Richard Wagner

September 27, 2015

How Death Came into the World

By ALLAN KELLEHEAR

Traditional, mythic accounts of the origin of death extend back to the earliest hunter-gatherer cultures. Usually these stories are morality tales about faithfulness, trust, or the ethical and natural balance of the elements of the world.

In Asante Culture the death of a person is seen as a blow to the entire community and everybody shares the grief.

According to an African Asante myth, although people did not like the idea or experience of death, they nevertheless embraced it when given the choice, as in the tale of an ancient people who, upon experiencing their first visitation of death, pleaded with God to stop it. God granted this wish, and for three years there was no death. But there were also no births during that time. Unwilling to endure this absence of children, the people beseeched God to return death to them as long as they could have children again.

The death myths of aboriginal Australia vary enormously among clans and linguistic groups. Among most of them, however, death is often attributed to magic, misfortune, or to an evil spirit or act. Occasionally death is presented as the punishment for human failure to complete an assignment or achieve a goal assigned by the gods. Still other stories arise from some primordial incident that strikes at the heart of some tribal taboo. Early myths about death frequently bear these moral messages.

Among the Tiwi of Bathurst and Melville Islands in northern Australia, the advent of death is explained by the Purukapali myth, which recounts a time before death entered the world, when a man lived with his infant son, his wife, and his younger brother. The younger brother was unmarried and had desires for his brother’s wife. He met her alone while she was gathering yams, and they spent the rest of the afternoon in sexual union. During this time, the husband was minding his infant son, who soon became hungry. As the son called for feeding, the husband called in vain for his missing wife. At sunset, the wife and younger man returned to find that the infant son had starved to death. Realizing what had happened, the husband administered a severe beating to his brother, who escaped up to the sky where he became the moon. His injuries can still be seen in the markings of the moon every month. The husband declared that he would die, and, taking the dead infant in his arms, performed a dance—the first ceremony of death—before walking backwards into the sea, never to be seen again.

The Berndts, Australian anthropologists, tell another ancient myth about two men, Moon and Djarbo, who had traveled together for a long while but then fall mortally ill. Moon had a plan to revive them, but Djarbo, believing that Moon’s idea was a trick, rebuffs his friend’s help and soon dies. Moon dies also, but thanks to his plan, he managed to revive himself into a new body every month, whereas Djarbo remained dead. Thus, Moon triumphs over bodily death while the first peoples of that ancient time followed Djarbo’s example, and that is why all humans die.

Death As a Being

None of these stories is meant to suggest that aboriginal people do not believe in spiritual immortality. On the contrary, their lore is rich in accounts of immortal lands. These are accounts of the origin of physical rather than spiritual death.

The idea of death as a consequence of human deeds is not universal. The image of death as a being in its own right is common in modern as well as old folklore. In this mythic vein, death is a sentient being, maybe an animal, perhaps even a monster. Sometimes death is disguised, sometimes not. Death enters the world to steal and silence people’s lives. In Europe during the Middle Ages death was widely viewed as a being who came in the night to take children away. Death was a dark, hooded, grisly figure—a grim reaper—with an insatiable thirst for the lives of children. Children were frequently dressed as adults as soon as possible to trick death into looking elsewhere for prey.

The film industry produced two well-known films, the second a remake of the first, which examined this idea of death as a being who makes daily rounds of collecting the dead: Death Takes a Holiday (1934) and Meet Joe Black (1998), both of which portrayed death as perplexed at his victim’s fear of him. In a wry and ironic plot twist, a young woman falls in love with the male embodiment of death, and it is through an experience of how this love creates earthly attachment that death comes to understand the dread inspired by his appearance.

But the idea of death as a humanlike being is mostly characteristic of traditional folktales that dramatize the human anguish about mortality. By contrast, in the realm of religious ideas, death is regarded less as an identifiable personal being than as an abstract state of being. In the world of myth and legend, this state appears to collide with the human experience of life. As a consequence of human’s nature as celestial beings, it is life on Earth which is sometimes viewed as a type of death. In this way, the question of how death enters the world in turn poses the question of how to understand death as an essential part of the world.

The Garden of Eden

In the book of Genesis, the first man, Adam, wanders through the paradisiacal Garden of Eden. Pitying his solitary nature, God creates the first woman, Eve, from Adam’s rib. Adam and Eve are perfectly happy in the Garden of Eden and enjoy all its bounty with one exception: God prohibits the couple from eating from the Tree of Knowledge.

The Garden of Eden is utopian. Utopia, in its etymological sense, is literally “no place.” It is a perfect, probably spiritual domain for two celestial beings who, bearing the birthmarks of the God who created them, are immortal. These two beings eat from the Tree of Knowledge, which ironically, distracts them from their awareness of God and his omnipresence. As a result of this error, Adam and Eve become the embodiment of forgetfulness of the divine. In other words, they become material beings, as symbolized in their sudden awareness of and shame in their nakedness.

Adam and Eve thus “fall” into the flesh, into the world as it is known, with the entire legacy that embodiment entails: work, suffering, and physical death. Paradoxically, the Tree of Knowledge heralds ignorance of their divine nature, and the fall into flesh signals their sleepwalking indifference to that nature. Human beings therefore need God’s help through the divine mercy of his Son or the sacred texts of the Bible to awaken them to their divine destiny. Without this awakening, the wages of sin are eternal death—an eternal darkness spent in chains of ignorance, a blindness maintained by humans’ attachment to mere earthly concerns and distractions. This famous story thus embodies all the paradoxical elements of creation, implying that human life is actually no life at all, but its opposite: death.

In the kernel of this local creation story lies the archaic analogy of all the great stories about how life is death and death is the beginning of true life. The cycles of life and death are not merely hermeneutic paradoxes across different human cultures, but they are also the fundamental narrative template upon which all the great religions explain how death entered the world and, indeed, became the world.

