Category: Death Curiosities

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Why Do We Always Want To Know How Someone Died?

— Mental health experts weigh in on this common impulse to find out the cause of death.

It’s natural to feel curious about death, especially in unexpected circumstances.

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When we learn that someone has died ― especially at an earlier age than expected ― there’s often a flood of painful emotions and difficult questions. Chief among them: How did this happen?

Whether we knew the deceased well or they were a complete stranger, some of us have a tendency to fixate on finding out the cause of death, perhaps devoting hours to internet research as we desperately search for clues that might provide an reason. Others might reach out to express condolences to their loved ones … followed by the blunt question. Though the approach to finding answers can vary, the underlying impulse is not uncommon.

“I think when we hear about someone passing away at a young age, it rocks our sense of normalcy and the way we conceptualize the world,” said Rachel Thomasian, a licensed therapist and owner of Playa Vista Counseling in Los Angeles. “We operate with the general belief that people live until they are older and, barring a major catastrophe, will die well after they retire. Believing this is our brain’s way of keeping us psychologically safe from worrying about all the bad things that actually could happen.”

She added that not knowing the cause of death can lead us to think about all the possible ways a person can die. This need to have the reason a relatively young person died is about giving us some sense of meaning as to why this could happen.

“People have a natural fear of their own death, so when they hear of an untimely death, it might give them a sense of control to know how they died so they can try to prevent that,” Thomasian said. “So when we hear about someone who dies at a young age, it reminds us not only of our own mortality but that we too are not immune from dying much sooner than our 100th birthday.”

Because most of us don’t enjoy actively thinking about our own mortality, we tend to counter such thoughts with the assumption or hope that we’ll die peacefully in our sleep of old age, as will our loved ones.

“So when we have to confront the reality that someone died young, it creates a conflict with this assumption and we try to resolve it by getting more information,” said Zainab Delawalla, a clinical psychologist in Atlanta, Georgia. “Ultimately, we want to reinforce for ourselves the idea ‘that [dying young] won’t happen to me.’”

This impulse to want to know the cause of death also stems from our natural curiosity as people. In the age of the internet and social media, those in younger generations particularly pride themselves on their ability to quickly find information about other people. So not knowing how someone died can feel like a frustratingly incomplete puzzle, which compounds the difficult emotions surrounding a tragic and shocking loss.

“This neurological need to understand how and why someone died relates to a concept that social psychologists call ‘cognitive closure,’ which refers to the motivation to find answers to ambiguous situations,” said Becky Stuempfig, a Southern California-based therapist. “All of us have different levels of need for cognitive closure, and this need often increases during stressful events such as a death. Our brains struggle with the unknown, and it brings us peace when we can answer the ‘why’ and dispel the mystery surrounding the loss. Even if we do not have accurate information, our minds may hold on to any answers we can gather.”

Is this impulse a bad thing?

“Generally speaking, I think trying to resolve internal conflicts by seeking more information is not a bad thing,” Delawalla said. “The impulse to figure out the exact cause of death when someone dies at a young age is likely rooted in us trying to desperately hold on to the assumption that we might still die peacefully of old age. More information on one specific case would allow us to figure out why these circumstances are different and how they don’t apply to us.”

There’s nothing inherently wrong with wanting details that allow us to put order to things that feel chaotic, and the unknown process of death and what happens after we die certainly fall into that category.

“For some, the attempt to understand how and why someone died stems from a desire to delay the frightening concept of death by prolonging life and avoiding whatever caused the death,” Stuempfig said. “This is often seen when children pass away. The loss of a child feels so unnatural and traumatic that others sometimes feel a desperate need to understand the cause of death in an attempt to avoid a similar loss and to place some kind of reason to a situation that feels like it should never happen.”

However, this impulse can become problematic in certain situations, she added. For example, you might need to take a step back if your desire to learn the cause of someone’s death becomes obsessive and interferes with your daily functioning. Don’t let it impact your sleep or ability to complete work or other tasks.

“On the extreme alternative end, those who fixate on all the alternative ways one could die young are usually dealing with some form of anxiety,” Thomasian noted.

Ask yourself if your desire for this information is related to a deeper problem you should work through with a professional therapist.

“I think the impulse can be bad if it influences you to cross boundaries or disrespect what a person or family has lost,” added Racine Henry, a licensed marriage and family therapist in New York City. “It’s not always appropriate to ask ‘what happened?’ ― especially when the loss is new and people are trying to figure out how to grieve.”

