Moving from the Environment of Death to the Environment of the Living

Abstract

The daily reminders of life’s fragility can lead to moral, emotional, and psychological distress. Establishing clear boundaries between work and non-work environments is a suggested approach to mitigate these adverse effects. Drawing on van Gennep’s work on rites of passage, this paper explores the rituals and strategies employed by professionals dedicated to the dying/deceased to transition between their work and home environments. Through a qualitative interpretive phenomenological analysis of 23 in-depth semi-structured interviews with Israeli hospice social workers and undertakers, two main strategies emerged as “rites of passage”: Physical Purification and Escapism. However, participants noted that these rituals were not always foolproof, with instances of “leakage” where elements from the realm of death and dying carried over into their personal lives. The study suggests that engaging in idiosyncratic rituals plays a crucial role in facilitating the reintegration of professionals involved in the care of the dead and dying, offering a means of expressing and containing challenging emotions and providing structure during the transitional phase.

Keywords:

• Experienced-space
• hospice
• palliative care
• social workers
• undertakers

While caring for the dead and dying can be professionally and personally rewarding (Funk et al., 2017), repetitive contact with death can affect such industry professionals’ psychosocial well-being and cause moral, emotional, and psychological distress (Brooks et al., 2017a, 2017b, Çobanoğlu & Algıer, 2004, Hamric & Blackhall, 2007, Henrich et al., 2016, Mahat-Shamir, 2022; Trankle, 2014) in part due to daily reminders of the fragility of life (Slocum-Gori et al., 2013). Exploring the challenges faced by professionals devoted to the dying and deceased, this study integrates insights from both undertakers and hospice social workers, recognizing the psychological hazards inherent in their respective roles. Undertakers contend with stressors such as the weight of grief, occupational hazards, and potential shortages of essential resources (Solomons, 2014). The constant exposure to death has been linked to a mortality salience effect, leading to high levels of death anxiety among undertakers (Mahat-Shamir, 2022; Thorson & Powell, 1996). Wegge et al. (2022) further delve into the emotional experiences of undertakers, emphasizing the intricate interplay of positive emotions, autonomy, and time pressure at work, with significant implications for their well-being. Similarly, hospice social workers navigate emotionally charged situations, including patients’ deaths, grieving families, and intense emotional states (Alkema et al., 2008). The long-term management of these stressors often leads to burnout or compassion fatigue, affecting individuals, work teams, and patient care (Kearney et al., 2009). Moreover, hospice social workers experiencing vicarious trauma face mental and physical health symptoms, stress, and feelings of inadequacy (Pross, 2006, 2014). Symptoms escalate into burnout, hindering clinicians’ ability to provide appropriate care for clients (Lizano, 2015; Newell & MacNeil, 2010). This underscores the need for distinct protective measures, such as self-care methods, to address the adverse effects on the hospice care system.

The integration of resource management issues and the psychosocial needs of clients poses a constant dilemma for both undertakers and hospice social workers (Quinn-Lee et al., 2014; Silverman, 2015). One way of reducing the above-mentioned undesired sequelae is to create and maintain clear boundaries between one’s work and non-work (home) environments. Thus, adding to the knowledge of the challenge faced by professionals caring for the dead and dying in managing the delicate balance between personal and professional lives (Berzoff, 2008; Sansó et al., 2015), the current study explored the rituals and strategies employed by these professionals to transition between their work and home environments.

The contexts of work (death) and home (life) are two contradictory “experienced spaces” (Clarke, 2000), defined as the relations between the individual as the body-subject and the things that the body-subject runs into. This concept implies that space is known through experience and that an individual’s perception of that space is very different from the accurate geometric depiction of the world surrounding them (Clarke, 2000). Individuals who work daily with the dead or dying frequently oscillate between contradictory experienced spaces (life and death).

