Category: Death Education

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Death and psychedelics

— How science is reviving this ancient connection

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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↩!

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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↩!

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Death’s Price Tag: An inevitable trauma

By Judas Cote

In the spirit of October, I figured I should speak on a topic I’m passionate about, as someone considering end-of-life care as a career (I gag at the connotation of making a career of death care, but such is the nature of capitalism): the funeral industry. Let that phrase sink in for a second: Funeral. Industry. Death that generates financial capital. Death, a necessary and inevitable part of the human experience, costs and generates money.

Death is a tough subject, and for good reason. It’s a reminder of all of our mortalities, and that’s a lot to be confronted with, especially considering how capitalism makes us proletarians believe that we’re inhuman, that we’ll simply be exploited for an indeterminate amount of time, and then disappear from relevance. This alienation from mortality and personhood diminishes the depth of life brought about by our own mortality, and then, once confronted with it, the capitalist robo-proletarian illusion shatters, bringing great distress but no room to heal from it due to the standard 9 to 5 workday and low wages.

Let me step back and explain what I mean by this though. Many people work some variation of an eight hour shift job. If they’re full time, that’s about 40 hours per week, sometimes more, which leaves one or two days off. The Ford model of the work day is supposed to be eight hours of work, eight hours of leisure, and eight hours of rest. This treats human needs as if they were easy to standardize. It takes no account for commutes, obtaining and preparing food, the amount of sleep an individual needs to function, or difference of ability as this does vary widely in the working population. Some people forfeit another one of these eight hour blocks, working two jobs to make ends meet. How much time does that leave for the necessities: nourishment and sleep? Not much. How much time does that leave for self-actualization? Barely any. So how much time does that leave to process grief specifically? Almost none. Capitalism forces us to go about our lives broken and exploited, many without the means to mend our psyches due to the high cost of mental healthcare (and healthcare in general).

Funerals with bodies are considered the standard of funerary action in the United States. Between the funeral ceremony and the embalming/preservation of the body, costs can surge to thousands of dollars just to make this arbitrary ceremony.

Now to the funeral industrial complex. Think for a minute—what would you consider a dignified burial for a loved one who left behind no death plan? Maybe cremation, maybe burial in a casket, but not much else. Cremation is the cheaper option, and embalmed casket burials are often expensive. Not only do they take into account the labor from the funeral home for a service, but also the labor of embalming (which is widely overused in the United States due to its popularity in the Civil War for the transport of the bodies of soldiers) and the price of the casket and headstone. Caskets run around $1,200, give or take, and funeral homes often mark them up to generate profit. Headstones vary widely but can run from around $65 to over $200 . This doesn’t take into account any markups from manufacturers either. Plots can run around $350 to $5,000, embalming costs upwards of $500. Add in flowers and concessions and you get an idea as to why traditional American funerals are so expensive.

So, I would like to talk about some alternatives. Firstly, there’s donating your corpse to science (which is my plan). This involves one’s body being brought to whatever scientific institution needs cadavers (medical schools mainly) for educational use, and then discarded in mass graves afterwards. There are no direct costs with this approach, but you can always hold a service for a loved one who donates their body, just without their cadaver. There’s also natural burial, either in a plain shroud or one with a seed pod. Connecticut has multiple natural burial grounds around the state. Better Place Forests prices ceremonies based on the memorial tree you want, starting at around $5,900 for the cheapest option. Depending on the grounds you choose, prices will vary, and without a tree the burial would be cheaper as well. Other options include Aquamation (which is legal for humans and pets in Connecticut, for those concerned with eco-friendliness) and feed blocks (mixing cremated remains into feed blocks for woodland animals).

So, what changes do I think need to be made?

I think that funerary and end of life care should cease to be an industry; just as medicine, infrastructure, internet, plumbing and the like should cease to be industries. A shift in governmental values from those serving the class with the highest accumulation of capital to serving the working class. A shift towards democracy centered on proletarian needs. A shift to a human collective-centered culture, rather than a profit-centered one. Replace dog-eat-dog with camaraderie. Truly place power in the hands of the people, and build a world of collaboration and healing.

