On Facing Our Own Mortality

There is, in the modern world, an absurd reluctance to speak of death

In Britain, sixty years ago, the subject of sex was surrounded by a bewilderingly complex set of taboos and prohibitions. Couples hoping to spend the night together in an hotel would routinely claim to be married, and children born out of wedlock were known either as ‘illegitimate’ or, less charitably, ‘bastards’. Words such as ‘pregnant’ were avoided in polite company and replaced by various euphemisms like ‘in the family way’, ‘joined the pudding club’ or ‘expecting’. Nice people did not talk openly about sex or its consequences. Death, by way of contrast, was treated in a robust and matter-of-fact way. The custom of keeping the coffin containing the corpse in the house on the night before a funeral was still around in the 1960s and people spoke without embarrassment about the death of family members. Death was considered a proper topic of conversation in a way which sexual activity was not.

     Today, attitudes to sex and death have been neatly reversed. The most breath-taking candour surrounds sex and what would once have been regarded as monstrous perversions are discussed freely on television or mentioned to children in sex-education lessons at school. Death, on the other hand, has become a forbidden topic, with even the very word being considered a little indelicate. Newspapers go out of their way to avoid printing those alarming words ‘death’ or ‘dying’ and substitute instead expressions such as ‘passed away’. Not so long ago, a genteelism like ‘passing away’ would have prompted howls of derision from many people, today it is de rigeur even for the police when announcing the death of a murder victim. All too often it is combined with a modifier such as ‘sadly’, which creates an incredibly mawkish air of false sentiment. In October 2019 the newspaper Scottish Sun reported a police spokesperson as saying that; ‘A 43-year-old woman was taken to St John’s Hospital, Livingston where she sadly passed away on Monday, 21 October, 2019.’ In an even more ghastly example of this euphemism, the death of a dog was announced by the police in similar terms the following day, as reported in the Daily Record; ‘Police Scotland posted on Facebook: ‘Sad news from us this today as we can now tell you police dog Buck has passed away this afternoon after a short illness.’ You quite literally could not make it up. The bowdlerisation of such a perfectly natural event is indicative of our modern feelings about death, which is of course an inevitable feature of life.

     Death is simply an ordinary and unremarkable process, to be placed in the same mental category as eating, sleeping and having sexual relations. These things are, like death, part and parcel of human life and it seems absurd to separate death from other ordinary human experiences and accord it a special reverence. If one thing is certain it is that despite all our precautions and however great our slavish adherence to this or that crank diet or healthy lifestyle; we, along with all those whom we love and cherish, are going to die in a relatively short time.

     It is the essentially random and wholly unpredictable nature of death, as well as its inevitability, which most of us frantically deny. Of course, some activities and lifestyles are more hazardous than others, but abstaining from them does not guarantee that you will die peacefully in bed at the age of ninety eight. Lifelong non-smokers get lung cancer and the most careful motorist can be killed by a drunken driver. Death cannot be tamed and domesticated, no matter how much progress medical science might make. There is always some crazed terrorist or homicidal mugger lurking in the shadows, ready and willing to bring an end to the life of the most cautious and healthy-living person. And the one certain thing is that this will happen; if not tomorrow, then without doubt soon enough in the future. Life is subject to sudden, lethal cancellation without prior notice being given.

      At the back of many people’s minds is the absurd notion that death can be in some way controlled and made to adhere to a set of guidelines which we have drawn up. If only we are careful enough to follow various rules and observe certain superstitious prohibitions, we have an excellent chance of evading it entirely. Some of these rules are simple; ‘Don’t smoke and you can avoid lung cancer’ is one of the most popular. Here is a question for those living in the United Kingdom. Which is a non-smoker more likely to die of, lung cancer or a road accident? Because we associate lung cancer with smoking, we automatically assume that the chances of a non-smoker developing this condition are rare. We know though that people are regularly killed by cars and so it must surely, or so we assume, be likely that this is a more probable fate for our non-smoker than lung cancer. As it happens, the chances of dying of lung cancer are at least two or three times as great. Between 10% and 15% of deaths from lung cancer are among non-smokers. Roughly 35,000 people a year in the United Kingdom die of the disease, of which between 3,500 and 7,000 will be non-smokers. Around 1,750 a year died in road accidents. This is hugely counter-intuitive and provides food for thought.

