Dying patients who are in pain are usually given an analgesic, such as morphine, to ease their final hours and days. And if an analgesic isn’t enough, they can be given a sedative – something to make them more relaxed and less distressed at the end of life. We have recently written about a third approach: using a general anaesthetic to ensure that the dying patient is completely unconscious. This has been described previously, but largely overlooked.

There are two situations when a general anaesthetic might be used in dying patients. The first is when other drugs have not worked and the patient is still distressed or in pain. The second is when a patient has only a short time to live and expresses a clear wish to be unconscious. Some dying patients just want to sleep.

But what type of anaesthesia are we talking about? If you need surgery or a medical procedure, there are three options. First, being fully awake, but having local anaesthesia to block the pain. Second, you could be partly sedated: you would be less stressed or worried about it, but you might remember some of the procedure afterwards. Finally, you could have a general anaesthetic and be out cold, with no memory of the procedure afterwards.

Any of these might be appropriate, depending on the procedure and depending on the person. But the option with the highest chance that you won’t feel anything is, of course, general anaesthesia.

These same three options could be offered to a dying patient. Some people might want to be as awake as possible. (Like the poet Dylan Thomas, they might not wish to “go gentle into that good night”.) Some might want to be sedated, if necessary. Others might want to be completely asleep.

The choice of general anaesthesia at the end of life is potentially popular. Last year, we surveyed more than 500 people in the UK about end-of-life options. Nearly 90% said they would like the option of a general anaesthetic if they were dying.

You might wonder, is this not just euthanasia by another name? Giving someone medicines to ensure that they are unconscious as they die naturally is different from giving someone medicine to end their life. General anaesthesia is legal, whereas in many countries, including the UK, euthanasia is illegal. This means that the option of anaesthesia could be available now for dying patients in the UK without changing the law. France has recently recognised the right for dying patients to be unconscious.

Wouldn’t it be too risky?

There are side-effects with all medicines, but recent advances mean that it is possible to give anaesthetic medicines to patients close to death without affecting their breathing. The medicine is given slowly, and the patient made unconscious gradually over 15 to 20 minutes. The medicine can be slowed or stopped at any point.

Previous studies that have used anaesthesia at the end of life, have continued the medicines for one to 14 days until the patient died naturally.

This will not be for everyone. It may not be possible for those who are dying in their own home. And some people will not want it. But we have the means to offer dying patients a gentle alternative end to their days. We believe that there is a strong ethical case to make the option of general anaesthesia at the end of life more widely available.

Complete Article ↪HERE↩!

March 29, 2021March 28, 2021

Does Marijuana Have A Place In Hospice?

Marijuana is used in hospice care to ease spiritual and existential suffering, with some studies showing an important therapeutic role for patients faced with the despair of a terminal illness.

BY Kate-Madonna Hindes

As Americans continue to age, hospices are exploring new ways to bring peace and calm to the often slow and painful process of end-of-life care. According to the CDC, in 2015, an estimated 1.4 million individuals on Medicare were patients in a hospice setting.

Quadrupling in size in the last 20 years, hospices are investing in creating a patient-centric approach that dismantles beliefs that hospices are cold, and unfeeling institutions. From massage to aromatherapy, some hospices are offering new additions to their programs including music and integrating family into meaningful experiences. While many hospices are focused on offering a thoughtful quality of care, many end-of-life-care specialists are also advocating for marijuana.

A MorseLife Hospice and Palliative Care study focused on advances in hospice care found changing attitudes on medical marijuana. They cited that, “87% of Americans support the use of medical marijuana as a treatment option for terminally ill patients, with nearly three in five Americans (58%) expressing strong support.”

The American Academy of Hospice and Palliative Medicine recently shared a video on how hospices can integrate medical marijuana into care, heralding more change in the market to accepting marijuana as a part of a patient’s care plan.

Pathways Home Health advocates for marijuana in hospice care, stating:

“Marijuana is used in the hospice care setting to ease spiritual and existential suffering, with some studies showing an important therapeutic role for patients faced with the despair of a terminal illness, as well as the loss of function that accompanies it. A mild euphoria or sense of well-being can ease a patient’s mind, body and spirit as they come to terms with their fate.”