In Greek mythology, as Mircea Eliade has observed, sleep (Hypnos) and death (Thanatos) are twin brothers. Life is portrayed as a forgetfulness that requires one to remember, or recollect, the structures of reality, eternal truths, the essential forms or ideas of which Plato wrote. Likewise, for postexilic Jews and Christians, death was understood as sleep or a stupor in Sheol, a dreary, gray underworld in the afterlife. The Gnostics often referred to earthly life as drunkenness or oblivion. For Christians, the exhortation was also to wake from the sleep of earthly concerns and desire and to watch and pray. In Buddhist texts, the awakening is a concern for recollection of past lives. The recollection of personal history in the wheel of rebirth is the only hope anyone has of breaking this cycle of eternal return.

Sleep, then, converges with death. Both have been the potent symbols and language used to describe life on earth. It is only through the remembering of human’s divine nature and its purpose, brokered during an earthly life of asceticism or discipline, or perhaps through the negotiation of trials in the afterlife, that one can awaken again and, through this awakening, be born into eternal life.

Modern Accounts

The humanistic trend of twentieth-century social science and philosophy has diverged from this broadly cross-cultural and long-standing view of death as earthly existence and true life as the fruit of earthly death. Contemporary anthropology and psychoanalytic ideas, for example, have argued that these religious ideas constitute a “denial of death.” The anthropologist Ernest Becker and religious studies scholar John Bowker have argued that religions generate creation myths that invert the material reality of death so as to control the anxiety associated with the extinction of personality and relationships.

Like-minded thinkers have argued that philosophical theories which postulate a “ghost in the machine”—a division of the self into a body and a separate spirit or soul—are irrational and unscientific. But, of course, the assumptions underlying these particular objections are themselves not open to empirical testing and examination. Criticism of this kind remains open to similar charges of bias and methodological dogma, and tends, therefore, to be no less speculative than religious views of death.

Beyond the different scientific and religious arguments about how life and death came into the world, and which is which, there are several other traditions of literature about travel between the two domains. Scholars have described the ways in which world religions have accounted for this transit between the two halves of existence—life and death. Often, travel to the “world of the dead” is undertaken as an initiation or as part of a shamanic rite, but at other times and places such otherworldly journeys have been part of ascetic practices of Christians and pagans alike.

In the past half century psychological, medical, and theological literature has produced major descriptions and analyses of near-death experiences, near-death visions, visions or hallucinations of the bereaved, and altered states of consciousness. Research of this type, particularly in the behavioral, social, and clinical sciences, has reignited debates between those with materialist and religious assumptions about the ultimate basis of reality.

Traditionally confined to the provinces of philosophy and theology, such debates have now seeped into the heretofore metaphysics-resistant precincts of neuroscience, psychology, and medicine. What can these modern psychological and social investigations of otherworldly journeys tell experts about the nature of life and death, and which is which?

The religious studies scholar Ioan Peter Couliano argues that one of the common denominators of the problem of otherworldly journeys is that they appear to be mental journeys, journeys into mental universes and spaces. But such remarks say more about the origin of “mental” as a term of reference than the subject at hand. The glib observation that otherworldly journeys may be mere flights of fancy may in fact only be substituting one ambiguous problem with yet another.

As Couliano himself observes, people in the twenty-first century live in a time of otherworldly pluralism—a time when such journeys have parallels in science and religion, in fantasy and fact, in public and private life.

Conclusion

Death has permeated life from the first stirrings of matter in the known universe—itself a mortal phenomenon, according to the prevailing cosmological theory of contemporary physics. Death came incorporated in the birth of the first star, the first living molecules, the birth of the first mammoth, the first cougar, the first human infant, the first human empire, and the youngest and oldest theory of science itself. Early cultures groped with the meaning of death and its relationship to life. The very naming of each, along with the attendant stories and theories, is an attempt to somehow define and thus master these refractory mysteries. All of the major myths about how death entered the world are, in fact, attempts to penetrate below the obvious.

Most have concluded that Death, like Life, is not a person. Both seem to be stories where the destinations are debatable, even within their own communities of belief, but the reality of the journey is always acknowledged—a continuing and intriguing source of human debate and wonderment.

Complete Article HERE!

September 26, 2015September 26, 2015

8 Lies We Need to Give Up About What It Means to Grieve

By Julie Zeilinger

“I live my sadness every day, but I don’t resent it any more,” Zelda Williams recently wrote in an Instagram post about depression and grieving her father, the late Robin Williams. “I do it now so that the wonderful moments of joy I do find are not in order to forget, but to inhabit and enjoy for their own sake.”

Williams is certainly not the only one grappling with the complex process of grief. Most people experience loss at some point in their lives. Yet stigmas and rigid stereotypes about the experience persist. Here are eight lies we need to stop perpetuating about the simultaneously universal yet deeply personal experience of grief.

1. Grief is finite.

8 Lies We Need to Give Up About What It Means to Grieve

“Society as a whole is extremely understanding when it comes to acknowledging that the days immediately following a loss are hard,” Vivian Nunez, founder of the organization Too Damn Young, told Mic. But after the funeral has been planned and final goodbyes said, “the understanding begins to dwindle.”

People are expected to “get over their grief, move on and have closure,” psychologist and grief counselor Heidi Horsley told Mic.

But in reality, grief is an individual process that arguably may never definitively end.

“Loss has a very long arc,” Rebecca Soffer, co-founder and CEO of Modern Loss, told Mic. “It’s something you live with in various forms throughout the rest of your life.”

Though sometimes interminable, grief is a dynamic process that becomes incorporated into one’s life.

“We transform our grief, but we don’t get over it,” Horsley said. Nunez described grief as an emotion that “morphs into something you learn to walk alongside of, but it never goes away.”

2. Grief is a linear progression.

On Grief and Grieving authors Elisabeth Kübler-Ross and David Kessler write that there are five stages of grief: denial, anger, bargaining, depression and acceptance. But while these stages may provide a useful framework, “grief is as individual as our lives,” rather than a concrete, universal timeline.

“There’s a bigger chance of you jumping between stages than there is that you’ll go in order,” Nunez said.

“There’s literally no rhyme or reason to what you’re going to go through because every human being is different, every loss experience is different,” Soffer said. “Loss is a very complex process.” It’s rare to have had complete closure with a loved one before losing them, which means stages of grief can manifest in “a completely haphazard format with endless permutations and combinations,” she added.

