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Is "death" a four letter word?

Dying is tough to talk about, and we can see that discomfort in the language we use.

Photo of Jim Rosenberg
21 19

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This infographic on how we talk about death in obituaries in different parts of the country caught my attention. My experience over the last few years (since Amy, my wife, died) is that many of us have a hard time simply using or hearing the word "died." I watch people flinch at the word and I often debate with myself, what word should I use to make others more comfortable when the subject of Amy's death comes up? We find it hard just to talk directly about the subject, to call it what it is. This makes it hard to have real conversations about each other's experiences and explore how we might best approach death in our world. 


What is a provocation or insight that might inspire others during this challenge?

How do we talk about death? How can we make it as natural a topic of conversation as birth?

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Photo of Hattie Bryant

You are so right.  Words matter especially when talking about a young person and when the death is fresh.  Twenty years have passed since my mom died and it's easy for me to say, "my mom died."  The words on your map read "softer" probably because we are all hoping the end will be soft.

Photo of Gavin Cosgrave

Interesting thought! I think this fear of being explicit and direct when talking about death after the fact also translates to a lack of conversations about planning for death before the fact. How can we help families talk about death (financial factors, hospital vs. home, etc.) before it's too late in the process?

Photo of Hattie Bryant

The funeral home people are pretty good at getting people to buy ahead.  They do this by saying, "You can choose now for yourself or these choices will be done without you by others."  Maybe talking about the logistics is easier than talking about the loss.  Maybe we should ask our elders questions like, "Who would you like to have your pearl earrings when you die?"

Photo of Jim Rosenberg

I think there is something rich to explore in these ideas about language. In my own experience, there seem to be three drivers behind the words I hear around death (just my anecdotal experience and interpretation):



1) Religion: For many religious people phrases like "passed" are not euphemisms but are their most accurate way of talking about death. The moment or act of dying isn't the important part, it is the transition to what comes next that matters and needs to be recognized. When I talk with these folks, I don't get a sense of the topic being pushed away as much as I do of the topic being redefined.
2) Discomfort: A lot of people I talk with have adopted softer language because it pushes death a bit further away in the conversation. The discomfort is pretty easy to see, and maybe most interesting is how I (and I imagine others) start to anticipate the discomfort and shift our own language, further curtailing the chance for real conversation.
3) Habit: We don't think that much about the words we use and how they affect us and others. We hear euphemisms more than we hear death and dying, and we just drift into that way of speaking. Could we create a different habit that would create different experiences?

Photo of Michael Fratkin

Practice reveals that practice helps.

As a physician walking into these rooms of people out of touch with the experience unfolding that they are a part of, I rarely call them out about their distance from the experience, but rather simply invite them closer to the truth by acknowledging the death occuring without fanfare.  It's not the word that matters....its the normality of demonstrated presence.

Photo of Jim Rosenberg

Beautiful. Thanks.

Photo of Hattie Bryant

Yes.  Death should come without fanfare; gently, sweetly, and peacefully.  It is the end we will all experience.  Death is nature taking its course but in the face of our modern medical industrial complex what nature  intends to do is more often than not interrupted.

Photo of Katherine Hill

Jim Rosenberg thank you for starting this much needed and important conversation. I'd like to add a fourth to your list - culture. 

Yes, you could note that culture is typically a by product of historically religious influences on a particular area/community/country. But, "culture" often includes a number of additional aspects particular to region or location and not necessarily under the umbrella of religion - are you a straight shooter or do you sugar coat difficult topics? Do you perceive raised voices as a "heated discourse" or "an upsetting argument"? These cultural norms (in some ways separate from standard language translations noted above) might offer additional insight to the conversation.

Similar to the post by Anne-Laure Fayard  on cultural norms, I think the conversation you have started has important nuggets to synthesize and include in the Ideas Phase. In our increasingly globalized world, these conversations are vital to ensuring inclusion and comfort on difficult topics. 

Rhetoric, tone, translation, expression, cultural norms- all key to a productive discourse. Thank you for the post!

Photo of Jim Rosenberg

Thanks Katherine. I've really been enjoying and learning from the conversations that took off from this post. I think you make a really good point about "culture" as a driver of how different groups talk about death. It makes sense that those underlying norms guide the language we use in talking about death. Thanks for the additional spark! 

