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British Journal of Social Work (2013) 43, 264281

doi:10.1093/bjsw/bct011
Advance Access publication February 13, 2013

Bodies-in-Life/Bodies-in-Death: Social
Work, Coronial Autopsies and the Bonds
of Identity

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John Drayton*

John Drayton is the Senior Coronial Counsellor at Queensland Health Forensic and Scientific
Services. He is a social worker and engaged in Ph.D. research at the University of Queensland.

*Correspondence to John Drayton, Queensland Health Forensic and Scientific Services,


Coronial Counselling Service, PO Box 594, Archerfield, QLD 4108, Australia.
E-mail: john.drayton@uqconnect.edu.au

Abstract
This paper addresses an aspect of bereavement which has received scant attention: the
various meanings of the dead body for the bereaved person and the practical implica-
tions of these for social workers in the field of grief and loss. The discussion is embedded
within a consideration of the role of social work in the field. The practice context is dis-
cussed and the literature of attachment in bereavement and conceptualisations of the
dead body briefly reviewed. The core of the paper derives from a series of interviews
with relatives of people whose bodies underwent autopsy-based coronial investigations
involving the retention of whole organs in Queensland, Australia. A number of emer-
gent themes are identified regarding the resonance of identity and the ways it is con-
tained, asserted and incorporated into the life and grief of the bereaved. Conflicts
and concurrences between the perspectives of interviewees and dominant medico-
legal perspectives are also considered. The paper concludes by discussing the role of
social work in bringing the perspectives of the bereaved person to the fore. It suggests
the profession, by virtue of its familiarity with the Ambiguous and Contradictory, is well
placed to develop practical understandings of death and bereavement and to enhance
the various governmental systems in which they are enacted.

Keywords: Autopsy, bereavement, body, sudden death, grief, social work

Accepted: January 2013

# The Author 2013. Published by Oxford University Press on behalf of


The British Association of Social Workers. All rights reserved.
Bodies-in-Life/Bodies-in-Death 265

Introduction
The coronial jurisdiction in Australia, like the English system from which it
derives, is a medico-legal forum in which the causes and circumstances of
sudden and unexpected deaths are investigated. Since 1995, I have been
employed as a social worker within the forensic pathology branch of the
system, first in New South Wales and since 2001 in Queensland. This
paper arises from an on-going qualitative study of the experiences of
bereaved families faced with a stark reality of the jurisdiction: the internal
autopsy and the retention of whole organs from the body of their relative.
The Queensland 2003 Coroners Act requires that coroners consider any

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objection families may have in relation to an internal autopsy prior to one
being conducted. In practical terms, this involves social workers contacting
the bereaved person and discussing with them details of the autopsy
process, typically within hours of the death occurring. In this paper, based
largely on a series of interviews conducted with bereaved people of the
Queensland Coronial Counselling Service, I discuss the bereaved persons
understanding of, and relationship with, the dead body of their relative
and the implications this understanding has for social work practice.
I begin by outlining the systemic context of my study with a focus on the
social work function, review briefly sociological conceptualisations of the
dead body and studies of on-going embodied relationship between
the bereaved person and the person who has died within bereavement.
I then present an analysis of interview data relating to the autopsy, the
body and the experience of loss. I conclude with an exploration of the impli-
cations of the data for social work practice.

Practice context: social work and the Queensland


coronial system

The realities of autopsy practice received public attention in the UK and


Australia in the early years of this century following revelations that
whole organs were retained from the bodies of infants without the knowl-
edge or permission of parents at Liverpools Alder Hey Childrens Hospital
(Knowles, 2001; Redfern, 2001; Fraser et al., 2003; Samuels, 2005). The
report of the resultant inquiry into practices includes statements from
bereaved parents expressing their anger at the system and, often, a sense
that the process of retention has in some fashion damaged both the child
and the parent (Redfern, 2001). The findings of the inquiry resonated in
Australia, resulting in systemic changes which emphasised the obligation
of pathology and forensic institutions to engage in the full disclosure of
autopsy details and procedures to bereaved relatives (Drayton, 2011).
266 John Drayton

