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As enormous community effort goes into cleaning up areas of pornography, litter, and dirt, such as in the recent transformation of New York City's Times Square area, modern society spends considerable effort on disinfecting the experience of dying. This inclination to hide and exclude death from everyday social activity is supported by the transfer of the place of death from home to the hospital.

During the second-half of the twentieth century the burden of care, once assumed by neighbors, friends, and family, was passed onto strangers and medical caretakers. The new sites of death which emerged, most notably the hospital and long-term care facility, enabled the removal of unpleasant and horrifying sights of the dying process from ordinary social and cultural experience. This transformation, whereby death was sequestered and institutionally confined, was attractive to a culture that was increasingly fearful of dying.

In the hospital, dying is removed from the moral and social fabric of the culture. It becomes redefined into a technical process that is professionally and bureaucratically controlled. The horribleness and enormous suffering of dying is banished from public visibility as it is isolated within the professional, technical confines of the hospital. It is also important to note that in this way the experience of dying has become both medicalized and sequestered out-of-the-way. It has been argued that the medicalization and isolation of dying are forms of death denial. Indeed, if we examine the way dying and death are organized in the hospital culture, a clear pattern of closed and obscured death awareness emerges.

In the modern context in which dying has lost its meaningfulness, death is viewed as failure. This fact helps explain the great sense of shame and humiliation that dying persons and their loved ones feel. In addition, many physicians view death as defeat and failure on both a personal and professional level. As long as dying is seen as shameful and death is viewed as failure, open and honest communication will be stymied. Simply, no one likes to talk about their shortcomings or failures. These, instead, are remanded to the isolated, invisible realm of our collective human experience. That is to say, they are, in fact, denied.

In the current cultural and medical framework, silence surrounds suffering, dying, and death. These keenly felt human experiences are plunged deep beneath the surface of everyday cultural activities, becoming concealed and privatized. Norms and rituals that once helped to sustain and guide persons through the dying process have vanished. It is precisely this devaluation of dying as an important cultural experience that has subsumed the management and control of dying in the technological, medical model. The crucial point to be made is that cultural meaninglessness prompts widespread avoidance and denial, and that the cultural campaign to deny death is waged largely within the strictures of technological medicine.

Yet, despite the widespread cultural inclination to avoid open confrontation, there may be reason to believe that death is not actually denied as much as some have claimed. In the first place, death has been a topic of increasing attention in academia and in popular literature. Scholars who have written, during the past two decades, about the American ways of death denial have contributed to a growing body of professional literature. The presence of this literature, some of it even publicly visible on the shelves of bookstores, mitigates denial. Slowly but surely, thanatology courses on college campuses began to emerge. Textbooks began to proliferate during the 1980s. Movies and plays began to tackle the culturally taboo topics of suffering and dying. Self-help and support groups have burgeoned.

An entire genre of popular, self-help literature on grief has emerged -- some of which, ironically in this age of denial, became best sellers. More recently, newspapers, television, and magazines have catapulted Jack Kevorkian into the mainstream of cultural conversation. National Public Radio has produced an excellent series on end-of-life care. Funeral homes advertise in the Yellow Pages, and more recently have advertised their services on the previously forbidden medium of television. A "dying well," palliative care movement is beginning to take form within the profession of medicine. Death, it seems, is slowly creeping out of the closet and assuming a somewhat visible status in an otherwise death-denying environment.

Thus, it would appear that the American relationship to death and dying is changing. Avoidance and denial seem to coexist with a newly fashioned thrust toward openness. The evolution of this relationship between "avoidance" and "acceptance" requires further contemplation. The key point to consider is whether or not the thanatology movement, with its focus on dignity and openly acknowledging death as a vital part of the human experience, represents a transformation of attitudes or is a recasting of the American framework of denial into a new form.

In primitive societies, ritual and ceremony were heavily relied upon to shield individuals and their community from evil and death. These rituals were connected to the ways of life and provided for cosmic meaning to suffering and the end of life. These rituals eased the terror of death, and enabled individuals to confront dying with courage and reassurance throughout the ages. Thus, the seeming absence of fear was in fact a reduction and control of fear by cultural intervention.