One theoretical framework for the experience of transitioning between experienced spaces is the classic work “The Rite of Passage” (1909/1960) by Belgian folklorist Arnold van Gennep, who describes the three-phase process that accompanies every change of place, state, social position, and age: separation, liminality, and incorporation. Namely, these phases describe a process that begins with separating from what came before, existing in an “in-between” stage, and then integrating what one has experienced and moving forward. Victor Turner (1967) asserts that such “rites of passage” are not confined to culturally defined life crises or cycles but rather can include any change or transition from one state to another. Unlike tribal cultures in which an individual was escorted through transitions with express communal recognition and support, in the context of more modern societies, when people are left to their own devices to cope with transitions, personal rites of passage are often created through symbolic acts or rituals (Schouten, 1991). A ritual is “a specific behavior or activity which gives symbolic expression to certain feelings and thoughts of the actor(s) individually or as a group. It may be a habitually repetitive behavior or a one-time occurrence” (Rando, 1985, p. 236). Rituals appear to perform a critical cathartic function when one is faced with epistemically threatening transitions and turning points (Durkheim, 1912/1995), enabling individuals to “spontaneously engage in rituals in the face of uncertainty as a means of reducing anxiety” (Marshall, 2002).

In the current study, we explored rites of passage and rituals that professionals dedicated to the dying/deceased use in order to transition between their work environment (associated with death) and home environments (associated with life). To accomplish this, secondary data analysis was carried out on two data sets previously collected from Israeli hospice social workers and Israeli Jewish undertakers. It is worth mentioning that in Israel, diverse views on end-of-life care emerge from the intersection of Jewish traditions and patients’ rights laws, influencing the entire Jewish population, regardless of religiosity (Leichtentritt, 2011). Despite this, hospice social work in Israel draws significantly from Western practices, encompassing informed decision-making, exploring alternatives, and aiding in emotional expression and grief coping (Leichtentritt, 2011). Conversely, Jewish undertakers engaged in various highly religious rituals such as digging the grave, conducting the purification ceremony, dressing the body, accompanying it until burial, offering prayers for the deceased, participating in the burial process, and filling the grave (Mahat-Shamir, 2022).

Method

To achieve a description and interpretation of the participants’ experiences, the study methodology was closely aligned with an interpretive phenomenological qualitative approach (Finlay, 2009; Langdridge, 2007; Smith et al., 2013; Van Manen, 2016).

Participants

Two data sets of participants were used for this study, which was originally approved by the first author’s university Institutional Review Board (nr. 904SOCMMS1): twelve Israeli hospice social workers (ten women and two men) and eleven Israeli Jewish Orthodox and Ultra-Orthodox undertakers (only men). Participants’ ages ranged from 25–72 years (M = 49.17). Work experience with the dead and dying ranged from 3 months to 40 years (M = 11.27), with most having worked with this population for over three years. This broad range of related work experience allowed exploration of change over time in the professionals’ rituals for transitioning between life and death contexts. A summary of participants’ demographic information appears in Table 1; all names are pseudonyms.

Table 1. Participants’ characteristics.

Name^1	Age	Profession	Family status	Years working in profession	Physical purification	Escapism
Abraham	25	Undertaker	Married +3	1.5	V	V
Benjamin	58	Undertaker	Married + 6	6	V
David	63	Undertaker	Married + 8	19	V
Haim	27	Undertaker	Married +4	.25	V	V
Jakob	26	Undertaker	Married + 4	1		V
Michael	51	Undertaker	Married + 8	27	V	V
Adam	53	Undertaker	Married +5	13		V
Levi	65	Undertaker	Married +7	20	V	V
Noah	34	Undertaker	Married + 4	4		V
Isaac	72	Undertaker	Married +7	40	V	V
Daniel	27	Undertaker	Married	5		V
Tal	55	Social Worker	Married +4	2	V	V
Gal	49	Social Worker	Single +2	13	V
Miriam	40	Social Worker	Married +4	7	V	V
Danny	58	Social Worker	Married +3	15	V	V
Dalia	63	Social Worker	Divorsed + 3	7		V
Anna	66	Social Worker	Married +4	10	V	V
Neomi	43	Social Worker	Married +3	6		V
Dror	46	Social Worker	Married +2	4	V	V
Anat	63	Social Worker	Married +1	2
Or	48	Social Worker	Married +3	7
Lee	35	Social Worker	Married	1
Talia	64	Social Worker	Married +3	10

¹All names are pseudonyms.

