The Mystery of The Corpse
Humberto Correa-Rivero*
Professor of Medical Humanism and Emeritus Dean of the Faculty of Medicine of the CLAEH University. Punta del Este - Uruguay
*Corresponding Author: Humberto Correa-Rivero.
Published: August 30, 2023
DOI: 10.55162/MCMS.05.157
Abstract
Posthumous dignity
“Corpses, body parts, tissues and skeletal remains always come from individuals, and even when these individuals lived in the distant past, they can never be completely dehumanized. They still remind us that they were once one of us.” [1].
When a human being (living biological organism) dies (stops living), a corpse (inanimate object or thing) remains. The corpse (physical entity perceptible by the senses) is what remains after death (episode, end of something, but not a physical entity).
In medical studies, the human cadaver as a learning material is associated with the Anatomy course. When the Faculty of Medicine of the CLAEH University inaugurated a new practical workroom, very adequate and functional, for this subject, the Dean asked me to expose some thoughts about the human corpse. This prompted me to new reflections. I had previously delved countless times into life, death, and the forms and circumstances of one and the other, but I had not stopped to think deeply, taking the corpse itself as a subject. That request motivated me, and what I am writing is centered on my own experiences, feelings, and reflections through time in front of a dead human body. I insist on making this remark, because if this were intended to be a scholarly essay, the corpse should be approached within the immense subject of death and in depth from multiples points of view: historical, anthropological, religious, psychological, philosophical, and others. I think it would deserve a whole book. Although I will refer to various aspects, my essay is based on my experiences and feelings and will be biased not only by my conception of life, but also by the circumstance that motivated the encounter: the inauguration of a new room for dissecting human corpses for medical training purposes.
Before continuing, we must keep in mind that what is experienced at the sight of a corpse, although it has some fundamental common and anthropologically constant elements (facing death, feeling of loss, giving meaning to what happened, and determining the destiny of the remains), has many other aspects that vary considerably according to the culture, tradition and history of the community, circumstances in which the death occurred, the relationship of the viewer to the deceased, age of the deceased and of the person viewing the body, degree of kinship or absence of it, time of evolution of the corpse, frequency with which this confrontation occurs, handling and use given to the corpse, and the profession related to the corpse that the viewer may have.
In Front of the Corpse
When I started Medicine, the only corpses I had seen were my paternal grandfather’s and maternal grandmother’s (“beloved corpses”). When I took Anatomy, I was in fairly close contact with cadavers all year. Anatomy is the topographical, descriptive, and detailed study of the human body from the skin to the bones. In programs where the teaching is integrated, it includes the relationship of these parts with the functions and with the clinic. Anatomy is studied by reading texts, studying detailed designs and figures of each part and region of the body made to perfection, observing artificial reproductions of some parts, and dissecting human corpses. The dissection of human corpses began centuries ago, with its beginning in the West around the year 1300 [2]. It was not only used for medical training but also for artistic purposes as Leonardo did in the Renaissance, who also had a specific interest in anatomy [3]. This practice that opens the body, separates it into parts and scrutinizes inside, was forbidden for many centuries and punishable by death. Leonardo stole the corpses of those hanged for crimes and kept them hidden to dissect in secret. Acting on the dead body, to do nothing much but to give it sepulture, has always been surrounded by legal, religious, and psychological conflicts, and molded by culture.
With the exception of the training of surgical specialists, I have doubts regarding when and how much cadaveric dissection should be used to train physicians and to what extents it can be substituted or complemented by other methods that simulate the corporeal body. Currently, cadaveric dissection is complemented by artificial anatomical models and by highly sophisticated electronically controlled systems that show images and volumes of the human body in all its aspects and from all angles: “Anatomage” [4]. However, some studies suggest that medical students prefer to learn anatomy by dissecting cadavers [5] and that anatomical dissection of cadavers continues to be a great tool for the training of students [6]. On the other hand, there are others that are beginning to propose its substitution by other methods, excluding the learning of surgical specialties [7].
