J Med Humanit (2006) 27:105–115DOI 10.1007/s10912-006-9009-6

ORIGINAL PAPER

“Seeing the Difference”: An Interdisciplinary Approachto Death, Dying, Humanities, and Medicine

Christina Marsden Gillis

Published online: 13 June 2006C© Springer Science+Business Media, Inc. 2006

Abstract This essay explores how strategies integral to inquiry in the humanities provideinsights into developing an interdisciplinary approach to studies of death and dying thatwill be relevant to medical practice as well as to humanistic study. The author asks how wecan produce new modes of knowledge in an area where “knowing” is highly problematizedand argues that while a putative field of death and dying studies must include a range ofdisciplinary approaches it must also account for lived, subjective experience and the waysthat we, as individuals and as a culture, create meaning.

Keywords Death and dying . Loss . Art . Bereavement

It was a still, gray, June morning when we gathered in a darkened meeting room at theTownsend Center for the Humanities at the University of California, Berkeley, to participatein a two-day institute titled Seeing the Difference/Seeing Differently. We were literaturescholars, historians, Hospice staff, medical faculty, social workers, grief counselors, writers,artists. Our subject was death and dying.

On that morning in June, I had been, for more than a decade, the associate director ofBerkeley’s Townsend Center, which was founded in the late 1980’s to promote interdisci-plinary work in the humanities and related arts and qualitative social sciences. Over thoseyears, I had produced a long list of public programs—and in many cases, publications aswell—on aging, suffering, death and dying. Seeing the Difference, in a sense, culminatedwork that was both personally and professionally motivated. Personally, I understood loss;professionally, I was committed to the need to develop interdisciplinary understandings ofdeath and dying and to bring into the discourse of death the strategies of interpretation andunderstanding that are central to humanistic endeavor.

I felt the usual pre-event anxiety that any organizer experiences early on that morning,but I was confident that if I got the structure for discussion right, the fifteen professionalsI had assembled as resource speakers—as well as the thirty-five committed individuals

C. M. Gillis (�)Berkeley, CA, (home), 2785 Buena Vista Way, Berkeley, CA, 94708, 510-845-5441e-mail: cmgillis@berkeley.edu

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from medicine, the humanities, and social sciences I had identified as participants (not apassive audience)—would promote, and exemplify, the interaction I was hoping to achieve.Interaction was key: my goal was to explore what makes interdisciplinary discussion work,particularly in an area like death and dying, and even more important, to demonstrate howthe humanities can speak to pressing human issues without adopting an instrumentalist modethat restricts their inherent value.

To this end, I had organized the Seeing the Difference sessions around three topics appro-priate to the humanist’s arsenal: the role of art and ritual—and silence—in the experience ofdeath; the element of time in defining the process of dying; and the significance of spatialmetaphor, particularly that of the boundary or border, in figuring our conceptions of life anddeath, living and dying. The rubrics for discussion were necessarily large, even amorphous,for Seeing the Difference was about ways of seeing, about making meaning.

And it was also about limits. It took its title from a statement by critic Regina Barrecawho gave special meaning to “difference” when she wrote:

Just in case you thought there was no distinction between representation and reality there is death. Justin case you thought experience and the representation of experience melted into one another, deathprovides a structural principle separating the two. . .. See the difference.1

Barreca writes of the difference between the living and the dead, life and death. She rightlypoints to the problem of representing death in ways that speak to “reality.” But there is ananalogous question for those whose task is to develop and facilitate new, institutionalizedways of seeing, to produce knowledge: we must ask ourselves, particularly when we entersubject matters like death and dying, what kind of knowledge we can produce. And howshall we do it? For seeing the difference also means “seeing differently,” understandingthe different kinds of seeing associated with disciplinary lenses. We are really speaking ofcognition, of how ways of understanding inform both specific analyses and interpretationsas well as more diffuse and diverse cultural behaviors. And we are speaking—and here ismy real focus in this essay—of the function of language as part of this process.

