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Culture

Death & life

S&U interviews

31 October 2023

8 min read

Rediscovering 'ordinary dying'

On the eve of her Theos annual lecture on 'Death for Beginners', Robert Wright speaks to former palliative care consultant Kathryn Mannix about the need for everyone to re-engage with the process of dying. Part of the Seen & Unseen How to Die Well series.

Robert Wright

Robert is a journalist at the Financial Times.

A woman stands in an autumnal-looking park, with her hands in her pockets

Katherine Mannix.

Shortly after the late Queen Elizabeth died, in September last year, Kathryn Mannix, a former palliative care doctor, decided to point out something that had been going unremarked. Mannix, who spent 30 years in various palliative care roles in the North of England until retiring in 2016, wrote on the social media platform then called Twitter that the world had watched the late monarch live through a process that she called “ordinary” dying. But, she added, the dying had gone “unspoken, un-named”.

Mannix’s 12-post thread pointing out what the world had been watching was to prove one of the most successful steps yet in her long-running campaign to refamiliarise the world with how people die, the signs that someone is dying and how the process works. The thread has been viewed several million times. Among the replies to her post, according to Mannix, were several from people saying they recognised from it that relatives were going through the process and they should prepare.

Mannix hopes that her efforts will ensure people learn to cope better with their own and others’ inevitable deaths in ways that work better both medically and emotionally.

“The queen’s death was no surprise to those of us who have been watching that process that we recognise as ordinary dying,” Mannix says, in an interview over lunch in Newcastle, near her Northumbria home.

“The person got into hospital to have treatment to stop them from dying. When they died, that was a medical failure. That was an embarrassment.”

Mannix will take another substantial step in her campaign on November 1 when she delivers the annual lecture for the religious think-tank Theos on Dying for Beginners. The lecture will revisit the lessons of her thread about the queen and two successful books about dying: With the End in Mind, recounting the lessons of her career in palliative care, and Listen, about finding the words for end-of-life conversations. All of her work has stressed the unhelpful aspects of medical practitioners’ increasing involvement in deaths. Doctors’ increasing power to prevent death in many circumstances and delay it in others has made it, in her view, damagingly unfamiliar.

However, Mannix insists that, while the November 1 lecture has been organised by a faith-based think-tank, her principles are applicable whether people understand their lives through a spiritual prism or via something else like family, politics or art.

“There are a number of constructs that give people meaning,” Mannix says.

At the heart of Mannix’s message is the idea that death was once a familiar process that people knew how to manage. She argues that the last century’s medical advances changed that.

“I think we’ve forgotten because over the course of the twentieth century life expectancies nearly doubled,” Mannix says.

She points to a range of factors behind the shift, from improved sanitation and vaccination programmes to the founding in the UK of the National Health Service and the introduction of antibiotics.

She dates the shift of dying from home to hospital to the second half of the twentieth century.

“It was almost like dying was kidnapped inside hospitals then,” she says. “The process itself got slightly distorted by the medical interventions like intensive care units, so the process became less recognisable.”

The key change, according to Mannix, was that death became “the enemy”.

“The person got into hospital to have treatment to stop them from dying,” she says. “When they died, that was a medical failure. That was an embarrassment.”

“It’s hard to have a conversation with a person who has no pegs to hang that conversation on. The current population has no idea about dying.”

Doctors started to keep in hospital people who would prefer to be at home with their grandchildren, in case there was one more thing they might try that would save their lives, Mannix says.

“We need to celebrate that medicine can do so much more than it used to be able to do,” Mannix says. “But we need to remember that those achievements are only postponing dying. We’ve not cured death.”

Clinicians need to recognise the point in illnesses where death becomes inevitable and speak to patients about their priorities for their remaining time, she adds.

“Survival at all costs might not be what is most important to them,” Mannix says. “There may be things that they wish to fulfil.”

Mannix is clear that the UK at least remains a long way from learning the lessons that she is trying to teach. She was prompted to write her thread about Queen Elizabeth’s death partly by the ending to a news bulletin announcing that the monarch’s family were rushing to her bedside at Balmoral. Mannix says the newsreader finished the segment, hours before the death was announced, by saying “Get well soon, ma’am.” She describes it as “a dreadful example of our death-denying”.