Who are those that are or have been frequently in front of corpse and perform maneuvers or procedures on them? Of course, outside of natural disasters and wars, not all people see dead bodies, but only a very limited proportion of them. We are those who, because of our profession, trade, or study, fulfill a necessary function for society by handling the corpse. Since society considers these activities useful for the common good, it authorizes us and lifts the old punitive prohibition as long as the purpose is in accordance with the aforementioned. Among those who frequently contact, contemplate, and handle corpses are: medical students, forensic doctors, doctors who work in centers for the assistance of seriously ill patients, policemen, priests, gravediggers, and those who work in funeral services (including those who embalm corpses). Also anthropologists, and eventually archaeologists, but these generally work on very old skeletal or mummified remains. The example of artists of the Renaissance is already in the past, although occasionally emulators appear who surprise us.
All those whose work involves handling cadavers must necessarily undergo an adaptive psychoemotional process in order to fulfill their task without the impact of the dead body disturbing the achievement of their objective. I am very familiar with what happens to medical students studying anatomy and to physicians who have worked for many years in critical care areas. Although I am not a regular witness to other cases, I suppose that all people who handle cadavers undergo a similar adaptation.
Some publications report disparate figures regarding the frequency with which young students in their first confrontation with the cadaver suffer significant discomfort. They vary between 7.5% [8], 16% [9], and 61% [10]. Perhaps this difference is due to research design or the ease with which students from different cultural backgrounds communicate their feelings. The unpleasant effects, many of which are related to thoughts about death, are of varying type and intensity. They may be simply the irritation of mucous membranes caused by formaldehyde and its dominant odor in the room, or significant affective reactions such as fear, anxiety, anguish, or desire to flee the room, usually coinciding with the invasion of the mind by fantasies about the possible life of the person who left the corpse. These imaginary representations can be about hypothetical family relationships, affections, fears, sufferings, projects, and feelings of the unknown person who died. The part of the corpse that provokes these effects the most is the face. However, almost all students quickly adapt and neutralize these negative emotions. According to several authors, 90% of medical students prefer to learn anatomy by dissecting human cadavers, and many consider the cadaver as excellent learning material, a very interesting object, and nothing more.
Psychological adaptation is very useful for them to fulfill an adequate learning process. Among the means that the authors point out to achieve this neutralization of sensitivity are humor about death and the dead, and an increase in the gregarious tendency to stay closer to their classmates. But there is a fine line between “dark” humor that makes discomfort disappear, and cynical treatment of the corpse, including “ridicule”, “practical jokes”, and sometimes reprehensible transgressions -committed by students and well-known to all- on parts or whole bodies. The aforementioned adaptation reaches a large proportion of anatomy students, allowing them to enjoy learning. However, it can only be considered a healthy and formative process if it is accompanied by a feeling of respect -and possibly gratitude- for the memory of the person who died and whose dead body is now used for learning. This can be favored by a personal reflection or periodic reflective exchange, either among groups of fellow students or with the participation of anatomy teachers who have an integral human vision [10]. On the other hand, if this “emotional neutralization” is extreme, or is done without periodic reflection, it can turn into a cynical attitude towards their work and learning material. It has been pointed out in recent works that the exaggerated request for sensitivity towards the cadaver may lead students to treat their future patients in a dehumanized way and without any empathy for their patients, extending their cynicism towards them [11].
Since I have been a physician for almost 40 years in Intensive Care Medicine centers, the frequent presence of dead bodies has not been unknown to me, given that one out of four of our patients died. Our efforts were compensated by the fact that, fortunately, the remaining three patients returned cured or improved. This circumstance put me in front of cadavers that provoked in me different reactions than those used in anatomy. There was an ambiguity given that, on the one hand, we had known the deceased in life, and we had witnessed their death, which perhaps increased the negative effect that every corpse provokes. On the other hand, we had made many efforts so that this would not happen, that is, we had tried to fulfill our duty towards that human being, which probably attenuated the negative effect.