     That one in six of the deaths from lung cancer have nothing at all to do with cigarettes will come as a surprise to most people. There is without doubt a link between smoking and lung cancer, but around 85 per cent of smokers will not die of lung cancer. There are many more instances of random mortality, which upset all our calculations about extending our lives indefinitely by obeying doctors and being sure to eat up our greens and walk 10,000 steps a day. A careful person might avoid climbing a ladder, lest he fall to his death, but in the United Kingdom five times as many people die falling out of bed as do tumbling from a ladder. Roughly 55 people a year are killed falling off ladders, but almost 300 die after falling off their beds. Best not to mention the 29 people each year who somehow contrive to be drown themselves accidently while taking a bath. It is figures like this, almost entirely ignored by the average person, which provide psychopaths with a healthy and realistic attitude to death; best summed up by dismissing it as just one of those things which happen to us all, eventually. 

     It is absurdly simple. Our mothers, fathers, husbands, wives, children and friends will all die and there is little or nothing which can be done to prevent it. Every so often, one sees articles in newspapers or pieces online which claim that thousands or millions of lives each year will be saved by some new medical procedure or recently tested drug. This is quite false. Those lives will not be saved at all. They might perhaps be postponed for another few months or years, but the mortality rate remains unchanged; it is, as it has always been, 100 per cent. Death is not an unfortunate mishap like a burst pipe in the winter or cracked cylinder in your car engine; things which can, with a little foresight, be mitigated or even wholly avoided. It will be arriving all too soon for us all, regardless of the frequency with which we visit the gym or how many vitamin-pills we swallow. However much sun cream we slather on, whatever the number of vegetables we eat or the amount of exercise in which we indulge, we are still going to die in a few years’ time.

     The mad idea that our lives can be extended indefinitely, if only we take the necessary precautions is deeply embedded in the modern psyche and reached its reductio ad absurdum in February 2020 when a report called, Health Equity in England: The Marmot Review Ten Years On was published. Life expectancy has been steadily climbing in England for many decades and it seems that there are many experts who see no end to this decrease in mortality. Men may now expect to live for around 79 years and women to the age of 83. This is surely cause for celebration, but the report mentioned above deliberately set out to sound the alarm, noting that life expectancy had only increased by a few months over the last decade. Newspaper headlines warned that increasing life expectancy had ‘stalled’.

     Let us pause for a moment and consider what this means. The complaint is that life expectancy in England has increased over the last decade by months, rather than years. We are led to believe that a regular, large increase in life expectancy of the kind seen every decade since the end of the Second World War is a natural process which will go on for ever and that the rise has ‘stalled’ because of policies instituted by the Conservative government. In short, life expectancy must rise inexorably, year by year, or something worrying is happening. This year, women live to be 83, on average, and in a few years, this will grow to 93 and then 103, 113 and so on. Any slowdown or, which God forbid, halt, in this dizzying rise, is a worrying glitch for which an explanation must be sought. Of course, we ask ourselves why this process should stop at 113. If a slowdown in rising life expectancy at 83 is alarming and in need of urgent examination, then why should we not feel the same if the climb ‘stalls’ at 93 or 103? Presumably, according to this extraordinary perspective, year after year the figure will go up until the average age reached is 113, 123 or 223. The ultimate goal appears to be immortality.

     When even doctors and statisticians promote the crazy myth that we can all live forever, provided that we eschew cigarettes and alcohol and, presumably, stop voting Conservative, then there is little hope that the man or woman in the street will start thinking sensibly about illness, accidents, old age and death.

