Dying produces human remains and is a unique period of human lives that remains poorly understood. The aims of this research were to validate the use of hair cortisol concentration (HCC) analysis in the study of stress at the end of life and to explore the effects of biocultural factors on stress experience in the last months of life. This study examined the dead from the 1st century CE Egypt, 19th-20th century Missouri, and 21st century Florida. A framework of embodiment and the good death was employed to interpret lived experience from HCC and examine the relationships between HCC, death, cause of death, duration of disease, and medical care and treatment.
HCC in the dead is higher than in the living, varies considerably between individuals, and can fluctuate across the last months of life. High HCC at the end of life cannot be easily accounted for by medications, serious disease, or decomposition; are within possible biological ranges; and are dynamic. However, leaching of cortisol from the archaeological samples is likely. Duration of disease or presence of multiple medical conditions does not influence HCC. While modern medical advancements do not improve stress levels in the dead, a reduction in stress is observed following hospital entry in the past.
HCC is a valid measure of stress at the end of life. The last months of life are periods of significant stress but dying is an inherently personal and dynamic experience that varies between individuals and over many months leading up to death due to the interaction of multiple biocultural factors. These findings contribute to the understanding of a unique period of individual lives, suggest that studies of HCC in bioarchaeology must focus on the dying period and be wary of leaching, and highlight the potential of HCC in palliative care research. / Dissertation / Doctor of Philosophy (PhD) / Today, death is often regarded with uncertainty and even fear, yet little is known about the experience of dying, especially in the past. Dying is difficult to study in modern people because of communication challenges and the number of complex factors at play while studies of the past are limited because human remains do not reveal how individuals felt. A better understanding of the dying experience can help bioarchaeologists clarify the relationship between dying, death, and skeletal remains and could help improve the care of dying people today.
This research evaluated a new method of stress assessment to study experiences in the last months of life in archaeological, historic, and modern samples. Hair cortisol concentration (HCC) analysis measures stress hormones in human hair to reconstruct stress experience at the time the hair was growing. High levels of HCC in dead individuals from 1st century AD Egypt, 19th-20th century Missouri, and 21st century Florida indicate that dying is stressful across time and place. HCC values from the Egyptian sample were higher than most living people but were lower than other archaeological samples which may be a result of cortisol leaching out of the hair shaft after death. Although higher than living people, HCC levels still differed between individuals and across individual hair shafts, indicating that stress experience can be different between individuals and change over an individual’s final months. These differences are not a result of biological factors such as duration of disease or the presence of certain preexisting conditions suggesting that stress at the end of life is complex. Despite advancements in medicine, the modern sample displayed similar HCC levels to those from earlier historic periods and for a number of individuals from the historic sample, hospital entry led to a temporary reduction in HCC levels. Together, these findings suggest that, while modern medical advancements have not improved stress levels at the end of life, some aspects of care could reduce stress.
The results of this study indicate that dying is a stressful, complex, and dynamic phenomenon that modern medical treatment alone may not be able to improve. Furthermore, studies of HCC in archaeology must focus on the effects of dying and be wary of leaching. Ultimately, HCC analysis could contribute to a greater knowledge of the dying experience, the understanding of past peoples, and improvement of the experience of dying.
| Identifer | oai:union.ndltd.org:mcmaster.ca/oai:macsphere.mcmaster.ca:11375/26335 |
| Date | January 2021 |
| Creators | East, Kaitlin |
| Contributors | Megan, Brickley, Anthropology |
| Source Sets | McMaster University |
| Language | en_US |
| Detected Language | English |
| Type | Thesis |
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