My personal doctor and two of my cherished mentors died within the past several years, each “after a long illness,” according to their obituaries. Rock legend David Crosby (The Byrds and Crosby, Stills, Nash & Young) recently died “after a long illness,” as stated by his wife, Jan Dance.
David Crosby’s co-musicians were perplexed that his widow would attribute his death to a long illness. Crosby certainly had his share of health concerns — substance use, hepatitis C, liver transplant, cardiac catheterization, and diabetes — and he frequently joked about his death, planning his funeral in advance. However, in his final days, Crosby’s new bandmates observed him “writing, playing [and] singing his ass off.” The day he died, Crosby “seemed practically giddy with all of it,” working on a new album and planning a tour. At 81, his vocal ability remained top-notch, even if arthritis made playing the guitar difficult. The fact is, David Crosby’s final decade of life was his most vibrant, releasing five studio albums. His sudden death was understandably puzzling.
I turned 69 in January. I have stage 3b chronic kidney disease, hypertension, gastroesophageal reflux disease, and hyperlipidemia (all treated with medication). I have Barrett esophagus without dysplasia. I have generalized anxiety disorder, including past episodes of depression. I have been overweight most of my life. I had lumbar spinal surgery in 2016, followed by chronic low-grade back pain. But overall, I feel good, and like Crosby was, I’m productive. If I were to die tomorrow, should my obituary attribute the cause of death to “a long illness?” Which one?
As a psychiatrist, I am accustomed to reading that someone has died after a long illness. I know that in most cases, the illness is depressive in nature, and the individual has died by suicide. The “long illness” is a euphemism for suicide, a word we struggle to say out loud. I can certainly understand why families would want to keep suicide a secret, given the stigma attached to it and the stigma that continues to surround mental illness in general. But unless we confront the epidemic of suicide, the problem will continue to fester, and we’ll never be able to break through the cloud of silence.
Perhaps we are more at ease discussing death due to medical illnesses than death due to mental illnesses, Crosby’s death notwithstanding. Even conditions once dreaded and believed to be horrifying and incurable, such as cancer and HIV/AIDS, are discussed openly — advertising their treatment on television to millions with catchy, upbeat melodies in the background. So, why do family members still prefer the term “after a long illness” as a code for conditions that result in death? Crosby’s guitar player commented: “He was a weakened guy from many different preexisting conditions, and everyone knew it …” Why not say what those conditions are?
The answer is: respect and privacy trump the need to know. However well-intentioned I may think it is to disseminate information about someone’s cause of death, the family’s interests in the matter override mine. Crosby’s fans were curious to know more about his death, but his wife had the final say, as it should be. (Ironically, her refusal to go into detail led people to question her background.)
I was reminded of the sanctity of death in an account by Ashley Judd to the New York Times about her mother, Naomi. You may recall that the iconic country singer Naomi Judd died by suicide in April 2022. Several months later, her daughter Ashley penned a guest essay in the New York Times about her family’s efforts to keep police reports related to the suicide private, including photographs and body cam footage. Judd wrote: “Though I acknowledge the need for law enforcement to investigate a sudden violent death by suicide, there is absolutely no compelling public interest in the case of my mother to justify releasing the videos, images, and family interviews that were done in the course of that investigation.”
At the urging of the Judd family, Tennessee Senator Jack Johnson introduced legislation to make death investigation records private when the death is not the result of a crime. Judd remarked: “The raw details [of death] are used only to feed a craven gossip economy, and as we cannot count on basic human decency, we need laws that will compel that restraint.” A catch-22 is that public disclosure of the nature of the death may be required to determine whether it is or is not the result of a crime, but such instances are rare.
Judd pointed out that a big problem for law enforcement personnel is that they are not adequately trained to respond to and investigate trauma-related cases. They employ outdated interview procedures and methods of interacting with family members who are in shock and grieving. Not only are families at their most vulnerable following the acute death of a loved one, but in Judd’s case, she felt “cornered and powerless” when interrogated by the police, “stripped of any sensitive boundary,” as though she were a suspect. Ashley Judd had to re-enter trauma-focused psychotherapy to deal with the events.
In addition, Judd wrote that her family felt “deep compassion” for Vanessa Bryant, the wife of NBA star Kobe Bryant who was killed along with his daughter and other passengers in a 2020 helicopter crash. Like the Judd family (and other families), Bryant had to endure the release of details surrounding the deaths. Families and their memories of deceased relatives deserve respect. To say that someone has died after a long illness, regardless of the specific cause of death, gives them that respect.
Regrettably, attempts to describe cryptic deaths are frequently inaccurate or maligned. My personal doctor did indeed die “after a long illness.” He was my neurosurgeon, and he died tragically by suicide. When I clicked on his “link” to an affiliated hospital’s website a week later, I received an error message: “Page not found.” Worse yet, Queen Elizabeth’s death was attributed to “old age,” as meager, and some would say ageist, as describing an elderly person’s death as “natural causes” or “failure to thrive.” The latter term originated in the pediatric world and has now migrated to geriatrics and might best be avoided.
I’ve kidded my family about what to write in my obituary and on my gravestone and how to divide my possessions when my time comes. In the final analysis, however, people should be remembered for how they lived, not for how they died, and certainly not for the private details of how they may have suffered. As Paul McCartney said, “Let it be.”
Arthur Lazarus is a former Doximity Fellow, a member of the editorial board of the American Association for Physician Leadership, and an adjunct professor of psychiatry at the Lewis Katz School of Medicine at Temple University in Philadelphia, PA. His forthcoming book is titled Every Story Counts: Exploring Contemporary Practice Through Narrative Medicine.