The changes were reflected in the Queensland 2003 Coroners Act in


which provision for the involvement of family members in decisions
regarding autopsies (Barnes, 2003, p. 1.3) is legislated. For the purposes
of the present discussion, this aspect of the act and associated guidelines
may be briefly summarised (in Drayton (2011), I provide a more detailed
discussion). Autopsies ordered by coroners under the act may involve at
times the retention of a whole organ (typically a brain) for further examin-
ation. Where this is recommended by the pathologist performing the pro-
cedure, however, the act requires that the family be advised prior to
release of the body for disposal (section 24). This allows for formal consid-
eration of any concerns the family may wish to raise. It is important to note

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here that this is not a process of consent seeking. The Coroners Act allows
for the ordering of internal autopsies and any further tests (including the
retention of organs) considered necessary, regardless of the views of the
family; while they are consulted, ultimate decision-making authority
resides with the coroner.
A team primarily composed of social workers at the Coronial Counsel-
ling Service at Queensland Health Forensic and Scientific Services where
I am currently employed undertake this notification (Barnes, 2003). They
are also responsible for providing families with information about the
autopsy findings and the broader coronial investigation. They are based
within the mortuary, meeting with families when they attend to identify
the body of their relative and supporting them through the viewing
process in which the physical reality of the death is often confronted for
the first time.
Underlying much of the medico-legal perspective and forensic pathology
is the assumption that the corpse is a container of knowledge for explaining
death (Hallam et al., 1999, p. 67). This is knowledge in the form of informa-
tion derivable empiricallyfacts which may be literally seen, held and
measured, either with the naked eye (macroscopically) or under the micro-
scope. Death is reducible to a measurable dysfunction of tissue (Prior,
1985), the preventable outcome of processes which may be traced and
located in both time and place. The Queensland Coroners Act
(section 45) requires coroners to make findings on the identity of the
person, the circumstances of the death, its time, place and medical cause.
The focus of the investigation is on demonstrable evidence, empirical fact.
Long-standing debates in the professions literature attest to social
works often critical relationship with positivism (a recurrent theme from
the 1970s as outlined in Payne (1991, pp. 44 7)). As discussions around
evidence-based practice indicate, this is an issue which remains of signifi-
cance (see, e.g. Nothdurfter and Lorenz, 2010; Dybic, 2011). In a sense,
the social workers field of practice is the space between the empirically
based medico-legal investigationa domain of expertise and legal author-
ityand the bereaved persontypically untrained in medicine or law and
struggling to come to terms with the reality of a death which has occurred
Bodies-in-Life/Bodies-in-Death 267

only hours before hearing from the worker and which is already enmeshed
in jargon, unfamiliar practices and seemingly unanswerable questions. In
order to effectively fulfil this role, however, workers need to engage with
a more confronting space: that between the bereaved person and the
body of the person they loved.
Further, the social workers function to enable the validity of ambiguity
within a governing system based on certainty (cf. Roose et al., 2012).
Their professional focus on the experiences and understandings of the
bereaved person means they are without both the limitations and certain-
ties of the fact-based disciplines which dominate the jurisdiction. To para-
phrase Imre (1984, p. 44), social workers in the coronial field are challenged

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to utilise an approach capable of encompassing all that is human.

Bodies-in-death
The ambiguous status and meaning of the dead body was noted by Hallam
et al. (1999). They argued for the need to problematise notions of the corpse
in order to deconstruct common-sense notions of it as an incontrovertible
biological reality (p. 64), suggesting instead that the dead body carries a
range of meanings and significations which are inadequately represented
by an assumption that its materiality is self-evident (p. 63).
Haddow (2005) distinguished two basic attitude sets regarding the dead
body. A broadly Cartesian conception of death as a point of division
between the self and the body, following which the remains are devoid
of particular significance, is contrasted with a belief that the body retains
its value as the embodiment of an individual person (see Hockey (1996)
for a related perspective). The former position represents a foundational as-
sumption on which much Western science and epistemology is based (see,
e.g. Turner, 1984; McNay, 1994; Gatens, 1996). It is, as we have suggested,
inherent in the coronial system in which the dead body within the coronial
field is discursively constructed as the location of the underlying cause of
death (Prior, 1985, p. 174).
The second category of attitude identified by Haddow, the dead body as
the yet-significant embodiment of an individual, is poignantly illustrated in
Hockeys (1996) analysis of practices whereby parents are encouraged to
nurse the body of their still-born infant. She argues that the corpse is the
locus of identity for the parents would-be daughter or son (Hockey,
1996, p. 55). More generally, Haddow (2005, pp. 108ff.) suggests that the
newly dead body remains a powerful representation of the selfa position
shared by Downie (2003): given that, in bereavement at least, our memories
of others are based on behaviour associated with their bodies, the close
identification between those others and their bodies is not immediately
removed at their death. The bereaved persons conception of the dead
body is consequently fraught (Hockey, 1996): the corpse has at least a
268 John Drayton

dual existencedetritus and person: the body is at once dead and alive
feeling and unfeeling, an object of, perhaps, love and of fear and repulsion.