Not Telling Your Doctor About Marijuana Use Can Hurt You

Stuck in political limbo

While some hospice programs are embracing medical cannabis, some are facing uncertainty about whether or not to allow medical marijuana, even when it’s legal inside their particular state. With an ever-expanding list of states that allow marijuana both medically and recreationally, hospices are taking an evidence-based, risk-management-forward approach to ensure they comply legally and ethically.

Changing attitudes are allowing for researchers to gain more insight and information regarding the role cannabis and CBD can both play in hospice and palliative care settings. Published in the Journal of Palliative Medicine, an October 2019 study focused on the responses of over 300 palliative care professionals from over 40 states on the use of medical cannabis. The study found “overwhelming support” for the use of medical cannabis in a hospice setting:

Regardless of legal status, hospice staff members were overwhelmingly in agreement that MC (medical cannabis) is appropriate for hospice patients to have access to and use.

Citing barriers such as legal status, clinical safety, and societal influence, the study believes opportunities exist to better support hospice providers and patients with education, research and policies that elevate the use of medical cannabis.

With new patients entering hospice every day and both clinicians and doctors looking to supplement old pain medicines with newer more effective treatments, marijuana will remain a top topic for years to come.

Complete Article ↪HERE↩!

March 15, 2021

Facing Terminal Cancer

Support helps families come to terms with looming loss

By Alexander Camp

Last April, Rogers Park resident Aisha Luster got the biggest shock of her life when she learned that her father was diagnosed with stage 4 esophageal cancer. “He didn’t tell me or my older sister,” says Luster, 37. “We were crushed. We felt left in the dark. It was devastating.”

Within two months of sharing the gut-wrenching news, Luster’s father died. “He spent the last week of his life in a hospital alone due to Covid,” Luster recalls. “That was one of the worst days of my life. I never knew I would lose him. I have definitely been affected mentally, physically, and emotionally. It still feels like a bad dream I can’t get out of.”

Luster’s father was one of an estimated 606,520 Americans who died of cancer in 2020. Grief, depression, panic, and anxiety — for both the individual and their family — are common when dealing with terminal cancer.

Facing imminent loss is not easy. Yet, end-of-life support from palliative care services, such as hospice care, can help patients and their loved ones cope with these emotions and prepare them for what to expect.

End-of-life discussions

Talking to family members about their wishes can help make choices easier for caregivers.

“Families are under an enormous amount of stress, especially if the medical problem came suddenly and they didn’t have any opportunity to talk to the patient or to anticipate the problems,” says sociologist Susan P. Shapiro, a research professor at the American Bar Foundation in Chicago and author of Speaking for the Dying: Life-and-Death Decisions in Intensive Care.

To watch their body breaking down before your very eyes definitely had a huge impact on me.”

End-of-life discussions establish transparency and prevent misinterpretations of the individual’s final wishes, she says. “When patients never spoke to family members in advance about what they wanted, family members were very, very torn about what they should do.”

For those living with terminal cancer, coming face-to-face with their looming mortality can be painful.

Between 15% and 50% of cancer patients experience depressive symptoms, according to a review article in the journal Dialogues in Clinical Neuroscience. Depression in cancer patients contributes to physical and psychological problems, it says. And depression may be associated with higher death rates.

Christine Schwartz-Peterson, MD, is a hospice medical director at JourneyCare, a hospice and palliative care agency that’s headquartered in Glenview and serves 13 counties in Illinois. Part of her role involves caring for terminally ill patients who experience depression or anxiety.

“Our patients and their loved ones are going through tremendous loss while on service with us,” Schwartz-Peterson says. “Our skilled hospice teams, which include social workers and chaplains, are trained to recognize this pain and help support them throughout this difficult time.”

Social workers provide resources such as emotional support, counseling for patients and caregivers, and funeral planning that reflects the patient’s final wishes. Chaplains, tasked with easing spiritual healing through physical and emotional pain, aid patients and families with some comfort in spite of illness.

