The impact of protracted dying
In this chapter, I examine the notion of social death, the factors which predispose someone to be defined as socially dead and the impact of such a definition for patients and families. In so doing, I examine the theoretical origins of the concept, its behavioural enforcement by health professionals and the psychological and social consequences of such behaviour. In particular, I draw attention to the way in which a diagnosis of cancer can impose a state of social deadness on sufferers.
Most people, including health professionals, define death in a 'clinical' or 'biological' sense – that is, when clinical signs or symptoms signify that the event has occurred in the case of the former, or that there is an absence of cellular activity in the case of the latter (Sweeting and Gilhooly 1991). However, when biological or clinical death is preceded by a period or phase in the illness when a person has lost their connection with the living world, we have begun to understand it in terms of 'social death'. This is the time when a person is treated essentially as a corpse, though they are still clinically and biologically alive (Sudnow 1967). Mulkay suggests that
the defining feature of social death is the cessation of the individual
person as an active agent in others' lives … Social death is the final
event in a sequence of declining social involvement that is set in motion
either by participants' preparation for, or by their reaction to, the advent
of biological death.
(Mulkay 1993: 33, 34)
In a review of the literature of the concept, Sweeting and Gilhooly (1991, 1997) demonstrate that the state of social death has regressed from being one where the body is revered and honoured to one of social exclusion and excommunication. Early anthropological accounts of burial traditions documented that people became socially dead only after the body had naturally disintegrated. Until that time, the dead were treated as though they were still alive, requiring food, company and conjugal rights (Sweeting and