Bereavement and holding on


The publication in 1996 of Continuing Bonds (Klass et al., 1996) marked
something of a watershed in the study of bereavement. The text overtly
challenged the long-standing and dominant Grief Work conceptualisation
which Stroebe (1992) summarised as a cognitive process of confronting a

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loss, of going over the events before and at the time of death, of focussing
on memories and working towards a detachment from the deceased
(Stroebe, 1992, pp. 19 20). The influential stage theories which
emerged from this perspective emphasised a linear progression within be-
reavement which, as Holloway (2007, p. 72) notes, fail to capture the com-
plexity of individual experience.
Silverman and Klass (1996) effectively and influentially asserted the non-
pathological nature of on-going connectednessa proposition many
bereaved people have found empowering (Walter, 1999). They argue that
the bond exists in memorialising behaviour, reminiscence, and an
on-going influence played by the inner representation of the person who
has died in the life of the bereaved person. A number of studies have con-
sidered how these bonds may be manifested in behaviour (e.g. Howarth,
2000; Francis et al., 2001; Klass and Walter, 2001; Epstein et al., 2006).
Outside of studies on funeral and memorialisation trends and behaviours
(see Holloway et al., 2013), however, the role of the dead body itself in
this process has received scant attention.

Research notes
Sampling and recruitment

A series of fifteen interviews were conducted with relatives of people who


had undergone a coronial autopsy in Queensland. Purposive sampling was
used to define the category of potential participants, all of whom were iden-
tified through a search of the Queensland Health Forensic Pathology data-
base. Participants were the adult next of kin of the person who had died,
with whom the issue of organ retention had been discussed by the allocated
social worker. The deaths all occurred no earlier than six months prior to
approach and no later than eighteen. In all cases, the investigation involved
an internal autopsy during which, with the knowledge of the family, the
brain was removed from the body and retained for further examination.
The author had not had any prior contact with anyone invited to participate.
Bodies-in-Life/Bodies-in-Death 269

Recruitment of participants was managed with the assistance of five Cor-


onial Counsellors, who were asked to review a shortlist of 203 cases and
delete from it any for which they considered that an approach in relation
to research may be distressing or inappropriate. The workers spoke with
potential participants to seek permission for the author to contact them.
The voluntary nature of participation was stressed in that conversation
and subsequently by the author both in writing and during the interviews
themselves. Ultimately, I contacted a total of eighteen people. Only three
declined participation, all indicating that they felt the process of discussing
the death would be overly distressing.

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Interview

The interviews were based on the model Minichiello et al. (2008) link to
in-depth interviewing. This involves a general topic list rather than a set
of specific questions and a conversational rather than interrogative ap-
proach, enabling a focus on the subjects account rather than on the
researchers perspective. The interview schedule I used identified four
topics: memories of the person who had died; events surround the death;
responses to, and understanding of, the autopsy and organ retention; the
grief experience. All interviews were digitally recorded and transcribed
by the author.
All names used in the following are fictitious, in keeping with confiden-
tiality arrangements.

Analysis

Data coding was managed using the following categories: participants as-
sessment of their relationship with the person who had died in life, partici-
pants views on the autopsy process, seeing the body, disposal of the body
and participants assessment of their relationship with the person who has
died in death. Thematic analysis was then conducted, focusing on contradic-
tions and concurrences in responses across categories and across interviews.
Key thematic concerns which emerged include ambiguity of the body, con-
tinuity of identity, continuity of relationship, intimate knowledge and
insight. Coding and analysis were done manually: qualitative research soft-
ware was not utilised.