Interviews

Individual in-depth semi-structured interviews had been previously carried out in Hebrew by two social work graduate students (one male, one female) trained by the authors in data gathering. The original purpose of interviewing hospice social workers and undertakers was to gain an understanding of the experience of encountering death and dying on a daily basis. Prior to participation, participants signed informed consent. An interview guideline included questions soliciting, for example, the means participants employed in order to protect themselves from the hardships involved at work or the strategies they used to rejuvenate themselves after a day at work. Although responding to the question prompts, since the aim of interviews in IP research is to facilitate participant sharing of aspects of their experience that are important to them, they were encouraged to lead the direction of the interview by discussing what they most wished to. Interestingly, informants in all interviews discussed their need to distinguish between their work and home environments and focused on strategies they had “developed” in achieving this goal. Active listening, characterized by the researcher’s focused attention, empathetic responses, and probing questions, was employed. Additionally, nonverbal prompts, including gestures, facial expressions, and open body language, were utilized to create a conducive environment, fostering participants’ willingness to offer comprehensive and detailed illustrations of their strategies. These procedures resulted in an extensive degree of sharing by the informants, with minimal redirection from the interviewers.

Interviews ranged from 1.5 to 3 hours, with the average interview lasting about two hours. They took place in the location most convenient for participants: six were conducted at the participants’ homes and 17 at the participants’ workplaces. Interviews were audiotaped, and notes were completed immediately.

Data analysis

In interpretive phenomenological (IP) research, the goal is to examine how individuals make sense of their life experiences. Epistemologically, it posits that subjective data provides valuable information regarding participants’ understandings of their experiences (Snelgrove, 2014) through phenomenology, hermeneutics, and idiography.

Following the interpretive phenomenological approach, the procedure followed in the current study was a step-by-step process: (1) Reading and re-reading a single narrative to immerse in the data/transcript of a single case (Eatough & Smith, 2017); as this research was based on two data sets, a rich and informative transcript was chosen from each set as a starting point for the analysis. (2) Initial coding and development of emerging themes: as the two cases were read, observations were recorded, and those observations addressing the same aspects of the experience were clustered and labeled as a “theme.” (3) Recognizing connections across emergent themes: various ways in which the themes could relate to each other were considered and finalized based on the agreement of the researchers. (4) Moving to another case: The themes derived from the previous case were “bracketed” as a new case was approached with “fresh eyes.” Steps 1–4 were undertaken for each case before progressing to the next stages of the analysis. (5) Seeking patterns across cases: in this phase, themes or qualities evident across cases were identified, although idiosyncratic differences were also noted. During this stage, intertextuality was further performed to ensure that analyzing the two data sets together was accurate and informative (Barthes & Duisit, 1975); subsequently, the analysis continued without distinguishing between the social worker and undertaker data sets. (6) Interpretation: the last phase of the analysis required an examination of the results while drawing on relevant theoretical views and related concepts. Our findings are presented as a coherent analytic account, including pertinent participant quotes and interpretative commentary.

Rigor

Four broad principles were used to assure the credibility of this research methodology: sensitivity to context; commitment and rigor in undertaking the analysis; transparency and coherence of the narrative produced; and identification of impact and importance. Several strategies were employed to enhance these principles: (1) Epoché (“bracketing”): assumptions were made explicit through joint meetings and individual field notes in an attempt to reduce biases that could influence the analytic processes. (2) Peer critique: the plausibility and acceptability of findings was enhanced by working as a peer group to critique each stage of the research process and comment on the descriptive validity and transparency of the interpretation of the data and findings. (3) Triangulation: throughout the interpretation process, different conceptual frameworks were used to increase the validity of the study by approaching the study phenomena from a range of perspectives, such as Bromberg’s (1996) concept of dissociation and Hegel’s triad of thesis, antithesis, and synthesis. (4) Structure resonance: other researchers were invited to comment on whether the findings resonated with them, enabling receipt of constructive criticism as well as encouragement and support. (5) Participant verification: participants were invited to comment on the researcher’s interpretation of the data; the informants who participated in this process provided positive feedback and acknowledged the relevance of the interpretation to their experience.

Results and interpretations

The two cohorts, the Israeli hospice social workers and the Israeli undertakers discussed their need to move between what they felt were two very different experienced spaces: the space of the dead and dying and the space of the living.