Relying on such services helped Lombard resident Melissa Schmitz.

In 2016, when she was 44, her father was diagnosed with stage 4 pancreatic cancer.

“There’s really no way to prepare for that. To watch the person you love, who has always taken care of you your whole life, to watch their body breaking down before your very eyes definitely had a huge impact on me,” Schmitz says. “But there was nothing I could do to actually fix it or help it, and that was devastating for me.”

Ultimately, palliative care, which supports patients and their families, enabled her to reach peace with the end-of-life process. As her father’s cancer progressed in the last weeks of his life, the Schmitz family decided to move him to hospice care.

With the help of hospice physicians and social workers, Schmitz was able to provide her father with individualized end-of-life care. “I was pleasantly surprised. I didn’t want him to be in a hospital room, and he didn’t want to be in a hospital room,” she says. They all achieved a measure of peace. “JourneyCare allowed me to basically move in for the last couple of weeks. I never had to miss a minute with him. And that was wonderful.”

Supporting the overlooked

It’s important to support the mental health of family caregivers as well as patients, says Dana Delach, MD, a JourneyCare physician specializing in hospice and palliative medicine. Caregivers, who are often physically and mentally exhausted, can be overlooked when someone is dying.

Friends and family can step in to listen, care, and offer support. “If you know someone who is a caregiver, it is important to ask how you can help,” Delach says. “Sometimes the best gift you can give a caregiver is the gift of being present. Truly present. Sit with them while they provide care. Be a person to listen as they express their myriad emotions.”

Like Luster and Schmitz, Lincoln Park resident Simone Malcolm understands the signifi-cance of addressing family mental health during this difficult time.

In 2010, Malcolm’s mother revealed to her that she had breast cancer. At the time Malcolm was 20 years old. “When my mother first told me of her diagnosis, I was devastated because I thought I was going to lose my mom. I was scared, and because of that, I wasn’t there for her as I should have been,” Malcolm says. “I put a lot of my focus on school, my friendships, and hanging out. I acted as if everything was normal and I didn’t have a sick parent.”

Complicating matters for Malcolm’s mother was that she was initially misdiagnosed. By the time she was properly diagnosed, the cancer had reached stage 3. “My mother was hopeful that she would beat the disease,” Malcolm recalls. “Because of this, we did not speak about what would happen if she was to become incapacitated.” Her mother passed away later that year.

Drawing from her experience, Malcolm offers recommendations for those facing the same situation she did a decade ago. It’s important to be present for loved ones and involved in their care, she says.

“The advice I would give is to make sure the family stays on top of doctor’s visits and make sure they ask a bunch of questions so they are informed,” she says. “Also, be there for your loved one. They need all the support and love.”

Complete Article ↪HERE↩!

December 16, 2020December 15, 2020

This empathic website helps you think and talk about death

Death is all around us this year. We need tools to help.

By Mark Wilson

It’s been a year of loss. But even seeing the devastation of COVID-19 hasn’t made it any easier to talk about death—and specifically, the possibility of our own deaths and deaths of those we love. Of course, ignoring death doesn’t make its inevitability any less real, during this year or any other.

Life Support is a new website from the London creative studio The Liminal Space, funded by the U.K. government. It’s a resource that proclaims, “Talking about dying won’t make it happen.” And with that premise as a baseline, it lets you explore topics about death and dying from the perspectives of experts, like palliative care doctors and social workers.

The design appears nebulous at first glance, with words floating in hand-drawn bubbles, which pulsate like the rhythm of your own breathing. But looks can be deceiving. What’s really lurking inside this casual space is a sharp curriculum built to answer your lingering questions about death.

As you scroll through the interface, the site offers several potential paths of thought that are probably familiar to most of us, like, “I’m scared to have a painful death” and “I don’t know if I should talk to my child about death.” When you find a question to explore, you swipe for more. That’s when experts come in. Some of their answers appear in blocks of text. Others are actually recorded, with audio you can play back. You might think the audio is a gimmick or unnecessary panache. In fact, I found it quite affecting to hear a doctor offering her own thoughts and advice about death aloud; it creates a level of intimacy that printed words can’t quite capture.

