How Anticipatory Grief Differs From Grief After Death

by Lynne Eldridge, MD

Anticipatory grief, or grief that occurs before death, is common among people who are facing the eventual death of a loved one or their own death. Yet, while most people are familiar with the grief that occurs after a death (conventional grief), anticipatory grief is not often discussed.

Because of this, some people find it socially unacceptable to express the deep pain they are experiencing and fail to receive the support they need. What is anticipatory grief, what symptoms might you expect, and how can you best cope at this difficult time?

As a quick note, this article is directed more to someone who is grieving the impending loss of a loved one, but preparatory grief is also experienced by the person who is dying.

Hopefully, this article (as well as another on how to cope with anticipatory grief later on), will be helpful to both those who are dying and those who are grieving a loved one’s imminent death.

What Is Anticipatory Grief?

Anticipatory grief is defined as grief that occurs before death (or another great loss) in contrast to grief after death (conventional grief). Rather than death alone, this type of grief includes many losses, such as the loss of a companion, changing roles in the family, fear of financial changes, and the loss of dreams of what could be.

Grief doesn’t occur in isolation. Often the experience of grief can bring to light memories of other episodes of grief in the past.

Differences From Grief After Death

Anticipatory grief can be similar to grief after death but is also unique in many ways. Grief before death often involves more anger, more loss of emotional control, and atypical grief responses.

This may be related to the difficult place—the “in-between place” people find themselves in when a loved one is dying. One woman remarked that she felt so mixed up inside because she felt she kept failing in her attempt to find that tender balance between holding on to hope and letting go.

Not everyone experiences anticipatory grief, and it is not good or bad to do so. Some people experience very little grief while a loved one is dying, and in fact, find they don’t allow themselves to grieve because it might be construed as giving up hope. Yet for some people, the grief before the actual loss is even more severe.

A study of Swedish women who had lost a husband found that 40% of the women found the pre-loss stage more stressful than the post-loss stage.1

For those who are dying, anticipatory grief provides an opportunity for personal growth at the end of life, a way to find meaning and closure. For families, this period is also an opportunity to find closure, to reconcile differences, and to give and grant forgiveness. For both, it is a chance to say goodbye.

One person related that the night their grandmother died they were lying in bed with her. She turned to them and said, “We’ll miss each other,” and hugged them. It was her goodbye gift.

Family members will sometimes avoid visiting a dying loved one. The comments they make include, “I want to remember my loved one the way they were before cancer,” or “I don’t think I can handle the grief of visiting.” But anticipatory grief in this setting can be healing.

One study found that anticipatory grief in women whose husbands were dying from cancer helped them find meaning in their situation prior to their husband’s deaths.1

Though anticipatory grief doesn’t necessarily make the grieving process easier, in some cases it can make death seem more natural. It’s hard to let our loved ones go. Seeing them when they are weak and failing and tired makes it maybe just a tiny bit easier to say, “it’s OK for you to move on to the next place.”

Does It Help Grieving Later On?

Grief before death isn’t a substitute for grief later on, and won’t necessarily shorten the grieving process after death occurs. There is not a fixed amount of grief that a person experiences with the loss of a loved one. And even if your loved one’s health has been declining for a long time, nothing can really prepare you for the actual death.

Yet, while anticipatory grieving isn’t a substitute or even a head-start for later grieving, grieving before death does provide opportunities for closure that people who lose loved ones suddenly never have.

Symptoms

The emotions that accompany anticipatory grief are similar to those which occur after a loss but can be even more like a roller coaster at times. Some days may be really hard. Other days you may not experience grief at all.

Listed are some of the typical emotions associated with anticipatory grief. That said, keep in mind that everyone grieves differently:

  • Sadness and tearfulness: Sadness and tears tend to rise rapidly and often when you least expect. Even small things, such as a television commercial may be a sudden and painful reminder your loved one is dying; almost as if it is again the first time you are aware of your impending loss.
  • Fear: Feelings of fear are common and include not only the fear of death but fear about all of the changes that will be associated with losing your loved one.
  • Irritability and anger: You may experience anger yourself, but it can also be difficult coping with a dying loved one’s anger.
  • Loneliness: A sense of intense loneliness is often experienced by the close family caregivers of someone dying from cancer. Unlike grief after a loss, the feeling that it’s not socially acceptable to express anticipatory grief can add to feelings of isolation.
  • A desire to talk: Loneliness can result in a strong desire to talk to someone—anyone—who might understand how you feel and listen without judgment. If you don’t have a safe place to express your grief, these emotions can lead to social withdrawal or emotional numbness to protect the pain in your heart.
  • Anxiety: When you are caring for a loved one who is dying, it’s like living in a state of heightened anxiety all of the time. Anxiety, in turn, can cause physical symptoms such as tremulousness, palpitations, and shaking.
  • Guilt: The time prior to a loved one’s death can be a time of great guilt—especially if they are suffering. While you long for your loved one to be free of pain, you fear the moment that death will actually happen. You may also experience survivor guilt because you will continue with your life while they will not.
  • Intense concern for the person dying: You may find yourself extremely concerned about your loved one, and this concern can revolve around emotional, physical, or spiritual issues.
  • Rehearsal of the death: You may find yourself visualizing what it will be like to have your loved one gone. Or if you are dying, visualizing how your loved ones will carry on after your death. Many people feel guilty about these thoughts, but they are very normal and are part of accepting the inevitability of death.
  • Physical problems: Physical problems such as sleep difficulty and memory problems. Learn more about the physical toll of grief.
  • Fears of loss, compassion, and concern for children: One study found that fears about what was going to happen and how they would be cared for were very strong in children who are facing the death of a parent or grandparent.2

While you may have heard of the stages of grief and the four tasks of grieving, it’s important to note that most people do not neatly follow these steps one by one and find that they wake up one morning feeling they have accepted what has happened and have recovered.