I knew from the beginning what kind of language would not work in the “Seeing the Dif-ference” discussions. Some years earlier, I had been disappointed, frustrated, even enraged,at a conference (sponsored by a humanities institute in another university) that reduced deathand dying to simply another topic, a vehicle for theoretical posturing that signaled, if any-thing, the avoidance of the “real” subject. Words floated free in a maelstrom of non-meaning.My companion at that conference had witnessed the horror of the Holocaust as a child inPoland and much later, as a physician, had spent years working with critically ill and dyingchildren. He left, in anger, even disgust, after the first afternoon of that conference. He hadbeen looking for something more from the humanities he said. Consciousness, vision, mem-ory, awareness of suffering, cultural understandings of loss: here are topics and categoriesthat any consideration of death and dying must explore.

Like analogous “studies”—feminist studies, aging studies, disability studies—a putativefield of death and dying studies must connect itself with lived, subjective experience andwith the ways that we as individuals, and as a culture, create meaning. What follows hereare traces of an intellectual process that is to some degree familiar to anyone who hasparticipated in an academic conference. But the dynamic relationship between the self andthe conference/collectivity that I, along with my fellow participants, experienced in the Seeingthe Difference discussions emerged as central to the very meaning of interdisciplinary workin this area.

1 Barreca, “Writing as Voodoo,” 174.

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“Interdisciplinary” is an active adjective; “envisioning” and “understanding” are its cor-relatives. The integration of death and dying into humanities and medicine fields demandsan interdisciplinary approach to death and dying that will interrogate and acknowledge thetensions between “disciplined” and subjective knowledge. I pursue my argument with whatthe late Marxist critic Raymond William called “keywords.” For Williams, keywords werehistorically charged; for me, they serve as connectors, enabling the engagement integral toan interdisciplinary and humanistic discussion of death and dying. They all cluster aroundnotions of sight and understanding. They all speak in some way to Barreca’s question ofrepresentation but ultimately gain their power from the dynamic process in which they playsuch an important role.

“Absence,” “ambiguity” and “uncertainty” are three examples of my keywords. Implicitin all of them is a not: not here, not clearly defined, not certain. But at the same time, thenot always calls up its putative opposite. These words functioned in my original thinking—and they function now—as poles around which various meanings are drawn. They mayslip and slide into one another, they defy precision, they invite engagement. They are thewords of a humanist’s vocabulary. “We do not have the luxury of delving into languagewhen we have decisions to make,” a physician once remarked to me. “It’s either A or B. Adecision has to be made, alternatives clearly enunciated.” But is that moment of apparentlybinary decision-making necessarily isolated? Is it not contextualized in the whole experience,professional and personal, of the physician decision-maker? Medical practitioners admit theirown uncertainty—their own lack of language—in discussing with seriously ill patients thepossibility of death. The medical language is limited. As psychiatrist and anthropologistArthur Kleinman reminded a Berkeley audience some years ago, meaning is not created inmedical settings.

In speaking of death and dying, we need words that contain within them layers of meaning,each merely the tip of a linguistic (and experiential) iceberg. These words need to be openedup, but the nature of that opening will differ greatly according to who does it. If the poet, thehistorian, or the oncologist come out at very different places in this process, the exploration ofthat difference is central to the making of meaning. In structuring my discussion here arounda trio of keywords that may be seen as negatives, I hope to provide a simulacrum of the open-ended strategy—an interweaving of subjective experience and disciplined knowledge—thatI view as essential to the subject of death and dying.

Keyword: Absence

It is perhaps an oxymoron to speak of absence in a discussion that is focused upon notions ofvisibility. How do we see what is not physically there? And it is particularly noteworthy thatthe word was introduced most fully into our conversation by pathologist Frank Gonzalez-Crussi, a self-described “professional viewer of the dead.” “The presence of the cadaveris fundamentally paradoxical,” Dr. Crussi said, “a presence that is also an absence; [and]the absence of a cadaver is doubly distressing, an absence of an absence.”2 Clearly, Dr.Crussi speaks here of a seeing that transcends the professional lens of the pathologist, visionderiving rather, I expect, from other sources—in philosophy, literature, or religion—andfrom his own cultural experience. Grounded in the human condition, such vision, seeingwhat is “not there,” cannot be measured with the tools of medicine or science.

2 Gillis, Seeing the Difference: Conversations on Death and Dying, 106. All subsequent references to thiswork appear in the text.”