You cannot come straight home… This [work as an undertaker] is something that is completely different. You need… you need to do or not to do something in order to come home…. [Abraham—Undertaker]

Participants also claimed that maintaining a clear separation between the two environments was essential for their and their family’s well-being. To create clear and strict boundaries, as well as move between these two contradicting spaces, they developed idiosyncratic rituals…

There are those small things that I do to take work “off” me… I do the same things every day for years now. Those rituals help me “clean my soul” from all the sorrow that I encounter throughout the day at work. They help me to transition from work to home… These are my own stupid repetitive behaviors, but they help! (Tal—Social Worker)

Hospice social workers and undertakers narrated two main strategies they applied as “rites of passage” between their work and home, which were named Physical Purification and Escapism. Notwithstanding, participants reported that the rituals were not always foolproof, and sometimes there was “leakage” such that elements from the experienced space of the dead and dying carried over into the experienced space of the living.

Physical purification

In agreement with van Geannep’s (1909/1960) conceptualization of rites of passage, the initial stage of the rites of passage described by the cohorts consisted of separation rituals that served to detach from one’s work- as a hospice social worker or undertaker. “The first stage, separation, is often marked by rites of purification and symbolic allusions to the loss of the old identity… the person is bathed, hair is shaved, clothes are switched, marks are made on the body, and so on” (Bell, 1997, p. 36). Indeed, participants discussed their own physical rituals aimed at disconnecting and “removing” the environment of the death from themselves before entering the home environment of the living.

It sticks to you… the smell… well, not really the smell but… it sticks to you. It is not something that I want to bring home to my wife and kids, that smell… so as soon as I come home, I take a shower. The first thing that I do is take a shower. (Benjamin—Undertaker)

This notion of separating or removing death from oneself is well-known in Judaism. The origins of ritual washing, which is intended to restore or maintain a state of ritual purity, are sourced in the Torah. These ablutions can be the washing of the hands, and the feet, or total immersion of the body, which must be done in “living water,” i.e. the sea, a river, a spring, or a ritual bath called a mikveh (WaZza et al., 2018).

I go to the mikveh every day. I’m not obliged by religion to do so, but I do. I go every day after work and before I go home. I purify my body, thus purify my soul, from that which I see, hear, and face at work before coming home. (Haim—Undertaker)

The undertakers’ use of physical purification as a ritual may be connected to their religious beliefs regarding their work. When a Jewish person dies, members of the sacred undertaker’s society attend to the care of the dead and perform a washing purification ritual on the body of the deceased. This activity, and all of the work related to caring for the deceased, is governed by the principle of respect for the Divine image that resided in the body of the deceased (Mahat-Shamir, 2022). Notwithstanding, the voluntary physical self-purification mentioned as a separation strategy among the undertakers may be connected to a primal instinct, as it was also cited by the hospice social workers as a rite of passage.

… [laughing] It may sound crazy, but I take off my clothes, well not all of them obviously, but what I can, at the door before I even enter the house. Then I go straight to the shower. Everybody at home knows that as soon as I come home, even before I say hi or anything, I take a shower. After I wash, they can talk to me. (Gal—Social Worker)

Rituals that involve physical components were described as the first to be used by the participants as a means of distinguishing between their work and home environments. The removal of clothing and washing of the body allowed the professionals to enter the context of the living by leaving the “contamination” of death behind.

Another physical purification strategy applied by participants to transition between work and home was physical activity. Physical activity is known as a tool to reduce psychological distress (Hamer et al., 2009), a distinct occupational hazard for those dealing with death and dying, and was described by participants as a ritual they used to disconnect, separate and purify themselves from death and dying before reengaging with the living.

I practice “chi gong.” Although it’s a form of meditation, it’s actually meditation by moving. I do that after work and feel new, purified. I forget about all that had happened at work, and I can go home to my family, to see my friends, whatever… (Miriam—Social Worker)

I come home without it [undertaker work]. I don’t want it to come home with me. I walk home by foot every day. I walk it off as a way to purify my body and soul… (David—Undertaker)

Indeed, physical activity in any form has been shown to decrease stress and benefit the treatment of anxiety and mood disorders (Aziz, 2020). Thus, participants in the current study intuitively used physical activity to disconnect from the environment of death, and it likely offered a protective effect against the emergence of anxiety from their work in addition to being a rite of passage toward their home lives.