Instead, any of these stages may be present at any one time and you may find yourself re-experiencing the same feelings of shock, questioning, or despair many times over. As noted above, there is no right way to feel or grieve.

Treatment and Counseling

Anticipatory grief is a normal process in the continuum of grief. But in some cases, this grief can be so intense that it interferes with your ability to cope. It’s also common for people to develop depression when faced with all of the losses surrounding grief and it can be difficult to distinguish grief from depression.

Coping With Anticipatory Grief

It’s important to express your pain and let yourself grieve. Finding a friend or another loved one you can share your feelings openly with is extremely helpful, just as maintaining hope and preparing for death at the same time is difficult.

It can be even harder as people may wonder why you are grieving—even become angry that you are grieving—before the actual death.

Keep in mind that letting go doesn’t mean you have to stop loving your loved one—even after they die. During this stage, some people begin to find a safe place in their heart to hold memories of their loved one that will never die.

Frequently Asked Questions

  • What is anticipatory grief?

    Anticipatory grief is a sense of deep sorrow that occurs before someone’s death, as you’re anticipating what will happen.3 Your feelings can be very confusing and may leave you lonely and anxious on top of feeling great sadness.

  • Why do I feel guilty about my friend dying?

    Guilt can be related to many emotions. You may have a sense of relief that a person who’s been ill is at the end of their suffering, but that feeling comes with guilt that you’re “happy” they’ll die soon. Sometimes, guilt comes from unresolved issues you may have had with the person who is dying.

  • Complete Article HERE!

The 11 qualities of a good death

Opening up about death can make it easier for ourselves and our loved ones.

By Jordan Rosenfeld

Nearly nine years ago, I received a call from my stepmother summoning me to my grandmother’s house. At 92 years old, my Oma had lost most of her sight and hearing, and with it the joy she took in reading and listening to music. She spent most of her time in a wheelchair because small strokes had left her prone to falling, and she was never comfortable in bed. Now she had told her caregiver that she was “ready to die,” and our family believed she meant it.

I made it to my grandmother in time to spend an entire day at her bedside, along with other members of our family. We told her she was free to go, and she quietly slipped away that night. It was, I thought, a good death. But beyond that experience, I haven’t had much insight into what it would look like to make peace with the end of one’s life.

A recent study published in the American Journal of Geriatric Psychiatry, which gathered data from terminal patients, family members and health care providers, aims to clarify what a good death looks like. The literature review identifies 11 core themes associated with dying well, culled from 36 studies:

  • Having control over the specific dying process
  • Pain-free status
  • Engagement with religion or spirituality
  • Experiencing emotional well-being
  • Having a sense of life completion or legacy
  • Having a choice in treatment preferences
  • Experiencing dignity in the dying process
  • Having family present and saying goodbye
  • Quality of life during the dying process
  • A good relationship with health care providers
  • A miscellaneous “other” category (cultural specifics, having pets nearby, health care costs, etc.)

In laying out the factors that tend to be associated with a peaceful dying process, this research has the potential to help us better prepare for the deaths of our loved ones—and for our own.

Choosing the way we die

Americans don’t like to talk about death. But having tough conversations about end-of-life care well in advance can help dying people cope later on, according to Emily Meier, lead author of the study and a psychologist who worked in palliative care at the University of California San Diego’s Morres Cancer Center. Her research suggests that people who put their wishes in writing and talk to their loved ones about how they want to die can retain some sense of agency in the face of the inevitable, and even find meaning in the dying process.

Natasha Billawala, a writer in Los Angeles, had many conversations with her mother before she passed away from complications of the neurodegenerative disease ALS (amytropic lateral sclerosis) in December 2015. Both of her parents had put their advanced directives into writing years before their deaths, noting procedures they did and didn’t want and what kinds of decisions their children could make on their behalf. “When the end came it was immensely helpful to know what she wanted,” Billawala says.

When asked if her mother had a “good death,” according to the UCSD study’s criteria, Billawalla says, “Yes and no. It’s complicated because she didn’t want to go. Because she lost the ability to swallow, the opportunity to make the last decision was taken from her.” Her mother might have been able to make more choices about how she died if her loss of functions had not hastened her demise. And yet Billawalla calls witnessing her mother’s death “a gift,” because “there was so much love and a focus on her that was beautiful, that I can carry with me forever.”

Pain-free status

Dying can take a long time—which sometimes means that patients opt for pain medication or removing life-support systems in order to ease suffering. Billawala’s mother spent her final days on morphine to keep her comfortable. My Oma, too, had opiate pain relief for chronic pain.

Her death wasn’t exactly easy. At the end of her life, her lungs were working hard, her limbs twitching, her eyes rolling behind lids like an active dreamer. But I do think it’s safe to say that she was as comfortable as she could possibly be—far more so than if she’d been rushed to the hospital and hooked up to machines. It’s no surprise that many people, at the end, eschew interventions and simply wish to go in peace.

Emotional well-being

Author and physician Atul Gwande summarizes well-being as “the reasons one wishes to be alive” in his recent book Being Mortal. This may involve simple pleasures like going to the symphony, taking vigorous hikes or reading books He adds: “Whenever serious sickness or injury strikes and your body or mind breaks down … What are the trade-offs you are willing to make and not willing to make?”

Kriss Kevorkian, an expert in grief, death and dying, encourages those she educates to write advance directives with the following question in mind: “What do you want your quality of life to be?”