     It has been necessary to look in some detail at the popular view of human mortality, to understand the gulf which separates the psychopath’s perception of the matter from most other people. At the back of the mind of almost every person in the Western World is the secret notion that they will never die and that modern advances will be able to stave off death indefinitely. It is that unspoken, irrational, but firmly held, belief which causes so much anguish.

     We are sure to encounter the deaths of others with remorseless regularity, particularly as we grow older, but society requires us to evince surprise and distress every time it happens. Convention dictates that we should treat each and every death as a surprising and unexpected catastrophe; even when the victim is in his or her nineties. Woe betide the honest individual who shrugs off news of his brother-in-law’s death with a carefree and light-hearted remark to the effect that such things happen and there is no point making too much fuss about it! On the one hand, we do not wish to become miserable and depressed, dwelling on our own, all too fragile, mortality, every time we hear of a death in our family or social circle. Then again, nor do we want to acquire a reputation for being cold-hearted and contemptuous of the feelings of others. The result of this conflict for many people is that they grow neurotic about bereavement, it genuinely makes them feel unhappy. Often, this is not because of the death itself but because of the rituals which surround it. They have tutored themselves to put on the mantle of thoughtful sombreness every time somebody known to them dies. It may be an uncle whom they have neglected for decades and about whom they could not have cared less, but the appropriate expression and correct words will still be required. However, in just the same way that smiling can make us feel cheerful, so too can adopting a mournful expression cause us to feel sad.

     This altogether false emotion spills over into ordinary life so that even when nobody has died, but there is merely the apprehension that somebody might be at hazard of death, we are expected to play the same game, putting on a serious expression and looking sad at the very possibility of death. An excellent example of how this pseudo-grief works is provided by the emotions and behaviour we feel compelled to feign when a diagnosis of cancer has been made.

     Hearing that somebody has cancer forces us to contort our features in a mask of sympathetic concern. However cheerful we are feeling and no matter how well our own life is going at the moment, we have to pretend to be awestruck and deeply saddened. This often creates resentment against the person who is so afflicted, who now becomes the centre of a strange species of ritualised grief-rehearsal. Our emotions are in a lower key than they would be at a funeral or wake, of course, but we are still mentally dressed in sober colours and ready to commiserate. This can be especially infuriating when the circumstances instead impel us towards laughter; a not uncommon experience. We cannot guffaw out loud or even smile, despite the situation and the words being spoken being so preposterous. Here is a common instance of this dissonance; the peculiar speculation about accidents involving buses and pedestrians which seems to develop in almost every person who has recently been diagnosed with cancer.

     One of the first things said by anybody, upon learning that he or she has cancer, is a statement to the effect that they might fall under a bus tomorrow anyway. Almost every single person that I know who has been treated for cancer, has remarked at some point, ‘Oh well, I suppose I could fall under a bus tomorrow!’ This is an attempt to persuade themselves that they have not really received news of a life-threatening disease at all and that the chances are anyway that something other than cancer will kill them. Invariably, we make the traditional response, which is to shrug, say ‘That’s true!’ and then remark that any of us could be taken at any moment. What we really want to do of, course, is point out what a foolish thing has just been said. The overall mortality rate in the Western World from cancer is extremely high, whereas the number of people who die under the wheels of buses is fantastically low. On a personal level, every person I have ever known who has said, on being diagnosed with cancer, that they could end up falling under a bus, has actually died of cancer. To my shame, I have never yet had the courage to point out what a truly ridiculous scenario this is; the idea of a person being diagnosed with cancer on a Monday and then the following day going under a bus. I mean, really!

     The actual figures for the two hazards are interesting. Approximately four hundred and fifty pedestrians die each year in road accidents in the United Kingdom. Perhaps half a dozen of these are killed by buses, one person every two months or so. By way of contrast, a hundred and sixty five thousand people die of cancer in a typical year; which is to say four hundred and fifty a day. It is easy to see that cancer is a considerably greater threat than the wheels of buses; 27 thousand times greater, in fact!