Escapism

According to Baumeister’s “escaping the self” theory (1991), escapism is a need to experience relief from selfhood, meaning the constant monitoring of one’s own actions, emotions, and thoughts. Escapism is accomplished through actions that draw one’s attention away from oneself and toward more particular aspects of a situation. Baumeister refers to several potentially self-destructive engagements in which individuals may experience relief from selfhood as well as benefit from self-nourishing activities. While examining the strategies participants reported using, it became clear that an escapist activity that may be beneficial for the informant might also be destructive to their family members. Three specific activities were reported by the cohort as forms of escapism: listening to music, watching TV and video games, and sleeping. It is noteworthy that none of these activities required the informants’ attention or concentration. These personal rituals, which may produce or intensify a sense of “being and not being” and do not require the person’s full “presence,” may create a liminal space necessary before joining (incorporating) the environment of the living after being immersed in the environment of the dead. Liminality is defined as a state of being “neither one thing nor another; or maybe both; or neither here nor there; or maybe nowhere…‘betwixt and between’” (Turner, 1967, p. 96).

Music. One specific activity participants mentioned as a rite of passage was the use of music: “I hum to myself on the way home. I don’t really sing. I hum, but it helps” (Jakob—Undertaker). Informants used music both as passive listeners as well as active singers. Some also noted that the volume of the music mattered, as loud music appeared to create a more effective barrier between their work and home lives.

Maybe it sounds bad, but when I leave [work], after all that dying and sad situations I'm in, in the car, I put on loud music, and that helps me. It’s like a switch. Loud music, and I can go home. (Dalia—Social Worker)

Music helps a lot. It helps me to not think about work. I play music on the way home and sing along [laughing]. That way, I think about the lyrics and not about what I went through at work seeing all these dying people. (Anna—Social Worker).

TV and video games. Another common escapist activity the participants described was watching TV and playing video games. Indeed, TV watching (Henning & Vorderer, 2001), online streaming (Flayelle et al., 2019), smartphone use (Wang et al., 2015), and digital gaming (Demetrovics et al., 2011; Yee, 2006) have all previously been recognized as motivated by escapism.

When I come home I just need to stare at the TV, not to talk, just stare… or go to a movie … these kinds of activities where I just stare, I don’t think, I don’t speak, I just stare at something played to me. After that, I can really be at home. (Neomi—Social Worker)

The way participants used TV appeared similar to the use of music as a buffer between work and home. Moreover, music, TV, and video games seemed to offer an alternative reality in which informants can immerse in order to enable moving from one extreme experienced space to the other.

Sometimes it’s too much. All that dying around me is too much, and I can’t come straight home and act as if it’s nothing. It’s hard to move between work and home as if it’s nothing. So sometimes, when I'm overloaded, I come home and say to my family members that I'm now going to watch “Friends,” and they can only talk to me in three hours…at other times, easier times [laughing], I just take like a half an hour to myself and play “Candy Crush.” (Talia—Social Worker)

The time needed to transition between contexts is also worth noting. The informants described transition processes that could take from several minutes to several hours (“on difficult days”). In fact, some participants reported they “just sleep or watch TV until morning,” thus not immediately re-connecting with the living but rather remaining in an extended liminal phase. When doing so, these so-called “liminal personae” or “threshold people” shed their former identities (in this case, their professional identity as hospice social workers and undertakers) but do not yet adopt their family member identity or hold both identities at the same time.

Interestingly, even Orthodox and Ultra-Orthodox men who participated in this study and are forbidden according to their tradition to use smartphones or watch TV mentioned these escapist activities as something they would probably use if they were allowed.

As a religious person I don’t watch TV. It is a pure waste of time, and there is, as I hear, some corrupt content in it. But if it wasn’t like that, I guess it is something one can do to take his mind off all the death around because you can stare and not think. (Michael—Undertaker)

Sleep. Another form of escapism the social workers and undertaker cohorts described using was sleep, which is often used as an escape from emotional distress or physical pain (Ahmad & Talaei, 2012).