The hospital setting alone can create anxiety or negative feelings in an ill or dying person, so Kevorkian suggests family members try to create a familiar ambience through music, favorite scents, or conversation, among other options, or consider whether it’s better to bring the dying person home instead. Billawalla says that the most important thing to her mother was to have her children with her at the end. For many dying people, having family around can provide a sense of peace.

Opening up about death and dying

People who openly talk about death when they are in good health have a greater chance of facing their own deaths with equanimity. To that end, Meier is a fan of death cafés, which have sprung up around the nation. These informal discussion groups aim to help people get more comfortable talking about dying, normalizing such discussions over tea or cake. It’s a platform where people can chat about everything from the afterlife (or lack thereof) to cremation to mourning rituals.

Doctors and nurses must also confront their own resistance to openly discussing death, according to Dilip Jeste, a coauthor of the study and geriatric psychiatrist with the University of California San Diego Stein Institute for Research on Aging. “As physicians we are taught to think about how to prolong life,” he says. That’s why death becomes [seen as] a failure on our part.” While doctors overwhelmingly believe in the importance of end-of-life conversations, a recent US poll found that nearly half (46%) of doctors and specialists feel unsure about how to broach the subject with their own patients. Perhaps, in coming to a better understanding of what a good death looks like, both doctors and laypeople will be better prepared to help people through this final, natural transition.

Complete Article HERE!

Planning your funeral doesn’t have to be scary, says the author of ‘It’s Your Funeral: Plan the Celebration of a Lifetime Before it’s Too Late’

By

The pandemic has forced many to rethink and readjust their present with their future. Some have left jobs that provided steady paychecks and a predictable complacency for unknown, yet meaningful passion projects. Others are are taking more control of their destinies as they see fit. Unwilling to settle in life anymore. So why would you settle in death?

That’s the question Kathy Benjamin, author of “It’s Your Funeral! Plan the Celebration of a Lifetime — Before it’s Too Late,” asks. Amid the book’s 176 pages, Benjamin exposes readers to death in a light, humorous, and practical way, akin to a soothing bath, rather than a brisk cold shower.

The Austin-based writer’s niche is death (her last book centered on bizarre funeral traditions and practices). Having panic attacks as a teen, Benjamin said enduring them felt like she was dying. It was then that she started wrestling with the idea of death.

“I feel like I’m actually dying all the time, so maybe I should learn about the history of death and all that,” she said. “If I’m going to be so scared of it, I should learn about it because then I’d kind of have some control over it.”

It’s that control that Benjamin wants to give to readers of this book. She introduces readers to concepts and steps one should contemplate now, in order to make sure the last big gathering centered on you is as memorable as you and your loved ones wish. Poring over the book, one finds interesting final resting options such as body donation that goes beyond being a medical cadaver, “infinity burial suits” that lets one look like a ninja at burial, but also helps nourish plants as decomposition begins; and quirky clubs and businesses that allow one to make death unique (as in hiring mourners to fill out your grieving space and time, and designing your own coffin).

Kathy Benjamin knows death can be scary, but she's determined to show that planning your own funeral doesn't have to be.
Kathy Benjamin knows death can be scary, but she’s determined to show that planning your own funeral doesn’t have to be.

Now before you think this is all a bit macabre, Benjamin’s book also serves as a personal log so you can start planning your big event. Amid the pages, she offers prompts and pages where you can jot down thoughts and ideas on fashioning your own funeral. If you want to have a theme? Put it down in the book. You want to start working on your eulogy/obituary/epitaph, will, or your “final” playlist? Benjamin gives you space in her book to do so. It’s like a demise workbook where you can place your best photos to be used for the funeral and your passwords to your digital life, for your loved ones to have access to that space once you’re gone. If all the details are in the book, a loved one just has to pick it up and use it as a reference to make sure your day of mourning is one you envisioned.

As Benjamin writes: “Think about death in a manner that will motivate you to live the best, most fulfilling life possible. By preparing for death in a spiritual and physical way, you are ensuring that you will succeed right to the end.”

“Everyone’s going to die, if you’re willing to be OK with thinking about that, and in a fun way, then the book is for you,” she said.

We talked with Benjamin to learn more about the details of death and thinking “outside the coffin” for posterity’s sake. The following interview has been condensed and edited.

‘It’s Your Funeral! Plan the Celebration of a Lifetime — Before it’s Too Late’ is by Kathy Benjamin, Quirk Books, 176 pages, $14.40.
‘It’s Your Funeral! Plan the Celebration of a Lifetime — Before it’s Too Late’ is by Kathy Benjamin, Quirk Books, 176 pages, $14.40.

Q: How much time did it take you to find all this data about death? You share what was in the late Tony Curtis’ casket.

Kathy Benjamin: I have shelves of books that range from textbooks to pop culture books about death, and it’s something that a lot more people than you think are interested in so when you start doing online research you might just find a list of, here’s what people have in their coffin and then from there, you’re like: ‘OK, let’s check if this is true.’ Let’s go back and check newspaper articles and more legitimate websites and things and those details are out there. People want to know. I think of it as when you see someone post on Facebook — somebody in my family died. I know for me, and based on what people reply, the first thing is: What did they die of? We want these details around death. It’s just something people are really interested in. The information is out there and if you go looking for it, you can find it.

Q: Was the timing for the release of the book on point or a little off, given the pandemic?