Ten or 20 years ago, a resource like this might have been a pamphlet (and indeed, anyone who frequents hospitals knows that pamphlets are still a mainstay to educate patients on topics of all types). But Life Support makes a convincing argument for how giving someone a bit of agency—like choosing our own questions to be answered, or hearing from doctors with our own ears when we’d like to—makes the information easier to digest.

I doubt there’s any quick resource out there that will ever get people completely comfortable talking or thinking about their own mortality. Religion and the arts have already attempted to tackle this topic for millennia. But Life Support is a solid attempt to ease us into the conversation.

Complete Article ↪HERE↩!

August 14, 2020August 13, 2020

The surprising benefits of contemplating your death

Now is the perfect time to face your fear of mortality. Here’s how.

By Sigal Samuel

Nikki Mirghafori has a fantastically unusual career. After getting a PhD in computer science, she’s spent three decades as an artificial intelligence researcher and scientific advisor to tech startups in Silicon Valley. She’s also spent a bunch of time in Myanmar, training with a Buddhist meditation master in the Theravada tradition. Now she teaches Buddhist meditation internationally, alongside her work as a scientist.

One of Mirghafori’s specialties is maranasati, which means mindfulness of death. Mortality might seem like a scary thing to contemplate — in fact, maybe you’re tempted to stop reading this right now — but that’s exactly why I’d say you should keep reading. Death is something we really don’t like to think or talk about, especially in the West. Yet our fear of mortality is what’s driving so much of our anxiety, especially during this pandemic.

Maybe it’s the prospect of your own mortality that scares you. Or maybe you’re like me, and thinking about the mortality of the people you love is really what’s hard to wrestle with.

Either way, I think now is actually a great time to face that fear, to get on intimate terms with it, so that we can learn how to reduce the suffering it brings into our lives.

I recently spoke with Mirghafori for Future Perfect’s limited-series podcast The Way Through, which is all about mining the world’s rich philosophical and spiritual traditions for guidance that can help us through these challenging times.

In our conversation, Mirghafori outlined the benefits of contemplating our mortality. She then walked me through some specific practices for developing mindfulness of death and working through the fear that can come up around that. Some of them are simple, like reciting a few key sentences each morning, and some of them are more … shall we say… intense.

I think they’re all fascinating ways that Buddhists have generated over the centuries to come to terms with the prospect of death rather than trying to escape it.

You can hear our full conversation in the podcast here. A partial transcript, edited for length and clarity, follows.

Sigal Samuel

You’ve worked in Silicon Valley and you still live near there, so I’m sure you’ve encountered the desire in certain tech circles to live forever. There are biohackers who are taking dozens of supplements every day. Some are getting young blood transfusions, trying to put young people’s blood in their veins to live longer. Some are having their bodies or brains preserved in liquid nitrogen, doing cryopreservation so they can be brought back to life one day. What is your feeling about all these efforts?

Nikki Mirghafori

It’s the quest for immortality and the denial of death. Part of it is natural. Human beings have done this for as long as we have been conscious of the fact that we are mortal.

A person who really put this well was Ernest Becker, the author of the seminal book The Denial of Death. I’d like to offer this quote from him:

This is the paradox. A human is out of nature and hopelessly in it. We are dual. Up in the stars and yet housed in a heart-pumping, breath-gasping body that once belonged to a fish and still carries the gill marks to prove it. A human is literally split in two. We have an awareness of our own splendid uniqueness in that we stick out of nature with a towering majesty, and yet we go back into the ground a few feet in order to blindly and dumbly rot and disappear forever. It is a terrifying dilemma to be in and to have to live with.

There is a whole field of research in psychology called terror management theory, which started from the work of Ernest Becker. This theory says that there’s a basic psychological conflict that arises from having, on the one hand, a self-preservation instinct, and on the other hand, that realization that death is inevitable.