Complete Article ↪HERE↩!

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My Dad Is Dead. His Landlord Just Evicted Him.

A jumble of complicated and unexpected logistical tasks can fall into your lap after a loved one dies.

By Stephanie H. Murray

When my father’s heart stopped, I had no choice but to keep moving. He had lived alone, and I understood that managing the logistics of his death—planning his funeral, settling his debts, divvying up his belongings—would be an enormous task. Those looming practical matters infuriated me; I hated that my world-shattering news had not, in fact, shattered the world. It kept spinning along, so I did too. I got the news on a Thursday; flew from my home in the United Kingdom to his home in Savannah, Georgia, on Saturday; and headed to his apartment with my sister on Monday to begin tying up the loose ends of his life. We didn’t have a key to his apartment, but my sister knew the building receptionist and was sure she’d let us in under the circumstances.

Instead, she turned us away. I began to panic: How would we get his suit for the funeral? How would we figure out if he had
life insurance that we could use to pay for the funeral? When would we be allowed to empty his apartment, and would I still be in the country by then?

I had never been to my father’s apartment before—I moved overseas in the fall of 2019, two months before my dad moved to Savannah and six months before the coronavirus pandemic thwarted my plans to visit family—but it hurt to be treated like a stranger there. I wanted to rifle through the artifacts of his life and sink into the happier memories their presence conjured. To sit with whatever remnants of my dad lingered among his belongings. To reclaim what little I could of the visit that COVID had denied me. And I resented the receptionist standing guard at the door to ensure that I didn’t.

I felt certain that there was some misunderstanding, but the only error was mine. Any permission I’d had to rummage through my father’s things had died with him. Successfully navigating the process, referred to as probate, for getting that permission back can be tricky and usually requires the help of a lawyer. Even then, things don’t always go as expected—which is how I ended up collecting my father’s belongings from the sidewalk when he was evicted almost three months after he died.

My circumstances felt bizarre, but it’s not unusual for a jumble of complicated and unexpected logistical tasks to fall into a person’s lap after a loved one dies. Stephanie Handel, a grief and trauma psychotherapist at the Wendt Center for Loss and Healing, in Washington, D.C., told me about pamphlets that the center used to provide recently bereaved people, detailing the enormous list of things they’d need to do in the following weeks and months: contact Social Security, find burial assistance (if they were eligible for it), publish an obituary, order death certificates, contact employers and banks, shut down social-media accounts, cancel subscriptions, handle medical paperwork, hire an attorney, pay taxes. “It’s an intellectually and psychologically challenging task. And it’s a task that you have to undertake when you’re not at your best,” R. Benyamin Cirlin, the executive director of the Center for Loss and Renewal, in New York City, told me.

What I learned after losing my father was that the laws protecting a dead person’s property are surprisingly robust. If he’s made prior arrangements, the ownership of some of his things will transfer automatically. Banks, for example, allow clients to name a “payable on death” beneficiary on some accounts. In almost all cases, practically everything else—even clothing and silverware—must go through probate before anyone can legally claim it. The fact that my father had a will that named me as his executor did not allow my sister and me to sidestep this process. “The will is just a piece of paper until the probate court has verified it,” Gerry W. Beyer, an estate attorney and a professor at Texas Tech University’s School of Law, told me.

The probate process varies by state and even by county, but it generally involves tracking down an original will and getting any “heirs-at-law”—usually the spouse and children—to acknowledge it. If all goes smoothly, probating a will might take a couple of weeks. But any hiccups—say the original will can’t be found, or a pandemic overwhelms the probate-court system—can slow the process down. And if an eligible heir contests the will, probate can take years, Gregory Matalon, an estate attorney based in New York, told me. In the meantime, the deceased person’s things are in a kind of legal limbo and, except in rare circumstances, no one’s supposed to touch them.