KB: That was unbelievable timing, either good or bad, how you want to look at it. I ended up researching and writing during that whole early wave in the summer (2020) and into the second wave, and it was very weird. It was very weird to wake up, and the first thing I would do every morning for months was check how many people were dead and where the hot spots were, and then write … just a lot of compartmentalization. My idea was because people who were confronting death so much, maybe it would open up a lot of people’s minds who wouldn’t normally be open to reading this kind of book, they’d be like: ‘OK, I’ve faced my mortality in the past year. So actually, maybe, I should think about it.’

Q: Is there anything considered too “out there” or taboo for a funeral?

KB: I always think that funerals really are for the people who are still alive to deal with their grief, so I wouldn’t do anything that’s going to offend loved ones. I can’t think of what it might be, but if there’s a real disagreement on what is OK, then maybe take the people who are going to be crying and keep them in mind. But really, it’s your party. Plan what you want. There are so many options out there. Some people, they still think cremation isn’t acceptable. Because death is so personal, there’s always going to be people who think something is too far, even things that seem normal for your culture or for your generation.

Q: You mention some interesting mourning/funeral businesses, but many seem to be in other countries. Do we have anything cool in the U.S. as far as death goes that maybe other places don’t have?

KB: One thing we have more than anywhere in the world is body farms. We have a couple and just one or two in the entire rest of the world. The biggest in the world is at the University of Tennessee. For people who don’t know, body farms are where you can donate your body as if you would to science, but instead of doing organ transplants or whatever with it, they put you in the trunk of a car or they put you in a pond or they just lay you out and then they see what happens to you as you decompose. Law enforcement recruits come in and study you to learn how to solve crimes based on what happens to bodies that are left in different situations. I think they get about 100 bodies a year. I always tell people about body farms because if you’re into “true crime” and don’t care what happens to you and you’re not grossed out by it, then do it because it’s really cool and it’s helpful.

Q: You mention mummification and traditional Viking send offs, what about the burning of a shrouded body on a pyre? Have you heard about that? It was the way hunters were sent into the afterlife on the TV series “Supernatural.”

KB: I haven’t heard of anyone doing it in America but obviously that’s a big pop culture thing. For Hindus, that’s the way it happens in India … you go to the Ganges, and they have places specifically where you pay for the wood and they make a pyre and that’s how people go out. I doubt there’s a cemetery or a park that would allow you to do it in the U.S., but on private land, you’re pretty much allowed to do whatever. I would definitely check on regulations. You would have to get the pyre quite hot to burn the body to ash, like hotter than you think to make sure you don’t get a barbecued grandpa.

Q: In your research, have you come across anything that completely surprised you because it’s so unheard of?

KB: There’s been things like funerary cannibalism, which is where you eat loved ones after they’ve died. But once you’ve read the reasons why different tribes around the world have done it, you’re like ‘OK, I can see why that meant something, why it was meant to be emotional and beautiful.’ Things like sky burial in Tibet, they have a Buddhist monk chop up the body and lay it out for the vultures to come get. Part of it ties back to Buddhist tradition but also it’s Tibet, you can’t dig holes there in the mountains. So, there’s a logical reason for it. When you look at these things that originally seem gross or weird, once you learn the reasons behind them it all comes back in the end to trying to do something respectful for the dead, and trying to give the living that closure.

Q: What are your plans for your funeral?

KB: I definitely want to be cremated. I don’t know if I want people to necessarily come together for a funeral for me but like I have a playlist, and even before the book I had a whole document on the computer of what I wanted. I want all the people to know about the playlist and then they can kind of sit and think about how awesome I am while the sad songs play, and then there’s different places that I would want my ashes scattered.

Complete Article HERE!

Why Some Scientists Think Consciousness Persists After Death

We should not assume that people who are near death do not know what we are saying

By News

A very significant change that happened in the last century or so has been the ability of science professionals to see what happens when people are thinking, especially under traumatic conditions.

It was not a good moment for materialist theories. Here is one finding (there are many others): Death is a process, usually, not simply an event.

Consciousness can persists after clinical death. A more accurate way of putting things might be that the brain is able to host consciousness for a short period after clinical death. Some notes on recent findings:

The short answer is, probably, yes:

Recent studies have shown that animals experience a surge in brain activity in the minutes after death. And people in the first phase of death may still experience some form of consciousness, [Sam] Parnia said. Substantial anecdotal evidence reveals that people whose hearts stopped and then restarted were able to describe accurate, verified accounts of what was going on around them, he added.

“They’ll describe watching doctors and nurses working; they’ll describe having awareness of full conversations, of visual things that were going on, that would otherwise not be known to them,” he explained. According to Parnia, these recollections were then verified by medical and nursing staff who were present at the time and were stunned to hear that their patients, who were technically dead, could remember all those details.

Mindy Weisberger, “Are ‘Flatliners’ really conscious after death?” at LiveScience (October 4, 2017)

Death is probably, in most cases, a process rather than a single event:

Time of death is considered when a person has gone into cardiac arrest. This is the cessation of the electrical impulse that drive the heartbeat. As a result, the heart locks up. The moment the heart stops is considered time of death. But does death overtake our mind immediately afterward or does it slowly creep in?

Some scientists have studied near death experiences (NDEs) to try to gain insights into how death overcomes the brain. What they’ve found is remarkable, a surge of electricity enters the brain moments before brain death. One 2013 study out of the University of Michigan, which examined electrical signals inside the heads of rats, found they entered a hyper-alert state just before death.

Philip Perry, “After death, you’re aware that you’ve died, say scientists” at BigThink (October 24, 2017)

Despite claims, current science does not do a very good job of explaining human experience just before death:

Researchers have also explained near-death experiences via cerebral anoxia, a lack of oxygen to the brain. One researcher found air pilots who experienced unconsciousness during rapid acceleration described near-death experience-like features, such as tunnel vision. Lack of oxygen may also trigger temporal lobe seizures which causes hallucinations. These may be similar to a near-death experience.

