Podsocs - podcasts for social workers

Transcription Podsocs 63: Bodies, grief and social work: In Conversation with John Drayton.

Thank you to Julie Matthews for this transcription

[musical intro to 00.10]

Hello, and welcome to Podsocs, the podcast for social workers on the run. Brought to you by a bunch of social workers from Griffith University in Australia.
I’m Tricia Fronek, one of that bunch, and we’re just basically really glad you found us. So, happy listening.

This morning on Podsocs we’re talking about social work and death and I’d like to welcome John Drayton to Podsocs.

Tricia: Welcome John.

John: Hi Trish.

Tricia: Now John, tell us a bit about you and how you got into this work.

John: Well I studied social work as a mature age student back in the mid-nineties. Early nineties and graduated in ninety-five. My first job in social work was in the coronial system in Sydney and I was based in West Mead in the Western suburbs of Sydney and worked under John Merrick who was the social worker in charge of all the coronial work at the time and John was a terrific mentor and was very instrumental in shaping how I think about a lot of these issues. Yeah, so I got into it that way and I’ve done that ever since.

Tricia: I liked one of the phrases you wrote about, about social work being familiar with ambiguous and contradictory things and I’m wondering what the relationship with social work and death is.

John: Yeah, I guess one of the things I was trying to bring out when I was thinking about a lot of this was the way that social work has this sort of space in what we do and how we relate to people in which we try I think to honour people’s emotions, not necessarily their rational understandings of things but their emotional responses and the way that they feel about things. I guess, for me, one of the interesting things about working in the forensic area, uhm, is that there is that interface between the emotions and let’s say the irrational side of things. A scientific approach to death which tries very hard to make everything measurable and objective as it were, and I don’t think that I’m sure that for all of us the experience of grief or the death of someone we love is very far from that sort of clean cut objective experience.

Tricia: And, and we’re protected a lot from it now aren’t we John? The society that we live in we don’t see it. It’s hidden away in hospitals and even our learning experiences of death as we grow up and we lose a pet, even children are protected from that to a certain extent. So, it’s becoming quite foreign in some ways.

John: It’s funny isn’t it at the same time it seems to me that we’re absolutely surrounded by so much depictions of violence and death on a popular culture, our news and everywhere we look there’s awful violent imagery. In some ways I think we seem to be a bit death obsessed as a culture and at the same time, yeah, we want to hide away from the realities of it when it affects us ourselves.

Tricia: And social work has a very practical role in many ways working with our clients and death, don’t we?

John: Look, absolutely and one of the things that I was very aware of as I was working of the paper was that while I’m focusing very much on social work within a coronial mortuary in my work, hospital social workers for example deal regularly with death and they are frequently working with families in the viewing rooms of the hospitals making sure that bereaved people have access to the body of the deceased person and and they’re are able to spend time with that person’s body. It’s actually a very widespread sort of focus in social work much more so than the limited sort of forensic mortuary focus that I have in my research. Social workers bring an awful lot to that issue I think.

Tricia: John what sort of things did you find in your research?

John: What I did Trish was I interviewed fifteen volunteers who had lost a family member in the previous eighteen months. These were people who following the death they’d gone through a forensic autopsy and a very invasive forensic autopsy. In each case, the deceased person’s brain was actually removed and retained for examination. I particularly wanted to focus on people who had to engage with that as part of their grief experience because I was trying to explore how people understand the dead body of their loved one. You know, they relate to it, they see it as still the person they have lost and how they understand the body. And with speaking with these people it was very interesting to me that what emerged was quite a complex way of relating to that person’s body. On one hand they were very, for want of a better word, they were very practical and very focused on wanting to understand the medical and the scientific investigation and the conclusions that might be drawn from that. So, they were quite open to the idea of an autopsy and in every case, they had accepted the notion of brain retention as something that was worth while and that they supported having done. So, on the one hand, they were very in touch if you like with that objective scientific view. At the same time, they also in different ways all spoke about the body of the deceased person as very much a continuation of the identity of the person who had died, and they related in different ways to the body itself in ways that were really expressed that on-going relationship and on-going connection with the deceased person. So, in contrast to the scientific approach that they held, they also held a very emotional and non-rational attachment to the dead body. And to balance those two contradictory things really well. They were able to keep that sort of balance and I was interested in the way that potentially anyway, social work can be a way of helping people to create an emotional space in a non-emotional field and to assert that sort of balance and understanding that is a bit missed by the scientific or medical approach so not to replace the rational objective approach but if you like to enrich the whole experience a bit.

Tricia: Because often that space is denied isn’t it? Because even when we think about language people are very reluctant sometimes to actually name death and to talk about it in direct language and it tends to be softened.

John: Look, that’s right. I think that when you talk to social workers in hospitals as well I think it doesn’t take long to realise that most families want you to speak plainly about these things and I think that my experience with families has been that grief actually sharpens their bullshit detector as it were. Um, they are very keen to hear it as it is, that sort of plain speaking approach and so yeah, I think that people can be hesitant to do it, to talk bluntly about what’s happening but by and large I think that people really appreciate it if we do and that’s something that I learnt from John Merrick and from some very experienced social workers in hospital settings as well.

