In the class I co-teach on death in Orthodox Tradition, last Thursday I lectured on the medicalization of death in the 20th century.

To give us all a kind of anchor in the many complexities that affect how people die in modernity and beyond, I selected one of my favorite works of art as a kind of symbol or icon of modern death. There were many I could have chosen from, but in the end I selected the German artist Paul Klee’s Tod und Feuer (Death and Fire), painted in Switzerland in 1940. To call this work simple is an understatement–as many art critics have pointed out, it looks like a 5-year-old could have drawn it.

Before we got into the lecture, I asked students to look at this image and explain to one another what they saw.

At first, I found some raised eyebrows staring back at me. I didn’t blame them; that’s how I felt the first time I looked at this painting.

I pointed out the basics–the ways the letters “T,” “o” and “d” (Tod is the German word for death) form the facial expression of the pale figure in the foreground (death personified). In the background, we see a stick figure person advancing towards death.

The students drew attention to other things they noticed or questioned about the painting–the three lines at the top (flames?), the golden orb death was holding up (lifeforce?). One of the students wondered aloud what the image had been painted on–it looks like burlap or materials that a grave shroud could be made of.

Still, they seemed a bit mystified by my choice.

“Why would you use this to symbolize death in the 20th century?” A student finally asked.

I told him we’d get there eventually–I’d share my interpretation at the end of class.

First, the lecture. We discussed how, after the 19th century, chronic and degenerative diseases (like heart disease and lung cancer) replaced infectious diseases (like tuberculosis or pneumonia) as the leading cause(s) of death. We talked about how that trend changed the whole end-of-life experience–chronic diseases are often incurable, they stretch on and on, they complicate and elongate not only what it means to die, but also what it means to care for the sick and the dying. We talked about how virtually every field of medicine witnessed rapid advancements in the 20th century, and how this progress often outpaced ethical innovation. By the 1970s, the boundary between life and death had become obscured by what was eventually termed Advance Life Support (ALS, or ALCS) protocols and technology. The ability to revive patients and keep them alive by artificial means quickly raised new questions about when to apply, forgo, or discontinue life-prolonging procedures. By the late 1960s and early 1970s, physicians and ethicists had begun to recognize that the goal of medicine could not just be about giving patients more time left on earth; quality–not just quantity–of life was gradually acknowledged as a therapeutic objective.

With these developments and many others in mind, however you look at it, death and dying became more complicated and fraught in the 20th century.

In preparation for class, students had spent time reading about Philippe Ariès’ concept of the “Forbidden Death,” the idea that death in modernity became a taboo subject. Like sex or pornography, death as Ariès saw it became a messy reality society shut up behind closed doors of institutions and hospitals. It’s a concept many have criticized, but nonetheless offers insight into one of the more troubling aspects of modern death.

Thankfully, in recent decades this aspect of death has begun to improve, particularly with the rise of palliative and hospice care paradigms.

Nonetheless, as a society we continue to be haunted by the aftermath of the so-called forbidden death. We find ourselves longing to re-humanize, re-dignify the end-of-life experience–to bring it back into our homes, to learn to care for our loved ones on the brink of death, to be more vigilant about quality of life. These are difficult things to talk about in a classroom setting.

We were nearly out of time when we finally made our way back to Klee’s Death and Fire.

“So why did you choose this image to represent modern death?” One of the students asked again.

I explained I had chosen the painting not desptie its simplicity but because of it.

Klee painted Death and Fire in the final months of his own life, after suffering from a chronic condition the previous five to seven years of his life. Although doctors at the time did not know what his condition was (it was likely scleroderma, a chronic autoimmune disease that affects skin, circulation, and organ function that even today can prove fatal) they had hopes he would recover. Yet despite their optimism, by 1940 Klee seems to have realized he was truly dying.

In Death and Fire, one of the last pieces he was known to have completed, he returned to an almost childlike simplicity. It’s an image a young child or caveman could have composed, and is reminiscent of ancient hieroglyphs. I find it oddly heartbreaking and heartwarming that Klee’s style became almost primordial in the midst of all the uncertainty of a 20th-century death—the unknown nature of his disease and its prognosis, the ongoing onslaught of World War II and the Holocaust (Klee was a Jew and had been exiled to Switzerland after the Nazis stifled his career in Germany). In the face of death, regardless of our technological capacity, we all in some ways become like cavemen or children—shorn of our self-reliance and sophistication. We see this even today, in 2018: after nearly a century of the complicated, forbidden, medicalized and institutional death, more people than ever long to return to simpler, more relational and involved ways of dying and caring for the dead.

However, the simplicity of Klee’s painting also risks obscuring a rather profound, heartbreaking scene. In the painting, death is in the foreground with man at a distance in the background, hesitantly and sadly moving towards death. (Some see the man holding a spear; either way, I see in this figure’s hunched posture a dejected stance.)

This reverses the optical relationship between life and death that one is used to seeing in paintings (think of the dans macabre, with death trailing after man, playing a fiddle in the background or calling after him from a distance). Here, man—not death—is at a distance. In addition, the figure of death has more substance, is almost more real than man himself—it is not just a stick figure. It has color, a facial expression, it is not transparent like the human figure is.

One almost senses that in this painting, man is alienated—certainly from life, from beauty, from sophistication, but also from death.

In thinking about the idea of the forbidden death, and the increasing complexities and fragmentation that affected attitudes towards death in the 20th century, you have to wonder who or what was being forbidden? Was it that death was being forbidden, shut up behind hospital or nursing home doors, excised from the land of the living? Or was it that man was being separated or forbidden from death? From everything death has to teach us about our condition?

Was death the alienated and exiled one, or are we?