But the most widespread explanation for near-death experiences is the dying brain hypothesis. This theory proposes that near-death experiences are hallucinations caused by activity in the brain as cells begin to die. As these occur during times of crisis, this would explain the stories survivors recount. The problem with this theory, though plausible, is that it fails to explain the full range of features that may occur during near-death experiences, such as why people have out-of-body experiences.

Neal Dagnall and Ken Drinkwater, “Are near-death experiences hallucinations? Experts explain the science behind this puzzling phenomenon” at The Conversation (December 4, 2018)

Such explanations are a classic case of adapting a materialist hypothesis to fit whatever has happened. They don’t explain, for example, terminal lucidity, where many people suddenly gain clarity about life.

Research medic Sam Parnia found, for example, that, of 2000 patients with cardiac arrest,

Some died during the process. But of those who survived, up to 40 percent had a perception of having some form of awareness during the time when they were in a state of cardiac arrest. Yet they weren’t able to specify more details.

Cathy Cassata, “We May Still Be Conscious After We Die” at Healthline (September 24, 2018) The paper requires a subscription.

So we should not assume that people who are on the way out cannot understand us. Maybe they can — and would like to hear that they are still loved and will be missed.

Complete Article HERE!

Why Americans Die So Much

U.S. life spans, which have fallen behind those in Europe, are telling us something important about American society.

By Derek Thompson

America has a death problem.

No, I’m not just talking about the past year and a half, during which COVID-19 deaths per capita in the United States outpaced those in similarly rich countries, such as Canada, Japan, and France. And I’m not just talking about the past decade, during which drug overdoses skyrocketed in the U.S., creating a social epidemic of what are often called “deaths of despair.”

I’m talking about the past 30 years. Before the 1990s, average life expectancy in the U.S. was not much different than it was in Germany, the United Kingdom, or France. But since the 1990s, American life spans started falling significantly behind those in similarly wealthy European countries.

According to a new working paper released by the National Bureau of Economic Research, Americans now die earlier than their European counterparts, no matter what age you’re looking at. Compared with Europeans, American babies are more likely to die before they turn 5, American teens are more likely to die before they turn 20, and American adults are more likely to die before they turn 65. At every age, living in the United States carries a higher risk of mortality. This is America’s unsung death penalty, and it adds up. Average life expectancy surged above 80 years old in just about every Western European country in the 2010s, including Portugal, Spain, France, Italy, Germany, the U.K., Denmark, and Switzerland. In the U.S., by contrast, the average life span has never exceeded 79—and now it’s just taken a historic tumble.

Why is the U.S. so much worse than other developed countries at performing the most basic function of civilization: keeping people alive?

“Europe has better life outcomes than the United States across the board, for white and Black people, in high-poverty areas and low-poverty areas,” Hannes Schwandt, a Northwestern University professor who co-wrote the paper, told me. “It’s important that we collect this data, so that people can ask the right questions, but the data alone does not tell us what the cause of this longevity gap is.”

Finding a straightforward explanation is hard, because there are so many differences between life in the U.S. and Europe. Americans are more likely to kill one another with guns, in large part because Americans have more guns than residents of other countries do. Americans die more from car accidents, not because our fatality rate per mile driven is unusually high but because we simply drive so much more than people in other countries. Americans also have higher rates of death from infectious disease and pregnancy complications. But what has that got to do with guns, or commuting?

By collecting data on American life spans by ethnicity and by income at the county level—and by comparing them with those of European countries, locality by locality—Schwandt and the other researchers made three important findings.

First, Europe’s mortality rates are shockingly similar between rich and poor communities. Residents of the poorest parts of France live about as long as people in the rich areas around Paris do. “Health improvements among infants, children, and youth have been disseminated within European countries in a way that includes even the poorest areas,” the paper’s authors write.

But in the U.S., which has the highest poverty and inequality of just about any country in the Organization for Economic Cooperation and Development, where you live is much more likely to determine when you’ll die. Infants in the U.S. are considerably more likely to die in the poorest counties than in the richest counties, and this is true for both Black and white babies. Black teenagers in the poorest U.S. areas are roughly twice as likely to die before they turn 20, compared with those in the richest U.S. counties. In Europe, by contrast, the mortality rate for teenagers in the richest and poorest areas is exactly the same—12 deaths per 100,000. In America, the problem is not just that poverty is higher; it’s that the effect of poverty on longevity is greater too.

Second, even rich Europeans are outliving rich Americans. “There is an American view that egalitarian societies have more equality, but it’s all one big mediocre middle, whereas the best outcomes in the U.S. are the best outcomes in the world,” Schwandt said. But this just doesn’t seem to be the case for longevity. White Americans living in the richest 5 percent of counties still die earlier than Europeans in similarly low-poverty areas; life spans for Black Americans were shorter still. (The study did not examine other American racial groups.) “It says something negative about the overall health system of the United States that even after we grouped counties by poverty and looked at the richest 10th percentile, and even the richest fifth percentile, we still saw this longevity gap between Americans and Europeans,” he added. In fact, Europeans in extremely impoverished areas seem to live longer than Black or white Americans in the richest 10 percent of counties.

Third, Americans have a lot to learn about a surprising success story in U.S. longevity. In the three decades before COVID-19, average life spans for Black Americans surged, in rich and poor areas and across all ages. As a result, the Black-white life-expectancy gap decreased by almost half, from seven years to 3.6 years. “This is a really important story that we ought to move to the forefront of public debate,” Schwandt said. “What happened here? And how do we continue this improvement and learn from it?”

