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Dealing with death – why the fuss?

“No fuss” cremations are getting more popular. Not giving a formal space or process to say goodbye feels like a seismic cultural shift to Jane Cacouris. Part of the How To Die Well series.

Jane Cacouris is a writer and consultant working in international development on environment, poverty and livelihood issues.

A sculpture shows mourning women raising hands and fists to the sky.
The Tragedy of the Sea memorial in Matosinhos, a Portuguese port.
Prilfish, CC BY 2.0, via Wikimedia Commons.

Widow’s Rip is a notorious swirl of ocean just offshore from Nazaré, a centuries-old fishing village on Portugal’s windy and unpredictable Atlantic coast. Decades ago fishermen used oxen to pull brightly painted boats onto the beach and then rowed into the giant waves. Many lost their lives when the seas were rough. I first visited Nazaré with my Portuguese grandmother as a child and stayed in a fisherwoman’s house with an orange-tiled roof just off the central square. My eyes had to adjust to the gloom every time we went inside as she kept all of the shutters drawn. Even though it was thirty degrees outside, I remember her tanned, crumpled face shrouded in a black shawl that covered her head and shoulders. She wore a black knee length skirt with an array of petticoats and black shoes. As a ten-year-old, I was a little scared. I asked my grandmother when the fisherwoman’s husband had died. “About twenty-five years ago at sea”, she said. She explained it would be a sign that you didn’t love your late husband if you didn’t wear black for the rest of your life.  

Nowadays, although fishing is still a livelihood for some who live there, Nazaré is known for its sweeping beach and touristy promenade of restaurants, bars and stalls selling Portuguese wares. But the widows, now very old ladies, who lost their husbands to the sea all those years ago still potter around the town dressed head to toe in black. An ingrained tradition of how to grieve.

No other event in our life brings us closer to facing questions of mortality and eternity than the death of a loved one.

Grief and how we deal with the loss of a loved one is of course deeply personal and expressed differently depending on so many things; culture, beliefs, personality, life experience, to name a few. But in recent years, there has been a defined shift in British society away from some of the traditions that have historically accompanied death.  

The growing trend for direct or “no fuss” cremations is an example of this shift, with a rise from 3 per cent of all cremations in 2019 to 18 per cent in 2022 according to a life insurance company’s recent report. A traditional cremation includes a service at the crematorium or place of worship beforehand, whereas a direct cremation does not have a service. Instead, the deceased is taken directly to be cremated with no one in attendance, unless witnesses ask to be present. A simple coffin is used, and the timing of the cremation is determined by the funeral director, usually according to availability.  

Why are families choosing to cut out the funeral?  

Sources point to a range of reasons. A matter of choice – perhaps a statement of faith that the afterlife is not about funeral rituals, or conversely, that there is no afterlife, and the body will just decompose organically and be subsumed back into the Earth so why make a fuss? It can be for practical reasons such as cost; traditional funeral services are much more expensive than a simple cremation, estimated to be approximately £2,500 cheaper. A “no fuss” cremation can also reduce the likelihood of family division or arguments over the type of ceremony. Or family living in different locations geographically means a memorial service scheduled for a more convenient time can be organised.  

All these reasons seem perfectly valid. But not giving a formal space or process to say goodbye does feel like a seismic cultural shift, even for the British, known for our ability to keep our feelings under wraps. Practical reasons aside, are we ducking the emotion that inevitably hits us when we lose someone we love? Or perhaps avoiding the difficult questions that come with death? No other event in our life brings us closer to facing questions of mortality and eternity than the death of a loved one.  

On holiday in Nazaré in his youth, my father remembers a fisherman’s death in the house where he was staying. The night before the funeral - with the deceased laid out in the dining room - each of the women in the family took it in turns to sit in the corridor outside, the top skirt of their seven petticoats over their head, wailing in an outpouring of grief so raw that they couldn’t continue for more than a couple of hours. The “wailing process” carried on throughout the night, the role passing from woman to woman until sunrise. Not only was the loss of the fisherman the loss of their beloved, it was also the loss of a working partnership - the women sold the fish that the men brought home – and the loss of the family’s livelihood and income. The wailing was a necessary part of expressing this agony ahead of the funeral service when the rest of the family would come together to support each other.  