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Nor can it be measured in the languages of the social sciences or the law. “I can’t hearhim coming through the door any more,” the wife of one of the victims of September 11 toldthe New York Times writer in an article that appeared in the spring of 2002. The woman waspart of a project to “assess loss.” Accounts like hers were designed to illustrate the impactof those losses and hence assist in the prosecutions of those accused of perpetrating thetragic 9/11 events. In retrospect, we see the absurdity of such an “assessment” project; forhow can we measure what the individual cannot “hear,” cannot “see”? Absence is not easilyvisualized, even though, as widely recognized, the photographs of the Trade Center couldbe seen to mark us visually as a culture. We can, as bioethicist Jodi Halpern, a speaker atthe Seeing the Difference institute, pointed out, narrate loss; but since a conversation, in theusual sense of that term, has ended, we must find other ways of holding on to the “meaningof people,” of asserting our connections with the absent.

I was no stranger to the task that Jodi Halpern identified. I never saw the remains ofmy son who died in an accident in East Africa on Christmas Day, 1991. There was no“seeing,” no “hearing,” no “conversation” except for the last telephone exchange on whatwas to be the morning of his death. “In cases of fatal accident abroad, we recommendcremating the body in the country where the death occurred rather than sending it home,”the kind but matter-of-fact voice on the telephone from the American consulate in Nairobitold us. The message was all too clear. The corporeal remains of our son, qua body, weregone from us. Instead, we would have a small, discreetly sealed, cedar box of ashes, atalisman for a young, vibrant life that has been lost. The box would travel from Nairobi, viaLondon, to Philadelphia, then to California, then back to the East Coast to be buried on anisland in Maine where our son had spent at least a part of the twenty-six summers of hislife.

My husband and remaining son dug a small grave in a nineteenth-century white-fencedcemetery overlooking the sea. In our own small boat, we brought to the island, and thenhauled in a wheelbarrow to the cemetery, a small slab of pink granite to mark the grave.Finally, in a simple burial ritual, shared with the neighbors we had known for more than twodecades, we were helped to deal with our loss and to create a non-corporeal presence thatboth depended upon and reinforced the power of memory to hold on to the child we had lost.

This is an account of memory work and ritual making that concretizes, or reifies, memoryand seeks to fill in or substitute for the emptiness of loss. It is, perhaps, more about actingthan seeing. But if viewing, visualizing, an actual body in death played no part in this ritual,the box of ashes we carried to the cemetery that day nonetheless signified for us what FrankCrussi called the “presence of an absence,” a stand-in for the body. The precious box in myhusband’s hands remains a central element in the memory picture of the three remainingmembers of our family, walking through grasses still damp from an early morning rain, whileour friends and neighbors gather at the cemetery gate to receive us in a simple ceremony ofour own devising.

The apparently paradoxical linkage of visibility with absence is central to the many ritualsthat signal the attempts of a given culture to deal with the void of loss. Funeral rites enable usto deal with the ambivalence that necessarily accompanies our viewing of the dead: “It [thebody in death] is a sight that we avoid as the all-too-obtrusive reminder of the precariousnessof our own life,” Frank Crussi pointed out. “ It is also a sight that we seek, as the onlyconcrete reality on which we can anchor the illusion of a living presence” (106).

This insight helps us understand the growth of the funeral industry, whose very being, ashistorian Gary Laderman reminded us, depends upon the ritualized handling of the body indeath. In tracing the discourses that evolved with the growth of the funeral industry, Garyfound that the notion of looking at the body, in a controlled, literal sense, is central. Providing

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a link between the apparently disparate areas of funeral practice and art, he suggested that itwas precisely through its capacity to preserve, in a quasi-aestheticized form, the corporealpresence of the body in death, that the funeral industry gained its power in the late nineteenthand early twentieth centuries in America. A 1921 writer on embalming explained (as quotedby Gary Laderman): “How a dead body looks to survivors is of the utmost importance toindividuals within the [funeral] industry. A successful funeral is one with an open casket andan embalmed body that appears familiar and nonthreatening to the visitors” (27). The roleof the funeral director is then to take the “threat” (sting) out of death through providing abody that looks “familiar.”