This psychological conflict produces terror. And how human beings manage this terror is either by embracing cultural beliefs or symbolic systems as ways to counter this biological reality, or doing these various things — cryogenics, trying to find elixirs of life, taking lots of supplements or whatnot.

It’s nothing new. The ancient Egyptians almost 4,000 years ago, and ancient Chinese almost 2,000 years ago, both believed that death-defying technology was right around the corner. The zeitgeist is not so different. We think we are more advanced, but it comes from the same fear, same denial of death.

Sigal Samuel

It seems like in the West, we really have a bad case of that denial. I think we rarely talk about death or are willing to face up to the reality that we’re going to die. We seem to be wanting to always distract ourselves from it.

You are a Buddhist practitioner and you have a practice that is very much the opposite of that, which is mindfulness of death, or maranasati. You’ve done trainings and led retreats around this subject. But some people might say this is too morbid and depressing to think about. So before we actually delve into the mindfulness of death practices, could you entice us by telling us a few of the benefits of doing them?

Nikki Mirghafori

First and foremost, what I found for many people, myself included, is that facing the fact that I am not going to live forever really aligns my life with my values.

Most people suffer what’s called the misalignment problem, which is that we don’t quite live according to our values. There was a study that really highlighted this, by a team of scientists, including Nobel Prize winner Daniel Kahneman. They surveyed a group of women and compared how much satisfaction they derived from their daily activities. Among voluntary activities, you’d probably expect that people’s choices would roughly correlate to their satisfaction. You’re choosing to do it, so you’d think that you actually enjoy it.

Guess what? That wasn’t the case. The women reported deriving more satisfaction from prayer, worship, and meditation than from watching television. But the average respondent spent more than five times as long watching television than engaging in spiritual activities that they actually said they enjoyed more.

This is a misalignment problem. There’s a way we want to spend our time, but we don’t do that because we don’t have the sense that time is short, time is precious. And the way to systematically raise the sense of urgency — Buddhism calls it samvega, spiritual urgency — is to bring the scarcity of time front and center in one’s consciousness: I am going to die. This show is not going to go on forever. This is a party on death row.

Sigal Samuel

So the approach here is to bring to the forefront of our consciousness how precious our time is, by impressing upon our minds how scarce it is. And that helps align our life with our values.

Are there other benefits to practicing mindfulness of death?

Nikki Mirghafori

The second benefit is to live without fear of death for our own sake. That way, we don’t engage in typical escape activities. And it frees up a lot of psychic energy. We have more peace, more ease in our lives.

The third benefit is to live without fear of death for the sake of our loved ones. We can support others in their dying process. Usually the challenge of supporting a loved one is that we have a sense of grief for losing them, but a lot of that grief is actually that it’s bringing up fear of our own mortality. So if we have made peace with our own mortality, we can be fully present and support them in their process, which can be a huge gift.

My mom passed away two years ago. And for me, having done all of these practices, I could be with her by her deathbed, holding her hand and supporting her so that she could have a peaceful transition. She didn’t have to take care of me so much and console me. She could be at peace and take delight in this mysterious process that we just don’t know what it’s like. It might be beautiful, might be graceful. We don’t know — there might be nothing; there might be something.

Sigal Samuel

Now I feel sufficiently enticed to learn about the actual practices of mindfulness of death. Let’s start with one that seems simple: the Five Daily Reflections, sometimes called the Five Remembrances, that are often recited in Buddhist circles. Would you mind reciting those?

Nikki Mirghafori

Happy to. These are the Five Daily Reflections that the Buddha suggested people recite every day.

Just like everyone, I am of the nature to age. I have not gone beyond aging.

Just like everyone, I am of the nature to sicken. I have not gone beyond sickness.

Just like everyone, I am subjected to the results of my own actions. I am not free from these karmic effects.

Just like everyone, I am of the nature to die. I have not gone beyond dying.

Just like everyone, all that is mine, beloved and pleasing, will change, will become otherwise, will become separated from me.

Allow whatever arises to come up. It’s okay. These contemplations can bring a lot up. So just be with them as much as possible.