Ethics

Ethical issues of particular concern related to the involvement of bereaved


people and the authors position as social work team leader. These were
270 John Drayton

managed through a rigorous informed consent regime for both bereaved


participants and gate-keeping counsellors. Oversight of the projects devel-
opment and ultimate ethical approval was provided by the University of
Queensland Behavioural and Social Sciences Ethical Review Committee
and the Queensland Health Forensic and Scientific Services Human
Ethics Committee.

Bodies-in-life/bodies-in-death

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In presenting the following extracts, I have selected those which touch most
fully on the emotional perceptions and intuitions arising from a rarely
explored social domain: the charged intersection between co-existent and
contradictory perceptions of the dead body. We will explore this by discuss-
ing two specific contexts in which participants encountered and expressed
this dual nature: experiences of the bodys appearance and responses to
the autopsy and organ retention.

Appearance

The majority of participants chose to view the body of the person who had
died, either at the mortuary or, following the autopsy, at the funeral home
a process which is well established in grief literature as representing a po-
tentially beneficial opportunity for bereaved people to begin processing
the reality of the death on a cognitive level (Hockey, 1996; Worden,
2001; Chapple and Ziebland, 2010). A number of interviewees, however,
described a somewhat more complex process. Physical features were
spoken of as representative of continuity at the same time as they confirmed
the severance of death. The body is empty, but rich with expressions of the
beloveds individuality from which participants found a reaffirmation of
relationship.
Rhiannons experience of seeing the body of her seventeen-year-old
daughter Jasmine illustrates the complexity of the issue. Jasmine died at
a friends house as a result of an epileptic seizure:
[She] had a tiny grin on her face, you know, a little expression that Ive seen
on Jas a lot when she was alive; and I know that doesnt quite make any
sense, because all her, you know, everythings relaxed and shes, you
know, she shouldnt have an expression, but, but as a mum, you know, I
can see this little expression that Id seen a million times. . . . [A]s far as
the Coroners office is concerned theyre dealing with a body. . . . Whereas
to us shes still Jas, you know?

Rhiannon describes a specific facial expression in language which is


direct yet fondly simple. More than an aid to identification, the tiny grin
Bodies-in-Life/Bodies-in-Death 271

is a point of intimate recognition, suggestive of a million moments. Inter-


estingly, Rhiannon says the smile was clear to her as a mum, suggesting it
may not be apparent to others. At the same time, there is nothing in what
she says to indicate that she considers the grin to be purely her invention.
This extract exemplifies the introduction of an interpretative authority
which is quite at odds with the professional expertise of the pathologist.
The autopsy examination, redolent with social and intellectual capital em-
bodied in qualifications, prestige and objectivity, notes physical attributes
which are deemed significant and authoritative. Observations about the
body become recorded facts in the final report. Rhiannon, however,
applies her own expertise to Jasmines body: an authority based on intim-

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acy. Further, she reports her findings in language consonant with that ex-
pertise: she says Jasmine was smiling.
The significance of this contrast is made plain when Rhiannon notes a
fundamental disparity between the coronial systems understanding of Jas-
mines body and her own. The former, she believes, objectifies Jasmine as a
body, an object for dealing with, while she is able to see the individual,
the person remaining. Rhiannon does not, however, reject the medicalised
view; she asserts rather the coexistence of a contrasting truth, distinguishing
between her experience and sense or the rationally explicable. Rhiannon
cites a popular understanding of post-mortem changes to assert that
muscles relax at death, rendering facial expressions blank and inexpres-
sive. At the same time, she is clear that her experience was otherwise.
The expression was both a function of post-mortem musculature and a
smile. Importantly, Rhiannon does not cede authority. It may not make
sense but, as a mother with insight derived from seventeen years of rela-
tionship, she saw what she saw: the tiny grin exists as surely as a lesion in
the frontal lobe of the brain, visible to those with the authority to discern
it, eyes that can see. Within the domain of grief and sudden death, ambigu-
ity and paradox are the familiars of reality.
Leanne saw her thirty-eight-year-old son Andrews body at the mortuary
following his death after a fall at home. She needed to travel from regional
New South Wales, arriving in Brisbane after the autopsy and brain removal
had been completed. Before seeing Andrew, Leanne met with the coronial
social worker, who discussed those processes with her:

When I went in to see him . . . that was the first thing I did, was look to see if
his head was still as big because it didnt have his brain in there. That sounds
really stupid coming from a 50 year old woman but thats the first thing I did,
cause I thought if his heads not as big it wouldnt be Andrew.