Show respect for the deceased person’s loved ones and their desire for privacy.

How can you avoid feeling consumed by your need to know?

If you’re feeling consumed by your need to know someone’s cause of death, try to shift your mindset. Examine the source of your frustration and ask what you see as the benefits to gain from knowing how they died and harms from not knowing.

“If the desire stems from concern over personal health or wanting to safeguard family members from potentially dangerous situations, open discussions and proactive steps can empower the individual to regain a sense of control,” Stuempfig said.

“For example, if someone feels preoccupied by a death that they suspect was caused by suicide, it could be therapeutic to have open discussions with people in their lives about how they can take care of their mental health. This can help give people a sense of control, counteracting the prevailing feelings of helplessness.”

Try to determine whether your feelings around wanting this information are related to something in your own life.

“Most often there’s a judgment attached to a manner of death ― i.e., if someone died from an overdose, you may feel they deserve less empathy vs. someone who died from a car accident or plane crash,” Henry said. “What does that judgment say about you, and why is it necessary to attach meaning to how someone passes away? Spend time thinking about how that informs the way you treat others.”

Focus on showing empathy for how their loved ones might feel about the cause of death as well.

“Remember that many times the cause of death is not revealed openly because of the family members’ fears about how others will respond and judge them,” Steumpfig said. “In the case of substance abuse overdose or death by suicide, family members are often reluctant to share the cause of death out of fear of judgment or blame.”

Give yourself grace as you process the uncertainty and difficulty of death as well. Stop the “what if” questions from turning into intrusive thoughts and feelings by labeling them without self-judgment.

“Instead of feeling shame for wanting to know the cause of death, recognize the need as a natural function of the human brain,” Stuempfig said. “It can be useful to alter our inner dialogue from ‘What’s wrong with me? Why am I so morbidly obsessed with finding out how this person died?’ to ‘OK, I’m having an intrusive thought about wanting to know the cause of death and that’s just my brain doing its job.’”

Shifting our negative self-talk helps reduce judgment, anxiety and shame ― which thereby decreases the frequency of potentially harmful impulses. So rather than judging yourself for having them (and thus helping them grow stronger), focus on awareness to avoid feeling consumed by intrusive thoughts.

“Discussing these impulses with trusted family and friends can also help reduce isolation and self-criticism as it is a universal human need to seek answers in such situations,” Stuempfig added.

If you didn’t know the person who died well, consider how you might channel your fixation into something more positive.

“Try to refocus on how you can honor what those who are impacted are going through,” she said. “Maybe you can drop off a meal or help with the funeral arrangements. How can that energy be used to benefit those grieving?”

The finality of death can prompt serious anxiety and fear, but no piece of information will make it feel less uncertain.

“Instead of frantically looking for information to confirm ‘that won’t happen to me,’ let us work on accepting that none of us knows how or when we will confront death,” Delawalla emphasized. “We do, however, know and have many more choices around how we confront life. Let us spend more energy on that.”

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Dia de los Muertos (Day Of The Dead) 2023

More than 500 years ago, when the Spanish Conquistadors landed in what is now Mexico, they encountered natives practicing a ritual that seemed to mock death.

It was a ritual the indigenous people had been practicing at least 3,000 years. A ritual the Spaniards would try unsuccessfully to eradicate.

A ritual known today as Dia de los Muertos, or Day of the Dead.

The ritual is celebrated in Mexico and certain parts of the United States. Although the ritual has since been merged with Catholic theology, it still maintains the basic principles of the Aztec ritual, such as the use of skulls.

Today, people don wooden skull masks called calacas and dance in honor of their deceased relatives. The wooden skulls are also placed on altars that are dedicated to the dead. Sugar skulls, made with the names of the dead person on the forehead, are eaten by a relative or friend, according to Mary J. Adrade, who has written three books on the ritual.

The Aztecs and other Meso-American civilizations kept skulls as trophies and displayed them during the ritual. The skulls were used to symbolize death and rebirth.

The skulls were used to honor the dead, whom the Aztecs and other Meso-American civilizations believed came back to visit during the monthlong ritual.

Unlike the Spaniards, who viewed death as the end of life, the natives viewed it as the continuation of life. Instead of fearing death, they embraced it. To them, life was a dream and only in death did they become truly awake.

“The pre-Hispanic people honored duality as being dynamic,” said Christina Gonzalez, senior lecturer on Hispanic issues at Arizona State University. “They didn’t separate death from pain, wealth from poverty like they did in Western cultures.”