There are also intensely reverent traditions observed with death in Portugal, particularly within the Catholic church. The burial or cremation is usually no more than three days after the person has died. When my grandmother passed away a few years ago, her body was laid in an open casket in a room of the Catholic church in the mountain village in rural Portugal where she had lived most of her life. The night before the funeral, a procession of people visited her to pay their last respects, including distant family members, whilst my immediate family sat with her all night. People touched her arm or hand, and sat and chatted to one another. After Mass the following day, her coffin lined with lead was sealed and she was taken to the family Mausoleum to be laid beside my grandfather, along with the remains of around thirty of our relatives dating back to the early 1900s.  

Brazil, where we lived for several years, has many similarities to Portugal in dealing with death. The time between death and burial or cremation is even faster, usually within twenty-four hours. Family and friends rapidly gather, usually together with the body of the loved one in an open casket. Touching and kissing the body and wailing over it is not uncommon. According to a Brazilian friend, “Bebendo do morto” which means “drinking to the dead” is an old custom where family members raise a final glass of Cachaça, a traditional drink, to the deceased in the presence of their body.  

A funeral service is partly about taking a look back at our loved one’s jigsaw of life, at all the pieces that have slotted together to make up their precious and unique time on Earth.

In all these traditions, the funeral service acts as the closure to the first “phase” of grief, and the passing of the deceased into God’s care. The next phase is then the more private continuation of grief for months or years to come.  

Christians believe in life after death based on a conviction that as Jesus rose from the dead, so will we. A funeral service is partly about taking a look back at our loved one’s jigsaw of life, at all the pieces that have slotted together to make up their precious and unique time on Earth. Of course, there are damaged and missing pieces, but Christians believe that the jigsaw will be made whole and perfect in Heaven with Jesus. It is also a chance to give thanks for the the life of a human being wonderfully and fearfully made in the image of God. 

Regardless of the country, the culture or the tradition, the death of someone we love means that our world will never be the same again. It will continue spinning without them and we have to get used to that. The Book of Ecclesiastes in the Bible says: 

 “There is a time for everything, and a season for every activity under the heavens: a time to be born and a time to die”.  

Death is an entire season; not only the end of the existence of a human on Earth who was created and loved by God, but a prolonged period of growth and change for those of us left behind.  

Death deserves us to make a fuss.  

  

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Ageing
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Death & life
6 min read

A Tolkien poem helps a nurse understand the ravages of dementia

'Not all who wander are lost.'

Helen is a registered nurse and freelance writer, writing for audiences ranging from the general public to practitioners and scientists.

An elderly woman wearing headphone looks up and to the side with a big smile.
Playlist for Life

Not all who wander are lost.

Often written on a care home wall, on an inspirational poster, these words are usually set against a forest background, or compass, for added effect. They have also been used as the title of a conference paper discussing so-called smart trackers for people with dementia, whilst, Not all who wander need be lost is the title of a concise guide to navigating the heartbreaking challenges when a loved one is diagnosed with Alzheimer’s disease or other dementia.

As a care home nurse for more than ten years, I have seen residents wander - not lost but “walking with purpose”, as it is sometimes known in the caring community. “Nobody gets up and walks without a reason,” says Suzanne Mumford, Care UK's Head of Nursing, Care and Dementia; perhaps they are easing pain, or boredom, or looking for something that they can’t describe. I remember residents exploring, enquiring into self-made mysteries solvable only by themselves, examining everything from door handles to another resident’s buttons, even escaping with surprising speed. Walking with them, often in silence, can bring a sense of relief, comfort and companionship.  

What I didn’t know was that this is a quotation from a poem by JRR Tolkien, published in The Fellowship of the Ring seventy years ago. The actual line is - “Not all those who wander are lost”. 

All that is gold does not glitter, 
Not all those who wander are lost; 
The old that is strong does not wither, 
Deep roots are not reached by the frost. 
 
From the ashes a fire shall be woken, 
A light from the shadows shall spring; 
Renewed shall be blade that was broken, 
The crownless again shall be king.” 

We first hear this poem in Chapter Ten of Book One, as Frodo reads it in the postscript of a letter from Gandalf. As I read it, the imagery of being lost, withered, frost-bitten, in darkness, burned and broken, speaks something, in poetic picture language, of the ravages of dementia, the harrowing losses, the valley of tears. It brings to mind residents unaware of familiar objects or surroundings, looking straight through loved ones without a flicker of recognition, losing also language, continence, mobility and the ability to swallow. 