At the inauguration ceremony that motivates this essay, it was inevitable for me to think specifically about the group of corpses (that remained when unknown people died, of whom we know nothing) that are kept in special tanks with preservative liquid in the back of the clean and luminous new room.
Thinking about the Corpse
To think deeply about the meaning of the corpse, consequence of death, I must begin by reflecting what I am as a living being, because when I die, I will lose this quality and there will remain an inert organic thing in the process of disintegration that will not be me. I will have disappeared from existence when I die. It is very difficult to think about what I will lose and what will be left if I omit to think first about what I believe I am and what I have while I am alive.
I believe that as a human being, I am “me” from the skin inwards and this is my limit. My body is my limit, my being, my way of being and being recognized in the world, my place of pains and pleasures, affections, reflections and memories, fantasies and projects, in the widest expression. Everything I feel, think, and do originates within that envelope, so smooth at birth and so worn in old age. It is generated in there as a result of what I have inherited and perhaps to a greater extent as a result of what I have exchanged and continue to exchange with others -with each other and with the whole community, historical and present-, and with the spatial-temporal environment that surrounds me and in which I live.
A living being is a functioning body, and a human being is a functioning body, including the sufficient function of that organ so precious and mysterious, so rich and so complex that is the brain. When a human being loses all functions of the body completely, or when he loses totally and definitively all the functions of the brain, he is no more [12]. Then, there remains a corpse. Here I remind you of the definition given by the Royal Spanish Academy’s Dictionary (RAE), Cadaver: dead body [13]. I interpret it as a non-animate form of a human that was, that is to say, a “thing”. The RAE also clarifies, Thing: something that has entity; inanimate object as opposed to living being [13]. In other words, the corpse is an inanimate biological object in the process of inevitable disintegration until it becomes elementary substances. But it is a very particular “thing”, or as Professor Guido Berro says in his book, “it is a thing, but not just any thing” [14]. It is a special thing that always disturbs us, to a greater or lesser degree. And this “special thing” must be handled with dignity and respect for reasons that we know, and other hypothetical reasons that I will try to clarify as I write.
I deeply respect -as I want to respect all human beings- all those who think that when we die, not everything that we were disappears, but the soul remains in a latent state, so something remains alive. Perhaps for this group of fellow travelers in life, my previous reasoning does not apply in many of its assertions. In any case, I believe that the consideration towards the corpse, the dignity and respect with which we should handle it in the different uses and purposes it is given, applies with few differences in almost all beliefs for the majority of humanity.
Naming The Corpse
I think it is very interesting to dwell on the way we refer to the cadaver. Although in Anatomy it is called “body”, we usually hear before a corpse the following phrases or sentences: “this is the corpse of So-and-so”, or “this is dead So-and-so”, or “So-and-so is dead”. I believe none of these three ways of referring to the corpse -relating it to So-and-so- are correct, because So-and-so only existed until he died. So-and-so is no more and is no longer here (except in the minds of those who loved him). Since he is no longer here, he cannot have or own anything or be anything. He is simply nothing. Perhaps we should refer to it in another way if we want to relate the corpse to who So-and-so once was in a proper way, such as “this is the dead body that remained when So-and-so died”. This makes more sense.
However, force of habit and the discomfort of saying that phrase will probably make it impractical to use. In any case, this concept should always be kept in mind.
I believe there are two main factors that generate the three “corpse and So-and-so” phrases. 1) the need to relate the corpse to the person that was, which is explainable; 2) our attempt to prolong life, to ignore the limits of our existence, and to tell ourselves that death is not the end, and that even in death we can be or have.
A Troubling Question
If the corpse is a thing, why do we as living beings grant it dignity? Dignity means to show deep respect or to proclaim and feel that this should be the proper stance. Let us leave aside for this reflection the considerations about those who transgress it and degrade, despise, or vilify the corpses, which is well known. They are, possibly, people with serious mental alterations or driven by hatred. We may recall the ancients who nailed the head of their enemies to a pike.