However, the Spaniards considered the ritual to be sacrilegious. They perceived the indigenous people to be barbaric and pagan.

In their attempts to convert them to Catholicism, the Spaniards tried to kill the ritual.

But like the old Aztec spirits, the ritual refused to die.

To make the ritual more Christian, the Spaniards moved it so it coincided with All Saints’ Day and All Souls’ Day (Nov. 1 and 2), which is when it is celebrated today.

Previously it fell on the ninth month of the Aztec Solar Calendar, approximately the beginning of August, and was celebrated for the entire month. Festivities were presided over by the goddess Mictecacihuatl. The goddess, known as “Lady of the Dead,” was believed to have died at birth, Andrade said.

Today, Day of the Dead is celebrated in Mexico and in certain parts of the United States and Central America.

“It’s celebrated different depending on where you go,” Gonzalez said.

In rural Mexico, people visit the cemetery where their loved ones are buried. They decorate gravesites with marigold flowers and candles. They bring toys for dead children and bottles of tequila to adults. They sit on picnic blankets next to gravesites and eat the favorite food of their loved ones.

In Guadalupe, the ritual is celebrated much like it is in rural Mexico.

“Here the people spend the day in the cemetery,” said Esther Cota, the parish secretary at the Our Lady of Guadalupe Church. “The graves are decorated real pretty by the people.”

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Supernatural Festivals

— A Cross-Cultural Look at the Celebration of Death

Candles placed on the river to carry intentions

By Dr. Ahriana Platten

Halloween, with its eerie costumes, spooky decorations, and a sense of playful fright, is a widely celebrated holiday in many parts of the world. It’s interesting to note that various faiths around the globe have their own festivals that share similarities with Halloween, a great example of the universal need to acknowledge our ancestors, the time of death, and our desire for life beyond our mortal walk. These celebrations may not always align perfectly with the modern commercialized version of Halloween, but they embrace themes of the supernatural, remembrance of the deceased, and the triumph of light over darkness.

Here are a few examples:

Dia de los Muertos – Mexico

In Mexico, Dia de los Muertos, or the Day of the Dead, is a vibrant and colorful festival that coincides with Halloween. Celebrated from October 31st to November 2nd, this holiday honors deceased loved ones. Families create elaborate altars adorned with sugar skulls, marigold flowers, and the favorite foods and beverages of the departed. People dress in skeleton costumes, and parades and festivals take place across the country to celebrate the cycle of life and death.

Pitru Paksha – Hinduism

In Hinduism, Pitru Paksha is a 16-day period when Hindus pay homage to their ancestors. It is believed that during this time, the spirits of the deceased visit the realm of the living. Families perform rituals, offer food, and conduct tarpana (libations) to honor their ancestors and seek blessings for their well-being in the afterlife. The festival is marked by a sense of solemnity and reflection, akin to Halloween’s connection with the supernatural.

Obon – Buddhism

Obon, or the Festival of the Dead, is a Buddhist tradition celebrated in Japan in July or August, depending on the region. During this time, families honor deceased relatives by lighting lanterns and setting them afloat on rivers and other bodies of water. It is believed that these lanterns guide the spirits of the deceased back to the world of the living. Bon Odori dances are also performed, and grave sites are cleaned and decorated to welcome back the spirits.

Samhain – Celtic Paganism

Samhain, originating from Celtic pagan traditions, is considered the precursor to modern Halloween. Celebrated on October 31st, it marks the end of the harvest season and the onset of winter. It is believed that during Samhain, the veil between the world of the living and the world of the dead is at its thinnest, allowing spirits to cross over. People would light bonfires, don masks, and leave offerings to appease the spirits. Many elements of Samhain have been incorporated into contemporary Halloween celebrations.

Chuseok – Korean Buddhism

Chuseok, also known as Korean Thanksgiving Day, is a major harvest festival celebrated in Korea. While it is not directly related to Halloween, it shares some thematic similarities. Families gather to pay respect to their ancestors by visiting their ancestral graves, offering food, and performing ancestral rites. Chuseok emphasizes the importance of family and the connection between the living and the deceased, similar to Halloween’s focus on remembering the departed.

Qingming Festival – Chinese Traditions

The Qingming Festival, also known as Tomb-Sweeping Day, is a Chinese tradition that occurs around April 4th or 5th. During this time, families visit the graves of their ancestors to clean the tombstones, make offerings, and burn incense. It is a day of remembrance and reflection, where people pay their respects to their ancestors and ensure their well-being in the afterlife. While not directly tied to Halloween, Qingming shares the theme of honoring the deceased and maintaining a connection with the spirit world.