One explanation begins with science and technology. Researchers found that nothing played bigger roles in reducing mortality than improvements in treating cardiovascular disease and cancer. New drugs and therapies for high cholesterol, high blood pressure, and various treatable cancers are adding years or decades to the lives of millions of Americans of all ethnicities.

Policy also plays a starring role. Schwandt credits the Medicaid expansion in the 1990s, which covered pregnant women and children and likely improved Black Americans’ access to medical treatments. He cites the expansion of the earned-income tax credit and other financial assistance, which have gradually reduced poverty. He also points to reductions in air pollution. “Black Americans have been more likely than white Americans to live in more-polluted areas,” he said. But air pollution has declined more than 70 percent since the 1970s, according to the EPA, and most of that decline happened during the 30-year period of this mortality research.

Other factors that have reduced the Black-white life-expectancy gap include the increase in deaths of despair, which disproportionately kill white Americans, and—up until 2018—a decline in homicides, which disproportionately kill Black Americans. (The recent rise in homicides, along with the disproportionate number of nonwhite Americans who have died of COVID-19, will likely reduce Black life spans.)

Even then, Black infants in high-poverty U.S. counties are three times more likely to die before the age of 5 than white infants in low-poverty counties. But Schwandt insists that highlighting our progress is important in helping us solve the larger American death problem. “We are wired to care more about bad news than about good news,” he said. “When life expectancy rises slightly, nobody cares. But when life expectancy declines, suddenly we’re up in arms. I think that’s a tragedy, because to improve the health and well-being of our populations, and especially of our disadvantaged populations, we have to give attention to positive achievements so that we can learn from them.”

We’re a long way from a complete understanding of the American mortality penalty. But these three facts—the superior outcomes of European countries with lower poverty and universal insurance, the equality of European life spans between rich and poor areas, and the decline of the Black-white longevity gap in America coinciding with greater insurance protection and anti-poverty spending—all point to the same conclusion: Our lives and our life spans are more interconnected than you might think.

For decades, U.S. politicians on the right have resisted calls for income redistribution and universal insurance under the theory that inequality was a fair price to pay for freedom. But now we know that the price of inequality is paid in early death—for Americans of all races, ages, and income levels. With or without a pandemic, when it comes to keeping Americans alive, we really are all in this together.

Complete Article HERE!

Death and psychedelics

— How science is reviving this ancient connection

By

In November 1963, the writer and psychedelic explorer Aldous Huxley laid in bed, unable to speak. He was dying of cancer. One of his final acts was to pass a handwritten note to his wife Laura. 

His famous last words: “LSD, 100 µg, intramuscular.”

It was Huxley’s dying wish: a large dose of acid, please. Laura Huxley fulfilled the request twice during her husband’s final hours.

First synthesized 25 years before Huxley’s death, LSD was still legal in 1963. Scientists were studying it as a potential treatment for alcoholism and other ailments, as well as investigating its similarity to other psychedelics. It wasn’t until 1968 that the federal government outlawed these drugs due to their association with the cultural turbulence of the 1960s.

Today, several decades later, terminal cancer patients are once again taking psychedelics. This time around the drugs are being administered by doctors and scientists in controlled settings—and they are not microdoses. The results of this research have been nothing short of remarkable.

Laura Archera Huxley, 40-year-old musician and filmmaker, and husband Aldous Huxley, 61-year-old British novelist, pictured at their Hollywood home in Hollywood in 1956. On his deathbed seven years later, Huxley asked his wife for a massive dose of LSD.

Alleviating anxiety and despair

Terminal patients often suffer from feelings of intense anxiety and despair after receiving their diagnoses. For many, this is just too much to bear. The overall suicide risk for these patients is double or more compared to the general population, with suicide typically occurring in the first year after diagnosis.

Terminal patients have twice the suicide risk of the general public. Psychedelics may help reduce their fear and suffering.

That’s where psychedelic therapy may help. After a single large dose of psilocybin, taken in a curated space and supervised by a pair of doctors, many patients report feeling reborn. It’s not that the underlying physical disease has been cured. Rather, the drug prompts a shift in the theme of their emotional self-narrative—from anxiety and despair to acceptance and gratitude.

It may seem curious to think about psychedelic drugs, often associated with hippies and the Grateful Dead, as clinical-grade tools for overcoming our primordial aversion to death. But maybe it shouldn’t be. Maybe this is only surprising if your window of historical perspective is too narrow. Maybe these “novel findings” are, in a sense, a return to somewhere we’ve been before.

Psychedelics at the dawn of civilization

In late 2020 I spoke to Brian Muraresku, author of The Immortality Key: The Secret History of the Religion With No Name, about the use of psychoactive plant medicine throughout antiquity. Our podcast conversation covers this history in more detail, but it’s clear that humanity’s relationship with psychoactive plants extends back at least to ancient Greece—if not further. It’s hard to look at prehistoric cave paintings like the Tassili mushroom figure and not wonder if psychedelics played a part in their creation.

Western philosophy may have developed with help from psychedelics as well. In Plato’s well-known allegory of the cave, a group of prisoners live chained to a cave wall, seeing nothing but the shadows of objects projected onto it by fire. The shadows are their reality; they know nothing outside of it. Philosophers, Plato states, are like prisoners freed from the cave. They know the shadows are mere reflections, and they aim to understand deeper levels of reality.

Plato’s philosophical ideas might have been influenced by psychedelic experiences.

Was Plato tripping?