In the event, she found that not only was she seeing her son, but that she
also found the appearance resonant of an earlier loss:

I could see Andrew laying there, I could see my dad laying there; cause
Andrew looked a lot like my dad, even though they were way different
272 John Drayton

builds and everything else; but he had features that were like my dad; and I
never seen my dad when he died.

In the following, which carries on directly from the above passage,


Leanne describes a vacillation at the door of the viewing room which
will be familiar to most hospital and emergency social workers:
. . . and then when the time came, [social worker] was absolutely brilliant.
You know, I wanted to go, I didnt want to go; Im going, No Im not
. . . Im really glad I did, but it was really hard, . . . but I just sort of said to
him, Youre now at peace and we will look after Robyn [Andrews
fiance] and Dylan [Robyn and Andrews son] for you; and say Hi to my
brother when you get there, wherever youre going.

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In the most recognisable, matter-of-fact terms, Leanne describes a
moment of profound crisis in her life. Supported by the social worker,
she is able to confront the reality of the loss the body of her dead son
and to immediately reassert a relationship with hima conversation
which, she mentioned elsewhere in the interview, had not always been
easy for them in life.
Although she does not go into detail about the role of the social worker
here, Leannes unprompted mentioning of her in relation to the resolution
of her indecision, combined with her positive assessment, indicates the sig-
nificance of the role. In a sense, more extended mention of the worker
would indicate a problematic issue: upon entering the viewing room, the
entire attention of the bereaved person is on the body; anything else is a
distraction.

Autopsies and organ retention


Under the 2003 Coroners Act (section 19), coroners are required to con-
sider any objections to an internal autopsy raised by the family prior to
ordering such an examination to proceed. Although none of the families
interviewed for the study had expressed concerns about the process at
that stage, it was clear from the interviews that a number were uncomfort-
able about the autopsy and its impact on the person who had died. The
dilemma facing families is simply expressed: a coronial autopsy is an inva-
sive, potentially disfiguring procedure conducted in order to determine the
cause of a persons death. The desire for knowledge of that cause was, for
many interviewees, a decisive factor which outweighed the practical real-
ities of the examination.
Merrill, whose son Paul died at twenty-one from complications arising
from a cyst in his brain, described in vivid terms her understanding of the
autopsy process and her need to know the outcome:
I knew that, I knew that they would probably be taking tissue samples and
everything and um looking at you know and looking at his heart and all that
Bodies-in-Life/Bodies-in-Death 273

sort of stuff . . . that didnt worry me. I wanted to know why he died. . . . It
was, like, its a burning desire; its a need to know. . . . Its like being
caught in a vacuum; and you cant get out because . . . there is a piece
missing. . . . I cant move on.

It would be simplistic to suggest that the internal autopsy represents an


unambiguous negative for the bereaved person: it can also represent an op-
portunity for answers.
In the following section, I will explore two particular themes related to
the autopsy and organ retention issue which emerged from the interviews:
the autopsy as an experience and the notion of wholeness.

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Experience

To what extent can the autopsy be meaningfully considered to constitute an


experience for the person who has died? Given the accepted absence of
consciousness, the answer to this question should be simple. Rhiannon, in
stark terms, reveals this not to be the case:
As a mother shes still a person and I know that shes gone . . . I mean were
all rational to know that; however when you read thats been done to your
child, its still your child, even though you know she cant feel it and she
doesnt know its happeningthats the rational sidebut to read it, some-
ones just done that to your child and youve gotta read all about it. Terrible!
. . . This is how it feels as a mother: . . . like a murderer or someone sending
you a letter telling you what he did before he killed her.