Traditional rituals and meanings generated an atmosphere of openness that eased the terror of death and offered solace to dying individuals. According to Becker, however, the terror of death would not remain submerged indefinitely. It would return with a fury if traditional rituals and meaning dissipated, as he argues is the case in the contemporary world. E. Becker (author, Escape From Evil and The Structure of Evil) argues that modern rituals have become hollow and unsatisfying. As a result, modern individuals are deprived of stable, meaningful life rituals, and have become increasingly "confused," "impotent," and "empty" during both their lives and deaths.

In light of Becker's criticism of the organization of modern life, it is important to pose the following question: What is it that makes humanity empty, confused, and impotent in the contemporary setting? His answer and mine are quite similar. It is because the meanings of life and death in the materialistic, technologically driven society have become shallow, thereby precipitating enormous insecurities and anxieties. One does not have to look too far to see how complaints of personal unease and worry permeate the culture. And, this widespread base of anxiety in living becomes exacerbated into a deep dread and anguish when individuals are forced to confront the end of life.

According to Becker, greed, power, and wealth have become the modern response to vulnerability and insecurity inherent in the human condition. They provide for a base of honor in our materialistic society, and generate an illusion of omnipotence and immorality. Becker takes this argument to its logical extreme, and asserts that the dread of death and emptiness of life in the twentieth century have been responsible for cultivating unprecedented evil through the pursuit of greed, power, and the associated development of destructive capabilities.

Thus, for Becker, the stupidity and inhumanity of humanity lies in the nature of our social arrangements. In the modern context, new patterns of death denial have emerged and have become dangerous and dehumanizing. Up to a point, traditional cultures creatively designed rituals to "deny" death, and these rituals enriched the life of the community. In the absence of meaning systems and rituals, modern society has exploded onto a dangerous and irrational course; shallowness and emptiness have created a crisis of legitimacy.

In this regard, the argument of Becker is remarkably similar to Moore and others who have made the case that one of the great afflictions of modern life is spiritual emptiness and soullessness. Narcissism, self-seeking materialism, and heroic use of science and technology have become prominent forces that shape daily life. In this environment of self-glorification, material gratification, and extraordinary technological achievement, suffering, dying, and death are pushed to the periphery of cultural experience. Individuals are seduced into believing the illusion that, in this cultural context of denial, the facts of death and suffering are inconsequential to their daily, personal lives.

Materialism is a prominent value in American life. Becker makes the argument that the evolution of capitalism as an economic and social system is a modern form of death denial. That is to say, in capitalism it is through the thrill of acquisition and the pursuit of wealth that human frailty is overcome. Power accrues as wealth and possessions amass, and wealth endows immortality as it is passed on to one's heirs. Narcissism, another prominent fact of American cultural life, is also related to the denial of death. In an age of individualism, we become hopelessly absorbed with ourselves. Although we know that death is an unavoidable reality, narcissism facilitates the self-delusion that practically everyone else is expendable, except ourselves. In this era of individualism, the death of oneself becomes increasingly inconceivable. When one matters more than anything or anyone else, self-absorption does not allow for the possibility that one will no longer exist. In this way, the deeper we plunge into narcissistic, self-admiration and idolization, the more we become oblivious to our inevitable fate. As a culture, the more oblivious we become, the more unable we are to face up to the facts of death in our daily activities. Death is accordingly hidden and denied.

Thus, the social organization of modern life precipitates widespread oblivion and denial:

Modern man is drinking and drugging himself out of awareness, or he spends his time shopping (or admiring and entertaining himself), which is the same thing. As awareness (of our common human condition) calls for types of heroic dedication that his culture no longer provides for him, society continues to help him forget [E. Becker/ Escape From Evil, The Free Press, New York, 1975, pp. 81-82].

Fear of Dying or Fear of Death?