Of course, in many cases, people touch them anyway. Family members take what they want of their relative’s heirlooms and donate the rest. Landlords may pressure a deceased tenant’s family to clear out his apartment. When it comes to items of little personal or monetary value, jumping the gun on probate is rarely a problem, the Ohio-based attorney Joan Burda told me, but prematurely making off with cherished or expensive items can lead to legal trouble down the road. For that reason, some landlords won’t allow anyone into a deceased tenant’s apartment without court approval. Our lawyer advised us to halt my father’s rent payments in the hopes that his building would relax this requirement. If my father was evicted, our lawyer reasoned, we could take his things when his apartment was being emptied.

There are some good reasons to protect a dead person’s belongings—you wouldn’t want the wrong person walking away with their prized possessions—but the rigidity of the process can create nightmares for loved ones with good intentions. One woman I spoke with had to take nine months off work to help her elderly father manage his late wife’s estate—he was the official executor but was unable to manage the task on his own.

These logistical headaches can shape the experience of grief in a variety of ways, Cirlin told me. Sometimes, the people saddled with the practical matters sideline their emotions for a while, which can seem strange to outside observers and can be unsettling for the bereaved themselves. People can feel like “Why am I not crying right now?” Handel explained. “But there are things that need to be done, which means that your ability to be present for your own feelings in some ways needs to be halted.” For others, these responsibilities can heighten grief. Filling out paperwork or donating clothing can serve as “another window into the fact that your whole reality has changed,” as Cirlin put it. Someone may feel they’ve found their footing in the aftermath of loss only for one of these innocuous tasks to pull them back into grief. Especially when the process doesn’t go smoothly—if a loved one’s paperwork is poorly organized, for example, or probate unveils unpleasant information about them—the ugliness of these chores can complicate the fond memories and rosy narratives we want to walk away with. “It’s hard to sit with resentment when you’re missing someone,” Cirlin said.

My father’s apartment building never relented, but with the help of our attorney, we did arrange a supervised visit to search for the will and pick up my dad’s suit. (An assistant property manager for the building declined to comment on specifics of the case, but noted, “Generally we are not allowed to provide individuals who are not on the lease with access to an apartment even if they are related to the resident. We try to work with family members of a deceased resident to allow them to obtain their loved one’s belongings. Our actions were taken with direction from, and in coordination with, the family’s attorney.”)

We couldn’t find his original will, but we printed a copy from his computer and then folded the lone suit hanging in his closet into a grocery bag, along with a pair of black sneakers. My sister slipped a plastic rosary from his bedside into the pocket of his jacket, and as she glanced over her shoulder to make sure the receptionist wasn’t watching, we both began to laugh, quietly and tearfully, at the absurdity of the circumstances. If his estate had anything of value, it wasn’t in that apartment. American property law stood between us and a crusty baseball cap sitting crumpled on the counter, a poem I’d written for him on his birthday that he’d printed and tacked to the wall in his office, a hundred worn books that his excessive underlining had rendered worthless to anyone but us.

On our way out, the receptionist gingerly peeked into our bag to ensure that we hadn’t taken anything we shouldn’t have and then escorted us to our car, where she reminded us that we’d be welcome back once we had the proper documentation.

He was evicted before we got it. Mercifully, the assistant property manager let us know the date and time in advance, so we hired movers to collect my father’s things and put them in storage. But when we arrived to get his belongings off the sidewalk, some of them had been damaged. An open bottle of Drano had soaked the contents of one bag. The praying hands of a statue of Our Lady of Fátima that my parents had gotten on their honeymoon had cracked off her arms. And there was nothing I could do about it, because the laws designed to ensure that my father’s things ended up safely in my possession had exhausted their reach.

“I think, very sadly, what you’re learning is that grief is very messy,” Handel said. It’s inextricably bound up with the tedium and absurdity of human existence. It may be triggered by death, but grief is a province of the living. And life goes on.

Complete Article ↪HERE↩!

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A Physician in the Patient’s Chair

Susan D. Block, who has taught and researched doctor-patient communication and severe illness for decades, found herself on the other side of that relationship in the fall of 2018, which would transform her work, teaching, and practice.

By Tamar Sarig

In the fall of 2018, three weeks into Susan D. Block’s first semester teaching a freshman seminar on death and illness — “The Heart of Medicine: Patients and Physicians and the Experience of Serious Illness” — she learned that she had a mass on her pancreas. In the worst way possible, her field of work and personal life had collided.