Regardless of the specific rituals and customs, these traditions serve as a reminder of the enigmatic and unexplained aspects of life and death, making them captivating parallels to the Halloween festivities we know and cherish. the value of exploring the rites, rituals, and sacred ceremonies of faiths other than our own is that we begin to identify aspects of life that are universally important to all human beings — and, in the process, we come to a better understanding of our interconnection. This serves the pursuit of peace — something much of the world is actively seeking now.

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How Aid in Dying Became Medical, Not Moral

— The debate over aid in dying still rages in the language that medicine and the media use to describe the practice.

By Rachel E. Gross

In rural Iowa, Peg Sandeen recalls, living with AIDS meant living under the cloud of your neighbors’ judgment. After her husband, John, fell ill in 1992, the rumors began swirling. The couple had almost learned to live with the stigma when things took a turn for the worse.

In 1993, ravaged by his disease and running out of options, John wanted to make one final decision: to die on his own terms, with the help of life-ending medication. But at the time, there was no way to convey to his doctors what he wanted. As the debate over assisted dying raged in far-off Oregon, the headlines offered up only loaded words: murder, euthanasia, suicide.

John was adamant that what he wanted was not suicide. He loved his life: his wife, who had married him even though he had asked her to leave when he learned he was H.I.V. positive; their 2-year-old daughter, Hannah; and playing Neil Young songs on guitar, a pleasure that was rapidly being taken from him as his faculties slipped away.

“This was not a man who wanted to commit suicide, at all,” said Ms. Sandeen, now the chief executive of Death With Dignity, a group that supports aid-in-dying laws across the country. To her, the word only added more judgment to the homophobia and AIDS phobia that they — and others who found themselves in a similar position — were facing.

John had expressed to his wife his wish to die on his own terms. But, to her knowledge, he never spoke about it with his physicians. At the time, it felt impossible to bring it up as simply a medical question, not a moral one.

“Even if the answer was, ‘No, we can’t offer that,’ that would have made such a difference,” she said. “We were just facing so much stigma that even to have the ability to have this end-of-life care conversation would have just been remarkable.”

John succumbed to the virus on Dec. 9, 1993, less than a year before the Death With Dignity Act passed narrowly in Oregon. Since its enactment in 1997, more than 3,700 Oregonians have taken measures permitted by the law, which allows patients with a terminal illness and the approval of two doctors to receive life-ending medication. The practice is now legal in 10 U.S. states and Washington, D.C.

With this shift has come new language. Like the Sandeens, many health advocates and medical professionals insist that a terminally ill patient taking medication to hasten the end is doing something fundamentally different from suicide. The term “medical aid in dying,” they say, is meant to emphasize that someone with a terminal diagnosis is not choosing whether but how to die.

“There is a significant, a meaningful difference between someone seeking to end their life because they have a mental illness, and someone seeking to end their life who is going to die in the very near future anyway,” said Dr. Matthew Wynia, director of the University of Colorado’s Center for Bioethics and Humanities.

In the 1990s, advocates were facing an uphill battle for support. Two assisted-dying bills, in California and Washington, had failed, and the advocates now faced an opposition campaign that mischaracterized the practice as doctor-prescribed death. “At the time, the issue very badly needed to be rebranded and repositioned,” said Eli Stutsman, a lawyer and a main author of the Death With Dignity Act. “And that’s what we did.”

The text of the law, however, only defined the practice by what it was not: mercy killing, homicide, suicide or euthanasia. (In the United States, euthanasia means that a physician actively administers the life-ending substance. That practice has never been legal in the United States, although it is in Canada.)

New terms soon became inevitable. Barbara Coombs Lee, an author of the law and president at the time of the advocacy group Compassion and Choices, remembers a meeting in 2004 where her group discussed which terminology to use going forward. The impetus “was probably another frustrated conversation about another interminable interview with a reporter who insisted on calling it suicide,” she said.

A phrase like “medical aid in dying,” they concluded, would reassure patients that they were taking part in a process that was regulated and medically sanctioned. “Medicine has that legitimating power, like it or not,” says Anita Hannig, an anthropologist at Brandeis University and author of the book “The Day I Die: The Untold Story of Assisted Dying in America.” “That really removes a lot of the stigma.”