Sigal Samuel

I’ve done these reflections before, but every time I do them, I notice that some are much harder for me to absorb than others. The fourth one — I’m of the nature to die — does not terrify me. Maybe that’s weird, but that’s not the one that really scares me. The one that I find impossibly hard is the fifth one. Everyone that I love and everything that I love is of the nature to change and be separated from me.

It’s really the death or the separation from the people I love that I find much harder to face than the death of myself. Because if I’m going to die, you know, then I’ll be gone. There won’t be any me to miss things.

Nikki Mirghafori

Yes. So appreciate and make space for the one that really touches you.

Also I would say that with the fourth one, making peace with our own death, I’ve done the practice and sometimes I’m like yeah, sure, whatever. And then I’ve really stayed with it, and thought, “This could be my last breath.” When the practice really takes hold and becomes alight with fire, it’s like, “Oh, my God, I am going to die!” It really hits home.

Sigal Samuel

Just to clarify, this is a separate mindfulness of death practice, where you contemplate with every breath, “This could be my last inhale. This could be my last exhale.”

Nikki Mirghafori

Yes. And to bring the historical context into it: This particular teaching is what’s called maranasati. Marana is death in Pali, the language of the Buddha. Sati is mindfulness. The mindfulness of death sutra, that’s where the Buddha taught it, and it’s actually quite a lovely teaching.

The Buddha comes and asks the monks, “How are you practicing mindfulness of death?” And one of them says, “Well, I think I could die in a fortnight, in a couple weeks.” Another one of them says, “Well, I think I could die in 24 hours.” Or “Well, I could die at the end of this meal.” Or “Well, I could die at the end of this bite of food I’m eating.” And another one says, “Well, I could die at the end of this very breath.”

And the Buddha says, “Those of you who said, two weeks, 24 hours, whatever — you are practicing heedlessly. Those who said right at this breath, you are practicing heedfully, correctly. That is the practice.”

There are ways to really bring the sense of immediacy and urgency to all this. It’s not out of the question that there could be an aneurysm or that a meteor could just hit the Earth in this moment. Use visualizations; be creative.

Sigal Samuel

Another thing I find really helpful is remembering the idea of impermanence. Which, of course, is the theme of our whole conversation — that our whole life is impermanent — and that’s a very central Buddhist teaching. But also any emotion that I’m feeling is impermanent. So if I’m feeling an intense surge of fear as I do a practice, that’s impermanent, too.

Nikki Mirghafori

Yeah, I love that. When I teach impermanence, there are little impermanences that come and go, and then there is the big impermanence, which is your life! I’m chuckling because this is a case where impermanence is on your side. Impermanence is just a rule of how things run in this world. It’s impersonal. It’s just the way things are. But in our perspective, it’s either working for us or against us.

Sigal Samuel

Can you tell me about another kind of contemplation — the “corpse contemplation” or “charnel ground contemplation”? Charnel grounds are these places where, after people have died, their bodies are left to decay above ground, to rot in the open air. And Buddhist monks would go and observe them up close, right?

Nikki Mirghafori

Many monks do that, especially in Asia. In order to become more intimate with a sense of mortality, the practice is to go to the charnel ground and to actually see a corpse. And the contemplation is: My body, this alive body, is just like this body that is decaying. It’s in different stages of being a body, of decomposing.

A specific practice in the Buddhist canon is to contemplate a corpse in different stages of decay. This particular practice requires a sense of stability of mind. Do the other ones first. I only teach it on a retreat when there’s a container of safety, holding people and supporting them through it.

Sigal Samuel

I definitely have not yet worked myself up to doing corpse contemplation by looking at images of actual human corpses. But when I go for a walk, whenever I see a dead bird or squirrel or mouse that’s been run over in the road, I actually pause and take a minute to look at it. I’m trying to ease my way into this practice.

Nikki Mirghafori

Brilliant. Similarly, another informal practice I wanted to share is having a memento mori. Like a little skull, or those bracelets that are all skulls. I just drew on a little Post-It a skull and bones, and posted it on my computer monitor, so I would remember: Life is short. I’m going to die.