3. There’s a “right” way to grieve.

Grieving individuals often feel caught in a double standard of emotionality: Especially beyond a certain age, people are often regarded as cold-hearted if not emotional enough or wallowing if their grief is too palpable. Should they fall somewhere in the middle, as many do, they may feel judged, or misunderstood.

Teens and young adults who participate in the Too Damn Young community often experience this, Nunez said, and feel “ashamed” or like “they’re carrying baggage” when their grief “doesn’t fit a set norm or the one-size-fits-all formula.”

“So many people were expecting me to be crying 24/7,” one community member, 18-year-old Selena, told Mic of her experience after losing her mother. “When I went back to school, everyone was staring at me waiting for me to break down in the middle of the room.”

“The way a person grieves is very much their own to experience,” Nunez said. “Unless you’re harming yourself or others, there’s no wrong way to grieve. No two grief experiences are the same, but there is comfort in knowing we all start from the same place — the simple fact we’ve lost someone.”

Ultimately, “everyone has their own ways of coping, and whatever is working for you is the right way for you,” Selena said. “Don’t feel bad if you aren’t crying all day. Don’t feel bad if you’re not a complete mess.”

4. There’s a right way to support somebody who is grieving.

The single worst thing one can say to somebody who is grieving, according to Horsley? Nothing.

“People feel like if they say something it might upset you, but by saying nothing, you’re not acknowledging that anything ever happened,” Horsley said.

Acting as a sounding board for those experiencing loss may be the best approach, Soffer said. Some may worry that the reminder of their loss will cause more emotional damage, she said, but asking them about the person they lost and asking them to tell stories about them can be helpful to them. That’s the idea behind the Too Damn Young community’s campaign #TellUsAboutThem.

“The goal is to remind people that our loved ones are more than just their deaths, they are the lives and moments they lived before they died,” Nunez said.

5. Either make a sweeping gesture or don’t bother.

There are easy ways one can acknowledge and support others’ loss — like setting a calendar reminder to check in with a grieving friend, Soffer suggests. A simple task like cleaning for them or bringing them dinner can be just as meaningful, if not more, than a concerted, serious conversation about their loss.

Support can also take the form of moderating one’s own reaction to those who are grieving. “You have no idea what’s going on behind closed doors,” Soffer said. “Try and stop yourself if they do something to frustrate you, or are a little obnoxious. Just remember that they’ve gone through something that’s really profoundly sad and life-altering and identity-altering and give them the benefit of the doubt.”

While supportive gestures likes these need not be daunting, Soffer said, they should go beyond a text or a Facebook like. While doing so may make grieving individuals briefly feel better, she encourages people to “use these amazing tools of connectivity to be a trigger for more thoughtful action.”

6. Other factors of one’s identity are irrelevant to their grief.

Gender may uniquely affect one’s response to loss, according to the experts.

“Men tend to grieve shoulder to shoulder, not face to face,” Horsley said. Men “have been socialized to suck it up, walk it off, that real men don’t cry,” she said, but “women haven’t been socialized with those kinds of beliefs.”

Research backs this up: According to a study released by the Comfort Zone Camp, 38% of women, compared to 29% of men strongly agreed that losing a parent in childhood was “the toughest thing [they] ever had to deal with.” While 57% of men who had lost a parent in childhood surveyed agreed that people need to get over death because it’s part of life, only 36% of women agreed.

On the other hand, men who lose their wives “are often unprepared,” Rochester Institute of Technology professor Javier Espinosa, a lead researcher of the study, told the Telegraph. Men’s health may be affected more by losing “their caregiver, someone who cares for them physically and emotionally,” than women who lose their husbands, since “this same mechanism is likely weaker,” Espinosa said.

Age can also be hugely impactful. “There are different challenges that come with grieving as a young person because you’re figuring yourself out a bit more,” Nunez said. “When a significant person in your life dies, you begin to ask the bigger questions at a much younger age. It’s hard to face mortality at an age when you feel as though you and those around you are essentially invincible.”

7. Talking about it is morbid and inappropriate.

“I was once a kid in a classroom, under the age of 20, who had lost her mom, and I never knew anyone else who had,” Nunez said. “This is where having a conversation around grief could significantly impact those who are in the shadows about those they lost.”

Soon after Nunez launched Too Damn Young, she received multiple emails confirming she wasn’t the only one who felt they couldn’t discuss the experience of loss.

Surrounding oneself with others who have experienced loss and sharing those experiences, Horsley said, can be hugely beneficial.

“When you’re with other people who have been there and made it, you know you can too,” she said. “You’re not alone and other people have been on this journey of grief that you’re on. You need to reach out and grieving in community is a great way to find hope.”

8. You should feel guilty about moving on.

“Sometimes we hold on to the pain even longer than we need to because the pain represents that person and the loss, and we feel guilty about moving forward and moving farther away from them, even though the reality is when we’re in a positive space,” Horsely said.

But in reality, moving past grief can be an enlightening experience all its own.

“When you experience a loss like this, you get to see a really wild new amount of life,” NPR producer Rachel Ward wrote in a Medium blog post about her experience losing her husband. “Suddenly the range of the type of sad you can feel, to the type of happy you can feel, is busted open. The spectrum from happy to sad isn’t a foot wide anymore ?—? it’s as far as your arms can stretch and then to the edges of the room and then up the block and over into the next neighborhood.”

Ultimately, Ward noted, grief — and life more generally — is not about seeking or even achieving constant contentment. Rather, she wrote, she found that accepting the feeling of “being uncomfortable is a very effective way to be a human.”

Complete Article HERE!

September 24, 2015September 23, 2015

Deeply religious Jimmy Carter embraces cutting edge science in cancer battle

By David Warmflash

Listening to the 90-year-old Jimmy Carter’s press conference last month concerning his battle with cancer, one might assume his pre-political career to have been in medicine, rather than nuclear physics for the U.S. Navy’s early nuclear submarine program. Not only did the former president explain his surgery in terms of the precise volume of liver tissue resected and the size of the four metastatic lesions in his brain shown on his MRI, but he also outlined the treatment plan.

