The script we all have to read

Recent doubters who question the relevance and intelligibility of current sociological work should look no further than this stimulating and lucid volume. Clive Seale is a sociologist who has devoted much of the past ten years to improving our understanding of the social circumstances that surround dying and death in late modern society.

He has demonstrated an appetite for both the rigorous collection and analysis of empirical data, and at the same time has made use of the best in social theory. Here, he treats us to the summation of a decade of inquiry in which his theme is that "social and cultural life involves turning away from the inevitability of death, which is contained in the fact of our embodiment, and towards life". In so doing, he has produced a book that will be of wide interest: to thanatologically minded social scientists, to students of health, illness and the body, and to the growing numbers of researchers and practitioners concerned with end-of-life care and the palliative care movement in particular.

In three chapters grouped as "Social and material worlds", Seale begins by testing the worth of social constructionist and phenomenological perspectives for understanding mortality and embodiment. Both are found wanting, as are others who have attempted to reconcile the structure/agency problem. Instead he draws on Thomas Scheff to outline a theory of everyday talk as ritual activity helpful in understanding the socially constructed and embodied experience of death and bereavement in contemporary culture. This theme allows Seale to view, for example, "symptoms" such as pain and breathlessness in the dying person as "the body's communicative interjection into social life", a theme taken up in some recent clinical studies of lung cancer. Similarly, he explores the characteristically modern stance of facing, rather than denying, the reality of death, which becomes the organising theme of three further chapters where he examines currently available "scripts" for dying.

Central to such scripts is a profoundly mistrustful attitude to biomedicine, to professionals, even to "revivalists" who see dying as a journey of personal growth and discovery. Seale also encourages us to be sceptical about research studies in these areas, for they too are moral tales that shape and influence our perception of how we should die. Research findings, like media representations, create a sense of some "imagined community" in which heroically confessional death is much to the fore. This gives Seale a problem, for ultimately he does not wish to abandon the truth claims of the most carefully conducted research studies (quantitative and qualitative) on these subjects. In this sense research studies can constitute a topic, but are also unequivocally a resource for our understanding of modern death and dying.

By moving from theory to representations, Seale arrives at the final section, which again reveals a welcome essentialism, titled "Experiencing death". Here we are invited to consider the extent to which people participate in the various available scripts as they approach the end of life. Familiar sociological determinants of age, gender, class and ethnicity come into play. An excellent chapter, "Falling from culture", strips away the mechanisms whereby we bracket the fact of our mortality, showing how this becomes ever more difficult as bodily functions come under pressure. The commensality of shared meals, or the consumption of any food or drink, accomplishments placed increasingly beyond the means of dying people, are striking examples. At the same time we also resist such processes, investing our trajectories of diminishment with particular meanings. Crucial to this is a degree of control over the timing and manner of our death. "Aware dying" appears to have its rewards; but it is a script upon which not all are able to embark - chiefly those who lack a progressive disease and a terminal diagnosis. This may yet prove one of the major obstacles to the extension of palliative care to those with non-malignant conditions.

Seale's final chapter echoes Peter Berger - in the last analysis, society itself is no more than the constructions and activities of human beings in the face of death. This is much in evidence in the "resurrective practices" of those who, through everyday talk and conversation, recall the lives and deaths of others. The book leaves us with an uplifting message: despite our corporeal vulnerability, the living and the dead can share a common social bond in which the defence of remembered moral reputation plays a central part.

David Clark is professor of medical sociology, University of Sheffield.