As the founding chair of the Dana-Farber Cancer Institute’s Department of Psychosocial Oncology and Palliative Care, Block, a psychiatrist, had spent almost 40 years treating patients with serious illnesses like cancer, trying to figure out how to make their last months more meaningful and less frightening. Now she found herself in the patient’s chair.

Block had been undergoing routine tests for pancreatic cancer as part of a research study for over a decade, due to a strong family history of the disease. Luckily, her preliminary screenings caught what seemed to be cancer at a relatively early stage. “People were looking for it and then they finally found it,” she says. “It was terrifying.”

That terror lasted for about three weeks, as Block prepared for a surgery to remove most of her pancreas. When she finally went into surgery, however, her doctors discovered that, against all odds, she had been misdiagnosed. The mass was the result of an autoimmune disease.

“People had told me that there’s a 95 percent chance that it’s cancer. I wish to be in the 5 percent, but I don’t ever assume that I am,” she says. “It was wonderful, amazing, incredible good news.”

Even after recovering, Block’s brush with cancer would touch all aspects of her life — her attitude toward work, her presence in the classroom, and her conversations with her own patients.

Block’s lifelong interest in the social and emotional aspects of serious disease began during her internal medicine residency program at Beth Israel Hospital in Boston, where she found herself gripped by “how poorly we cared for people who were at the end of their lives.” Drawn to understand her patients’ psychological experiences, she ended up completing a residency in psychiatry as well.

At the time, Block says, “there was no field of palliative care, and there was barely a field of psycho-oncology” — the study of the social and psychological dimensions of cancer. “There was sort of no way to go forward.”

If Block couldn’t follow traditional paths to change the way medical institutions supported critically ill patients, she was determined to forge a path herself. In 1998, she started a new job at Dana-Farber with a substantial mission: to build a psycho-oncology and palliative care program from scratch.

By the time Block landed in the operating room herself, she was a leader in her field. But even after 40 years of teaching about severe illness care and doctor-patient communication, when she found herself on the opposite side of that relationship, Block discovered that some things could still surprise her.

“The one really bad part of my care was being in the hospital after the surgery,” she remembers. Struggling to recover from the operation, Block shared a two-bed hospital room with another woman. “I had to crawl over her to get into the bathroom,” she says. “It was so cramped, and so small.”

At night, after her crowd of visitors had left, the woman began sobbing, and Block’s instincts as a physician kicked in.

“There I was, half doped-up still from the anesthetic, I was trying to comfort her,” Block says. “How can you not respond to somebody who’s that vulnerable?”

In that hospital room, she also saw another, uglier side of the health care system up close. “[The woman] felt like the nurses weren’t taking good care of her because she was Black,” Block says. “Because [nurses] put on their best behavior when the doctor comes in the room. I’d never seen that kind of dismissive, seemingly racially-driven behavior, as I saw from nurses.”

Back home from the hospital, readjusting to normal life after the surgery brought its own set of challenges.

“​​I had a pretty hard recovery,” Block says. “And I thought a lot about how much stress was safe to put my body under.” This was especially challenging after decades of juggling a fast-paced career of clinical work, field-building, teaching, heading departments, and research.

Three years before, she had been by her husband Andy’s side through his own struggle with and, ultimately, death from an aggressive lymphoma. The pain of that experience instilled in her a philosophy of “do it now,” and in the wake of her own treatment, she’s focused on putting it into practice.

She built her own house in western Massachusetts — something she’d always wanted to do. She gave herself permission to cut back on the parts of her career that drained her energy, and focus on teaching and seeing patients instead. When she met a new partner, she allowed herself to find love again.

“I’ve been really lucky in terms of my material circumstances, and I have just wonderful people in my life,” she says. And, of course, she feels lucky to be back in the classroom, teaching undergraduates.

Leaving her seminar three years ago was bittersweet — she didn’t want to stop teaching, but she knew her experience with illness would be an arduous one.