Importantly, in response to more than one question regarding whether, due to his religion beliefs, age, or other reasons, he ever considered something other than what his doctors — topic specialists in oncology, surgical oncology, and radiation oncology — were recommending, he replied with a resounding “no”. Despite talking frequently about his religious faith, despite teaching Bible classes to kids on Sundays in his hometown church, Carter will do what he can to prevent nature from running its malignant course. He will not sink into the gutter of alternative, faith-based medicine, but quite the contrary. He his put his fate in the hands of science. In his case, that means immunotherapy, which currently is showing promise for just a handful of cancerous conditions, but that includes the one he has, melanoma. It also radiation therapy, targeted very precisely to the four lesions in his brain.

What the treatment will mean for Carter’s prognosis is not something that can be answered with great precision, given the small amount of information that’s been released about his condition thus far. What is both public and improves his prospects is the fact that the four brain metastases are tiny, approximately 2 mm each, and the fact that it’s a cancer that responds to the immunotherapy drug that he’s getting. On the other hand is a concern that other metastases may yet turn up in other parts of his body. Either way, however, Jimmy Carter apparently plans to make his battle with cancer very public, and potentially this can do a lot for cancer awareness that ultimately can save many lives.

Carter’s diagnosis

In recent years, health-centered media have done a fairly good job at making people aware of malignant melanoma. For this reason, the public has a fairly accurate image of melanoma as a type of skin cancer, in fact the most deadly type. Many people are aware that a change in in a mole or the appearance of a new, dark mark on the skin is not something to ignore, but something to have examined by a dermatologist and biopsied. But what’s not well known is that approximately 2 percent of melanomas begin deep inside the body, not in the skin. These internal melanomas come from melanocytes, the same types of cells that cause cutaneous melanoma. But, unlike cutaneous melanoma on Sun-exposed areas, you cannot prevent internal melanomas by controlling your Sun exposure, nor can you see them in an early stage with your own eyes.

In President Carter’s case, the only reason why doctors found his melanoma, initially in the liver, is that he had an abdominal magnetic resonance imaging (MRI) scan as part of a comprehensive exam after developing a very bad cold. After approximately 10 percent of his liver was resected biopsied, it was confirmed that the liver lesion was cancer, and specifically it was melanoma. However, the testing also showed that it had been removed with clear margins of healthy tissue around it, meaning that the rest of the organ was in good shape.

In a certain sense, the melanoma diagnosis after surgery was a relief for Carter, because initial presentation had looked as though it could have been pancreatic cancer, which runs in Carter’s family. His father, two sisters, and brother all died from it, and the liver is commonly a presentation site, even though it starts in the pancreas. But Carter’s doctors had a high level of suspicion that the melanoma had not started in the liver, that the liver lesion was a metastasis from another site. Consequently, they ordered more MRI scanning. This revealed the four spots in his brain and it’s the reason why some media outlets have referred to Carter’s condition rather inaccurately as “brain cancer”.

Different types of cancer affect the brain

What President Carter has is not “brain cancer”. It’s metastasis to the brain from somewhere else. Metastasis by cancers starting somewhere else actually is the most common kind of cancer to have in the brain. However, it’s important to distinguish brain metastasis from malignant tumors that arise in the brain itself. One category of primary brain malignancies is glioblastoma, which kills approximately 15,000 adults in the US each year and is the brain malignancy that Vice President Biden’s son, the late Beau Biden, may have had, based on reasonable speculation by the Washington Post.

It’s particularly important to raise awareness about brain malignancy and where state-of-the art medicine is at present, in light of a scientifically illiterate and extremely paranoid accusation made last June by writer Mike Adams of the pseudoscience publication Natural News. After outlining his opinion that the younger Biden was “killed by a combination of chemotherapy, radiation, and glyphosate”, Adams went on to slam the field of oncology with a string of accusations and insults:

Oncologists who prescribe chemotherapy drugs earn massive profits from those drugs, all while failing to disclose their own conflicts of interest to their patients. Unfortunately, chemotherapy kills far more people than it saves because its primary side effect is recurring cancer. Yes, chemotherapy causes cancer. And the ignorant oncologists who prescribe it actively encourage patients to avoid protecting their healthy cells with nutritional therapies such as medicinal mushrooms, anti-cancer foods and healthy oils such as cod liver oil. In fact, oncology as practiced today is a barbaric medical practice that quite literally kills people by the hundreds of thousands each year…Beau, it seems, was handed over to the conventional cancer industry which, sadly, told him he had a “clean bill of health” just 18 months before the cancer surged back… almost certainly worsened by the chemotherapy itself.

After attributing Beau Biden’s death to chemotherapy, Adams goes on to blame the herbicide glyphosate (an analog of the amino acid glycine) — and indirectly Hillary Clinton and others who support biotechnology companies — for Biden’s developing the malignancy in the first place. The possibility of a glyphosate-cancer connection has been addressed, and shown to be highly speculative, on the Genetic Literacy Project and other news outlets, but here we can address Adams’ alarmist assertions regarding conventional oncology treatments, and chemotherapy in particular.

Chemotherapy saves lives

There are two things that Adams got right, although he wrote about them so far out of context that they can do nothing but mislead the readers. First of all, people do receive chemotherapy and then die, and often this happens after they initially start to get better after following a cancer diagnosis; they go into what is called remission, but often the remission does not turn into a cure. That happens because many types of cancer respond well at first to certain cancer drugs, and then more resistant cancer cells take over.

What Adams didn’t say is that with many types of cancer, today the incidence of the cancer coming back after initial remission is reduced compared with a half century ago, because of increasing understanding of how the chemotherapy drugs work, increased capabilities of new chemotherapy drugs, and because of the development of systematic protocols for using particular chemotherapeutic “cocktails” of different agents. Adams also didn’t say that reason why patients die when cancer comes back after a remission is not that chemotherapy causes new cancer. He implied that in his article, but it’s completely false. What comes back is the same cancer that the patient had before.

The second thing that Adams got right is that many chemotherapy drugs can themselves cause cancer. As explained above, it’s not the same cancer that comes back within weeks or months in cases when chemotherapy doesn’t get rid of a cancer. Instead, the correct but out-of-context fact is that there are cancer drugs that can cause secondary malignancies decades later. This is particularly true of a category of anti-cancer drugs called alkylating agents. This is a huge issue in oncology, particularly in cases of people who are treated with those drugs for childhood cancers, who are then at elevated risk for other cancers decades later.