     Of course, almost every reader of this book has had a similar experience of finding something laughable and absurd about the subject of cancer and having been quite unable to express the least amusement. This, like the prohibition on admitting an antipathy for a stepchild or dislike of an elderly relative, is just one more aspect of modern life which leads to suppressed feelings liable to turn into internalised rage, with all the consequent ill effects for both psychological and physical health.

     Discussion of death has so far been concerned with cancer for the simple reason that most people in Europe and America will develop and quite possibly die of this disorder. This is not of course because there is some dreadful epidemic of the disease, caused perhaps by chemicals, pollution or climate change, but rather because we are not dying any more from smallpox, cholera, typhoid or any other of the other infectious diseases which were once such a scourge. Nor do people in the West often fall victim to the effects of malnutrition, drought or war. Because they live so much longer, developing cancer at some stage in their lives is almost a racing certainty. This being so, it is astonishing how coy we are when it comes to talking about the subject. We refuse to talk of an event which is statistically almost inevitable, if our lives are preserved for long enough. The use of euphemism to avoid mentioning the word ‘cancer’ is a fascinating field of study in itself.

     Today, many of us still avoid mentioning certain topics for fear of ‘tempting fate’. It is this superstitious dread which prevents us from naming cancer out loud, lest we somehow bring into concrete existence the thing we fear most. This bizarre linguistic contortion, adhered to by even doctors and other medical professionals, is dangerous to all concerned, for it discourages people from making proper provision; either for their own death or those of people close to them. It is this dishonesty and refusal to call things by their real names  which is responsible for much of what currently ails society, not least in producing the many psychological disorders which are now proliferating like fruit flies across the whole of the western world.

     Looking at a specific, real-life example of how this works is instructive. After visiting her doctor and subsequently being seen by a consultant at the local hospital, a friend of mine received a letter. This was a copy of the letter which the consultant at the hospital had sent to her general practitioner. Because she is a rational woman who found the whole thing hugely amusing, she showed this letter to me, and pretty grotesque reading it made too.  She had apparently, ‘presented with a nodular lesion on her right shoulder.’ This was, ‘Clinically and dermoscopically compatible with a BCC.’ Later on, there is mention of ‘CWT’.  This letter is a masterpiece of obfuscation! It would be entirely possible for a patient to read through it and still not realise that he or she had been diagnosed as suffering from cancer. A mild and largely innocuous form, it is true, but cancer never-the-less. ‘BCC’ is an initialism for basal cell carcinoma, a type of skin cancer, and ‘CWT’ refers to cancer waiting times.

     The word ‘nodule’ is a popular way to avoid talking of cancer, as is ‘mass’ or ‘swelling’. Using clinical terms and describing a lump as ‘carcinoma’ was popular for a time, but then everybody began to get wise to this and it was seen as almost as tactless as talking directly of cancer. This is why in the letter quoted above, only the letter ‘C’ is used to stand for ‘carcinoma’. Another popular shunt word, or way of avoiding pronouncing an unacceptable word, is ‘lesion’. The fact that in the letter, not one but two euphemistic terms are used would enough to raise the suspicions of a lot of us that there was something to conceal. As soon as my friend set eyes on the phrase, ‘nodular lesion’, she was left in no doubt at all that she had been diagnosed with cancer.

     Cancer is an interesting subject because it is one of those things which most of us will encounter and it is for this reason that the reluctance to talk of it or call it by its correct name is significant. It sums up the attitude to death which has become all too common in the Western World; that is to say, pretending that it does not really exist. Not only is the subject of human death subject to a strict and universally observed taboo, this squeamishness extends, almost incredibly, to pet animals as well. The person who announces to her friends that she is about to have her beloved pet cat killed will cause eyebrows to raise and will be thought of as a most peculiar and cold-blooded individual. If she abides by modern tradition though and tells people in a mournful voice that she intends to have the animal ‘put to sleep’, then she may be sure of sympathy.

     There is something distinctly unhealthy about this fixed reluctance to to speak plainly about a simple fact of life and environ it with countless euphemisms. It is akin to a superstitious dread that if we name the thing out loud, we shall in some mysterious fashion bring it about!