Photo of Barbara

I am surprised that my favorite - left their body - is not on the map! For me, I don't use the word dead because I have experienced enough evidence that in some form consciousness survives the loss of our flesh puppet. So the word dead has no meaning for me. It is not descriptive enough.
It is definitely not because I don't want to talk about death! I am actually much more interested in talking about it than anyone I can find. :)

Photo of Liz Salmi

Love this graphic! As "they" say, "a picture is worth a thousand words." In this case, a picture of words may communicate even more.

I'd love to see a similar graphic detailing the words used around the world!

Photo of Jim Rosenberg

That would be really interesting. I found this discussion of the language used in different countries but nothing comprehensive or visual:

http://blogs.bmj.com/bmj/2012/08/16/richard-smith-and-nataly-kelly-global-attempts-to-avoid-talking-directly-about-death-and-dying/

Photo of Shane Zhao

Yes absolutely Jim. This is the white elephant in the room that many people will find difficult to talk about. Even in challenge, the words "death" and "dying" may come across as a stigma. We'll have to ask ourselves why different words signify very different experiences to us — and why it's hard to talk directly about the dying. Thank you for highlighting something that's at the heart of this challenge:)

Photo of Aaron Wong

Very interesting infographic Jim Rosenberg  and thanks for sharing.
And yes, Shane Zhao , I think the words we use signal very different meanings.

I would be interested to see how death is communicated in everyday conversation compared to what we say in obituaries as well as how it is communicated around the world.

Photo of Jim Rosenberg

Aaron, those are great questions. Maybe those are two things we can investigate as a community here, through interviews and some research. I found these two articles that touch on the subject further:

What language do people use to talk about death around the world: http://blogs.bmj.com/bmj/2012/08/16/richard-smith-and-nataly-kelly-global-attempts-to-avoid-talking-directly-about-death-and-dying/

What language do doctors use with patients: http://jco.ascopubs.org/content/26/1/157.full

Photo of Anne-Laure Fayard

Great post Jim. Language reflects our beliefs and values, as much as it shapes and influences them.

I'm also curious of cultural variations. For example, in French (my mother tongue), we all use a variety of words... although I had to spend some time thinking about it because I tend to usually use the word "die" in French... Yet, in English, I tend to use "pass away" (which funnily is not on the infographics) as I rarely heard someone using "die". And a couple of time, when I said "die" it  seemed to make that people felt uncomfortable. I'm curious to know what we can learn something from different cultures when it comes to language to evoke death, and related practices.

I like @michaelfrakin's point: "euphemisms as necessary guides to the exact places where human beings are in conflict with themselves" ... and we shall also remember that some experiences don't have words to encompass them...

Photo of Chiara Pineschi

Anne-Laure Fayard I think you highlighted a very important point, which I also perceived as an Italian speaker of English: when I need to use the verb 'die', I spontaneously come up with 'passing', 'passing away', 'not being here anymore'. I also felt this to be an issue in the language, as people wouldn't feel at ease with the word. In my opinion, this has much to do with the denial of death. Metaphors are used to cover up fear or anxiety. However, this issue is critical and needs to be addressed especially when children's education about death is concerned, for leaving a vague aura around 'dying' might cause emotional and psychological stress.

Photo of Lauren Brown

Jim Rosenberg I think another really important point is to not only think about how patients and patients' families prefer to talk about death, but how doctors themselves prefer to talk about death. What I found to be interesting was that by using the word "die" doctors in a way admit to their failure: “Worse, death has become medicine's enemy—a reminder of our limitations of medical diagnosis and management. Viewing dying and death as merely a failure of medical diagnosis… trivializes the final event of our lives, stripping it of important nonmedical meaning for patients, family, and society. Respect for the wholeness of life requires that we not debase its final stage.” - http://jco.ascopubs.org/content/26/1/157.full

That said, I think it's important to be sure to think about not only the patient's experience, but the doctor's experience as well as the beginning and tone of the conversation starts there.

Photo of James Takayesu

Disclosing a death is always traumatic for families and providers, especially when the death in unexpected.  Using the word "died" sometimes seems cruel but is important to ensure there is no misunderstanding of the outcomes.  While it may seem strange, I have seen many families not understand what happened when providers use other euphemisms that we all know mean the same thing. 

Photo of Michael Fratkin

In the hospital that use the word "expired". 

I am not a credit card or a carton of milk.

These euphemisms are critically necessary guides to the exact places where human beings are in conflict with themselves

Photo of Rochelle

Very interesting infographic!  People want to avoid the topic because we don't know how to talk about in our culture.  Thanks for sharing.