If that sounds like someone who’s explored those deeper levels with psychedelic assistance…well, maybe it was. In his book, Brian Muraresku explores the significance of the Eleusinian Mysteries, secret ceremonies that involved death and rebirth. For centuries, philosophers and mystics traveled to the Greek town of Eleusis to partake in a ritual that involved an elixir known as pharmakon athanasias, “the drug of immortality.”

“Within the toolkit of the archaic techniques of ecstasy–plant medicine just being one among many–something you find again and again, in Ancient Greece and other traditional societies, is this sense that to ‘die’ in this lifetime, or achieve a sense of timelessness in the here and now, is the real trick.” -Brian Muraresku

Contemporary archaeologists, digging outside Eleusis, have unearthed ancient chalices containing a residue of beer and Ergotized grain. Ergot is a fungus that grows on grain. It produces alkaloids similar to LSD. It’s possible, then, that influential thinkers like Plato were inspired by genuine psychedelic experiences.

This connection between psychedelics and death didn’t end with Eleusis. It survived, often repressed and hidden from view, right through the time of Aldous Huxley.

The connection re-emerges in the 1960s

In the 1960s, Timothy Leary co-wrote a book called The Psychedelic Experience: A manual based on the Tibetan Book of the Dead. Leary, the exiled Harvard professor and psychedelic guru, dedicated the book, “with profound admiration and gratitude,” to Aldous Huxley. It opens with a passage from The Doors of Perception, Huxley’s essay on the psychedelic experience. Huxley is asked if he can fix his attention on what the Tibetan Book of the Dead calls the Clear Light. He answers yes, “but only if there were somebody there to tell me about the Clear Light.”

It couldn’t be done alone. That’s the point of the Tibetan ritual, he says: You need “somebody sitting there all the time telling you what’s what.”

Huxley was describing a trip sitter, someone who guides a person along their psychedelic journey. Sometimes it’s an ayauasquero in the heart of the Amazon. Sometimes it’s a doctor holding your hand in a hospital.

Timothy Leary, shown at home in California in 1979, was deeply influenced by Huxley’s work.

Seeking rebirth within the mind

In his book, Leary grounded Eastern spiritual concepts in the understanding of neurology we had at the time. The states of consciousness achieved by meditation masters and those induced by three hits of Orange Sunshine, he wrote, may actually be the same. Both involve dissolving the ego (“death”) and allowing it to recrystallize as the default mode of consciousness returns (“rebirth”). 

Leary wasn’t talking about magic. Scientists know these as “non-ordinary brain states,” inducible by rigorous attentional practice (meditation), pharmacological intervention (psychedelics), and organic decay (dying).

The ability of psychedelics to induce these remarkable brain states may also be why they’re showing such promise in alleviating the very ordinary fear of death.

Today’s psychedelic treatments: Coping with death

So what, exactly, has recent research on psilocybin as an end-of-life anxiety treatment involved?

A few small studies have seen psilocybin administered to dozens of cancer patients. They’ve been conducted in a randomized, double-blind, placebo-controlled fashion. In general, a large majority of patients showed sustained, clinically significant reductions in measures of psychosocial stress and increased levels of overall well-being.

For example, in one study, 80% of the patients found that a single dose of psilocybin quickly relieved their distress. Remarkably, in some patients that positive effect lasted for more than six months.

Sprouting new physical connections

What’s going on at the neuronal level to produce those changes? We don’t know for sure, but some preclinical research has given us a hint. Both psilocybin and LSD have been shown to induce rapid and lasting antidepressant effects in lab animals.

Early studies hint at how psychedelics may produce positive changes in the brain.

Early indications are that psychedelics may allow brain circuits to rapidly sprout new physical connections. This is exciting, but again: These are non-human studies, and it’s early.

It’s gratifying to see any of these studies happening, frankly. This is research that’s been stalled by the Schedule I status of psychedelics for half a century. Much of this work requires obtaining a special federal waiver to study banned substances, which slows progress.

Potential help for end-of-life patients

Fortunately, the FDA recently designated psilocybin therapy as a “breakthrough therapy” and the DEA has proposed increasing the supply of psilocybin for research. This should speed up the rate at which we understand the clinical efficacy of psilocybin and related psychedelics.

Here’s more good news: In terms of psilocybin’s efficacy as a treatment for end-of-life anxiety, larger human trials are already underway.

Dr. Stephen Ross, one of the field’s leading researchers, has described the significance of this work: “If larger clinical trials prove successful, then we could ultimately have available a safe, effective, and inexpensive medication—dispensed under strict control—to alleviate the distress that increases suicide rates among cancer patients.”

Huxley: Ahead of his time

In one sense, Aldous Huxley was ahead of his time. More than a half-century before today’s renaissance in psychedelic research, his own experiences had evidently brought him to the conclusion that the best way to experience death was in a psychedelic trance.

In another sense, though, Huxley was one in a long line of creators stretching back to ancient Greek philosophers and perhaps even to prehistoric cave artists. They may all have used psychedelics to catalyze their outward creativity and comfort their inner distress.

Huxley titled his famous introspective essay, The Doors of Perception, after a quote from the English poet, William Blake: “If the doors of perception were cleansed everything would appear to [us] as it is, infinite.”

We will never know what he experienced in the final hours before his death, after handing that note to his wife. I like to think that for him, the last breath seemed to last forever.

Complete Article HERE!

4 ways to improve the lives of older people

By Prakash Tyagi

  • By 2050, it is expected there will be more humans over 60 than under 15 for the first time in history.
  • Older people are harder hit by poverty and ill-health, necessitating better support structures be put in place.
  • The UN Decade of Healthy Ageing gives a framework for improving older people’s lives.

