PREFACE

The Macmillan Encyclopedia of Death and Dying is a contribution to the under-standing of life. Scientists and poets have long recognized that life and death are so intimately entwined that knowledge of one requires knowledge of the other. The Old Testament observes that "all flesh is as grass." Religions have addressed the question of how one should live with the awareness of inevitable death. Often the answer has been based upon the vision of a life beyond death. Societies have developed systems of belief and practice to help their people cope with the prospect of death and the sorrow of grief. Children are often puzzled by the curious fact that flowers fade and animals stop moving. This incipient realization of mortality eventually becomes a significant part of the adult's world-view in which hope contests with fear, and faith with doubt.

The twenty-first century has inherited an anxiety closet from the past, a closet packed with collective memories of unsettling encounters with death. This history of darkness concealed threats from predators and enemies; child-bearing women and their young children would suddenly pale and die; terrible plagues would periodically ravage the population; the dead themselves were sources of terror when resentful of the living; contact with corpses was perilous but had to be managed with diligence, lest the departing spirit be offended; the spirit world often intervened in everyday life; gods, demi-gods and aggrieved or truculent ancestors had to be pacified by gifts, ceremonies, and conformity to their wishes; animal and human sacrifices were deaths intended to protect the lives of the community by preventing catastrophes or assuring good crops. Everyday life was permeated by rituals intended to distract or bribe the spiritual forces who controlled life and death. Fairly common were such customs as making sure not to speak ill of the dead and protecting home and person with magic charms.

Particular diseases have also left their lingering marks. Tuberculosis, for example, horrified several generations as young men and women experienced a long period of suffering and emaciation before death. The scourge of the industrial era did much to increase fears of dying slowly and in great distress. Syphillis produced its share of unnerving images as gross disfiguration and a descent into dementia afflicted many victims near the end of their lives. All of these past encounters and more have bequeathed anxieties that still influence attitudes toward death today.

The past, however, offers more than an anxiety closet. There was also comfort, wisdom, and the foundation for measures that greatly improved the chances of enjoying a long, healthful life, and to palliate the final passage. The achievements of public health innovations and basic biomedical research are fulfilling dreams that motivated the inquisitive minds of early healers. The hospice care programs that provide comfort and pain relief to terminally ill people build upon the model demonstrated by devoted caregivers more than 2,000 years ago. The peer support groups that console grieving people were prefigured by communal gatherings around the survivors in many villages. Religious images and philosophical thought have helped people to explore the meanings and mysteries of death.

The Macmillan Encyclopedia of Death and Dying draws extensively from the past, but is most concerned with understanding the present and the future. The very definition of death has come into question. The ethics of assisted death and euthanasia have become the concern of judges and legislators as well as physicians and clergy. Questions about ongoing changes in society are raised by the facts that accidents, homicide, and suicide are the leading causes of death among youth, and that the suicide rate rises so precipitously for aging men. Continuing violence in many parts of the world suggests that genocide and other forms of mass killing cannot only be of historical concern. Other death-related issues have yet to receive the systematic attention they deserve. For example, widowhood in third world nations is a prime example of suffering and oppression in the wake of death, and, on a different front, advances in the relief of pain too often are not used in end-of-life medical management.

Each of these issues are addressed in this two-volume set as part of a more comprehensive exploration of the place of death in contemporary life. The coverage of the topics is broad and multidisciplinary because death threads through society in so many different ways. Attention is given to basic facts such as life expectancy and the changing causes of death. Many of the entries describe the experiences of terminally ill people and the types of care available while others focus on the situation of those who grieve and mourn. How people have attempted to understand the nature and meaning of death is examined from anthropological, historical, psychological, religious, and sociological perspectives. The appendix, which complements the substantive entries, can be found near the end of the second volume. It provides information on numerous organizations that are active in education, research, services, or advocacy on death-related topics.

The contributors are expert scholars and care providers from a variety of disciplines. Many have made landmark contributions to research and practice, and all have responded to the challenge of presenting accurate, up-to-date, and well-balanced expositions of their topics. As editor in chief, I am much indebted to the distinguished contributors for giving their expertise and time so generously. Contributing mightily to the success of this project were associate editors Jim Crissman, Mike Kearl, and Brian Mishara, each also providing many illuminating articles of their own. Macmillan has published reference books of the highest quality on many topics; the high standards that have distinguished their publications have assured the quality of this project as well. The editor appreciates the opportunity to have worked with Macmillan's Shawn Beall, Joe Clements, Elly Dickason, Brian Kinsey, and Jill Lectka.

ROBERT KASTENBAUM