We noted above the relationship between the autopsy and a Cartesian


understanding of the body. Rhiannon acknowledges this rational side,
accepting that Jasmine did not suffer as a result of the procedure and had
no awareness that it occurred. At the same time, she continues to refer to
Jasmine as a person: she remains a daughter as Rhiannon remains a
mother. The autopsy then necessarily involves both the person who has
died and those who love them. The body being autopsied is the daughter
having an autopsy.
Nor does the process occur without a resonance of feeling. Rhiannon had
earlier in the interview referred to it as a violation of Jasmines body. The
distressing imagery she uses in the extract above, combined with a frank ad-
mission of the emotions experienced on reading the report, suggest the vio-
lation is experienced by Rhiannon, as if in Jasmines stead. The thought of
Jasmine being eviscerated is horrific, but the passionate language with
which Rhiannon describes her experience suggests more than the distress
caused by disturbing thoughts. She talks about her own feelings of violation,
as if she has herself suffered an assault, experiencing the clinical account of
the autopsy as some gloating message sent in a crime film.
274 John Drayton

It is important to note, however, that Rhiannons response was itself not


unambiguous, for all her revulsion. Late in the interview, she returned to
the topic:
I know theyre not there, but its pretty invasive stuff, you know? . . . you
hate the thought that your loved ones body has to endure that kind of
stuff, but at the same time, I didnt want to go on forever not knowing
what happened to her. And I think I owed her that, as well as me.

The sense of Jasmine experiencing an autopsy is made clear, but it coex-


ists with an assertion of the significance of the process. The autopsy is a
horror, but a horror to be endured in the name of the information it may

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provide.
Tom recounted an episode following his reading of the report on the
autopsy on his wife, Jo:
The autopsy was a very nasty sounding thing and very intense . . . but she was
in no pain, I mean itd be worse if she was alive: she was in no pain and I
could see it is for a reason. . . . and then when I went down to show Alex
[son], he hadnt turned 15 at that stage, . . . I said Just realise, mate, that
the bloke, you know, doing this is doing a job. Hes not looking at your
mum, mate, hes just doing a job, like hes unpacking a bag of groceries.
. . . He read it for about five minutes and just said to me How do they
know how much everything weighed? And I said Well mate, theyre chop-
ping her up, you know, like thats how they do it. And then he sort of
stopped reading it; and thats when it sorta hit me a bit more; that Oh
shit, you know?

Tom adamantly distinguished between Jo and the autopsied body


throughout the interview. He underlines that stance, using the graphic
simile of a bag of groceries to depersonalise the process for his son.
Alexs reaction, stopping reading, eloquently challenges Toms Cartesian
stoicism. He experiences a translation of the autopsy experience when
confronted with his sons quiet distress. Tom reaches the limit of his
ability to exclude Jo from the body. His words begin to fall apart.
The autopsy, performed on the body of the beloved, is envisaged and
endured by the lover, just as boundaries between bereaved people and
those they mourn are compromised and traumatically redefined through
the grief process. Whether expressed in the language of pulp fiction or
muted colloquialism, the connections of feeling, embodied in life, persist
in death.

Wholeness

For a number of participants, the implications of brain retention were a par-


ticular concern. Many related the notion of bodily integrity to the whole-
ness of the person who has died.
Bodies-in-Life/Bodies-in-Death 275

Nicoles uncle, Alec, collapsed and died at home at eighty-three. Alec


was the only surviving relative of her parents generation, so Nicole had
maintained a close relationship with him and oversaw the many services
required for him to remain in his flat. She described her mixed response
to the autopsy information:
Well theres gonna be body parts thatll have to be removed and tested and
his brain . . . it just all . . . didnt seem right. And I had my brother going Oh
well, it doesnt really matter, hes dead. Well he is dead, I know that, but . . .
its not that simple to me.

This anecdote neatly encapsulates the dilemma facing many of the people

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interviewed: the struggle to explain their response in the face of a seemingly
detached rationality, itself perhaps somewhat impatient with any acknowl-
edgement of ambiguity. Nicoles brothers responsepragmatic, common-
sensicalis dismissive of her concerns. Interestingly, Nicole is not swayed
by his assertion of the obvious: she recognises the reality of her uncles
death but at the same time rejects a simplistic response to it. The death
does not render the body insignificant to her.
Later in the discussion, she talked about her perception of the impact of
brain retention on Alec himself:
I thought, Oh, I dont want Uncle Alec cremated and hes not a whole
person . . . I wanted him to be the person, the whole, you know, who he
was before he diednot a major part like his brain gone. . . . I just felt
that his spirit as a whole should go up to Heaven and be with God, not
bits and pieces missing all over the place.