Here is the phenomenon that Frank Crussi has identified as seeking out the vision of thebody in death as the “only concrete reality on which we can anchor the illusion of a livingpresence.” The funeral industry that Gary Laderman describes is well aware of its power toprovide such “illusions” within a more general ritualized context. Rising to a crescendo, thecomments of the protagonist for the industry endow the embalmed and aestheticized bodywith the power to control memory and emotion: “Proficiency in [embalming] will enable themortician to improve one of his greatest services to the public, and that is the alleviation ofgrief” (28). The body here is not only “nonthreatening”; it serves as a talisman in a ritual ofconsolation.

In Gary’s historical account, the funeral industry marketed itself by emphasizing this“last view” that putatively offered both realization and consolation. But last view of what?Of whom? Returning us to Frank Crussi’s “paradox,” these questions take us again to thepractices of the visual arts, specifically the work of San Francisco photographer Jim Goldberg,whose work both launched the Seeing the Difference institute and became a reference pointto which the discussion constantly turned. For Jim also gave us a last view: he presented aseries of photographs he had taken of his dying father, providing in his remarks an accountof the physical and emotional context in which the images were taken. Jim’s image of theempty chair, the Barcalounger that had come in the final days of his father’s life to definea world—the only place to which the dying man could move as an individual—is aboutabsence. The man who sat in the chair, and to whom the chair meant so much, is no longerthere.

But something remains. If the corporeal form is absent, the chair still maintains thetrace of the body of the man who has died; hence, literally, we see both absence andpresence here. The trace stands in as a metonymy for the man. Art thus functions—andhere is one answer to bioethicist Jodi Halpern’s question, “What do we do with art?”—in thecomplex set of interconnections among loss, memory, vision, consolation. Jim’s photographs,representations created by the artist who is also grieving son, represent in Halpern’ s termsa search for the meaning of his father’s living as well as his dying, a meaning “[to] hold onto.” The photograph is a record of that meaning, and it is also a story whose re-telling—wedidn’t just see Jim’s photographs; we also heard his story—creates of the absent a continuingpresence.

Keyword: Ambiguity

Seeing absence may be no less paradoxical than seeing ambiguity, my next keyword. Wehear as well as see ambiguity, of course. Differences in language are key barriers to interdis-ciplinary discussion, particularly in those instances like medicine and humanities where theprofessional gaps are broad. Anthropologist Sharon Kaufman takes up this issue, and howit plays out in an actual death scene in an essay titled, “Narrative, Death, and the Uses of

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Anthropology.”3 Drawing upon a recently completed ethnography of dying in a Bay Areacommunity hospital, Kaufman argues that if death in America is viewed as a “problematic,”this sense arises from cultural conventions that leave all the “actors” (Kaufman’s term) inthe dying scene unsatisfied. “There is never just one story to be told [about a trajectory ofa given person’s illness and decline] Kaufman writes; “there are always a variety of view-points, different kinds of knowledge and interpretive frames brought to bear. The lay andmedical worlds experience different kinds of understanding.” The lens provided by healthprofessionals is not understood by patients. Patients have no worlds of experience fromwhich to make their so-called “choices.” At the same time, Kaufman concludes, “the goalsof medical practice in the face of death are ambiguous, and the national conversation isoverly simplistic.”

Kaufman makes a valuable point. She alerts us to the fact that it is not only disciplinedknowledges that differ one from the other; in the world of the suffering and the dying,different knowledges and interpretive frames prove crucial blocks to understanding and, byextension, to the alleviation of the suffering of both the dying and those who survive them.What, then, are the languages through which we can speak to one another?

We live in a world that wants definitive answers or solutions to specific problems. “Andwhat is the possible use of a meeting in which humanists meet with medical practitioners toexplore the ‘meaning’ of death in American culture?” asked a foundation that had just rejectedmy initial proposal for Seeing the Difference project. It was over a year before the eventsof September 11. Emptiness and loss were not yet inscribed on the national consciousnessas they would be after that date. Illness and suffering, the agonies of end-of-life decisionmaking, the meanings of palliative care, were. But it still proved difficult, if not impossible,to argue to organizations that function within an instrumentalist model, that “use” is not aone-dimensional criterion, that the humanist’s approach to a subject matter is not necessarilyto pose one “problem” to which one solution must be sought.