I’ve had various memento moris on my desk throughout the years, and I invite people to have them. They don’t have to be sophisticated. On a piece of paper, just write out, “Life is short” or “You are going to die” or “Traveler, tread lightly.” Whatever works for you to keep death in your perspective. And I think it’s good to switch memento moris around so that your mind doesn’t get used to seeing the same thing all the time.

Sigal Samuel

I’m glad you brought this up because I was going to say the corpse contemplation reminds me a lot of that memento mori tradition, which is a centuries-long tradition in Christianity. So many different religious traditions have emphasized the importance of meditating on our death and have devised ways like the memento mori to try to keep forcing the ego to recognize its looming demise.

Nikki Mirghafori

Yes. And I know that for me, I feel most alive and I feel happiest and I feel most connected with myself, when I’m aware of my death. If it happens for a day or two that it’s not in the forefront for whatever reason, I’m not as bright, as sharp, as alive. So I just love bringing it back. It enlivens me. It supports me to live more fully and hopefully die with more delight and joy and curiosity.

Sigal Samuel

I’m wondering if you can help me with something else. I mentioned earlier that I’m not really scared of my own death so much, but I am scared of the death of the people I love. And especially during the pandemic, I think that’s causing a lot of anxiety for me and probably a lot of others. We’re scared about the potential death of our grandparents, our parents, our friends. Is there a way to free ourselves of the overwhelming fear of their death?

Grief is a natural part of the process. However, it is complicated by our own seen and unseen fear of death. So I invite you to actually work with the practice of making peace with your own death. That’s what’s underlying it. Even if you think you’re not afraid of your own death, you probably are.

When people are really at peace with their own passing, there is a different perspective. There’s a different way of being with the fear or sadness of losing others. There is still a pain of loss, but it shifts.

Complete Article ↪HERE↩!

August 11, 2020August 10, 2020

‘Spiritfarer,’ a game about the afterlife, seeks to ease the terror of death

By Elise Favis

“Goodbye, my friend,” said a deer named Gwen, holding me close in a final embrace as we sailed into the blood red waters of the River Styx. Despite the intense color of the sea, and the intensity of the moment, I felt calm. Flower petals drifted on the surface of the water, and white, lush trees swayed in a tranquil way. Gwen disappeared into thin air.

“Spiritfarer,” a game releasing later this year (on several platforms including Switch, PlayStation 4, Xbox One, PC and Stadia), is about guiding spirits to the afterlife. It hopes to make the subject of death comfortable, even cozy, by focusing on relationships and care in people’s last moments while guiding them to the other side. After playing for an hour, I came away feeling hopeful and uplifted, even after experiencing its somber themes.

You play as Stella (or Daffodil, her accompanying cat, if you’re player-two via local or online co-op), a young girl who becomes a new spirit guide to the dead after Charon, inspired by the ferryman of Hades in Greek mythology, retires from that same position. You sail a fantastical world, gathering spirits and convincing them to board your ship. You help them through their problems and encourage them to accept their fates. For creative director Nicolas Guérin, building a death-positive game was cathartic; a way to cope with his own mortality as well as the passing of loved ones.

“I’m terrified of dying,” Guérin told The Washington Post in a recent interview. “I’m terrified of leaving my daughter behind me. I’m terrified of losing my friends and my family.”

His whole team drew inspiration from their experiences with losing someone. The characters in the game are each inspired by grandparents, uncles and friends who died. They’re not “carbon copies,” Guérin said, but composite characters; a mix of traits, personalities, feelings and anecdotes derived from connections they’ve had with deceased loved ones.

Guérin and his colleagues at indie studio Thunder Lotus Games had “no idea at first” if they could pull off themes of death positivity in a management sim, saying he “lucked out” with how it all came together. He said it was important to combine normal, mundane tasks with the “extraordinarily, terribly gruesome moment we face when we know we’re going to die.”

