more than a decade after he died.

Titled Last Letter, the poem is an account of the night Plath died. The various versions of the previously unknown poem were published in the New Statesman magazine, in part to report and register the historically unacknowledged torment Hughes lived with following the death of Plath and also to bear witness to his repeated attempts to perfect his poetic account of the night she died. 

In the poem, which was read live on BBC Channel 4 News by actor Jonathan Pryce, Hughes recalls the night of Plath’s suicide, even the phone call that delivered the dark news: 

What happened that Sunday night?
Your last night? Over what I remember of it… 
Then a voice like a selected weapon
or a carefully measured injection
coolly delivered its four words deep into my ear
your wife is dead.

In this way, the writing of the poem as a private obituary, along with the promise of a probable audience in some future, allowed Hughes to live productively with grief in a way that writing about dead loved ones makes possible. 

It is the singular power of the obituary, the making into artful verse the painful episodes in our personal universes. We write obituaries, read them out loud to gathered friends, to make certain that we are not alone in our hour of need. The legislated dearth of community in dealing with death during the Covid-19 pandemic denies us this connection. The omission of audiences for obituaries is central to the larger loss of our time.

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