Tricia: John, can you give us an example of that on-going relationship that people describe?

John: Yeah, I can. There was one very moving interview that I had with a woman whose baby had died at birth. There was a series of questions around whether there had been some sort of treatment error, so the baby’s death was reported to the coroner. Because it had been in the trauma of the birth itself, the woman had been quite heavily medicated she had no memory of her baby. She never heard her cry and couldn’t remember having held her. And, what she spoke about to me was that she had some photos. Some photos were taken but they didn’t hit it for her, they didn’t connect with her. What connected for her was actual hand prints taken from her baby and footprints. The reason these were so powerful for her was that her baby had a funny shaped toe. It was the same misshapen toe that the baby’s father had. It was that sort of embodied reality that drove home to her that she was a mother and she had that print made into a pendant that she always wore, and she would physically hold that pendant as she talked about her child. There was that physical link and that there was a sense of the baby’s identity. The photos didn’t capture this embodied sort of reality that she was dealing with. There was another person I spoke with who had a picture of her deceased adult son tattooed on her arm and she actually used the words that she wanted him to make him a part of her and the best way she thought of doing that was actually to make his image part of her body. So, she went through the process of the tattoo and said that now he is with her and in her and always be with her, and again there’s that sort of level of a body that was so resonant for her.

Tricia: It really just highlights how important the way we deal with a person’s body is for families and for how they deal with death.

John: I think it does. One of the things I think that came from the study and you referred to it earlier Trish I think, was that we can tend to be a bit overprotective of families and what you see when you’re working with bereaved people and their body is that they, in there bereavement they are able to cope with a whole range of things that we might consider to be being potentially shocking or traumatic, or God forbid upsetting and see beyond say scars or injuries or wounds to the person. And having access to the body in that sense gives them, gives them an ability to connect and to make sure that connection is maintained with the person who’s died. Although my study didn’t look at this specifically, in my experience and I’m sure the experience of hospital social workers as well as my colleagues in forensic social work too will bear this out, is that regardless of the extent to which a dead person’s body has been disfigured families will really feel very strongly that they need to see them and need to connect with them. And that can be really confronting for us as workers.

Tricia: John, did it matter in any of these situations how the person did die?

John: Well, yes it did, but not in terms to how it related to the person’s body. It mattered in terms of the family’s support to the coronial investigation. For example, one person had died following an operation and there was a question about whether or not there had been an error in the operation and that wasn’t resolved very clearly at first. In that case, the person I interviewed was extremely supportive of the autopsy and the investigation because he wanted as detailed a report that he could get to find answers.

Tricia: So, it relates to whether they have all of the answers that they need at that time as opposed to that relationship with the body.

John: Yes, absolutely. Every single person I interviewed emphasized how important it was for them to know the cause of death and a number of them spoke about how irresolvable they felt their grief was until they had an answer. Until they had some understanding about how exactly and why the person had died. If it was just sort of putting a medical label to it, they needed that.

Tricia: Some reason, yeah.

John: Yeah, they can make some meaning around.

Tricia: John, in your sample was there any opportunity to look at cultural differences?

John: Only limited, aah early on in the planning for the study I made a decision not to include Indigenous Australians.

Tricia: Because it is very different isn’t it?

John: Well, it is but one reason in particular for that was just the issue around using the person’s name. And the interviews that I did were very detailed, very in-depth and involved a fairly free flowing conversation and I was just really concerned not to cause some sort of inadvertent offense by using the person’s name or something like that. So, I excluded Indigenous people from the study for that reason. Across, there was quite a cultural variation across the people I did interview. A couple of people with an Indian background, one person with an Italian Australian background, no real variation in what they had to say. That was the same across different religious positions as well so the majority of people I interviewed would have described themselves as agnostic I think. But there was no variation even there around what people believed about the body.

Tricia: So, was there particular themes that came out of that?

John: There were. I guess one of the things that I looked at was the different ways in which people were able to talk about the subjectivity if you like, of the dead person within their body and the different range of ways which that came about for them. One was appearance, and I mentioned before the example of the toe and how significant that was. Another issue that was very significant for people was the issue of wholeness and that really came about as a result of the focus on the retention of brains in the study. I guess I should mention that arose from the controversies in Australia and in the United Kingdom back in the early parts of the two thousands when it had become clear that that particularly children in the UK that had had autopsies and major organs were kept without the knowledge of the families and that led to a hole outrage. Bereaved people and a lot of changes in the way autopsies are governed in the UK and here in Australia. Now part of that meant that here in Queensland coronial social workers are responsible for contacting bereaved people and actually talking with them about the autopsy and explaining to them if a whole organ has been kept why that has happened and what sort of options they have. So, in every case where I’ve interviewed people what my sample focused on people who had been advised that the brain was being kept and had not objected to that being done. And I was particularly interested in people who did not have an objection because so much of our understanding of people’s responses to this has been based around the outrage that came from earlier on. So, I was interested in that other group of people who don’t express outrage and who were accepting of the process of brain retention.