I go home mentally exhausted. It’s hard, all that death around you… so I usually come home, take a shower, and go to sleep. It’s just too much of an emotional burden that I just need to sleep it off. (Adam—Undertaker)

Sometimes when I leave work, I just need to sleep. It’s like I can’t do anything else. The tiredness is like…I try to be at my best, but I just can’t move, and I just want to sleep. I feel it in my body, all the sadness and the death and… I just go to sleep, and then, after I wake up, I can go on with life, with my life. (Or—Social Worker).

At first, when I just started [undertaker work], I thought I was sick or something. I wanted to sleep all the time. Now I know it’s the way work affects me. I need to sleep and escape all that I've seen during work so I will be able to be at home with my family. After I sleep, I'm a new person. (Noah—Undertaker)

In sum, the cohorts’ most common transitional rituals or rites of passage consisted of physical purification for the first stage, allowing disconnection from the work environment. This was followed by a second strategy, escapism, that served as a means to be “in between” contexts and thus not fully present in either environment. This “limbo” stage (Turner, 1969) appeared to provide participants with the time needed to transition between environments. Despite the generally reported effectiveness of these strategies, they were also reported as not always being foolproof. Participants reported that sometimes “leakage” occurred, in which elements from the experienced space of the dead and dying carried over into the experienced space of the living.

Leakage

While participants described active attempts to help themselves transition between work and home environments by employing liminal phase rituals, such attempts are driven by mental activity that is enabled by ego defenses, which tend to be lower during sleep. As defenses lessen, traumatic content that was otherwise repressed during wakefulness can emerge during sleep, resulting in horrific nightmares (Taub et al., 1978).

Sometimes it is very hard. It comes up in dreams. I dream about work, about difficult situations that happened or will happen or… I don’t know, sometimes I dream about it. (Anat—Social Worker)

I won’t tell you that as we go to sleep, it doesn’t come up [content from undertaker work]. Sometimes there are all sorts of things like thoughts or rather dreams… sometimes one finds himself in a kind of movie which is very unpleasant. Not sure anyone in their normal lives can come up with such dreams. I can’t tell you about the dreams. I don’t remember them, but they happen. (Levi—Undertaker)

Perhaps to protect himself from leakage, it was noted that Levi spoke in plural (“we go to sleep”) and with third person pronouns (“one finds himself”) while talking about elements of the experienced space of the dead that leaked into his space of the living. Also noteworthy is that as he spoke of himself in the first person, he was not able to recall his dream content; this may be a result of the higher defense mechanisms activated during wakefulness.

Some participants however, do remember the content of the leakage, especially if it occurs during wakefulness or daydreaming states.

Yesterday, for example, I came home and just sat there in my underwear, and my wife came along and looked at me. And then I thought to myself that I wonder how I would look like to her if I was on the purification surface [where undertakers perform the purification ritual]. So, as she saw me like that, wondering to myself, my wife asked me what I was thinking about. So, I told her the truth. She was startled and told me I was insane. I agreed. What can I do? Sometimes this work makes one insane. (Daniel—Undertaker)

While describing a linkage between life and death, some participants reported perceiving themselves as existing outside the normal structures of society that distinguish clearly between life and death and instead residing in a liminal state characterized by the mixture of the environments of death and life.

Those are terrible, terrible thoughts, frightening ideas… I looked at my 8-year-old daughter and thought about her as a patient of mine in the hospice… I saw her in that image! Terrible idea! You make every effort to block out those ideas, but once in a while, your strategies fail, and they sneak in… Several of my co-workers decided to leave the hospice as these images…they could not handle them. It was too much for them, so they left. (Lee—Social Worker)

Participants reported that leakage is undesirable and uncontrolled (“It bursts into your thoughts” [Anat—Social Worker]); and they make strong efforts to block it (“I try hard not to think about work while at home, to take the occupational hat off and put the family hat on” [Danny—Social Worker]). However, although leakage may be unavoidable, we can hypothesize that those who actively engage rites of passage on a daily basis, primarily through personal rituals that assist in disconnecting from work and create a liminal space not fully in either work or home environments in order to recuperate, may experience greater well-being. Indeed, the informants’ descriptions of how such rites of passage are often followed by their willingness to re-connect to the environment of life and the living may be supporting evidence that such strategies assist in extending the professional longevity of those who work in the challenging experienced space of the dead and dying.