“I felt this obligation to the students,” she says, “but it was really clear that I couldn’t teach a class on serious illness, death, and dying, while I was in the middle of this very terrifying personal experience.”

Her class focuses on encouraging difficult discussions about health; she often brings in speakers ranging from doctors to chaplains to seriously ill patients. At the beginning of the semester, she asks students to fill out a survey about their own attitudes toward death, and for freshman family weekend, she asks them to interview a family member about their goals for end-of-life care.

“I love the idea of trying to teach about this very difficult topic to younger people who hadn’t had the kind of indoctrination or socialization into either the pre-med world or the medical culture,” Block says.

At the end of fall 2018, she returned to the seminar class she had to leave behind when she began her treatment and told them her story.

“They didn’t really know me that well, but it was still sort of a traumatizing, discombobulating, upsetting experience for the students,” she says. She believed sharing her story would serve as a valuable learning opportunity. “I don’t like the word closure that much, but it brought things full circle in a way.”

This semester, Block is teaching “The Heart of Medicine” for the third time. The seminar looks different today than it did in the fall of 2018, but not necessarily because of her own harrowing diagnosis. She’s modified the course to incorporate a discussion of Covid-19, and to focus more on health inequities. She says she doesn’t go out of her way to bring up her story, although she does touch on it when the class opens up about personal experiences with death.

“I want them to name their experiences. So I can’t just stand behind a sort of wall of neutrality and pretend I don’t have relevant experiences,” Block says. “That would not feel right, as a teacher.”

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Everything Dies

It’s the Buddha’s basic teaching. It’s life’s universal truth. It’s what we most want to deny. Sallie Jiko Tisdale on how this hard but liberating truth can transform your life.

Death and Life” by Gustav Klimt.

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Most Buddhists put flowers on the altar. We know flowers are beautiful, but that isn’t their purpose here. Flowers begin to die as soon we cut them; we carefully lay death in the place that symbolizes our awakening. We bow and make offering to this crucial truth, built into the bones of the world.

The Buddha spoke volumes of words, an immense canon, but most of what he said comes down to this: Things change. Change cannot be avoided. Change hurts. The fundamental teaching of all Buddhism can be stated as everything dies. The Buddha taught this, it fills the sutras, it is repeated by our teachers. But most of all, we learn this from our own daily lives.

Do we believe that we will dissolve? No. Not deep down in the root of the small self, because the small self plans to live forever.

You have probably learned a traditional formula or two for this insistent teaching about the transitory nature of all things:

Anicca vata sankhara: “Impermanent, alas, are all formations!”

Sabbe saokhara anicca: “All conditioned factors of existence are transitory.”

In the Maha Satipatthana Sutta: “[One] abides observing the phenomenon of arising…abides observing the phenomenon of passing away…”

As a new practitioner, I learned the catechism this way: “All compounded things are subject to dissolution.” The language was strange when I first heard it, and as a young practitioner I found myself parsing the words: Compounded. Dissolution. Notice, I was told, how everything is put together from other things and will be taken apart. I began to notice. A table, a house, a nation—I could see this.

But if all things are compounded and will dissolve, then I am compounded and I will dissolve. And this was not something I could easily accept.

I pretend to accept my own death. Most senior practitioners do; many of them may even believe they accept it. Buddhists have their own peculiar points of pride, outside the usual stream of things we pride ourselves on, like humility and asceticism. Plenty of us are proud of our equanimity in the face of extinction, at least until we see the headlights bearing down.

So how deep does this acceptance really go? It’s not just Buddhists who kid themselves about being prepared for death. It’s people. It’s all of us who don’t want to admit that we are organisms fighting for life, that we can sagely repeat, “Annica, annica, all compounded things are subject to dissolution,” without really confronting what it means.

Do we believe that we will dissolve? No. Not deep down in the root of the small self, because the small self plans to live forever. When we say that “Everything dies,” we mean everything dies but me. And we can get kind of fancy about this point: Everything dies, including my body (but not my awareness—not me). Everything is subject to dissolution, but something passes through to a new form and doesn’t ever go away (that’s me). In a thousand ways, most of them not entirely conscious, we hold on to the hope that something of this self, somehow, will remain, and we hold on to that even as everything we touch slides away like sand in running water.