But what Adams did not say–what makes it extremely out of context–is the reason why we know about secondary malignancies caused by certain chemotherapy agents. We know about it because there is an increasing number of survivors of childhood, teenage, and young adult cancers who are walking around today and sometimes developing cancer 20, 30, or 40 years after chemotherapy, radiation, and surgery cured them of the cancer they had in their youth, that otherwise would have killed them.

In the 1940s and 50s, cancers, such as acute lymphoblastic leukemia (ALL) in children and Hodgkin lymphoma in teenagers and young adults, were nearly complete death sentences. But today, most of the kids diagnosed with these two conditions survive, and they survive because of chemotherapy. How did this happen? By the 1960s, oncologists had just a handful of chemotherapeutic agents. Sometimes, they worked a little for certain cancers. People got better, or went into remission for a little while, and a small fraction were actually cured. Overall, the cure rate was dismal, but then researchers started noticing that the cure rates varied a great deal from medical center to medical center. Different oncology teams were using and dosing the different drugs in slightly different ways. Some were combining more than one drug but the combinations also varied between institution.

Thus, in the 1960s and 70s, oncologists and scientists started having cancer teams report what their cases and treatments very systematically, and they started looking at the outcomes of different drugs, alone and in combination with other drugs, for different types of cancers.

What grew out of this approach was a knowledge base founded on the collective experience of oncologists around the world. This led to very particular protocols for combined chemotherapy cocktails for specific types of cancer. As the various cocktails were being developed, various new drugs were also introduced to mitigate the side effects, thereby allowing for more aggressive doses. Depending on the type of cancer, and the locations within the body, the chemotherapy protocols are also combined with radiation therapy and surgery, along with other types of drugs.

All of this together has given oncologists the ability to kill off cancer to the point that it does not come back, because any cell that happens to be resistant to one agent is killed by another agent, or by the radiation, or, if the tumor mass gets low enough, by the patient’ own immune system. Thus, while chemotherapy armaments today do include many old drugs used unsuccessfully 70 years ago, they way they are used today is very different, and for a bunch of cancers the rate of survival has increased significantly. At the same time, radiation oncology has also gone through major advances. Not only is the power of radiation that can be delivered to a tumor gone up steadily, but the targeting has gotten better, due to precise imaging with technologies such as MRI and computed tomography (CT) and nuclear medicine techniques. Also, the shielding has improved, which makes a huge difference, allowing delivery of powerful radiation only where it is needed while sparing healthy tissues.

Importantly, one of the main factors affecting survival is matching the precise staging of the cancer (where and to what extent is has spread in the body) to the appropriate treatment. Today, the staging is more precise that it used to be, because of improved diagnostic capability, and that is improving survival as well.

President Carter’s Treatment Plan

Based on what information is available, President Carter is now receiving radiation to the four metastases in his brain. There is a very good chance that all four lesions will be eliminated from his brain with minimal side effects, because of the small size of the lesions, the precise targeting, the high tech shielding, and because of one other reason: special agents can be given that will make the brain metastases more sensitive to radiation. Carter is also getting treatment with pembrolizumab, which is being called abreakthrough drug. It works by boosting the immune system, and therefore is part of an emerging type of therapy known as immunotherapy. Currently, immunotherapy has limited use for cancer across the board, but melanoma is one type of cancer where immunotherapy is showing particular promise.

Complete Article HERE!

September 23, 2015September 21, 2015

Sexuality and Illness – Breaking the Silence

By: Anne Katz PhD

Sexuality is much more than having sex even though many people think only about sexual intercourse when they hear the word. Sexuality is sometimes equated with intimacy, but in reality, sexuality is just one way that we connect with a spouse or partner we love (the true meaning of intimacy). Our sexuality encompasses how we see ourselves as men and women, who we are attracted to emotionally and physically, what turns us on (eroticism), our thoughts and fantasies, and yes, also what we do when we are sexually active, either alone or with a partner. Our sexuality is connected to our image of ourselves and it changes over the years as we age and face threats from illness and disability and, eventually, the end of life.

Am I still a sexual being?

Illness can affect our sexuality in many different ways. The side effects of treatments for many diseases, including cancer, can cause fatigue. This is often identified as the number one obstacle to sexual activity. Other symptoms of illness such as pain can also affect our interest in being sexually active. But there are other perhaps more subtle issues that impact how we feel about ourselves and, in turn, our desire to be sexual with a partner or alone, or if we even see ourselves as sexual beings. Think about surgery that removes a part of the body that identifies us as female or male. Many women state that after breast cancer and removal of a breast (mastectomy), they no longer feel like a woman; this affects their willingness to appear naked in front of a partner. Medications taken to control advanced prostate cancer can decrease a man’s sexual desire. Men in this situation often forget to express their love for their partner in a physical way, no longer touching them, kissing them, or even holding hands. This loss of physical contact often results in two lonely people. Humans have a basic need for touch; without that connection, we can end up feeling very lonely.

Just talk about it!

Communication lies at the heart of sexuality. Talk to your partner about what you are feeling, how you feel about your body, and what you want in terms of touch. Ask how you can meet your partner’s needs for touch and affection. The most important thing you can do is to express yourself in words. Non-verbal communication and not talking are open to misinterpretation and can lead to hurt feelings. Our sexuality changes with age and time and illness; we may not feel the same way about our bodies or our partner’s body that we did 20, 30 or more years ago. That does not mean we feel worse – with age comes acceptance for many of us – but we do need to let go of what was, and look at what is and what is possible.

The role of health care providers

Health care providers should be asking about changes to sexuality because of illness or treatment, but they often don’t. They may be reluctant to bring up what they see as a sensitive topic and think that if it’s important to the patient, then he or she will ask about it. This is not good. Patients often wait to see if their health care provider asks about something and if they don’t, they think that it’s not important. This results in a silence and leaves the impression that sexuality is a taboo topic.

Some health care providers are afraid that they won’t know the answer to a question about sexuality because nursing and medical schools don’t provide much in the way of education on this topic. And some health care providers appear to be too busy to talk about the more emotional aspects of living with illness. This is a great pity as sexuality is important to all of us – patients, partners, health care providers. It’s an important aspect of quality of life from adolescence to old age, in health and at the end of life when touch and love are so important.