Discussion

The influential British anthropologist Mary Douglas (2002) argues that “There are some things we cannot experience without ritual” (p. 80). This research appears to demonstrate that reintegration into the environment of living among professionals involved in the care of the dead and dying may be one of them. All participants discussed their own idiosyncratic rituals that assisted with reentry into their home environments. These rituals appeared critical to the informants, providing a vehicle for expression and containment of strong and often difficult emotions resulting from working around death. These repetitive rituals appeared to ease anxiety and provide structure and order during the transition period that informants perceived as having the potential for causing personal chaos.

This study’s findings correspond with van Gennep’s (1909/1960) rites of passage sequence consisting of three sub-categories, namely rites of separation, a liminal period, and incorporation. Van Gennep (1909/1960) explains that even though the tripartite structure is always recognizable and to some extent present, the rites of separation, transition, and incorporation are not always equally important or equally elaborated in specific rituals (Thomassen, 2016). The rituals our cohorts discussed were mainly associated with the first and the second phases: separating from the environment of the death and dying and a liminal phase. Specifically, separation from the context of death was carried out through physical activities and was closely associated with the body. Disengaging from their work environment necessitated purification rituals. In other words, the work with death and dying was perceived as “dirty work” and required sanitization rituals in order to detach from it. Hughes (1951) first invoked the phrase “dirty work” to refer to occupations and their related responsibilities that are perceived to be repulsive or demeaning by other members of society. He argued that in order to sustain the effective functioning of society, “dirty workers” must manage the unpleasant aspects of their role in order for others to subsequently consider them “clean” (Hughes, 1962, p. 9). Hospice social workers and undertakers are deemed as “dirty workers” as they deal with individuals from whom wider society disassociates, is afraid, and makes an effort to distance. Purification rituals therefore appear needed in the process of separating from the context of death and dying to avoid “contamination” of family members and society at large.

It has been suggested that the use of uniforms, like those used by Israeli undertakers, can be both physically and symbolically protective, offering a shield-like separation between the employee and the unpleasant aspects of the work environment (Crawley, 2004; De Camargo, 2019). Twigg (2000, p. 403) argued that social workers, who do not tend to wear uniforms, have “little or no symbolic protection against the polluting nature of their work.” However, this distinction between professions was not evident in the current study narratives, as all of the informants discussed the need to go through purification rituals in their rites of passage. Moreover, uniforms were not a professional panacea; like the nursing aides in Jervis’ study (2001, p. 89), the uniform-wearing undertakers in the current study still referred to themselves as “deeply affected by their intensive contacts with clientele and their bodily substances.” Thus, it seems that while the uniform may offer some physical protection (Crawley, 2004; De Camargo, 2019) and perhaps some emotional distance as well, it does not totally protect the wearer from feeling contaminated by the difficult nature of the work. Hence, there remained a need when exiting the environment of the dead and dying to undertake various personal purification rituals to avoid symbolic pollution of the context of living.

A liminal period was perceived by the participants as both a necessary stage in their rites of passage and as a backdrop for disturbing experiences resulting from work content “leakage.” Liminality was experienced as being in both and neither context, since the context of death intertwines with the context of life “betwixt and between” (Turner, 1967, p. 96). This essential stage produced a sense of “limbo” or of standing at the threshold between the two contexts. “Lacking a firm identity, [liminars] have shed their old identities and have not been given new ones, so they are neither one thing nor another” (Turner, 1967, p. 96). In this regard, liminality was utilized as a phase of “construction and deconstruction…during which the normal limits to thought, self-understanding, and behavior are relaxed” (Thomassen, 2016, p. 2), this was creatively expressed by one informant:

I feel as if I peel off parts of myself, parts that are associated with my work, while allowing other parts that are associated with my home, with my family, to come up front…. It is like you build a new puzzle out of the various pieces of yourself. Take some parts out and put other parts in… Driving… music assists in this puzzling process (Dror—Social Worker).