Why should we pretend to more confidence than we feel? Everyone is a beginner when it comes to death. We can’t practice it. When my mother died, it was the very first time that my mother died, and I didn’t know how to do that, to be a daughter whose mother was dying, to be a daughter whose mother had ceased to exist. When my best friend died—when my teacher died—I didn’t know how to do it. Each death I’ve known has been the very first one of its kind. Even with experience—I know how grieving feels, I know the altered state of a vigil, I know a lot about that—I can’t entirely prepare. And when I die, it will be the first time this particular me dies, and I will be a beginner.

Yes, I know that we are all dying all the time. That’s what it means to be a compounded thing dissolving—this self, this moment, gives way to the next as the girl gives way to the woman who gives way to the crone. I know that the me of today is not the me of yesterday, and I was also taught that if you die once, you never need to die again. But the real teaching of that formula, the falling away of body and mind for a ceaseless moment, is that you are already dead. I know this, but I don’t think my body does.

Slay the demons of hope and fear. My teacher would say this to me at a time when I was knocking up against deepening anxiety. My stubborn refusal to submit to the meaning of that anxiety made me more anxious still. The stronger I resisted, the deeper my anxiety became, until I sank well into true fear. How could I slay that demon when I was afraid to walk out the door?

We need to talk about death bluntly, honestly, and often.

“Vanitas Life, Death, and Resurrection by Ezio Gutzemberg.

The original Pali word for aversion, dosa, is various and shaded. It can be translated as anger or hatred, denial, projection, distortion, aggression, repulsion, even disgust. That is how it can feel to talk about death, about our own death. But I want you to think about it and I want you to talk about it. Even if you have considered your own death deeply, how often do you talk about it? Do you talk about your private conflicts or confusion, your questions, your plans?

How do we begin? Begin with the fear. Begin with the resistance. We know the question. It is why we begin to practice in the first place: Why do we suffer? And we know the answer. It is why we keep practicing: We suffer because of change and resistance to change.

But knowing the answer does not stop the question from being asked, and knowing an answer today doesn’t mean we will remember the answer tomorrow. Ignorance is the first link in the twelve-fold chain of causation—ignorance of impermanence, of anicca, of anatta, of no-self. This chain feeds itself endlessly—our ignorance of the ephemeral nature of the self building a self over and over. The chain is broken only by the transformation of that first mistake, being ignorant about the compounded nature of the self, which is not separate or bounded at all.

What do you fear about death? Make a list. Be honest. Autopsy? Being alone? Pain? Loss of privacy? Do you fear soiling your bed? Do you fear needles? For what do you hope? Make a list. Be honest. Do you want to see it coming? Do you want to be asleep? Do you want to be very old?

Ask the question again. Why am I afraid? Because I will die. What does that mean? (Wait a minute. Will I die? Do I have to die?) Ask yourself: Are you ready to die? Don’t answer too quickly, because that last one is a doozy. Even people who have made great strides in accepting the fact of their own inevitable dissolution will be flooded with adrenaline when the headlights bear down. The body has its own hopes.

Talk about death. Talk about everything. Imagine it. Write a description of the scene of your death. Where are you? What do you see? What do you smell, taste, touch? Who is there? Are you inside or outside? Is it warm or cool? Is there music, or words?

Imagine it. Write it down. Then tell everyone who needs to know—your family and friends and teacher and doctor—what you want. Make a record of your wishes and don’t forget to decide how your body should be handled after you’re done with it. Make copies and pass them out.

Then tear it up. Let it go with all your heart. This will be the work of the rest of your life.

We can do all this. We can make a plan, buy a plot, fill out the advance directive, decide what music we want to hear as we go. But we can’t plan not to die. The essence of dying is the loss of control. This is the hardest part for many of us—not that death will happen, but that it will happen without our hand on the controls. It will happen as it happens, when it happens, where it happens, and chances are it won’t go according to plan. The only thing we can control, and only with practice, is how we face whatever happens.