Ask for a referral

If you want to talk about this, just do it! Tell your health care provider that you want to talk about changes in your body or your relationship or your sex life! Ask for a referral to a counselor or sexuality counselor or therapist or social worker. It may take a bit of work to get the help you need, but there is help.

Complete Article HERE!

September 22, 2015September 22, 2015

Sexuality at the End of Life

By Anne Katz RN, PhD

In the terminal stages of the cancer trajectory, sexuality is often regarded as not important by health care providers. The need or ability to participate in sexual activity may wane in the terminal stages of illness, but the need for touch, intimacy, and how one views oneself don’t necessarily wane in tandem. Individuals may in fact suffer from the absence of loving and intimate touch in the final months, weeks, or days of life.

It is often assumed that when life nears its end, individuals and couples are not concerned about sexual issues and so this is not talked about. This attitude is borne out by the paucity of information about this topic.

Communicating About Sexuality with the Terminally Ill

Attitudes of health care professionals may act as a barrier to the discussion and assessment of sexuality at the end of life.

We bring to our practice a set of attitudes, beliefs and knowledge that we assume applies equally to our patients.
We may also be uncomfortable with talking about sexuality with patients or with the idea that very ill patients and/or their partners may have sexual needs at this time.
Our experience during our training and practice may lead us to believe that patients at the end of life are not interested in what we commonly perceive as sexual. How often do we see a patient and their partner in bed together or in an intimate embrace?
We may never have seen this because the circumstances of hospitals and even hospice may be such that privacy for the couple can never be assured and so couples do not attempt to lie together.

For the patient who remains at home during the final stages of illness the scenario is not that different. Often the patient is moved to a central location, such as a family or living room in the house and no longer has privacy.

While this may be more convenient for providing care, it precludes the expression of sexuality, as the patient is always in view.
Professional and volunteer helpers are frequently in the house and there may never be a time when the patient is alone or alone with his/her partner, and so is not afforded an opportunity for sexual expression.

Health care providers may not ever talk about sexual functioning at the end of life, assuming that this does not matter at this stage of the illness trajectory.

This sends a very clear message to the patient and his/her partner that this is something that is either taboo or of no importance. This in turn makes it more difficult for the patient and/or partner to ask questions or bring up the topic if they think that the subject is not to be talked about.

Sexual Functioning At The End Of Life

Factors affecting sexual functioning at the end of life are essentially the same as those affecting the individual with cancer at any stage of the disease trajectory. These include:

Psychosocial issues such as change in roles, changes in body- and self-image, depression, anxiety, and poor communication.
Side effects of treatment may also alter sexual functioning; fatigue, nausea, pain, edema and scarring all play a role in how the patient feels and sees him/herself and how the partner views the patient.
Fear of pain may be a major factor in the cessation of sexual activity; the partner may be equally fearful of hurting the patient.

The needs of the couple

Couples may find that in the final stages of illness, emotional connection to the loved one becomes an important part of sexual expression. Verbal communication and physical touching that is non-genital may take the place of previous sexual activity.

Many people note that the cessation of sexual activity is one of the many losses that result from the illness, and this has a negative impact on quality of life.
Some partners may find it difficult to be sexual when they have taken on much of the day-to-day care of the patient and see their role as caregiver rather than lover.
The physical and emotional toll of providing care may be exhausting and may impact on the desire for sexual contact.
In addition, some partners find that as the end nears for the ill partner, they need to begin to distance themselves. Part of this may be to avoid intimate touch. This is not wrong but can make the partner feel guilty and more liable to avoid physical interactions.

Addressing sexual needs

Couples may need to be given permission to touch each other at this stage of the illness and health care providers may need to consciously address the physical and attitudinal barriers that prevent this from happening.

Privacy issues need to be dealt with. This includes encouraging patients to close their door when private time is desired and having all levels of staff respect this. A sign on the door indicating that the patient is not to be disturbed should be enough to prevent staff from walking in and all staff and visitors should abide by this.
Partners should be given explicit permission to lie with the patient in the bed. In an ideal world, double beds could be provided but there are obvious challenges to this in terms of moving beds into and out of rooms, and challenges also for staff who may need to move or turn patients. Kissing, stroking, massaging, and holding the patient is unlikely to cause physical harm and may actually facilitate relaxation and decrease pain.
The partner may also be encouraged to participate in the routine care of the patient. Assisting in bathing and applying body lotion may be a non-threatening way of encouraging touch when there is fear of hurting the patient.

Specific strategies for couples who want to continue their usual sexual activities can be suggested depending on what physical or emotional barriers exist. Giving a patient permission to think about their self as sexual in the face of terminal illness is the first step. Offering the patient/couple the opportunity to discuss sexual concerns or needs validates their feelings and may normalize their experience, which in itself may bring comfort.

More specific strategies for symptoms include the following suggestions.

Timing of analgesia may need to altered to maximize pain relief and avoid sedation when the couple wants to be sexual. Narcotics, however, can interfere with arousal which may be counterproductive.
Fatigue is a common experience in the end stages of cancer and couples/individuals can be encouraged to set realistic goals for what is possible, and to try to use the time of day when they are most rested to be sexual either alone or with their partner.
Using a bronchodilator or inhaler before sexual activity may be helpful for patients who are short of breath. Using additional pillows or wedges will allow the patient to be more upright and make breathing easier.
Couples may find information about alternative positions for sexual activity very useful.
Incontinence or the presence of an indwelling catheter may represent a loss of control and dignity and may be seen as an insurmountable barrier to genital touching.

It is important to emphasize that there is no right or wrong way of being sexual in the face of terminal illness; whatever the couple or individual chooses to do is appropriate and right for them. It is also not uncommon for couples to find that impending death draws them much closer and they are able to express themselves in ways that they had not for many years.

Complete Article HERE!

