Speaking of Dying

Posted on October 3rd, 2012

Why can we not talk honestly and openly about dying, in our churches and in the surrounding world?

The preeminence of medical science and advanced technology, which have led to the eradication of many diseases once considered death sentences, permit us the belief that we have conquered death, that it is no longer the inevitable, natural progression of life. The ability to receive medical treatment and advanced testing has caused illness to become a permanent condition rather than a temporary state. This prolongation of life has shifted the cause of death from infectious to chronic and terminal diseases. As more causes of death result from chronic conditions, people are living in a dying role longer, thus increasing the necessity of communicating more frequently with dying persons.

Many Americans today see technology as an escape from the inevitability of death and believe that technological advances will fix any bodily damage suffered throughout their lives. Moreover, the attempt to control death has resulted in a loss of understanding of the meanings surrounding dying.

Austin Babrow and Marifran Mattson conclude that the dying process has thus become, paradoxically, even more agonizing. Barriers to communicating openly about dying are a result of a lack of open awareness about dying, society’s high expectations and emphasis on health restoration and recovery, and the change from community-based religion to individualized religion. Our care of chronic and terminal illness is medicalized; this replaces the care we could receive from other sectors and institutions of society, the church being a dominant one.

The trepidation associated with communicating with dying persons who are seen “as living reminders of the unavoidable reality of death” is commonplace for most of us, and can be the common experience of dying even in our own families.

Medicine has largely usurped our involvement in dying.

The loss of public rituals and practices surrounding dying (both cultural and religious) has contributed to communication apprehension in these contexts. Daniel Callahan argues that it is these practices that teach us “the comfort of knowing how to behave publicly in the presence of death—what to say, how to compose one’s face, to whom to speak and when to speak.”

Church members and pastors are not immune to the ideology of impending death denial. The typical funeral sets a low bar for entry into some rewarding afterlife. That afterlife is typically conceived as a continuation of this life. This in itself is astonishing in light of our increasing knowledge of physics and cosmology. Thus the church typically ignores dying, not on theological grounds but because (1) technology postpones it, (2) culture removes it from view, and (3) the focus is diverted elsewhere. Thus the imponderables are rendered manageable by medicine, technology, institutionalization, and the church’s simplistic pandering to a softhearted and softheaded universalism that places an easy judgment on each soul as it ushers them to a heaven that is simply earthly life in perpetuity.

In his survey of Western attitudes toward death, Philippe Ariès describes how our views of death have changed from the natural occurrence that takes place in the bedroom (ideally) to the virtual banishment of dying from our minds by outsourcing it so that it is “hushed up” or “furtively pushed out of the world of familiar things.” Death in a medical facility signals a shift from dying as a ritual to dying as a “technical phenomenon.”

Helpful Communication Concepts

Medicalization and related factors help explain how and why the church has outsourced the management of dying to institutions other than itself. Some concepts in communication theory will also aid us in understanding how the church fails to properly or constructively engage the dying in its midst. Diagnosis responses among church family members are as varied as the dynamics in any human system. Other than the patient, family is most immediately affected by a terminal diagnosis: their system is altered and will continue to evolve radically as the pressures of suffering intensify. Research performed in the last two decades recognizes the “intimate reciprocity of suffering by patients and families experiencing terminal illness.”

For all parties, there is the individual concern of coping with the suffering of self, as well as the interpersonal concern of coping with the suffering of the other.9 Both a pastor and congregants share the fatiguing duality of living with and dying of an illness.

Caring for the terminally ill can produce profound psychological effects, increase anxiety and depression, cause deterioration in other relationships, and suppress professional roles and involvement in personally fulfilling and healthy activities.  In the church context, basic congregational needs continue and members of a church family likely feel the pressure of increased responsibilities or increasing avoidance of responsibilities. In addition, patient suffering can commingle with these shifting roles of responsibility to create feelings of high anxiety, frustration, confusion, anger, and loss in a church community. Congregational conflict can become untenable as a pastor becomes too sick to participate in the decision-making processes of the church. Amid all this tension and confusion, there are three communication approaches that help us explain how churches can fail to share ideas about a pastor or member who is terminally ill: mutual pretense, strategic ambiguity, and Communication Privacy Management (CPM) theory.