Our institute was not about palliative care, physician-assisted suicide, patient autonomyper se; death cannot be contained that way. One must begin with a broad field, take broadconceptions as invitations to engaged thought. If, in experiential terms, words like absenceand presence keep sliding into one another, we need the fuzzy borders. Beth Dungan, an arthistorian working on the connections between medical imagery and the representation ofillness and death in art, remarked in her comment to the Seeing the Difference group: “Oftenwhen I describe my work to people, they say, ‘Oh well, you must know a lot about death.’ ”But Beth finds herself “amazed” at this comment simply because she cannot “know” death inthe way her interlocutors are suggesting. Death is the “one thing that was not imaged throughthe medical imagery that I was looking at,” she emphasized; “vision has a relationship bothto the imaginary and to the externally visible” (137).

Once again, “vision” and insight inhabit a porous border between what Dungan called the“externally visible” (the “knowable”) and the imagined. Interestingly, both come into playin Sandra Gilbert’s notion of “plausibility,” which also affirms the idea of a border even as itsuggests the possibility of seeing or understanding what is on the other side. As poet, critic,and bereaved wife, Sandra described the experience of viewing the body of her husbandwho had just, unexpectedly, died in a California hospital: “Serious and material rather thanmaternal, this death forced me, horrifyingly, to confront the metamorphosis of a body I hadloved into a dead thing that now appeared to be the material of fate itself.” “Death,” shewent on, “was made eerily plausible [italics mine] by my husband’s lingering presence in

3 Kaufman, “Narrative, Death, and the Uses of Anthropology,” 342–364.

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the midst of it. . .. He wasn’t there, but he was there. And his thereness, his presence at thecenter of massive absence, was what made death plausible, what flung it open like a doorinto an all too easily accessible space. . .” (16).

Metaphors of space, of a place that is other, provide for Sandra Gilbert an imaginedconcreteness: “So and so is ‘gone,’ we say. But gone where? It doesn’t matter how oneimagines the place, what’s important is that it’s a place and that, given the weird familiarityof the body of the dead one, the place the dead one has gone must also be weirdly familiar”(17). In Gilbert’s terms, plausibility locates itself in the gap between presence and absence,that vexed space that Frank Crussi pointed to in his comment that “the presence of the cadaveris fundamentally paradoxical . . . the presence of an absence” (106). Like Frank, Sandra has“seen” absence through the presence of the body.

Similarly, ambiguity and apparent paradox go together when Jim Goldberg describes hisexperience of photographing his father’s death in terms of what could not be seen: “I could feelsomething when my father died, but I couldn’t see it.” What Jim Goldberg shows us, however,is the photograph “7:41,” where a sharply focused watch face in the foreground reveals thetime of Jim’s father’s death (7:41), and the face of Jim’s father occupies the background inunfocused relief. What the photograph reveals—or does not reveal—constitutes a problemin representation that begs interpretation on both an aesthetic and a human level. It suggests,in a larger sense, the power inherent in representational strategies when art becomes whatJodi Halpern calls the “acknowledgement” sought by those who are dying and those whoare left to grieve.

The odd disjunction, the ambiguity, between the corporeal and the absent, the “there” and“not there,” is fundamental in the accounts offered by both Jim Goldberg and Sandra Gilbert.And Jodi Halpern’s question—“What do we do with art”?—points once again to what wemight call the ritualistic power of aesthetic representation to hold on, albeit in transmutedform, to those we have lost. Perhaps this is why art, as non-discursive communication, earnsits traditional role of consolation. To seek the particular truth that art offers in the arena ofloss and absence is to accept ambiguity and acknowledge a presence that, as Frank Crussihas said, “remits us to an absence.”

Keywords: Uncertainty

“Meaning” was our real subject throughout the two days of the Seeing the Differencediscussion: how does death mean—to those who are dying, to those who care for them, towhose who grieve for their loss? As we have seen, important conceptual terms evolved fromthe exchanges among participants. Sandra Gilbert gave us plausibility; Jodi Halpern, author ofa book on empathic practice in medicine, contributed acknowledgement: “When we imagineour own dying, there is something we want. We want some form of acknowledgement, someform of recognition” (39).