It is important to emphasise here that it is the absence of the brain, even


more than the death, which compromises Alecs identity. Nicoles wish for
him is that he retains his personhood beyond death; the lack of an integral
part of his body, however, causes her to question this as a possibility. More
than that, the physical integrity of the body has, for Nicole, religious impli-
cations in which Alecs destiny seems jeopardised. His physical fragmenta-
tion is linked for Nicole to a spiritual one: lacking a whole body, Alecs
spirit is scattered beyond evenseeminglythe reach of an omnipotent
deity.
This apparently bleak scenario was not, however, the end of the story. I
asked Nicole if she believed Alec was at peace:
Oh definitely. Yeah, I do. We had a lovely send-off for him . . . I think hope-
fully he would have appreciated what we did for him and having the funeral
at my church with my Minister and all his friends and family there, so I think
hopefully his spirit would be at peace and hell be happy now.

There is a sense here that the wholeness of the body (and the spirit), dis-
rupted by the autopsy, is socially reinstated. Nicoles sense of Alec at peace
derives from a rituala physical bringing together of his friends and family
276 John Drayton

at a church for the funeral. The unity he lost is restored, enacted for him in
the gathering of those who cared.
The interview with Paula included an extended discussion of this issue
and its implications. Lee, Paulas son, was forty-five when he died from a
previously undiagnosed heart condition. Paula described the troubled rela-
tionship she had with Lee and his struggles with the traumatic impact of his
experiences in the South African military some years before coming to Aus-
tralia. Wholeness of the body, for Paula, is inseparable from integrity of her
sons identity. It emerged that she considered Lee to have been psycho-
logically fragmented throughout his life: a situation she feared the brain re-
tention would perpetuate:

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I wanted the whole body to be back together . . . in some way shape or form
it matters to me that everything is returned to where it should be. . . . I
wouldnt want him to be in pieces in death if you know what I mean. . . . I
would want for him to have a wholeness as far and wide as he could.

Alone among the interview participants, Paula chose to delay the funeral
for some weeks until the brain could be returned to the body. Interestingly,
Paula was also the only participant who chose to divide the ashes, half
staying with her and half going to Lees father in South Africa. She accepted
the apparent contradiction:
Paula: I didnt do that easily, but to me justice is more important . . . theres
the issue of Lees father . . . to me it was inconceivable that he should not be
part of that process. If we were in the same country he would have been part
of that process.

Interviewer: So that idea of justice, you said, over-rode that (wholeness)?


Paula: Yes, absolutely. Everybodys got to be served justifiably.
The social reintegration Nicole spoke of is paralleled in Paulas experi-
ence by her decision to reconnect with her ex-husband after many years.
At the same time, and somewhat paradoxically, this is achieved through
the physical fragmentation of Lees remains. Integrity of the body, achieved
through the return of the brain prior to cremation, becomes, as it were, a
means to an enda social reconciliation for which the body itself serves
as both catalyst and rationale. The notion of wholeness takes on a reson-
ance which encompasses but transcends that of bodily integrity: it cuts to
the issue of identity.

Implications for social work practice

I turn now to consider the implications for social work practice and, in so
doing, I will outline briefly four practice orientations which relate directly
to the issues we have been discussing.
Bodies-in-Life/Bodies-in-Death 277

A focus on process

One of the challenges in bereavement social work is the profoundly irre-


solvable situation with which the bereaved person is faced. Outcome-
focused interventions can assist in dealing with immediate, practical
aspects of the bereavement (Davis, 1999; McBride and Johnson, 2005; cf.
Stroebe and Schut, 1999) but the loss itself and the emotional impact of
that loss is amenable to neither anticipatory nor cognitive restructuring
coping responses (Murgatroyd, 1982) nor to a problem-solving approach.
The conversation between social worker and bereaved person regarding
organ retention is a clear example. A focus on processthe tone of conver-

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sation, allowing the time for rapport to develop, acknowledgement and val-
idation of the emotional crisis confronting the bereaved person, a
willingness and ability to engage directly on the most apparently painful
issues, flexibilityrather than a task-oriented approach is crucial. These
are issues primarily of respect: the cooperative establishment of a dialogue
in which the social worker is able to assist and inform, in which the bereaved
person will be able to give voice to concerns which a dominant practicality
will only too easily suppress.

