The American Way of Death Revisited (12 page)

I could not have put it better.

In a curious, perhaps inevitable, reversal, the decades spent persuading the public that embalming is a sound public health measure have come back to haunt the funeral folk. Angrily protesting new Occupational Safety and Health Administration (OSHA) regulations that end the practice of dumping bodily wastes and embalming fluids down drains or in Dumpsters, one mortician, according to Mortuary Management, ridiculed the “illogic of it all.” It seems, he claims, “that waste from dead people is now deemed to be more dangerous than that which comes from the living.” He goes on to protest that not one case of infection has been reported as resulting from the longstanding practice of dumping bodily wastes and embalming fluids down sewers.

If the public health benefits of embalming are elusive, ten times more so is the role of “grief therapy,” which is fast becoming a favorite with the funeral men. Trying to pin down the meaning of this phrase is like trying to pick up quicksilver with a fork, for it apparently has no meaning outside funeral trade circles. Although it sounds like a term picked up from the vocabulary of psychiatry, psychiatrists of whom I inquired were unable to enlighten me because they had never heard of it.

“Grief therapy” is most commonly used by funeral men to describe the mental and emotional solace which, they claim, is achieved for the bereaved family as a result of being able to “view” the embalmed and restored deceased.

The total absence of authoritative sources on the subject does not stop the undertakers and their spokesmen from donning the mantle of the psychiatrist when it suits their purposes. As an embalming textbook says, “In his care of each subject the embalmer has a heavy responsibility, for his skill and interest will largely determine the degree of permanent mental trauma to be suffered by all those closely associated with the deceased.”

Lately, the meaning of “grief therapy” has been expanded to cover not only the Beautiful Memory Picture but any number of
aspects of the funeral. Within the trade, it has become a catchall phrase, its meaning conveniently elastic enough to provide justification for all of its dealings and procedures. Phrases like “therapy of mourning” and “grief syndrome” trip readily from industry tongues. The most “therapeutic” funeral, it seems, is the one that conforms to their pattern, that is to say, the one arranged under circumstances guaranteeing a maximum profit.

I had a long discussion with Mr. Raether about “grief therapy,” in which I sought to know what medical or psychiatric backing he could produce to substantiate the funeral industry theory that viewing the restored and embalmed body has psychotherapeutic value. He spoke of grief and ceremony; he mentioned some clergymen of his acquaintance who thought viewing the body was a valuable experience; but no qualified psychiatric reference was forthcoming.

Eventually he referred me to an article by Stanford University professor Edmund H. Volkart which had appeared in
Explorations in Social Psychiatry
and which allegedly supported the proposition that “viewing” was therapeutically valuable to the bereaved. Since Professor Volkart’s article was the only authoritative published work cited by Mr. Raether, it seemed advisable to check with him. Professor Volkart, who was at the time director of Stanford’s program in medicine and the behavioral sciences, wrote to me as follows:

Demonstrably flimsy and absurd as the justifications for universal embalming and “viewing” may have been, these patently fraudulent claims of undertakers for their product remained immune from government intervention until 1984, when the Federal Trade Commission’s funeral rules were adopted. These provided, among other things, that:

The rule went on to provide that prior approval for embalming must be obtained from a family member.

The howls of dismay that greeted these seemingly innocuous rulings were pitiful to behold. They echoed, indeed, the eruption, five years earlier, that followed the introduction of a similar requirement at a meeting of California’s State Board of Funeral Directors and Embalmers. I had special reason to take note of it at the time, because the proposer was my husband, Bob Treuhaft, who had been appointed to the board by then governor Jerry Brown.

The proposed regulation required that a responsible party confirm that he or she understood that:

Bud Noakes, an editor of
Mortuary Management
, responded emotionally in a leading editorial:

There follows a call to action. There will be a hearing at the state capitol (date and address given) to vote on the proposal. “It is incumbent upon all funeral directors to take immediate action to protect the best interests of the bereaved public we are dedicated to serving.”

So the brethren rallied, and the lobbyists lobbied, and the proposal was defeated. Dead, yes, but destined to be reincarnated five years later in the Federal Trade Commission’s Funeral Rule.

The funeral folk soon had another opportunity to show their tender concern for the feelings of those in bereavement. When, in the early eighties, the outbreak of AIDS became a matter of public anxiety, there was panic on the part of funeral directors and embalmers for their own safety. Most mortuaries refused to accept cases where it was believed that the deceased had been exposed to the HIV virus; those that did accept AIDS victims refused to wash, dress, or embalm the victim.

The New York State Funeral Directors Association (NYSFDA),
on June 17, 1983, advised members to institute a moratorium on the embalming of AIDS victims. Reaction was quick.