But neither plausibility nor acknowledgement takes us to the certainty that a given patientwith life-threatening illness, or indeed an entire culture, may seek.

The language of “triumph,” of successfully waged war against death, as oncologist DebuTripathy pointed out, plays a major role in contemporary culture, signaling a need to controlthat is in turn allied to a need to know. We crave certainty. We are, in Dr. Tripathy’s terms, a“culture of technology, a culture of high expectation”; new therapies are presented in mediaas the “triumph of technology” over illness and disease (56). We want to share in that victory,to be among the winners.

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Certainty is sought by those who suffer life-threatening illness and by those who carefor them. “We lack role models in how to die. It’s a very foreign thing, and it’s foreign tophysicians as well,” Dr. Tripathy explained. Confronting the uncertainties inherent in newtherapies, confronting mortality and death, should be part of an initial consultation with acancer patient; but Dr. Tripathy admitted to nervousness about this process: “This is not anarea where there is background science to guide us” (58).

The humanist’s response is not to limit the question (“how can we achieve certainty”?)but to broaden the frame in which we pose our questions. All conceptions, all “meanings,”are, for example, culturally and historically grounded. What are the questions that will lendus insight, or even lead us to new questions? An important strategy of our work as humanistsis to draw upon historical contexts in our search for understanding questions that are hardlyunique to ourselves and our own generation. Juxtaposed (in the session on time: “Countingthe Moments/Making the Moments Count”) to Dr. Tripathy’s emphasis on the problem ofcontemporary culture’s desire for certainty, we heard the comments of Michael Witmore,a scholar of literature in the early modern period. Michael remarked that the fundamentalanxiety in the period of his research was the suddenness of death. Since the ending of a lifereflected the meaning of that life as a whole, one sought a mortal ending that was deliberatelyscripted (62).

In Michael Witmore’s analysis, the ghost that speaks to the young Hamlet, a disembodiedvoice, may be likened to the black box that records the final words from a plane that hasgone down: in both, it is as if echoes are captured from oblivion, and brought back to life.Both voices, the one that comes from beyond the grave or the one recorded in the blackbox, mitigate the shock of sudden death; it is as if the voice “lives on,” and in articulating aknowledge not ordinarily available to us, seemingly transcends the margin between the livingand the dead that Sandra Gilbert so eloquently described. In the historical/cultural momenthe studies, Michael Witmore identifies the capacity for a split gaze: on the one hand, thereis life, and on the other, an always present mortality. The two are never cleanly severed, butrather, each serves to define the other. Certainty, a need to know that science will triumphover death, is irrelevant.

Knowing and non-knowing, the discomfort with uncertainty, the recognition of differentrealms of knowing, were recurring motifs in the two days of our discussion. The voice ofthe ghost, the voice in the black box, convey partial knowledge at best. “We not only do notknow anything about death in an essential sense but cannot know anything,” asserted oneparticipant; but he was countered by Michael Witmore’s dismay with the notion that “becausethe experience of death is one that we have to interpret, one that is open to cultural influences,it is on those grounds unknowable.” Historian Tom Cole reiterated the humanist’s positionwhen he said that “death is no thing; it loves to be represented, it has to be represented.. . . But it doesn’t mean that we shouldn’t take our words very seriously and our imagesvery seriously. That’s the part of what allows us to be human and continue to be human.”Ultimately, said Cole, we need our cultural representations. And we need our words (83–84).

Reprise

The three main program sessions that comprised the Seeing the Difference institute culmi-nated in a fourth that was planned as a summarizing discussion (led off by the remarksof three “reporters”). This fourth and final session was titled simply, “Speech: Finding theLanguage.” Its purpose was to demonstrate the value of Tom Cole’s assertion: “. . .we needour words.” Like its predecessors that had taken up the meanings provided by art and ritual,

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the importance of time in thinking about the dying process, and the role of spatial bound-aries and borders in our conceptualizing notions of death and absence, the final conversationdemonstrated once again our need for words that are not placed in rigid categories. Linesnecessarily blur. Dying bridges a no man’s land where the unfathomed and the unknowableconfront the scientific and the humanistic imaginations. While death may be the vanishingpoint of medical knowledge and representation, it is also a point of mediation.