A focus on meaning

Finding some meaning in the death of a loved one is increasingly recognised


as a significant aspect of the bereavement experience (Neimeyer, 2000; Nei-
meyer et al., 2002; Holloway et al., 2013). The autopsy report starkly con-
firms the fact of the death, but often in language redolent with a clinical
objectivity which can undermine the bereaved persons own sense of the
bodys significance. Further, the language and the social capital associated
with medical and legal knowledge can imply that the report, the coroners
findings, are the totality of what can be said and known of the death. In
working with bereaved people, social workers have an opportunity to
assist in the development of the bereaved persons own sense of the
deaths significance. By clarifying the limited nature of the autopsy
report, such as discussing what can and cannot be definitively established,
the social worker is able to validate the experience and knowledge of the
bereaved person as a form of expertisean authority derived from relation-
ship and intimacy.

A focus on ambiguity

A focus on meaning necessarily involves an ability on the part of the social


worker to comfortably accept ambiguity. As we have discussed, bereave-
ment can typically involve the coexistence of apparently contradictory
278 John Drayton

beliefs about, for example, the body or the impact of the autopsy. The chal-
lenge facing social workers is profound: to resist the urge to make sense of
what they are being told, to work from the assumption that the apparent in-
coherence of the bereaved persons view may be more a function of the in-
ability of our language to cope with metaphysics than individual distress or
delusion or wishful thinking; that the perceptions of bereavement are
rooted in practical experience and thus imbued with their own validity.

An engagement with the body

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As McCarroll et al. (1993) demonstrated, coping strategies among workers
confronted with traumatised bodies on a regular basis typically include
non-engagement with notions of the person who has died as an individual.
In the Queensland coronial jurisdiction, however, social workers deal dir-
ectly with both the body of the person who has died and the bereaved
person. When social workers enter the viewing room with a bereaved
family, they are met with death as a physical and emotional reality. The
social work presence in the room can counteract dominant clinical construc-
tions of the medico-legal corpse, opening a space for the construction of
meaning and expression of loss. This engagement with material complexity
is, perhaps, a defining aspect of social work across international and juris-
dictional practice contexts. The profession asserts embodied experience
as a social domain inseparable from emotion and imperfectly expressed
in the language of clinicians.

Conclusion

I argue on the basis of the interview data discussed above that the invasive
disruption of the internal autopsy, a key element of coronial investigations,
is necessarily problematised for the bereaved by their sense of an on-going
vital identity within and about the dead body. This sense, avowedly
non-empirical, is at odds with the positivist underpinnings of the jurisdic-
tion. It is important to avoid oversimplification, however: the interviewees
were not opposing those underpinnings; wanting the information it could
potentially provide, they did not argue against the practice of the
autopsythey demonstrated the complexity of its consequences. By involv-
ing bereaved people in deliberations about the autopsy, therefore, the
system engages with a set of responses arising from a distinct epistemologic-
al base. Social workers enable this engagement through their direct commu-
nication with the bereaved person, operating within a space of discursive
intervention I depicted above as being between the body and the grieving,
the jurisdiction and the family.
Bodies-in-Life/Bodies-in-Death 279

For all the information it contains about death, the body remains the
beloved. The people interviewed for the study underlying this discussion
clearly articulate their on-going, embodied attachment to the person who
has died at the same time as they acknowledge the reality of the death
and the at times devastating means by which that death is investigated
and explained. It misrepresents the responses of interview participants to
draw pro or anti autopsy conclusions: the body is depicted as neither
some sacred relic to be forever left untouched nor insignificant detritus.
It remains the person, even as its changes in appearance confirm the per-
manent absence of the person. She is dead, he is dead. We are challenged
to hear the personal pronoun and the present tense in this stark formula-

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tion. Social work brings to the field a means of enabling articulation of
that position and a profound assertion that any apparent contradictions
or ambiguities within it are valid in themselves. Social work assists bereaved
people most directly by maintaining a space for reflection within the confu-
sion and demands of the coronial jurisdiction, enabling and validating
insights unavailable to the microscope or the legislature.

Acknowledgements

The author gratefully acknowledges the generosity of those people who


participated in interviews for this study as well as the critical assistance
and support of Prof. Karen Healy, Prof. Robert Bland, Dr Charles
Naylor, Mr John Merrick, his colleagues at the FSS Coronial Counselling
Service, Ms Cathie Peut and WCY.

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