Death duties

A blood-red cover with central shading slashed by the title Mortality cast a sense of foreboding over me when this journal appeared on my desk. I feared that its dramatic cover, devoid of any aspect restful to the eye, was intended to make a statement about the horrors of death and dying, the subject matter of the journal. My first reaction was that such an image should not appear among the magazines in the reception area of a palliative care unit where dying people and their families might find it. My second reaction was to wonder for whom such a journal was intended. Was the dramatic and rather fearful image of mortality portrayed by the cover to be sustained throughout the journal and, if so, what did the editors intend should be the motivation of potential readers?

The journal was first published in 1996 and appears three times a year. Some clues about its content and purpose were provided in the first editorial by Glennys Howarth and Peter C. Jupp: "This journal ... aims not only to reflect current research issues, but also to stimulate and develop further studies in the field." The "field" in question is dying, death and bereavement. They further state that "from the outset our intention has been to provide an interdisciplinary journal which has relevance both for academics and other professionals engaged in this field of work". They go on to explain that the journal is pertinent both to academics (in the suggested areas of sociology, history, literature, anthropology, art and classics) as well as to those professionally or voluntarily engaged in healthcare work, the funeral industry or even in government. A wide audience indeed.

Clearly the journal is not intended for those dying or recently bereaved, but rather for those studying death or those caring professionally for the dying and bereaved. The editors have thus made it much safer to read. The overall impression is that dying is something that happens to someone else, which seems extraordinary given that the issue of mortality is inextricably linked to the humanity of every reader. Can one really undertake what the editors refer to as "death studies" without thinking deeply about one's own death, its meaning to oneself and the possibilities of continued existence after death?

There are few papers about the process or meaning of dying or death from the point of view of the person dying. Instead, most papers are about the study of the effects of death on others, or about funeral rites and social reactions to death. Some papers report research conducted by detailed interviews, for example with those bereaved of a child, or a partner through Aids, or with anorexic women. Others describe death and funerals in different ages and cultures.

Since health-care professionals are already deluged with professional journals containing very pertinent material, and most are involved to a greater extent with the care of the very ill and dying rather than with the bereaved, they may not feel sufficiently motivated to buy this journal themselves, although many would be grateful for access to it via a library. The book reviews in the journal are particularly informative.

But even if we grant that the main perspective is academic rather than professional, the terminology in a few articles verges on parody. For example, the following sentence is unlikely to be comprehensible, let alone relevant, to health-care professionals: "The paper discusses how poststructuralist theorisations of discourse, subjectivity, gender and social discipline can facilitate an understanding of the ways in which socio-historically specific discourses and discursive practices constitute and regulate experiences of the death and dying of women diagnosed as anorexic." We are told that the editors' aim is to create a journal that has relevance, interest and appeal of a truly interdisciplinary nature. If so, then simpler language is essential.

There is no doubt that some of the articles are outstanding. Tony Walter's autobiographical paper on "A new model of grief" is understated yet very powerful. It successfully challenges the current model of bereavement that implies leaving the dead behind and moving on and instead suggests that grief is about "finding a place for the deceased in our lives". Similarly, Louis Heyes-Moore's paper on spiritual pain in the dying is excellent and inspiring. It recommends a non-intrusive, sensitive, practical and realistic approach. Perhaps the quality that comes through both of these articles is that of genuineness - one feels they have been written by people who have come close to death, who have not studied it at a safe distance, yet who have described it accurately and often in quietly moving terms without overdramatisation.

Throughout the journal there is little about the meaning of death in a philosophical sense, as it might to apply to every one of us. Instead there is an underlying assumption, which is rarely questioned, that there is no continued existence after death. Yet as Paul Badham concludes in his paper: "The question of whether or not there is life after death is potentially the most important issue that could be raised." I hope future editions of the journal will address this question, which is central to the great mystery that death holds for us all.

Fiona Randall is consultant in palliative medicine, Royal Bournemouth and Christchurch Hospital Trust.