What we witnessed in the two days of discussion was a process of “mediation” at work.We saw that any inquiry into the cultural, scientific, and perhaps even spiritual contours ofdying and death must be a plural one. The humanistic perspective may invite a search intohistory for precedents that illuminate our own cultural anxieties over suffering and dying.It may locate an issue like patient autonomy in a broad area where, to cite one example,informed consent is linked to the even larger question of a culture’s emotional need forcertainty as to medical outcome. Humanities approaches make special demands upon us.We are offered not certainties but rather, questions that can spark imaginative, personal, andbehavioral engagement with other questions.

“When is death?” Here is another large question. It was asked specifically by physicianGuy Micco in response to a discussion on the important role of technology in our under-standing and, responding to, death. With Debu Tripathy, Guy questioned the language of“triumph of technology over nature.” The monitor of the electrocardiogram is for him notthe only gauge of when death has occurred. Recalling Lear’s desperate search for life in thedead Cordelia, he privileges rather a definition based on the absence of “breath,” “spirit” or“life force” (75). The absence of life may be “seen,” or felt, but not necessarily measured.

Is this perhaps the moment that Jim Goldberg intended when he said of his father’s death,“I could feel something but I couldn’t see it”? Is this why Jim’s “7:41” photograph givesus a sharply focused watch face in the foreground and the blurred, unfocused face of hisdead father behind it: the face in death. The position of the viewer (Jim himself perhaps, orourselves) is crucial here: what can be seen? what is occluded? what—returning to Jim’sown statement—is felt but not seen? In the foreground is the technology of the watch and itscounting of moments; beyond the technology is the human face.

While ethicist and physician Lawrence Schneiderman called in his remarks for a returnto a “natural death,” other discussants suggested that the boundary between nature andtechnology may be a deception. “We no longer have that option,” responded Shai Lavi, whowas at that time completing a dissertation on physician assisted dying (134). Turning to JimGoldberg’s “7:41,” Lavi contrasted the apparent fixity of the time as recorded by the watch(technological time, we might say) with the much more open-ended questions linking timeand death: What is the difference between the existential feeling of dying and the temporalityrelated to it? How do suffering and pain affect our understanding of time? Is not time itselfmore than a linear and quantifiable measure but also something that becomes part of theprocess of dying?

I remember how I tried to imagine the exact moment of my son’s death. I rememberhearing a clock tick when I picked up the phone to receive the call that came through fromAfrica at 2 a.m. I tried to imagine that moment of death in a time zone eleven hours ahead ofmy own. It would have been late in the evening of what was still Christmas Day in California.My husband and I had gone to bed early. We would have been asleep when our son died.So the moment of the call became the reality, the moment of knowledge checked out onthe clock: the moment that became part of my own subjectivity, marking off a “before” andan “after” in my life. In “7:41,” the unfocused face of Jim’s father, who died on anotherChristmas Day, bespeaks then not the technological knowledge imparted by the watch butthe emotional knowledge—perhaps inchoate—of those who are left to mourn.

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These knowledges collide with and interrupt one another. Vision, as Beth Dungan said,may be fractured. We live in a split world that Shai Lavi described, a place where thehuman and the technological co-exist. Each contains its own kind of knowledge, its own“information.” Neither is adequate in itself. We want and need both, even if they seem tocontradict each other. But perhaps it was this very experience of collision, even cracking,that proved essential to our discussions, forcing us to acknowledge our own place as bothsensate individuals and professional decision-makers.