September 21, 2015September 20, 2015

Cultural Aspects of Death and Dying

by Marcia Carteret

While the end of life experience is universal, the behaviors associated with expressing grief are very much culturally bound. Death and grief being normal life events, all cultures have developed ways to cope with death in a respectful manner, and interfering with these practices can disrupt people’s ability to cope during the grieving process. While health care providers cannot be expected to know the mourning ceremonies and traditions of each family’s culture, understanding some basics about how different cultures may prepare for and respond to death is important. Though difficult to ask, there are crucial questions that need to be part of conversations between doctors and nurses and families. For example:

What are the cultural rituals for coping with dying, the deceased person’s body, the final arrangements for the body and honoring the death?

What are the family’s beliefs about what happens after death?

What does the family consider to be the roles of each family member in handling the death?
Who should the doctor talk to about test results or diagnosis?
Are certain types of death less acceptable (for example, suicide) or are certain types of death especially hard to handle for that culture (for example, the death of a child – this example may seem too obvious, but in countries with high infant mortality, there are indeed different attitudes about the loss of children.)3

This list of questions is so important because patients and families should be viewed as a source of knowledge about their special/cultural needs and norms – but health care professionals sometimes are at a loss about what to ask under such trying circumstances. There is perhaps no area where reliance on cultural reference books is less useful. The degree of acculturation is absolutely paramount in determining the beliefs and traditions a family will follow when coping with impending death, post-death arrangements and mourning. While we can find many similarities across cultures, such as wearing black as a sign of mourning, there are always exceptions. In China, for example, white is the color of death and mourning. Part of why the degree of acculturation is highly significant is that blending belief systems becomes more pronounced in highly acculturated persons. There are places in the world where accommodation is made for multiple faiths. For example, in Nigeria there is a triple heritage of Christianity, Islam, and ancestor worship2. Similar blending can be found in Caribbean nations and Mexico where Catholicism can be mixed with indigenous folk beliefs like Voodoo and Curanderismo. Another layer of expectation comes with living in the United States culture and relying on the Western medical culture. The mix of cultural/religious attitudes and behaviors surrounding death and dying can become very complex indeed. And when a death actually occurs, some individuals suddenly choose to break with tradition entirely, often creating chaos within families.

Burial ceremony of late Hassan Fanstastic at Baqdaad Village, outskirts of Mogadishu. Hassan was the Director of local Radio and Television Shabelle. He became the Shabelle Director killed since 2007. He was Murdered on Saturday 28 January, 2012 near his home in Wadajir district.

What follows in this article are some important points of consideration, but the list is introductory in nature at best. There is a strong focus on religions because religion can be thought of as a cultural system of meaning that helps to solve problems of uncertainty, powerlessness, and scarcity that death creates. In placing death within a religious perspective, bereaved persons find meaning for an event that for many is inexplicable.1 (Each underlined heading is a link to further resources for readers.)

Monotheistic Religions: Especially since the events of 911 changed many people’s views of Muslims, it is important to be aware that Christians and Muslims both believe death is a transition to a more glorious place and both believe in the sovereignty of a God (Allah) in matters of loss and take consolation in phrases such as “Allah giveth and Allah taketh away.” Both are also faiths springing from a single scripture, founder or sacred place. Readings from the Koran or Bible are important parts of the recognizing the departure of a loved one from this life. Similarly, in the Jewish faith, there is the expression mourners recite a few minutes before a funeral begins: “The Lord has given and the Lord has taken, blessed be the name of the Lord.” Both Muslims and Christians believe in the afterlife and view worldly life much in terms of preparing for eternal life. In the Jewish tradition, the focus is on the purpose of earthly life, which is to fulfill one’s duties to god and one’s fellow man. Succeeding at this brings reward, failing at it brings punishment.

The traditions around death and dying differ greatly across all three major monotheistic religious systems (as well as within different branches of each faith, i.e. Jehovah’s Witnesses and Mormonism in Christianity). They are highly nuanced and very hard for outsiders to understand thoroughly. Key rituals and practices that differ widely between religions include the preparation of the deceased person’s body, the permissibility of organ donation, and the choosing of cremation vs. burial.

Ancestor Worship: The premise of ancestor worship is based on understanding that the course of life is cyclical not linear. Those who are dead may not be seen physically, but are alive in a different world and/or can reincarnate in new births. Ancestor worship in various forms can be found in many parts of the world and is very strong in parts of Africa and Asia. Many Native Americans and Buddhists alike believe that the living co-exist with the dead. A central theme in all ancestor worship is that the lives of the dead may have supernatural powers over those in the living world – the ability to bless, curse, give or take life. In some cultures, worship of the dead is important, and includes making offerings of food, money, clothing, and blessings. In China there is the annual observance of “sweeping the graves” and as its name denotes, it is a time for people to tend the graves of the departed ones. In Mexico, there is The Day of the Dead (Dia de los Muertos), a holiday that focuses on gatherings of family and friends to pray for and remember those who have died. The Day of the Dead is also celebrated by many Latin Americans living in the U.S. and Canada. The intent of the celebration is to encourage visits by the souls of the departed so that those souls will hear the prayers and the comments of the living directed at them. It makes sense that in cultures where ancestor worship is common, the acceptance of organ donation and cremation may be low.

Buddhism and Hinduism: Hinduism does not have roots springing from a single scripture, founder or sacred place. It is more like an umbrella term describing a set of philosophies and ways of life. Buddhism has a single founder, but the Buddha is not prayed to in the same sense as a God or Allah. Buddhism is also a set of philosophies for living. There are marked differences between the two, or course, but in both death is not seen as the end of life; it is merely the end of the body we inhabit in this life. The spirit remains and will seek attachment to a new body and a new “life” – in Buddhism it is called a “kulpa,” which is a unit of time. Where a given person will be born again is a result of the past and the accumulation of positive and negative action, and the result of karma. Followers of both traditions keep in mind the impermanence of life. The transition of a soul to a new life is very important so both traditions observe specific rituals at the time of dying and the handling of the body. The corpse of a Buddhist should not be touched for 3-8 hours after breathing ceases as the spirit lingers on for some time. Hindus believe the body of the dead must be bathed, massaged in oils, dressed in new clothes, and then cremated before the next sunrise. It follows that cremation would be acceptable in a faith where the soul will be released to find another body to inhabit.