Tricia: So, how do you make sense of that?

John: Well, again it came back to balance for them. They were balancing their need to know why the person died with their understanding of the person’s body as still expressing the individuality of that deceased person. And what so many of them spoke about was their concern that a wholeness be maintained for the deceased person and respect. I explored with a number of people what they meant by that wholeness and although what they meant in many cases was that for them if you like the spiritual integrity of the deceased person somehow existed and was maintained despite this enormous invasion of their body and the removal of what all of us I guess consider to be that part of us which determines our individuality.

Tricia: So, the time spent in the process of helping people understand is well spent.

John: Absolutely, yeah, it’s crucial I think because it then helps people or gives people an opportunity to develop their own understanding and interpretation of what it means. And, as I said, for most people what that meant was that they engaged in this process of deciding whether or not they wanted an understanding of the cause of death was of primary significance to them and so they would as it were, talk about the deceased person in two ways. They’d talk about the body as something which could be autopsied without effecting the deceased person but at the same time and without any real sense of contradicting themselves they would talk about the body as still very much the deceased person themselves. So, they had this really delicate balance going and it’s not, well what I’ve sort of speculated about is that from our outside perspective, from observing them we might think of that as a contradiction or some sort of issue that needs to be resolved in one way or the other but for the people I was interviewing that sense of contradiction didn’t exist so much. If you like, a paradox that they just lived with. The dead body was both, the deceased person who they still loved and tissue, anatomical tissue that could be dissected and it seemed as if through the experience of their grief and as they worked towards resolving their grief involved an ability to take both perspectives at the same time and one of the things that I’ve suggested I guess is that as social workers we’re in an ideal position to honour that and to work with because we don’t insist on a sort of empirical positivist reality as the only thing that matters. We’re able to recognise that emotions can be messy and contradictory and still need to be honoured as it were. And I think in a sense that for me illustrated just how important it was to listen to what bereaved people are telling us and to look for the way that their describing is really complex experience. Without trying to over simplify it by getting all psychological about it or squeezing it into a model of grief with all these steps and tasks or whatever, or more or less just accepting that this very delicate process their going through is going to be huge and very contradictory as they say.

Tricia: John, we’re almost out of time but I do have a question. Did it matter to the person, or did it come up if the person felt that the person who had died looked like themselves?

John: Absolutely,

Tricia: Because sometimes people think of how a body is made up because it doesn’t look like them anymore and if that can be an issue.

John: One of the things I should say is that because most of the people I spoke to saw the person’s body at the coronial mortuary so there was no make-up, there was none of the cosmetic stuff that can happen at funeral homes and so many of them did emphasise to me that their sense of seeing the person as themselves. Seeing them as they still looked the same and one very moving conversation I had with a participant who said that when she saw her daughter's body her daughter had this particular smile on her face that she said that no one else would have recognised that or seen it. But I’m her Mum and I could see that it was still there and new it was her.

Tricia: So perhaps there’s not only lessons for social work in your work but perhaps also for funeral parlours, businesses that do look after the bodies after they’ve left the health system.

John: Look, there could be, but I’d hesitate to push that too far, because I think once the person’s body is removed from the health system there’s probably a different set of expectations coming into play.

Tricia: True

John: In a sense, once the person’s body gets to the funeral home it might be that it’s more about going through the funeral rituals there might be ceremonial expectations that might exist and while they’re in the mortuary there’s more that sense of unalloyed death. So, yeah, there could be some, but I don’t feel able to push that to far.

Tricia: That actually makes sense because it’s more personal and relational at that time after death or after the autopsy whereas there is that more public relationship or ritual as you said after that once the scene changes.

John: Yeah, I think that’s right.

Tricia: John, we’re out of time. Final words?

John: Once again I have to um, I just really feel that it’s important to acknowledge that the social workers who I’ve worked with who I’ve learned so much from John Merrick paramount amongst them but also someone who I worked with, some people watching this no doubt new him and that’s a guy called Greg Ellison who was a social worker at West Mead Hospital and I worked with Greg for about five years before we moved up here to Queensland and Greg died in a motor vehicle accident a couple of weeks ago. Um, and he was a very experienced social worker who worked with an awful lot of people. He didn’t work in the coronial field, he worked in the hospital field. He engaged so much with families that I think he represents for me too just the great potential social work has in this field. Yeah, I think his tragic death like that just makes me think that’s it’s worth acknowledging him as well.

Tricia: Thank you John. And so much of this work is invisible to, so I think it is important that we acknowledge social workers who are working with death.

John: Yeah

Tricia: John, thank you so much.

John: Not a problem

Tricia: Okay, thanks for being on Podsocs.

John: Bye-Bye

[Musical outro 30.31 to END]

Interview ENDS: 30:57