Perhaps too, this is what defines, finally, an engaged conversation or what Patricia Benner,a professor of Nursing, labeled, in an account of stories of critical care, an engaged seeing.If so, our conversation may share with art and with ritual the power to help us, in our diverseprofessional roles, avoid the pitfalls that threaten any investigation into death and dying.Over the years of planning programs at the Townsend Center for the Humanities, I had beenexpressly concerned with the tensions between the moral orientation that subject areas likesuffering, aging, death and dying, pose, especially within the pragmatic orientation of publicinstitutions. I was acutely aware of what Walter Benjamin had called the “incongruencybetween the concept and event of death and the multiplicity of approaches–avoidance, repe-tition, metonymy, particularized description of historical moments and events.”4 Similarly Iwas sensitive to Zygmunt Bauman’s ‘s observation that “modernity did not conquer mortality.It categorized the knowable techniques and practices of measurable efficacy and effective-ness.” In Bauman’s terms, we “humanize” mortality by viewing it as a set of “problems.”We seek an “enemy” and kill it. We turn, says Bauman, to “projects” that we can handleand attempt to give ourselves a sense of mastery over reality.”5 But I think that Bauman wasnot considering the kind of inquiry with which the arts and humanities are more familiar.Dualities, dichotomies, split visions, tensions, engaged seeing–conceptions such as these, sofamiliar to humanistic activity—do not after all lend themselves to “projects” or processesof “mastery.” They suggest, rather, the humility that comes from engagement in process.45

It is almost 4 pm on a beautiful Friday afternoon in June. I am thinking back to an imagethat informed my first thinking about this institute, the photograph in the New York Timeson the occasion of the plane crash at Peggy’s Cove in Nova Scotia in August 1998. TheTimes photo portrays a group of people spread out along the barren and rocky coast of amist-shrouded sea, apparently looking for word, evidence, or explanation of the losses theyhave suffered when the plane went down. They have not seen that fall from the sky. Theyhave not witnessed the moments of these deaths. These figures, strung along that barrenstage, that margin, no two close together, assume tragic proportion: symbols of grievingparents, children, lovers, friends. The photograph bespeaks expectancy, but at the same timesuggests that the charred bits of fuselage, body parts, and even the famous black box, willnot yield up the answer to those who wait. And though these particular people stand nowin the mist on a rocky boundary between land and sea, their experience, writ large, mirrorsthat of all those who wait in ICU units, who watch the monitor to catch a final moment, whohear the “pronouncement” just uttered by the physician and will then strive to deal with themeaning of those words.

It’s the line, literally the rocky margin, and the vagueness beyond it that I am stillremembering in that Times photo. In retrospect, I see it as representing a dichotomy be-tween the so-called known and unknown that Jim Goldberg’s “7:41” also suggests—the line

4 Schleifer, “Walter Benjamin and the Crisis of Representation: Multiplicity, Meaning, and Athematic Death,”313.5 Bauman, Mortality, Immortality and Other Life Strategies, 152, 163.

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between the focused and the unfocused. But as the afternoon of the final session of the Seeingthe Difference meeting came to a close, it seemed to me that the individuals in the room,with both formal presentations and informal responses, had in a sense peopled an otherwiseobscure landscape. We had joked about that macabre black box in the course of these twodays. And no, no one had received, like Hamlet, a ghostly message from beyond. But we hadposited what we could from our differing perspectives. We had not ceased to be physicians,nurses, Hospice staff, literary critics, historians, artists, or philosophers; but we had engagedtogether in a process of imagining.

On the day after Seeing the Difference, I asked my husband, a historian who was also aparticipant in our discussions, how many times he had thought of our son, Ben, in the courseof the two-day program. “All the time,” he answered.

References

Barreca R (1993) “Writing as Voodoo: Sorcery, Hysteria, and Art.” In Bronfen E, Goodwin SW (eds.) Deathand Representation. Johns Hopkins Press, Baltimore.

Bauman Z (1992) Mortality, Immortality and Other Life Strategies. Stanford University Press, Stanford.Gillis CM (2001), ed. Seeing the Difference: Conversations on Death and Dying, D.B. Townsend Center

Occasional Papers, Nos. 24–25. All subsequent references to this publication are provided in the text.Kaufman S (2000) “Narrative, Death, and the Uses of Anthropology.” In Cole TR, Kastenbaum R, Ray RE

(eds.) Handbook of the Humanities and Aging. Springer, New York.Schleifer R (1993) “Walter Benjamin and the Crisis of Representation: Multiplicity, Meaning, and Athematic

Death” In Bronfen E, Goodwin SW (eds.) Death and Representation. JHP, B.

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