By contrast, words like “suicide” could have a devastating effect on patients and their families, as Dr. Hannig learned in her research. Grieving relatives might be left feeling shamed, isolated or unsupported by strangers or acquaintances who assumed that the loved one had “suicided.” Dying patients often hid their true wishes from their doctors, because they feared judgment or struggled to reconcile their personal views on suicide.

Unlike an older term, “physician aid in dying,” “medical aid in dying” also centered on the patient. “This is not a decision the physician’s making — this is not even a suggestion the physician is making,” said Ms. Coombs Lee, who has worked as an emergency-room nurse and a physician assistant. “The physician’s role is really secondary.”

An equally important consideration was how the phrase would be taken up by the medical community. Doctors in Oregon were already practicing aid in dying and publishing research on it. But without agreed-upon terms, they either defaulted to “assisted suicide” (generally used by opponents of the law) or “death with dignity” (the term chosen by advocates for the name of the law). A more neutral phrase, one that doctors could use with each other and in their research, was needed.

Not all organizations today agree that “medical aid in dying” is neutral. The Associated Press Stylebook still advises referring to “physician-assisted suicide,” noting that “aid in dying” is a term used by advocacy groups. The American Medical Association also uses this language: In 2019, a report from the association’s Council on Ethical and Judicial Affairs concluded that “despite its negative connotations, the term ‘physician assisted suicide’ describes the practice with the greatest precision. Most importantly, it clearly distinguishes the practice from euthanasia.”

Medical language has long shaped — and reshaped — how we understand death. Dr. Hannig noted that the concept of brain death did not exist until 1968. Until then, a patient whose brain activity had ceased but whose heart was still beating was still legally alive. One consequence was that any doctor removing the patient’s organs for transplant would have been committing a crime — a serious concern for a profession that is notoriously fearful of lawsuits.

In 1968, a Harvard Medical School committee came to the conclusion that “irreversible coma,” now known as brain death, should be considered a new criterion for death. This new definition — a legal one, rather than a biological one — has paved the way for organ transplantation around the world. “Before the definition of death was changed, those physicians would be called murderers,” Dr. Hannig said. “Now you have a totally new definition of death.”

Of course, doctors have always assisted patients who sought a better end. But in the past, it was usually in secret and under the shroud of euphemism.

“Back in the day, before the laws were passed, it was known as a wink and a nod,” said Dr. David Grube, a retired family physician in Oregon who began prescribing life-ending medications after one of his terminally ill patient violently took his own life. He knew doctors in the 1970s and ’80s who prescribed sleeping pills to terminally ill patients and let on that combining them with alcohol would lead to a peaceful death.

For a brief time after the Death With Dignity law was passed, some doctors used the word “hastening” to emphasize that the patient was already dying and that the physician was merely nudging along an unavoidable fate. That term did not catch on, in part because hospices did not like to advertise that they were shortening lives, and patients did not like hearing that hospice care might lead to their “hastening.”

In the absence of other language, the name of the law itself became the preferred term. The phrase allowed patients to open conversations with their physicians without feeling as though they were raising a taboo subject, and doctors understood immediately what was meant. The name has stuck: Even in his retirement, Dr. Grube gets calls from patients asking to talk about “death with dignity.”

Yet in some ways, Dr. Grube believes the use of the word “dignity” was unfortunate. To him, the crucial point is not the kind of death a patient chooses, but that the patient has a choice. “You can have a dignified death when you pull out all the stops and it doesn’t work,” he said. “If that’s what you want, it’s dignified. Dignity is defined by the patient.”

To him, that means avoiding language that heaps judgment on people who are already suffering. “There’s no place for shaming language in end-of-life,” Dr. Grube said. “It shouldn’t be there.”

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Why Some People Wait To Die Until They’re Alone

By Jennifer Anandanayagam

Dying alone usually has a negative connotation attached to it. This is probably why movies portray it as sad and heartbreaking. On the flip side, dying while being surrounded by friends and family is often thought of as a good death. The person was loved and made to feel secure as they passed on. They didn’t have to endure the pain of dying alone.

But what happens in the final moments of death is a subject that’s largely still being discovered. No one really knows for sure definite answers to the big questions like “Does your consciousness continue after you stop breathing?” or “Will you have a better death if you have loved ones surrounding your bed?”