Why are we overcome by silence, feel certain apprehension, sometimes fear, guilt, or even a certain reverence before the corpse? Why do we resist its proximity? Why must we overcome a consistent inner barrier -and process an adaptation- to use it for learning or other necessary purposes?
A corpse, although it lacks the movements, expressions, color, temperature, and that indefinable “living” appearance, is the natural form most similar externally to a living human being. It could be topped by wax figures or other materials in museums -made to great perfection- and perhaps in the future it will be surpassed by humanoid robots. But in these two situations, the living “know” that both lack something essential: they are not what is left of someone who was once born from a woman’s womb, who was alive, who loved, laughed, cried, gazed, who had a history, a job, a hand capable of caressing, and a fear -sometimes dread- of the possibility of one day disappearing and that only this form would remain of him.
Form at first identical to what he was, but without life. That form represents in a way the past of his present (since he had, but has no more, something very similar to what he, alive, has now to a certain extent), and also the future of his present (since the one who is alive will inevitably die one day and a similar dead body will remain, a dead body that at first will resemble what he is now). When we are in front of that thing, we cannot eliminate from our mind (consciously or not) that kind of metaphor of becoming when some die before others, as it always happens. And we cannot eliminate it because although the one who died and left that corpse became history, we too are ongoing history that will one day stop. Each one of us is history-memory, and this “pattern” is deeply imprinted in our Self. The past life of the one who died is very similar to my present life. At one time, we were the same (before). This is one of the causes of fraternity and fear.
Possibly here also lies a cause of guilt because there was one who lost everything, and yet I still possess everything. There is a disparity, an intrinsic imbalance that makes us guilty of our invaluable richness of living. I remained with the richness, and he lost it all. And the one who died and whose dead body I now look at, will he not come back to settle the account for this difference? This hypothesis may be one of the explanations of the fear-guilt.
By treating the corpse with dignity and respect, an attitude that we must always maintain, we are doing three things: 1) a kind of homage so that the one who died (but whom I revive in my imagination) does not get angry and punish me in an unknown way and therefore full of terror. See in this regard the chapter “The Double. Ghosts and Spirits” by Edgar Morin [15]; 2) to remind us all that among us, the living, -so similar to that form that in a way signifies us- we must treat each other with dignity and respect (“human dignity”) to be able to live together in harmony and make life more bearable and perhaps joyful; and 3) to thank the one who once was, the dead, all the teachings they have left us, and those that even the body they once were continues to provide when we dissect it.
We and our World Are Built by and on Those Who Have Died
As I write, other ideas start appearing -this time luminous-, brought one by the other, and lead me to end with something very gratifying related to all those who have died. Although in the present we build each other among the living, all the foundations of what we are, the vast majority of discoveries and proto-knowledge we make use of, almost all of what we find in the world when we are born, in science, art and all philosophical reflections of the past that sustain us, were generated by humans who lived before and who one day, in the long existence of the world, died. Of them, physically, remained only a corpse, which then turned to dust. But it does not really matter that at the end it was dust, because what they built remains. Each new generation is founded, grows, and builds on the basis created by those who died before. The corpses that remained when they ceased to live were just like those we dissected in the anatomy room. I thank from the bottom of my heart this immense memory of the dead, the history, art, culture, knowledge, and technique they left us. I believe this may be a reason to treat the corpse with dignity and respect. In doing so, we are paying homage to the immeasurable humanity of the past.
The Beloved Corpses
I have specifically left aside the corpses that remain when very dear people die, because the inner response of those who remain alive, and who they loved, contains other components. Among these components, pain for the loss -sometimes unfathomable- stands out. Loss that is absent when we dissect cadavers in anatomy. However, when love has really existed between the one who died and the one who is still alive, the brain of the latter has copied neurobiological elements of the other when they lived and shared and has some neuroaxonal networks that are equal or very similar that will persist definitively. In our mind, thanks to the “Mirror Neurons” and other mechanisms, the remaining memory of the beloved dead is not immaterial, but a copy of some of their neurobiological structures they enjoyed [16].