She is giving the annual Theos lecture as the group is in the midst of releasing a suite of resources designed to provoke greater debate around death and dying. They include a video where Mannix explains the dying process. The group’s research paper Ashes to Ashes, published in March, showed that many British people had similar priorities for their own deaths and those of loved ones as set out in Mannix’s work. They wanted to be free of pain or suffering, surrounded by family, probably at home, to be reconciled to people and to be prepared.

According to Mannix, however, even her fellow medical professionals feel poorly equipped to begin conversations with patients or their families about impending death. Many people had contacted her after reading With the End in Mind saying that they were convinced of the need for frank conversations about death but had no idea how to start them.

“The feedback from doctors and nurses was the same as from the general public – ‘I don’t know how to talk about this bit’,” Mannix says. “’Nobody taught us about this in training’.”

It is also a challenge for medical professionals that patients and their families are typically resistant to conversations about death, she adds.

“The doctor doesn’t want to be the bad guy or girl and constraints in the NHS are such they can’t find time for the length of conversation that’s likely,” Mannix says, adding that many doctors are also unfamiliar with exactly how the dying process tends to unfold.

“They’re not taught about dying,” Mannix says of trainee clinicians. “They’re not taught to see good dying as a good medical outcome and it could be.”

Those conversations are all the harder, she adds, because society as a whole has so little conception of the process of death.

“It’s hard to have a conversation with a person who has no pegs to hang that conversation on,” Mannix says. “The current population has no idea about dying.”

In wider society, meanwhile, she would like to see far more communities taking the opportunity to support the dying.

The questions fundamentally end up being spiritual or philosophical ones, Mannix says. She declines to be drawn on her own spiritual practices but describes herself as “spiritually curious”. She similarly declines to outline her position on the debate about assisted dying, saying that expressing a view on that would be a distraction from her primary purpose of promoting discussion of the ordinary dying process.

But she says questions about how to manage death, whether to prolong life and the balance between quality and length of life inevitably raise “societal questions”.

“We all want to think about our life being worth something and about the purpose that we think is the purpose of being alive,” Mannix says.

Mannix hopes her campaign will prompt religious leaders to think more carefully about how they support families and dying people. In particular, she would like priests to acknowledge to those they are supporting that faith will not always banish fear and that the faithful will sometimes feel abandoned by God in the face of death. She would like to see far more thorough training for clergy throughout their careers in how to have such conversations.

She would also like to see more clergy learn more about the process of death, so that they can reassure families about what they are witnessing – for example, that apparent gasping from the dying person does not indicate pain. She expresses optimism about the growth of civil society organisations – some based around religious organisations – seeking to encourage a more open discussion of death and dying. She speaks particularly warmly of the Death Cafe movement – where people meet for cake and coffee to discuss death issues – and the End of Life doula movement. End of Life doulas seek to shepherd people through death the same way that birth doulas assist women in labour.

Both of those movements have a key role to play in bringing about the revolution that Mannix would like to see in society’s understanding of death and its role in life.

Asked what a balanced approach to the issue would look like, Mannix says it would be “very helpful” if people were told at the outset when they were diagnosed with a long term, potentially life-limiting condition that it could be so.

“Currently, people understand that cancer can kill you,” Mannix says. “But there are many people walking around the country who have long-term lung diseases, kidney diseases, who just wonder why they never feel as well as they used to do.”

In wider society, meanwhile, she would like to see far more communities taking the opportunity to support the dying.

“A decision for the public would be to think of an organisation or society or a community that they belong to and how could they be agents of change in that community to explore the concept or ordinary dying,” Mannix says.

Such communities can decide how best to prepare and make available support for other community members when they are dying.

“Their dying will come one by one,” Mannix says. “We’ll all take our own turn.”

While most tickets for Kathryn Mannix’s talk on November 1 have been taken, some more may become available at theosthinktank.co.uk. For those unable to attend, the lecture will be filmed and posted afterwards on the Theos website.

Molly Worthen on the charismatic leaders of America's cosmic drama

The plots and plotters that hold us spellbound

Nick Jones

Nick is the senior editor of Seen & Unseen.

Viewed from behind, Trump raises a fist.

Trump on the stump.

White House via Wikimedia Commons.