Social researcher and death studies scholar Glenys Caswell from Nottingham University noted that, for some people, dying alone is something that they choose of their own accord (via The Conversation). One of Caswell’s studies, which was published in the journal Mortality in 2017, involved interviewing 11 elderly persons who lived by themselves and seven hospice nurses about their thoughts surrounding dying alone. While there was some belief among the hospice nurses that dying alone is not something they’d endorse, Caswell found that for the older people, “dying alone was not seen as something that is automatically bad, and for some of the older people it was to be preferred.” They preferred it to having their freedom curtailed or being confined to a care home.

They might die alone to spare their loved ones pain

Lizzy Miles — a Columbus, Ohio-based hospice social worker and author of “Somewhere In Between: The Hokey Pokey, Chocolate Cake and The Shared Death Experience” — is of the opinion that some people can choose when they die. She wrote in the hospice and palliative medicine blog Pallimed that people who choose to wait and die alone might be doing so out of concern for their loved ones.

“We have those patients who die in the middle of the night. We hear stories about the loved one who just stepped out for five minutes and the patient died. We may have even witnessed a quick death ourselves. I believe this happens by the patient’s choice,” wrote Miles. She added that this happens mostly in instances when the dying person is a parent. “I believe it is a protective factor,” she explained.

Henry Fersko-Weiss, a licensed clinical social worker and executive director of the International End-of-Life Doula Association, feels slightly differently about the topic. While he doesn’t discount the fact that some people might die alone, he shared in a YouTube video that people like feeling connected and safe before they pass away. Fersko-Weiss said that “because of the way we think about death, [we] feel that we’ll be a burden to loved ones” if we let them see us die. Sparing loved ones the pain of it all might be at the heart of the decision but this is something friends and family should have an open conversation about, he added

Having an open dialogue with your loved one can help

No matter how painful those final moments might be, it can be a good idea to equip yourself with the right tools to have open conversations that foster understanding on both sides, say the experts. You might want to lean into what dying people want you to know about how they’d ideally want to go, and also assess your own emotions, cultural biases, and ideas around it. If you’re unable to broach the topic yourselves, enlist the help of hospice care workers or even a therapist.

It is possible that the person who is dying is concerned that the loved ones whom they are leaving behind will carry with them for the rest of their lives the burden of seeing them pass, shared Fersko-Weiss in the video. You could reassure them by saying something like, “Of course, we want to be there. It doesn’t matter how it looks or how it sounds or how emotionally difficult it may be to be present. It is part of our love for you that we would want to be there,” said the death doula.

How you choose to be present when someone you love is dying is a decision both the dying and those being left behind can arrive at together, per the experts. And, in the instance when your loved one chooses to wait and die alone, “openness created through discussion might also help to remove some of the guilt that family members feel when they miss the moment of their relative’s death,” added Caswell

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Why Are So Many Americans Dying?

By David Wallace-Wells

Since it was first introduced by the economists Anne Case and Angus Deaton in 2015, the phrase “deaths of despair” has become a sort of spiritual skeleton key that promised to unlock the whole tragic story of a new American underclass.

Beginning around the turn of the millennium, Case and Deaton showed, deaths from suicide, opioid overdose and alcohol-related liver disease among less educated, white, middle-aged people began to grow in a pattern that seemed to demonstrate how the country’s white working class was being — or at least feeling — left behind. Last month, the economists presented their updated data with a new paper showing a growing divergence in life expectancy between those with college degrees and those without.

But over the past few years, the “deaths of despair” story has come to seem thinner to many of those reading the literature most closely. And in response to the new findings, pointed critiques were published by Dylan Matthews in Vox and by Matthew Yglesias in Slow Boring, arguing that the deaths of despair narrative had been overhyped, creating a just-so story about postindustrial decline that had seemed too good to scrutinize.

Eight years on, the central claim from Case and Deaton holds up relatively well: Deaths by suicide, overdose and liver disease have been on the rise among the white working class and the middle class. But so have gun deaths across the country, deaths among the young and suicides, which puts the data on white middle-aged men and women in a different light. Among other questions about that data, it turns out that deaths of despair increased pretty uniformly across all demographic groups and that the rise in such deaths among white middle-aged people was, while real and concerning, not all that exceptional.

What does that imply, though? In their critiques, both Yglesias and Matthews argue that the data tells a narrower story than Case and Deaton do — and that rather than invoking national malaise we should focus on the role of opioids among the country’s worst off in the first case, or high school dropouts and heart disease in the second.

But it seems to me that the opposite is true: The American mortality crisis is much larger than deaths of despair, in fact too broad and diffuse to be stuffed into one demographic box or characterized as a failure of one policy area. You can see it almost anywhere you care to look and any way you slice the data.