Peter Slocum, a spokesman for the State Department of Health, said that funeral directors had previously been advised to handle the bodies of victims of AIDS as they handle victims of hepatitis B—that is, to wear latex gloves, a procedure that had already been prescribed to prevent spread of any contagious disease and required for health care workers under all circumstances when working with dead bodies. “We have not seen anything that suggests that there needs to be any precautions beyond that.”

Governor Mario Cuomo introduced a bill in the state legislature which would make funeral directors liable to loss of license if they refused to embalm AIDS victims, saying, “We must not permit AIDS sufferers and their families to be subjected to irrational and unscientific behavior born out of fear, not fact.” One week later, the NYSFDA lifted its moratorium on embalming, and the bill died in committee.

This, however, is by no means the end of the story. It is now cash-in time. The mortuaries that did take AIDS cases began charging healthy “AIDS handling fees,” usually $200 to $500. Others used subcontractors to do the embalming, covertly adding the cost by inflating the basic service fee. When the problem began to reach crisis proportions in New York City, the Gay Men’s Health Crisis (GMHC), with the help of volunteers, surveyed the city’s five-hundred-odd licensed funeral homes to identify their AIDS policies. With that information in hand, it put together a guide recommending only forty-two of the five hundred mortuaries to the thousands of friends and relatives of people with AIDS.

The New York City Human Rights Commission got involved in the matter and, as reported in the
Boston Phoenix
(March 12, 1993), published GMHC’s list, which fanned public outrage. Loss of business and some successful damage actions helped produce a turnaround, and many mortuaries asked to be added to the referral list.

Elsewhere, however, the AIDS surcharge persisted in one form or another, despite its illegality under the Americans with Disabilities Act (ADA), which requires funeral homes to “provide their services on a non-discriminatory basis to persons who have had AIDS.” Since the government was doing nothing to ensure compliance, California
assemblywoman Jackie Speier, prodded by the funeral and memorial societies, in 1992 introduced two antisurcharge measures in the state legislature. The leaders of the campaign—Ann Tompkins, president of the California-Hawaii Federation of Funeral and Memorial Societies, and Karen Leonard (dubbed by the
Boston Globe
the “scourge of the funeral industry”)—feeling that something was needed to waken the legislators from their lethargy, had Ann appear dressed in a “state-of-the-art” protective suit, the outfit that coroners wear when opening and dissecting bodies for autopsies … a far more invasive procedure than embalming. Ann then did her striptease, removing the entire “protective” outfit down to the latex gloves, while Karen explained that the gloves were the sum total of protection needed, or prescribed by OSHA (Occupational Safety and Health Administration), for handling supposedly diseased cadavers. Wholesale cost: two dollars per hundred pair.

Everyone enjoyed the performance except the funeral directors, who were there en masse. The bills passed and were signed into law, the first such legislation in the nation.

T
he undertaker, who pockets slightly more than half of the funeral dollar, has generally drawn the spotlight upon himself when the high cost of dying has come under scrutiny. But he is not the whole show. Behind the scenes, waiting for their cue, are the cemeteries, florists, monument makers, vault manufacturers. The casket-manufacturing companies, to whom the undertakers are perennially and heavily in debt, are often lurking in the wings like ambitious understudies waiting to move in and assume control of the funeral establishments should financial disaster strike.

The cast in this drama is not always one big happy family. There are the usual backstage displays of irritation, pique, jealousy, a certain vying and jockeying for position. There are lawsuits and scathing denunciations which arise because of the stiff competition. These can be submerged in the interests of a common endeavor, for the show must go on, and the common goal must be served: that of extracting the maximum admission fee from the paying audience.

The casket companies reported that the alarming condition of the industry’s accounts receivable was “far more aggravated in the casket field than in any other manufacturing endeavor.” Back in 1961, the funeral establishments owed the casket makers more than $39 million, 20 percent of the year’s production, an amount equal to about 317,000 caskets, of which, groaned the creditors, some 40 percent had “already been interred!” Presumably making repossession a most inconvenient remedy for the creditor.

The answer to this problem is, of course, to sell in ever-higher brackets. As Herbert L. Stein, vice president of the National Casket Company and president of the Casket Manufacturers Association,
said, “Since the public’s purse limits funeral expenditures and nature limits the number of funerals … skillful merchandising of quality goods is about the only avenue for upping profits anywhere along the line.”

Selling the public on the “quality” of his merchandise can tax the ingenuity of the undertaker. The costliest caskets are those built of the thickest metal. The cheaper lines of metal caskets, constructed of thin sheet metal over a wooden frame, achieve the same look of massive elegance, and can hardly be distinguished (except by grateful pallbearers) from the heavyweights that weigh hundreds of pounds more and sell for thousands of dollars more. A writer in
Mortuary Management
described the average run of lightweight metal caskets as “nothing more or less than stovepipes. Stovepipe gauges are always misleading the public.… ‘Metal is metal,’ says John Public.”