Population ageing and the resulting demographic transition around the world present complex challenges. It is estimated that the global population of older persons will rise by 56% between 2015 and 2030, from 956 million to 1.4 billion, and hit the 2.1 billion mark by 2050. Between 2015 and 2050, the proportion of the 60+ age group globally is expected to rise from 12% to a staggering 22%. People over 60 will outnumber those below the age of 15 for the first time in history.

The transition is rapid and dramatic, and uneven in different parts of the world. While it took France about 150 years to rise from 10% to 20% of the population being older than 60, a similar transition will occur India, China and Brazil in about 20 years. In high-income countries, the proportions of older people have been rising gradually, with over 28% of Japan’s population already being over 65 years of age.

The proportion of older people worldwide is ageing
The proportion of older people worldwide is ageing Image: UN

Large numbers of older people, particularly in lower- and middle-income countries, live in severe poverty and in poor health, with no or limited access to basic health services and social protection benefits. There are gender disparities too, with older women experiencing greater deprivation. Research suggests that in sub-Saharan Africa households headed by older women live in greater poverty compared to households headed by men of equivalent age. Furthermore, the correlation between ageing and disability is clear, with over 46% of older people worldwide living with some form of disability. Over 250 million older people have moderate to severe disabilities. These numbers are likely to rise further, causing more hardship.

This significant demographic transition means there is unprecedented need for age-friendly and responsive healthcare systems and a range of coordinated services to address the complex needs of this ageing global population.

The proposal of observing a Decade of Healthy Ageing from 2021 to 2030 was adopted by the UN General Assembly last December. This global collaboration is led by the World Health Organization (WHO) and will bring together governments, civil society, international agencies, professionals, academia, the media, and the private sector, in alignment with the Sustainable Development Goals (SDGs).

To foster healthy ageing and to improve the lives of older people, the Decade of Healthy Ageing will focus on four action areas. The first is to create and strengthen age-friendly environments by removing physical and social barriers and by converting them into better places to live and to age. The second is to combat ageism: Older people, despite their significant contributions to society, are often overlooked and subject to prejudice. Such stereotyping and discrimination must be addressed.

The third is to provide integrated care. All older people should have non-discriminatory access to integrated care, which should include but is not limited to: prevention, promotive, curative, rehabilitative, and palliative and “end of life” care – which must be safe, affordable and of good quality. The fourth is to support long-term care (LTC). With significant decline in their mental and physical capacities, many older people are unable to live an independent life or to actively participate in society. Hence, access to good LTC services is essential to maintain their functional ability, to ensure that they enjoy basic human rights and that they live a life with dignity.

Numbers of older people above 60 by world regions
Numbers of older people above 60 by world regions Image: UN

Four further enablers will be critical to the Decade of Healthy Ageing: engaging directly with the voices of older people; leadership development and capacity-building at all levels; connecting all stakeholders; and strengthening research, data and innovation.

The decade, its action areas and enablers lay out a solid framework to foster healthy ageing around the world. However, stronger efforts will have to be made into converting a theoretical framework into practical and measurable actions. To date, progress has been limited and further delayed by priorities imposed by the pandemic. On 1 October, International Day of the Older Persons (IDOP), which this year has a theme of Digital Equity for All Ages, is an important opportunity to take stock of what has been achieved.

Looking ahead, it may be worthwhile to categorize basic needs into groups. The first is to design a comprehensive communication mechanism and to deliver the decade of healthy ageing messages to all stakeholders, most importantly to older people themselves. The sooner the information disseminates and is well understood, the more active the stakeholder participation should be.

A second key group of needs is to develop a strategy for partnerships that are going to be crucial in engagement of key groups, delivery of services and for research and advocacy. Civil society, government agencies and the private sector are three important constituents of the partnerships spectrum, and a clear plan for involving them must be developed at both macro and micro levels.

A third is to create guiding groups at national level (and at provincial or sub-national levels too in the case of larger countries) comprising representatives from different sectors who can ensure dynamic planning, implementation and monitoring of actions.

Fourthly, the decade also provides an important opportunity to strengthen LTC services and improve integrated care – fundamentally important blocks of healthy ageing that require greater attention. Community-based LTC will have to be reinforced by promoting self-care and by training and capacity-building of formal and informal caregivers. Primary care needs must be addressed in remote and rural settings, assuring integrated care for older people. Existing models and past experiences from Help Age Global network and from organizations like GRAVIS in India may provide replicable insights. The knowledge accumulated by senior-age people’s organizations, especially how to strengthen intergenerational exchanges to ensure lifelong application of healthy ageing principles, is a valuable resource worth utilizing.

COVID-19-related challenges are already a hindrance and will likely continue to hamper progress on healthy ageing for many years. Mitigation strategies will have to be worked out in advance in the context of community education and delivery of care services using digital education, telemedicine and within COVID guidelines, keeping the local context and situation in view. Existing healthcare infrastructure overburdened by the pandemic will have to be used judiciously. Future of Work

What is the World Economic Forum doing about including older people in the workforce?

There is a global myth that productivity declines as workers age. In fact, including older workers is an untapped source for growth.

The world has entered a new phase of demographic development where people are living longer and healthier lives. As government pension schemes are generally ill-equipped to manage this change, insurers and other private-sector stakeholders have an opportunity to step in.https://www.weforum.org/videos/promoting-an-age-inclusive-workforce-living-learning-earning-longer

The World Economic Forum, along with the Organisation for Economic Co-operation and Development (OECD) and AARP, have created a learning collaborative with over 50 global employers including AIG, Allianz, Aegon, Home Instead, Invesco and Mercer. These companies represent over two million employees and $1 trillion in annual revenue.

Complete Article HERE!