Unless they’re in the top 1 percent, Americans are dying at higher rates than their British counterparts, and if you’re part of the bottom half of income earners, simply being American can cut as much as five years off your life expectancy. At every age below 80, Americans are dying more often than people in their peer nations: Infant mortality is up to three times as high as it is in comparison countries; one in 25 kindergartners can’t expect to see 40, a rate nearly four times as high as in other countries; and Americans between 15 and 24 are twice as likely to die as those in France, Germany, Japan and other wealthy nations. For every ethnic group but Asian Americans, prepandemic mortality rates in the United States were higher than those of economic peer countries: In 2019, Black Americans were 3.8 times as likely to die as the residents of other wealthy countries, white Americans were 2.5 times as likely to die, and Hispanic Americans 1.8 times as likely to die. Americans with college degrees do substantially better than those without, but that second group represents almost two-thirds of the country. And while mortality rates show a clear geographic divergence, with life expectancy gaps as large as 20 years between the country’s richest and poorest places, just a fraction of American counties even reach the European Union average.

When looking at American trend lines alone, anomalies like overdose spikes or mortality increases among high-school dropouts can jump out, and the divergence between, say, those with bachelor’s degrees and those without is quite striking. But in comparing the overall health of Americans to those in other wealthy countries, almost everyone looks to be suffering, and even those remarkable anomalies turn out to be quite small, contributing only somewhat trivially to the widening gap between how many Americans are dying each year and how many of our peers elsewhere are.

Overdose deaths involving synthetic opioids, for instance, have grown from less than 10,000 in 2015 to 70,000 in 2021. Add heroin and other overdoses and the total grows to more than 100,000 — a public health horror story, and a much graver problem than in any of our peer countries. But that barely explains a fraction of the exceptional American mortality pattern identified by the researchers Jacob Bor and Andrew Stokes, who found that a million more Americans died each year than would have if the country’s overall mortality rates matched those of peer countries in Europe.

Those million extra deaths exceed even the nearly 700,000 who die each year from cardiovascular disease, the country’s biggest killer. But of course many residents of other rich countries die from it, too. And though, as Matthews emphasizes, American progress against heart disease has stalled in recent years, the gap between our cardiovascular mortality and those of our peers turns out to be relatively small, accounting for just another fraction of Bor and Stokes’s “missing Americans.” Which tells you something about how large that number of extra deaths really is: If American mortality rates simply matched those of peers overall, the country’s total number of deaths would have fallen 22 percent on the eve of the pandemic in 2019. In 2021, the researchers found, extra mortality accounted for nearly one in every three American deaths.

“The United States is failing at a fundamental mission — keeping people alive,” The Washington Post recently concluded, in a remarkable series on the country’s mortality crisis. “This erosion in life spans is deeper and broader than widely recognized, afflicting a far-reaching swath of the United States.” In a quarter of American counties, The Post found, death rates among working-age adults are not just failing to improve but are also higher than they were 40 years ago. “The trail of death is so prevalent that a person could go from Virginia to Louisiana, and then up to Kansas, by traveling entirely within counties where death rates are higher than they were when Jimmy Carter was president.” If death rates just among the country’s 55-to-69-year-olds improved to match the rates of peer countries, The Post calculated, 200,000 fewer of them would have died in 2019. That is more than the number of them who died of Covid in 2020.

There are a few things that Americans do as well or better than other countries (cancer treatment, where outcomes have been steadily improving now for decades, and keeping old people alive), so chances that a 75-year-old makes it to 90 or 100 are about the same as in other wealthy countries — though that stat is somewhat distorted by the fact that many fewer Americans make it to 60 in the first place, with those who do likelier in better health.

But by almost every other measure the United States is lagging its peers, often catastrophically. The rate of homicides involving a firearm are 22 times higher in the United States as in the European Union, for instance, a worsening trend that has given rise to research suggesting that the country’s mortality crisis is primarily about gun violence. Another set of researchers emphasize exceptional mortality rates among the young, with rates of death among American children growing more than 15 percent between just 2019 and 2021, with little of that increase attributable to Covid. Americans also die much more often in car crashes, workplace accidents and fires. Our maternal mortality rate is more than three times as high as that of other wealthy countries, and our newborns have the highest infant mortality rate in the rich world. We are almost twice as likely to suffer from obesity as are our counterparts in countries of the Organization for Economic Cooperation and Development, and the downstream consequences — from hypertension to heart disease and stroke — mean that obesity could explain more than 40 percent of the U.S. life expectancy shortfall for women, and over 60 percent for men. The life expectancy among America’s poorest men may be 20 years shorter than that of their counterparts in the Netherlands and Sweden. Overall, among 18 high-income countries, America’s life expectancy ranks dead last.