Mutual Pretense

The ritual drama of mutual pretense is established when medical staff, church, family, friends, and patient agree to behave as though the patient is not dying. To create this context, a complex, mutually achieved but often unspoken coordination is necessary. If one participant in the context is unable to pretend death is not encroaching, the pretense will end. Of course, mutual pretense is eventually unsustainable if a patient is actively dying. The pretense denies family a closer relationship with the dying patient, leaving the patient very much alone in dying and silenced. The most prominent organizational consequence of the mutual pretense context is that it eliminates any possibility that family and friends might psychologically support the patient and one another in the dying process.

Strategic Ambiguity

In 1984, Eric Eisenberg defined strategic ambiguity as an “instance where individuals use ambiguity purposefully to accomplish their goals.” Strategic ambiguity allows points of agreement to be found and values to be shared at an abstract level; agreement occurs in general and the grand narrative of the group is preserved. Conflict can be avoided.

Communicators use resources of ambiguity in language because they always have multiple goals in communicating (though sometimes we are not fully conscious of these goals). The classic example is a person wanting to be simultaneously truthful and tactful. Conversations aimed at breaking bad news or talking about the loss of life as we know it are rife with multiple goals, so it is not surprising that pastors, congregants, and church hierarchy are at times strategically ambiguous.

There are two sides to strategic ambiguity. The first is selfprotective, political, and even manipulative—power and privilege can be preserved by avoiding conflict that can occur as a result of directness. The second side of strategic ambiguity is inclusive and even transformative—by avoiding clarity, a communicator can make room for multiple interpretations and in so doing engage disparate stakeholders.13 Though the properties of this communication strategy can serve an organization and its process, we find that this method used purposefully and passively (without training) presents challenges of vagueness, nonspecificity, distraction, and evasion when a church is confronted by a dying leader or member. The essential problem is this: strategic ambiguity allows people to avoid responsibility for the messages created in a culture of death avoidance. Strategic ambiguity can contribute to the patient and her or his immediate community buying into a story of recovery when it is inappropriate, given the diagnosis.

Communication Privacy Management (CPM) Theory

According to Communication Privacy Management (CPM) theory, private information is owned by individuals and this information is maintained by boundaries. The flexibility of the boundaries and the inclusion of certain people are determined by something called boundary conditions.  Once private information is shared, the new recipient assumes coownership of the information. Boundaries are continually managed between individuals. Terminally ill patients and congregants/staff must ultimately manage co-owned information as a means of managing uncertainty. For example, if two members of a congregation learn of a serious advanced disease diagnosis for another church member, they now must manage that information. Will they share the information and report to supportive others that their co-congregant has a terminal illness? Will they share that their co-congregant has received a difficult diagnosis but is doing well and is committed to recovery? Will they share that their co-congregant has received a difficult diagnosis but is hopeful for recovery?

Each choice will have a different impact on the people who become co-owners of this private information.

Thus individuals manage personal (e.g., pastor to congregant), shared (e.g., congregant to congregant, or staff to congregant), and organizational boundaries of private information (e.g., congregant to church hierarchy; parties throughout the entire structure of the church and its governance) through privacy rules that dictate how a boundary can operate for people. CPM theory helps us consider what information is actually exchanged about the dying reality for a person in the church. Originally proposed as a way of understanding organizational culture, CPM theory is easily applicable to family and church systems and is useful in determining group culture during terminal illness. In addition to understanding boundaries, the ideas held within CPM theory identify the ways in which people go about managing uncertainty.

What we found in the churches examined in this chapter is that uncertainty management was primarily achieved by avoiding an open awareness of dying as well as limiting access to private information not only to the local church family but also within larger governing structures.

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Excerpted from Fred Craddock, Dale Goldsmith, and Joy V. Goldsmith, Speaking of Dying: Recovering the Church’s Voice in the Face of Death, Brazos Press, a division of Baker Publishing Group, ©2012.

Used by permission. All rights to this material are reserved. Material is not to be reproduced, scanned, copied, or distributed in any printed or electronic form without written permission from Baker Publishing Group.

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