These days it is common to talk about a “good death.” (There are many official, even government-issued, definitions of a good death.) A good death is usually defined as one where a person is comfortable and at peace.

For myself, I want to think about a right death, a death that fits the life I’m trying to live. Most deaths include what anyone might call good moments and bad moments, desired and undesired consequences. So it is with our lives, and so it is with death. Right deaths are all different; you can’t define the details. For me, it means a death unhidden—from me and from those who love me. It means a death met with grace and willingness when the time comes. Achieving this will be the work of the rest of my life.

If we can face it, recognizing the reality of death will transform our lives.
Flowers are beautiful because they are brief. Beauty is a measure of fragility and brevity and transformation, created in part by our awareness of the precious value of this moment—this moment is what we love. Death is utterly natural, shared by all; it is also heartbreaking. That equation isn’t dissonant; it’s the nature of love. With our eyes open to change, each thing we meet is luminous and sparkling. To love means to lose. To lose means to love. The last breath allows us to cherish another without reservation, holding nothing back.

Slay the demons, my teacher told me. That meant accepting my anxiety, my fear. It meant coming to see that hope and fear are one thing: fantasies of the unborn future. Hope pulls and fear pushes and together they keep us stuck in what has not happened, living a half-life of imaginary events. I exhausted myself on that mountain, until I gave up. Giving up was the key. Accepting the demons of hope and fear until they slew me, which was what my teacher had been saying all along.

The parable of the burning house told in the Lotus Sutra is a familiar one. The children do not know the house is on fire, so they won’t leave until their father tempts them with carts full of treasure. So we are with our own suffering, our ignorance. The Buddha offers us treasures, including one so great we couldn’t even imagine it.

Some years ago, I had a brief, vivid dream. I saw a room completely engulfed in flames, and several people were walking calmly through the room, smiling. One turned and looked at me and said, “I can’t tell you how safe I feel in this house.”

When I begin to truly accept myself as this compounded thing—a dewdrop, a bubble, a cloud—when I really believe for a moment that my precious me is a passing sigh in the oceanic cosmos of change, then I begin to find safety inside the burning house. I don’t need to escape if I know how to live inside it. Not needing to escape, I no longer need rewards. I just walk through it, aware of dissolving.

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Why it’s healthy to think about your own death

Everyone who’s alive now – you, your friends, your family – one day won’t be. It’s an unavoidable fact, and yet we often go to great lengths to avoid acknowledging it. Jules Howard explains why that might be a mistake.

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According to data from the company Statista, just 11 per cent of us consider death in our daily lives. Most of us are clearly busy with the subject of life, perhaps only considering the subject three or four times a year.

We in the West are, in the words of social psychologist Sheldon Solomon, masters of “burying existential anxieties under a mound of French fries”. But that’s understandable, right? Death is horrible. We live. We die. And then it ends. What possible reason could there be for thinking about death more? Plus, French fries are delicious.

According to some scientists, however, there are advantages to thinking about death more. Psychologists, in particular, point to a number of studies that suggest that thinking about death (‘mortality salience’) can raise people’s self-worth, encourage them to be less money-orientated and even make them funnier. Buoyed by research like this there are social movements, such as so-called Death Cafés and the Death Salon collective, that provide space for people to meet and talk openly about death.

In many ways, groups like these mirror Eastern philosophies, which have urged people to consider death and the frailty of human existence, for centuries.

Buddha, for instance, was an advocator of ‘corpse meditation’ where dead bodies are observed in various states of decay. “This body, too,” one text states… “such is its nature, such is its future, such its unavoidable fate.”

And the very notion of ‘yin and yang’ – the dualistic idea of ‘light and dark’ and ‘fire and water’ and ‘life and death’ – appears to inspire in non-Western audiences a greater appreciation of everyday things than in Western audiences.

So, are we in the West thinking about death wrong? I would argue, no. Because there’s no ‘wrong’ way to do it.

But we could certainly do with thinking about it more. Not loads more, just as much as each of us feels is right. In so doing, our perspective on day-to-day events might be imperceptibly improved. After all, to those of us that know that life is impermanent, the French fries have never tasted so good.

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