What happens when Americans lose faith in their religious institutions—and politicians fill the void? In Spellbound: How Charisma Shaped American History from the Puritans to Donald Trump, Molly Worthen sweeping history helps us understand the forces that create leaders and hold their followers captive.

Everyone feels it. Cultural and political life in America has become unrecognizable and strange. Firebrands and would-be sages have taken the place of reasonable and responsible leaders. Nuanced debates have given way to the smug confidence of yard signs. Worthen asks just how did we get here?

Worthen, a historian argues that we will understand the present moment if we learn the story of charisma in America. From the Puritans and Andrew Jackson to Black nationalists and Donald Trump, the saga of American charisma stars figures who possess a dangerous and alluring power to move crowds. They invite followers into a cosmic drama that fulfils hopes and rectifies grievances—and these charismatic leaders insist that they alone plot the way.

Author and historian Tom Holland loved this book.

“The great story of charisma in American history, from the Massachusetts Bay Colony to MAGA, has never been more thrillingly told, never more learnedly explicated.”

In this extract, entitled Plotlines, Worthen introduces her four categories of charismatic leader: Prophets. Conquerors, Agitators, and Gurus.

Plotlines

Over the past several years, whenever I told friends or family that I was writing a book about charisma, they responded with a reasonable question. Which charismatic figures would I include? They peppered me with suggestions: What about Elvis Presley, or Dolly Parton? Michael Jordan or Muhammad Ali? Surely I had to say something about Taylor Swift, right?

None of these fascinating people appears in this book. As you read it, you will probably think of a dozen others whom you wish I had included, and I’m sure you’ll have a point. I have mostly stuck to individuals who worked to build a movement in organized religion or politics, rather than musicians, artists, or athletes. Even within the spheres of religion and politics, I’ve been selective in order to craft a manageable story and bring into focus the patterns and transformations of charismatic leadership over the course of American history.

Sometimes this is an inspiring story, because charismatic leaders often turn up—and people decide to follow—out of a desperate response to alienation and injustice. People in anguish seek a savior. Yet charisma has no fixed moral standing. It can carve a path to freedom or to enslavement; it can lead people to embrace the rule of law or to sneer at it. Charisma causes problems for democracy as well as for authoritarian regimes. Without a sustained analysis of charisma over the long haul of American history since European settlement began, we are doomed to bumble along, blandly observing that ordinary people declare many allegiances that seem to contradict their own material interests and sabotage democracy—but never understanding why.

Over the past four centuries, five types of charismatic leaders have surged to dominance, each offering a variation on the great paradox, a different way for followers to hand over control while feeling liberated. I use these categories both to classify leaders and their movements, and to chart historical change: each type reacts to the type that came before, and responds to the pressures and anxieties of its own era. Like all typologies, this one maps imperfectly onto real people. Almost no one is a “pure” example of these categories, and some leaders are interesting precisely because they react against their age’s dominant type. But these categories have compelled even leaders who defied easy labels—that’s most of them—to respond to the ascendant charismatic style of their age.

The Prophets take us from the end of the Middle Ages into something beginning to resemble our own world. They drew on ancient patterns of contact with the divine to challenge authorities and captivate followers with the terror and ecstasy of God’s presence. They hewed close to tradition, operating in a time when Old World strictures still constrained life in the New World rather tightly. But some used those traditions to undermine reigning institutions, whether by violent rebellion or illicit gatherings—and so provoked a backlash. If the Prophets conceived of freedom in terms of divine salvation, they often harnessed mystical power for this-worldly ends. Usually this meant dismantling any structure that stood in God’s way.

The Prophets were, essentially, destroyers. In their wake they provoked an age of builders.

The Conquerors rose to prominence in the early nineteenth century—an age of mythology, mass media, and frontier enthusiasm in the European American imagination. They swung away from the age of the Prophets, who had so much to say about how powerless humans are.

Some of the Conquerors wielded military power, but all of them pursued what we might call metaphysical conquest. They fought to control spiritual forces. As the predestinarian Puritanism of earlier generations lost its appeal, more people placed an almost fundamentalist faith in the power of free will. It was tempting to think of spiritual forces—perhaps even the Holy Spirit— as a kind of technology, ready for manipulation. The stakes in these campaigns were high at a time when new advances in science impinged on everyday life. Waves of immigration made the country more religiously and ethnically diverse. Americans felt both freer and yet more confined than ever before.

