Funeral Directors

They do their best to comfort families, but they feel like pariahs. Next time you meet one at a cocktail party, give him a break.

William Counce loves football. He also loves parties. He particularly loves chatting about football at parties. That's why he was so upset at one social gathering when the woman with whom he was having a lively discussion about the University of Tennessee football team asked him what he did for a living.

He told her he was a funeral director.

"There was dead silence," recalls Counce, who is also the director of the funeral-service program at Jefferson State Community College in Birmingham, Alabama. "Then the lady said, 'Oh, my mother died six months ago. How did they get that smile on her face?' Now that's the last thing I want to talk about when we're connecting about football. It was unpleasant. It made me have to assume a posture with her to reassure her that I wasn't what she thought -- some sort of ghoul. If you let the stigma bother you, it's stressful."

Few people would be surprised to learn that those working in funeral services may be at risk for exposure to infectious diseases and to toxic embalming substances, but they probably don't realize that, for many funeral directors, stress may poses a greater danger to their health and well-being.

Licensed funeral directors -- a great many of whom are also licensed as embalmers -- are acutely aware of the public's negative image of them. They know that people assume they have an unnatural interest in corpses or are out to rip off the customer at a time of emotional vulnerability. And that awareness takes an enormous psychological and emotional toll, which -- if not addressed -- can easily result in burnout.

"They feel like pariahs sometimes, and it really bothers them," says Sherry Williams, president of Accord Grief Management Services, a consulting firm in Louisville, Kentucky, that works extensively with funeral service professionals. "They all talk about that, about the remarks people make. Some tell me they can't even go to the hospital to visit friends because they'll get comments like, 'I'm not dying yet, don't come and measure me.'"

Funeral directors -- the term is preferred to the more archaic 'mortician' and 'undertaker' -- say the notion that they are obsessed with death and corpses represents a deep misunderstanding of the nature of their work. They note that they spend only about 15 percent of their time with the bodies; the rest is spent with the living, either counseling the bereaved, organizing the funeral, or performing administrative duties.

And this work, too, is highly stressful; like doctors, funeral directors are on call 24 hours a day. "You get calls in the middle of the night, then you have to meet with the families first thing in the morning," says Jacquie Taylor, president of the San Francisco College of Mortuary Science and funeral director at the affiliated College Chapel Mortuary. "We always say this would be a great job if we could get people to die Monday through Friday from 9 to 5, but we can't seem to get them to do that."

While some people take a year or more to plan weddings, funeral directors usually have just a couple of days to pull off one of the biggest and most important rituals in people's lives. And they often do it 100 or 200 times a year while having to be sensitive to the needs of people in the throes of intense emotional distress. "In an attempt to gain control, grieving people will often lash out at the professionals who are working with them," says Williams. "We tell funeral directors that the anger is not directed at them, but at the situation."

Despite the stress levels, funeral directors generally echo Jacquie Taylor's sentiment that helping families cope with their grief is where they find their greatest sense of accomplishment. "Even though you're dealing with a lot of sorrow, it's a very rewarding industry and profession," says Mark Kuhn, funeral director of three small mortuaries in California's Central Valley. "You help them through the process, and a few weeks later you get a letter or see them on the street, and they are really grateful for how we've helped them. It's very gratifying."

But even those who find fulfillment in the business say the stress can overwhelm them at times. Many professional conferences now include sessions on relaxation techniques and coping with what Sherry Williams calls "compassion fatigue." In her seminars with funeral directors, Williams suggests various approaches to deal with the problem, including physical activity, such as running, playing tennis, or working in the garden; breathing exercises to calm the body; making sure to schedule time for recreation and hobbies as well as work; creating an "applause box" full of thank-you cards and notes to review on a bad day; and keeping a journal, or writing down feelings no matter how outlandish or unreasonable they may seem.

The seminars also include strategies for releasing excess anger or other bottled-up emotions. "We give them rubber bricks to throw," says Williams. "We do some drum-pounding and throwing pillows and marshmallows at 50 paces. We tell them, 'What you have to do is put some motion to the emotion.' "

In the area of physical health, regulations from the US Occupational Safety and Health Administration (OSHA) guide funeral homes in their practices; some states, like California, have promulgated standards stricter than the federal ones. In general, the laws to prevent transmission of blood-borne pathogens, such as HIV or the various hepatitis viruses, require anyone potentially exposed to blood or body fluids to follow what are called "universal precautions."

"The OSHA standards are not profession-specific," explains Baltimore attorney Ed Ranier, who represents the National Funeral Directors Association on OSHA-related issues. "Universal precautions means treating all blood and body fluids as if they contain a blood-borne pathogen and acting accordingly."

When handling the body, embalmers and funeral directors must wear a head cover, a shield to protect the eyes, a nose-and-mouth mask to screen out particles, a gown impervious to fluids, surgical gloves and shoe covers. Funeral service professionals say that cases of transmission of infectious diseases are extremely rare. They do happen occasionally, however, if someone jabs himself with a suturing needle, a scalpel, or the wires used to close the mouth.

William Counce says he recently spoke with an embalmer who stuck himself while working on the body of a man who died of Creutzfeldt-Jacob disease, a human cousin of mad cow disease. "It can have a 20-year incubation period, so he will worry," says Counce. "His state of mind is not good. He'll require some counseling for this."

OSHA also requires workplaces using formaldehyde to conduct air sampling and ensure that levels of the gas -- the key substance needed for the embalming process -- do not exceed legal limits. Formaldehyde is a carcinogen at high levels of exposure. It can exacerbate respiratory problems and chronic conditions like asthma and allergies; in liquid form, it can cause skin irritation.

Many funeral homes test the air every six months to make sure they have enough ventilation to meet federal and state standards for allowable concentrations of formaldehyde. "Most formaldehyde overexposure is in the plastics industry, not the funeral industry," says attorney Ranier.

A final problem -- and an often overlooked one -- is injury to muscles and joints. It is a problem, says Jacquie Taylor, executive director of the New England Institute of Funeral Service Education at Mount Ida College, one that stems from a macho ethos. "There are a lot of funeral directors and embalmers out there with bad backs and knees because they don't lift the bodies and the caskets right," she says. "I've seen that more among men. They try to lift more and they say, 'I can lift this, I don't need to wait for help.'"

Further resources

Occupational Safety and Health Administration. It provides information about workplace safety guidelines and regulations.

http://www.osha.gov

National Funeral Directors Association On-line. Dedicated to improving the funeral industry profession.

http://www.nfda.org

References

Thorson JA, Powell FC. Undertakers' death anxiety. Psychol Rep. (3 Pt 2):1228-30.

Start RD, Dube A, Cross SS, Underwood JC. Funeral directors, mortuaries and necropsies: implications for necropsy consent rates and the prevention of infection. J Clin Pathol; 49(3):217-22.

National Funeral Directors Association. Winners Accomplishments Inspire Todays Female Funeral Service Professionals.

Kusnetz, Sentinel staff writer, Funeral Director and HBO Find Some Common Ground (Six Feet Under), July 19. 2003

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