The Impact of Social Death Enactments on an Individual’s Mental and Physical Health

Social death can be defined as the condition of people not fully accepted as human by the wider society. From various studies conducted on social death, three underlying notions have arisen: ‘a loss of social identity, loss of social connectedness and losses associated with the disintegration of the body’ (Králová, 2015). I will be exploring these factors in greater depth to demonstrate how enactments of social death, in those who are both biologically alive and dead, can impair an individual’s mental and physical health.

Firstly, social death of an individual can occur after their biological death, which can be depicted through funerary practices that ritualistically mark the transition of the deceased person from a state of being alive into the segregated domain of the dead (Borgstrom, 2016). Funerary practises range from mummification of the body exercised in Ancient Egypt to modern day burial and cremation. These ceremonies which have been acclaimed as a natural, integral part of many cultures and may even be aligned with the wishes of the individual, is arguably an act of dehumanisation. Whilst it is not morally acceptable to mummify, cremate or bury a living person, we plausibly dehumanise the dead by subjecting them to these inhumane acts. In Indonesia's Torajan culture, families keep the bodies of their relatives to 'live' at home with them, sometimes for years after their deaths. Family members and relatives state how it provides them the time to deal with the loss of the individual (Sahar Zand, 2017). The function of social death in this instance can be viewed with the analogy of a car accident. When a car collides, the airbag is designed to inflate and serve as a cushion to minimise injuries to the head and chest. Likewise, the gradual and prolonged enactment of social death can be likened to the inflation of an airbag. This is largely beneficial, as it curtails the shock and grief elicited in the bereaved and provides them time to adjust slowly to the death of their loved one. Yet, it is difficult to ascertain whether this funerary practice withholds the rights of the deceased to undergo the liminal transition into the state of being biologically and socially dead, as it is unfeasible to assess the mental and physical impairment of an individual who has undergone the permanent cessation of all biological functions. Thus, exploring the extent of which an individual’s wellbeing is compromised due to social death, subsequent to their biological death, is implausible.

Alternatively, social death can also occur before the biological death of an individual, for instance when someone undergoes a loss of moral entitlement (Lock, 2002, p.119). This can be elucidated as others perceiving the individual with a lack of social worth, which results in detachment within relationships the individual has with others, thus a loss of social connectedness. Clinically, this could lead to a lack of investment into both the quality and quantity of patients’ lives, namely through the provision of resuscitation attempts as well as nutritional and hydration assistances provided for the patient. For example, the fervour, the length and plausibly the outcome of the reviving attempt can be dependent on a hierarchy of lives which the healthcare staff consider salvaging, largely regardless of the patient’s clinical viability. The extremities of this ‘moral hierarchy’ consist of those of who are socially perceived as immoral (for instance criminals) as well as elderly and terminally patients for whom death is considered an appropriate “punishment” or a welcome “friend/blessing” (Timmermans, 1998). Children and other individuals who depict a degree of personhood and surmount the neutrality or the detached nature of resuscitation have the ‘best chance for a full, aggressive resuscitative effort’ (Timmermans, 1998). Consequently, social death can become a direct predictor of biological death for an individual, due to socially ingrained morals and prejudices of others that directly influence the service of healthcare options and treatments the individual receives.

Moreover, social death can occur in individuals, who are undeniably still part of society yet deemed socially dead. This ‘liminal incorporation’ (Knight, 1984) of individuals in society is evident in those subjected to slavery but also in refugees. War refugees primarily undergo social death due to their loss of identity and personal agency. This is apparent as, they are forced to leave their country of origin, thereby losing access to their ‘cultural heritage, social networks, economic capital and roles associated with family and employment’ (Králová, 2015). Their human rights becoming endangered coupled with their stigmatised status triggering social exclusion, has severe impacts on their mental and physical health. This is depicted in a study of the general population of civilians in Afghanistan after two decades of war which show a definite increase in the incidence and prevalence of mental disorders. This is evident as symptoms of depression were observed in 38.5% of civilians; symptoms of anxiety in 51.8% and PTSD in 20.4% (Murthy and Lakshminarayana, 2006). These figures were accounted predominantly by women and other vulnerable groups such as children, the elderly and the disabled. Therefore, this manner of social death in war refugees have impaired their wellbeing, through the repercussions of mental disorders brought by the onslaught of trauma in warfare and their subsequent disintegration of the mind.

Furthermore, contrary to previous examples, where the dissolution of oneself has been coerced upon individuals, there are cases wherein social death occurs as a result of isolation but without the individual’s loss of agency. This may be apparent in patients with terminal conditions in hospices, where they may actively turn away from life, thereby choosing to have a form of social death prior to their physical death (Lawton, 2005). These individuals isolate themselves before their biological death by detaching themselves from relationships, consequently undergoing a loss of social connectedness. People, with terminal illnesses feel a certain degree of helplessness when dealing with their disease, primarily due to the inevitable nature of their disease. This sense of helplessness or loss of control results in psychological responses such as loneliness and depression (Mabenagha, 2009).

Figure 1: Mean score of depression, anxiety, and stress among cancer patients and control (Singh et al., 2015)

This graph portrays a correlation between patients with cancer and the incidence of depression, anxiety and stress, particularly how cancer patients are twice as likely suffer depression in comparison to those without cancer. Also, these patients are more susceptible to experience more physical symptoms, have a poorer quality of life, and are more likely to have suicidal thoughts or a desire for hastened death than cancer patients who are not depressed (Rosenstein, 2011). Thus, this self-inflicted nature of social death does not sheild the terminally ill against impairments in their wellbeing, rather it instigates detrimental deteriorations in their mental and physical wellbeing, once again resulting in the disintegration of their body.

In addition to the individuals themselves experiencing impairments in their wellbeing, the bereaved can also suffer from their loved one’s social death. In contrary to as stated above, where the bereaved may benefit from the social demise of their loved one, they may on the contrary experience their own manner of social death. This could result as a direct consequence to the isolation caused by caring for someone as they were dying, as well as the health and social care professional contact diminishing after someone has died (Schneider, 2006). The lack of social activity coupled with a loss of role in relation to the deceased, compounds their resulting loss of identity and the deficits in their health. Those undergoing bereavement could experience adverse physical and psychological wellbeing, poorer mental health and social functioning, which could occur up to four years following bereavement. Bereaved females experienced a sharper fall in vitality and suffer greater deterioration in mental health compared to their male counterparts (Liu, Forbat and Anderson, 2019). Consequently, witnessing the social and biological death of a loved one, can leave these individuals bereft and impaired in their psychological and mental wellbeing.

To conclude, I personally think that social death to a large extent does impair the wellbeing of both the deceased and the bereaved, with repercussions of the event permeating and debilitating their mental, physical and psychological health. Social death strips individuals of their dignity and humanity, as they are belittled to a lower social standing than those society deems to have social worth. It also can create a widening gulf of detachment between the relationships the individual has with others, particularly those who aren’t undergoing social death. Whilst it is difficult to assess the harm social death inflicts on the dead, in a living person it is likely to forge an inevitable trajectory towards biological death.