Truth-telling to Patients: In collectivist cultures, the good of the individual is often so enmeshed with the good of the family or in-group that family members may have a greater say in health care decisions than the patient does in some circumstances. In many countries, family members may become very upset if a physician reveals bad news directly to the patient. Families and patients may place great value on the right NOT to know! This is completely at odds with the standards set forth in the Patient Self Determination Act http://en.wikipedia.org/wiki/Patient_Self-Determination_Act which secures certain rights legally for all patients in the U.S. The health care system needs to be flexible enough to accommodate communication patterns that look different from those within the informed-consent tradition which insists doctors and nurses tell patients everything. So, a key question in cross-cultural health care situations would be: Who do you want me to talk to about test results or diagnosis?

Expressions of Grief: In some cultures, showing grief, including wailing, is expected of mourners because the more torment displayed and the more people crying, the more the person was loved. In other cultures, restraint is expected. Rules in Egypt and Bali, both Islamic countries, are opposite; in Bali women may be strongly discouraged from crying, while in Egypt women are considered abnormal if they don’t nearly incapacitate themselves with demonstrative weeping. In Japan, it is extremely important not to show one’s grief for a number of reasons. Death should be seen as a time of liberation and not sorrow, and one should bear up under misfortune with strength and acceptance. One never does anything to make someone else uncomfortable. In Latino cultures, it may be appropriate for women to wail, but men are not expected to show overt emotion due to “machismo.” In China, hiring professional wailers may be customary in funerals, which may sound odd, but this was also a common practice in Victorian England.

Conclusion: For health care professionals, providing culturally sensitive bereavement/end of life care is understandably an issue of discomfort. Language and cultural barriers obviously compound the challenges of being professionally appropriate and compassionate. Patients and families may be in need of compassion, advice, and guidance from doctors and nurses, but often the realities of a given situation include a press for time and both physical and emotional exhaustion among providers and families. It happens – sometimes we simply fail, in the moment, to express sufficient sensitivity and warmth when critical decisions must be made. The clinical facts are immediate and demand logical linear thinking which is natural for those trained in the Western medical tradition. For many cultures, such a direct approach may seem harsh, and decisions about something like organ donation might be experienced as inhumane immediately upon death. The questions suggested in this article can be used to ease some of the communication challenges and facilitate more openness between health care professionals and families around death and dying. Of course they should be tailored to the context of a given situation.

Complete Article HERE!

September 20, 2015September 20, 2015

As Alzheimer’s Symptoms Worsen, Hard Conversations About How To Die

By Rebecca Hersher

Six years after he was diagnosed with early onset Alzheimer's disease, Greg O'Brien is thinking differently about the future. Even as he fights to hold onto his memory, he and his wife Mary Catherine are discussing how to let go. — Six years after he was diagnosed with early onset Alzheimer’s disease, Greg O’Brien is thinking differently about the future. Even as he fights to hold onto his memory, he and his wife Mary Catherine are discussing how to let go.

In this installment of NPR’s series Inside Alzheimer’s, we hear from Greg O’Brien about his decision to forgo treatment for another life-threatening illness. A longtime journalist in Cape Cod, Mass., O’Brien was diagnosed with early onset Alzheimer’s disease in 2009.

These days, Greg O’Brien is thinking differently about the future. It’s been six years since his Alzheimer’s diagnosis, and he’s shared with NPR listeners a lot about his fight to maintain what’s left of his memory. He’s shared his struggles with losing independence, and with helping his close-knit family deal with his illness.

What O’Brien hasn’t wanted to talk about until now is the diagnosis he got two weeks before he and his family learned he had Alzheimer’s disease: O’Brien also has stage 3 prostate cancer. Now, as his Alzheimer’s symptoms worsen, the cancer is increasingly on his mind.

“I just don’t know how much longer I can keep putting up this fight,” he says.

This summer, Greg and his wife, Mary Catherine O’Brien, have started talking about how he wants to spend the final years of his life — and what Greg calls his “exit strategy.”

He hopes the cancer will kill him before the Alzheimer’s disease completely robs him of his identity.

Recently Greg sat down with his close friend and primary care physician, Dr. Barry Conant, and with Mary Catherine, to talk about that decision and about Greg’s prognosis.

Interview Highlights

Dr. Barry Conant on the ethics of not treating Greg’s prostate cancer

I think honestly, in a perverse kind of a way, it gives you solace.

Maybe it will shorten the period in your life which you find right now to be something you want to avoid, and so far you’re only talking about neglect of a potentially terminal condition.

If you decided to be more proactive, that’s where the discussion becomes more interesting. Some people would say I’m violating my Hippocratic oath by discussing that, but I think — I don’t feel uncomfortable having that discussion. And, while you still have the ability to reason, it wouldn’t be a bad discussion to have with your family.

Conant — who, like O’Brien, has cancer — consoles Greg that his family will be OK

Nobody is indispensable — nobody. And if you or I were to immediately vanish from the Earth, our families would do fine. They have family support. They have friends’ support. They’re in a nice community. It’s a terrible sense of loss that they’ll have, but they will do fine. And if they’re honest with themselves, they’d realize that they’re going to do fine.

Greg and Mary Catherine discuss Greg’s prognosis

Mary Catherine: Going through Alzheimer’s, it’s not the plan.

Greg: Where do we go from here?

Mary Catherine: That I don’t know. …

Greg: It’s getting so frustrating for me. I mean I care, obviously, deeply about you and the kids. I could see 3 or 4 more years of this, but I can’t keep the fight up at this level. We talked about that the other night. How did you feel about that?

Mary Catherine: Wow … (chokes up). I don’t want to talk about it.

Greg: Can you see it coming?

Mary Catherine: Yeah, I can. Fast.

Greg: Are you OK with me not treating the prostate cancer?

Mary Catherine: Only because you’re OK with it. You need that exit strategy, and the exit strategy with Alzheimer’s is horrible. Well, they’re both horrible.

Greg: You know I’ve been there with my grandfather and mother, and don’t want to take my family and friends to that place.

Mary Catherine: Right. I know. I understand.

Greg: Do you still love me, dear?

Mary Catherine: Yes, I do, dear.

Greg: I love you, too.

Complete Article HERE!