The TV presenter Fiona Philips recalled an agonising decline in her mother as she succumbed to Alzheimer’s, describing how, in the final stages, her mother “spent whole chunks of time just sitting and staring ahead, only able to give out a series of sounds”. Fiona herself now lives with dementia. “'It’s devastated my family and it’s the biggest health and social care challenge we face as a country,” she says. 

I once interviewed retired doctor Jennifer Bute, who lives with dementia. She talked of time travel (perceiving herself as living in a time from her past); disorientation to place and person; frightening hallucinations when old memories are seemingly ‘unlocked’; and ‘emotional unzipping’ when agitation and anxiety increase, often in the late afternoon or evening in something poorly understood as a symptom, known as ‘sundowning’. 

Yet there is something more to this poem – each of the pains has a promise – not all who wander are lost; the old that is strong does not wither; and, most poignantly, deep roots are not touched by the frost. In dementia, it is true that deep roots are untouched, that an enduring aspect of a person’s identity never truly withers, though it may be mostly unseen. Something remains. Oliver Sacks the famous neurologist emphasised that, even in the late stages of Alzheimer’s, the person is still ‘alive inside’ (the inspiring documentary with this title is recommended). In stunning real-life stories, he has shown how music appears to ‘call back the self’, awakening moods, memories and thoughts that had seemingly been lost. He refers to music’s extraordinary ‘neural robustness’ and describes one man, unable to tie his tie or find his way to the stage, yet able to perform a perfect piano solo. In one life-affirming, must-watch, tear-jerking video, gospel music was shown to enliven, calm, focus and engage a man simply known as Henry.    

Watch Henry

Singing can “provide islands of arousal and awareness like nothing else can”, according to Alicia Clair, Professor of Music Therapy. I’ve seen singing bring the person into the present for a passing moment, illuminating a face that seemed far away. One otherwise-silent lady completed the chorus of ‘Daisy, Daisy’ before descending into dementia again. Others have laughed, clapped, danced, embraced and even shed a silent tear during music therapy sessions, when music elicits memory. Doll therapy meanwhile has sometimes restored and revealed a sense of nurture, purpose, care and pride, with residents feeding their new friend before accepting their own food, folding its clothes and taking care of it cradled in their arms. Though it divides opinion, a doll can preserve dignity if it de-escalates agitation or engagement in physical or verbal abuse; a sense of dignity also comes from the person being able momentarily to give care rather than receive it. 

“From the ashes a fire shall be woken, A light from the shadows shall spring; Renewed shall be blade that was broken,” continues Tolkien's poem, and, though not the original intention, these powerful images of renewal and restoration paint a picture of something known as “paradoxical lucidity”, or unexpected cognitive lucidity and communication in some patients with severe dementia, especially around the time of death (though sometimes long before).  

Anecdotes are recorded of “unexpected, spontaneous, meaningful, and relevant communication or connectedness in a patient who is assumed to have permanently lost the capacity for coherent verbal or behavioral interaction due to a progressive and pathophysiologic dementing process”.  Some scientists are seeing them as a paradigm shift in the understanding and perhaps even treatment of dementia. I will never forget when a woman in the late stages of dementia, with little spoken language, was brought back to the nursing home weeks after hospital admission; she had been perilously ill. With bright eyes, she took my arm and, as if the mist had cleared for a moment, spoke warmest words of thanks to me for helping her on the day she collapsed. In another fleeting and irreproducible moment, a lady wished me happy birthday, before continuing her silent walk around the home. Witnessing such an event is ethically and emotionally transformative. 

The concept of remaining ‘alive inside’ even when abilities, language and memory are eroded by dementia is taken to the next level in Christianity, which teaches that life continues even after death itself. The Bible speaks of new life beyond the grave; the fire shall be woken, a light shall spring. And there will be a crown (and the gold will glitter). The Crown of Life is referred to, being bestowed upon "those who persevere under trials." Dementia is one of life’s severest trials; a cross to bear. In the 1912 hymn “The Old Rugged Cross”, another cross is spoken of, being the cross of Christ at his crucifixion. Clinging to that cross, living out a Christian life, the hymnwriter wrote of “exchanging the cross for a crown” at life’s end. After ashes, hope awaits the Christian. 

 

Playlist for Life is a charity encouraging people to create playlists for people living with dementia.