The Agitators gained sway at the turn of the twentieth century, protesting modernity as a raw deal and democracy as tyranny in disguise. The Conquerors had, overall, expanded government authority over Americans’ lives and advanced a golden idea of progress. Now the pendulum swung back toward calls for destruction. The Agitators found a market for attacking the state and denouncing so-called progress as a lie. They defined themselves as outsiders whether they were or not, and discovered that gaining material power does not mean that one must stop telling a story of exile and affliction. This proved to be an important lesson in an age of world war and economic disaster: global crises have a way of transfiguring an outcast dissenter into a credible threat tot he standing order. Meanwhile, Christians grew wilder in their displays of New Testament charisma—because, paradoxically, it was easier to grapple with what Max Weber called the “iron cage” of modernity by embracing ever more outlandish signs of divine power.

The Experts were, on the face of things, the Agitators’ opposite in charismatic style. They were builders. In the wake of World War II, they capitalized on a backlash against the nightmare years of fascist demagogues, embraced the zenith of traditional institutions’ authority across Western culture and politics, and nurtured Americans’ faith in the power of technology and bureaucracy to solve large-scale problems.

They claimed the mantle of reason and procedure and did their best to relegate the political or religious clout of charisma to the distant past or primitive cultures.

But in fact, the three decades after World War II witnessed an explosion of religious revival in America—led by Christians who spoke in tongues, looked for the end times, and claimed to heal through the power of the Spirit. Even in the domain of credentialed and supposedly secular healing, the line between medicine and spirituality grew fuzzier. These years were the Experts’ apogee of cultural prestige, but Americans’ long- standing ambivalence about intellectual elites persisted. The most successful leaders capitalized on those mixed feelings. They nursed the tension between the Cold War celebration of science and freedom and, on the other hand, the lurking sense that technological leaps obscured eternal truths and needed the organizing power of a good story.

By the end of the twentieth century, as Americans lost faith in established media, churches, government, and nearly every other bulwark of modern society, the destructive strain of charismatic leadership re-surfaced in the form of the Gurus: preachers of self-actualization and get-enlightened-quick schemes, promoting God’s new temp job as personal assistant. Old-fashioned Pentecostal revival persisted too, but its leaders struggled to prevent the culture wars from capturing the Holy Spirit.

The Gurus looked, at first glance, like the Prophets and the Agitators. But in the generations since those earlier eras, it had become harder to pay obeisance to tradition—which was just fine, since the erosion of institutions had weakened traditions anyway, and opened a path for Gurus to achieve more influence than their destructive predecessors. Religious and philosophical tradition, in the hands of the Gurus, was no longer a firm guide but a palette for painting illusions of independence. Sometimes they used it to depict a new reality impervious to fact-checkers.

“Guru,” which means “remover of darkness” in Sanskrit, was originally a religious term. But in the third decade of the twenty-first century, the most prominent guru in the country was a businessman named Donald Trump. Trump was not, personally, a paragon of conventional religious devotion. Yet his political career depended on a hunger among his most dedicated supporters that can only be called spiritual. Like so many relationships between charismatic leaders and their followers, it stumped and angered those on the outside. Against the backdrop of the American charismatic tradition, however, his success makes perfect sense.

How, then, did early modern mystics and Puritan heretics who heard the voice of the Holy Spirit give way to devotees at a modern presidential rally, jostling toward the candidate iPhone-first, praying for a selfie? By the early twenty-first century, most religious institutions in the West had declined into husks of their former authority—at least by the usual measures. Today commentators turn more than ever to materialist explanations for political dysfunction, polarization, and the culture’s general crisis of confidence. They cite growing social inequality, impassable disagreements on policy, persistent racism and xenophobia, evil automated forces lurking on the internet. All true—yet all insufficient accounts. If we define the religious impulse as a hunger for transcendent meaning and a reflex to worship, then it is a human instinct only slightly less basic than the need for food and shelter, and Americans are no less religious than they have ever been. They will always find a way to satisfy these desires, even if charisma carries them down strange and costly paths.

Spellbound: How Charisma Shaped American History from the Puritans to Donald Trump, Penguin Random House, 2025.