It’s not quite right to call all this simply “despair,” even if social anomie plays a role. Doing so places too much weight on the suffering of individuals and not enough on what epidemiologists call the social and environmental determinants of health: community support, education and, perhaps most important, health care access. (Since 2015, Case and Deaton have acknowledged these factors; their 2020 book on the subject emphasizes health care inequalities, and Deaton’s new book “Economics in America” focuses squarely on inequality.)

But the bigger problem seems to me to be that talking narrowly about despair localizes the American mortality dysfunction in a small demographic, when almost the entire country is dying at alarming rates. The burden does not fall equally, and the disparities matter. But looking globally, our mortality crisis appears, effectively, national.

Complete Article ↪HERE↩!

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Can We Choose When We Die?

— What We Know

By Jennifer Anandanayagam

Movies, books, and even personal accounts record how, sometimes, people who are in the last stages of life hold on until something they dearly wished for gets resolved. It could look like reconciling with a loved one, spending time with someone they haven’t seen in years, or getting the blessing of a priest.

Given that there’s a lot we don’t know about what people see and hear before they die, is there any truth to the fact that we can choose when we die? Can we willfully resist death until we’re ready to let go? Science tells us that dying is a process: The person’s breathing slows down; their skin color and temperature change; they might experience difficulty breathing; they could sleep a lot more than usual; and their thinking and other senses may dwindle, per Health Direct. However, according to several hospice and palliative care workers, there is some truth to the thinking that people can hold on till they’re ready to let go.

Dr. Toby Campbell, a thoracic medical oncologist in the Division of Hematology, Medical Oncology and Palliative Care at the University of Wisconsin School of Medicine and Public Health, told STAT News, “People in end-of-life care wouldn’t bat an eye if you asked if they think people can, to a certain degree, control those final moments. We’d all say, ‘Well, yeah. Sure.’ But it’s inexplicable.” Science might not have studied this phenomenon extensively nor arrived at one possible explanation, but there are some theories.

It could be related to a hormonal stimulus

Old lady being hugged nurse

What allows someone in the last stages of dying to prolong their life until some unfinished business is completed? Dr. Campbell thinks it could have something to do with a hormonal stimulus (via STAT News). People in the final stages of death “probably have some kind of hormonal stimulus that’s just a driver to keep them going. Then, when whatever event they were waiting for happens, the stimulus goes away, and there must be some kind of relaxing into it that then allows them to die.”

Charles F. von Gunten, a pioneer in the field of hospice and palliative medicine, agreed. “What people will do for one another in the name of love is extraordinary. I think of it as a gift when it happens,” he told The Washington Post.

However, there might be something else that happens that gives dying people a chance to enjoy what time they have left with loved ones before they die. Healthcare professionals call this “rallying” or “the surge,” as explained by licensed hospice nurse, Julie McFadden, who goes by the name Hospice Nurse Julie on YouTube. “A patient will look like they are actively dying or getting very close to death … And then suddenly, they perk up and they start acting like their old selves again. They may be hungry, eat, talk, laugh, joke around, be a little sassy with their family … They frequently do this and then pass away usually the next day.” Again, this isn’t understood well by healthcare workers but it does give loved ones a chance to say goodbye.

How to let go when death is near

Family visiting grandfather in hospital

Regardless of whether your loved one is holding on so they can spend more time with you or they are experiencing a surge in life just before dying, death is often something we aren’t prepared for. Some people may even experience what is known as “anticipatory grief” — feelings of loss even before their loved one has actually died.

What dying people want you to know, on the other hand, might change depending on their particular life situation; but there is a big possibility that there might be regrets, most of which might have to do with relationships.

The author of the book “Dying Well: Peace and Possibilities at the End of Life,” Dr. Ira Byock, seems to think that we can choose how we die. Byock, who’s a physician and advocate for palliative care, shared in his book that people who are about to die should take the time to say goodbye (via Help Guide). Sentiments like “I love you,” “I forgive you,” “Forgive me,” and “Thank you” are not overrated and should be prioritized between loved ones and the person who’s dying. For loved ones who are letting go, it might also be important to let your dying family member know that it’s alright for them to go and that you will be okay. It could offer immense relief to them when they need it most.

Complete Article ↪HERE↩!