Professionals who work with death and dying and go through a liminal phase are in a unique position as Turner (1967) recognized them as “temporarily undefined… This weakens them, since they have no rights over others. But it also liberates them from structural obligations” (p. 27). Liminality, thus, is characterized by the blurring and merging of contradictions. It is further recognized as a temporary state with limited duration. One should notice that occasionally for this research participant there was no hurry to be reintegrated into the world of living.

Moreover, during the liminal stage, the distinct boundary between the two environments was sometimes not maintained (“leakage” in the words of the participants) and the experiences of leakage were described as “difficult,” “frightening,” and “intimidating.” Understandably, lack of a clear, defined boundary between life and death may threaten one’s sense of security and well-being. Moreover, given the notion in the literature that “the possibility that people undergoing any form of liminality might be better off defining themselves as ‘both’ rather than ‘neither’ is inaccurate” (Ibarra & Obodaru, 2016, p. 58) when the environments referred to are life and death, the option of being in “both” simultaneously is challenging and frightening.

Implications, limitations and future research

In our societal construct, we have crafted notable rituals for engaging with death and dying, as exemplified by O'Gorman (1998). However, the process of reintegration—transitioning back to the realm of the living—is often devoid of such prescribed rituals, opting instead for a discreet and private approach. Individuals are left to formulate their own rituals and idiosyncratic rites of passage as they navigate the intricate journey from death to life. While the participants in the present study adeptly managed this transition, they also recounted instances when reconnecting with the context of living proved challenging, prompting an extension of the liminal stage. The prevalence of burnout among hospice workers and undertakers is well-documented, attributed in part to the permeation of the death and dying context into their personal lives, a phenomenon corroborated by our study participants and supported by prior empirical research (Kavalieratos et al., 2017; Quinn-Lee et al., 2014). Consequently, there appears to be a pressing need for comprehensive support mechanisms to aid professionals immersed in death and dying as an integral facet of their daily work in reintegrating into life.

The current study finding suggests that people working in industries related to death and dying should recognize that, contrary to the common coping behaviors, a more effective strategy to maintain wellness should be to integrate death and dying in the context of life and living. We should aim toward perceiving death as part of life, creating a less strict boundary between “life” and “death,” and integrating dying people into the context of living. Doing so would likely reduce the professional and societal perception of such workers as engaging in “dirty work,” lessen anxiety, and obviate some of the difficulties associated with leakage between these two environments. By viewing one context as the natural continuation of the other, and acknowledging that both contexts are seamlessly intertwined, the need to “protect” oneself and others from death and the emotions that accompany resistance to it will necessarily be reduced.

Alongside the study’s strengths, attention ought to be given to its limitations. The present study did not focus on gender or professional differences concerning their rites of passage rituals. That said, when reviewing the interview transcripts, no explicit professional differences were identified, similar to the findings of Ashforth and Kreiner (1999). The same was so for gender differences. Nevertheless, future research, when examining professionals’ transitions between two opposing environments, especially in the context of what is perceived by society as well as by the professionals themselves as “dirty work,” should carefully examine the potential contribution of gender, profession, and the use, or lack of, professional uniforms to the participants’ experience. All these require that scientists continue to investigate and comprehend the experience of moving between opposing environments and the personal rituals professionals encounter in managing this task. Further studies can broaden the scope of this research by comparing the findings with other population samples. Such studies should also supplement the professionals’ narrative with those of their family members, whose perspective concerning their family members’ constant move between opposing environments is currently unknown.

Disclosure statement

No potential conflict of interest was reported by the authors.

Data availability statement

The data that support the findings of this study are available from the corresponding author, MMS, upon reasonable request.

Additional information

Funding

The authors reported there is no funding associated with the work featured in this article.

Notes on contributors

Michal Mahat-Shamir

Michal Mahat-Shamir is an Associate Professor in the School of Social Work at Ariel University, Israel. She is an active scholar in the field of loss, trauma, and bereavement, with a specific interest in traumatic and disenfranchised grief.

Ronit D. Leichtentritt

Ronit D. Leichtentritt, an Associate Professor at the Bob Shapell School of Social Work,Tel Aviv University, Israel, conducts research on topics including death, dying, loss, bereavement, and the distinctive challenges faced by disenfranchised populations. Additionally, she is an expert in qualitative methodologies.