In “Spiritfarer,” your ship evolves over time as you build different structures on top of one another like eclectic towers. Some of these are temporary homes for the spirits you gather, and others are stations for cooking, harvesting, gardening and more. Each character wrestles with something. A lion couple, for example, struggles to find happiness together when one of them is unfaithful. Others, like Stanley, a talking and walking mushroom with childlike traits, just wants to be cared for, so I made him his favorite meal: french fries. Some just want to be hugged. You spend time on and off the ship, completing quests for these spirits and finding out more about Stella along the way, too.

It isn’t just through mechanics that “Spiritfarer” achieves a sense of serenity. The game has a calming atmosphere, with a striking art style inspired by Japanese painter Hiroshi Yoshida and from whimsical Hayao Miyazaki films like “My Neighbor Totoro.” This world about death is bright and colorful, rather than dark and morbid.

Having spent 15 years in the games industry, much of that time at Ubisoft working on franchises like “Assassin’s Creed,” Guérin wanted to explore death in a way that forces the player to think about it outside the bounds of a game. Instead of a fail state mechanic, death in “Spiritfarer” is the key to progress. Every time a character dies, they leave behind a room filled with beautiful, overgrown flowers. It’s a symbol of heritage, Guérin explained.

“You need to actually gather some of these flowers that are used as a token to pay a shark, to build upgrades on the ship,” Guérin said. “And those upgrades will allow you to go across specific barriers like ice or rocks.”

Guérin’s brother is the chief of staff for a geriatric ward in southern France. During early development for the game, Guérin spent a significant amount of time “documenting and understanding” what people think and feel during their final moments by meeting patients in hospice and end-of-life care facilities. As he visited the terminally ill, he noticed their drive to experience human connection or enjoy a peaceful moment. He wanted to convey this in “Spiritfarer,” rather than have characters give grand speeches or make sweeping life changes as they faced death.

“They just want to still wake up in the morning, brew themselves some coffee and spend time with their family, relatives and friends. And that’s it,” he said.

Complete Article ↪HERE↩!

July 26, 2020July 25, 2020

Death anxiety

– body bags, catastrophic thinking and facing the inevitable

By Lydia Hales

Rachel Menzies has lost count of the number of people she has zipped into body bags.

While other people stood around watching – sipping tea and nibbling on cake, or snapping photos of their friends’ faces disappearing into the plastic – she always stayed close by, waiting for rustling or a shout from inside the bag.

“They would stay in for however long they felt comfortable – some just for 10 seconds, others for a few minutes,” says Menzies, a Sydney-based psychologist and researcher at the University of Sydney.

After the occupants of the bag – psychologists, psychiatrists, and counsellors – clambered out, they were treated to a video of decomposing human bodies: bloating, maggots swarming over flesh that then ruptures and leaks fluids, and the open grin of a skull wrapped in shrunken skin. It was deliberately shocking, but Menzies says it serves as a reality check.

“It’s important to come to terms with the fact that, at the end of the day, we are all made of flesh and bone which will eventually decay. We need to stare death in the face instead of turning away and pretending it doesn’t happen.”

Psychologist Rachel Menzies says there is growing evidence that death anxiety is a transdiagnostic construct – something that causes or worsens a range of mental health disorders

The idea of death anxiety as central to mental health has been gaining attention in clinical psychology since roughly 2014, says Menzies. So in 2019, she and her clinical psychologist father, Professor Ross Menzies, toured the country running workshops to help mental health professionals address it with patients.

“We wanted to get participants trying out exercises they might recommend as exposure tasks [for clients], with the body bags being one of the more unusual tasks.”

“I would have loved to get a coffin and carry that around Australia, but it’s much less practical than a foldable plastic body bag.”

When fear of death becomes debilitating

Being afraid of dying and having occasional thoughts about it is normal, but if it gets in the way of life – working, travelling, or seeing friends – it’s becoming a problem, Menzies says. And in this particular Covid moment, it’s hard to escape reminders of our mortality, with doom and death tolls constantly in the news.

Canadian-based clinical psychologist Patricia Furer has been working with patients on death anxiety for about 20 years.

“I have found most people who are struggling with fear of death have had difficult experiences with illness and death that have made them particularly attuned to these concerns,” says Furer, an associate professor and director of the anxiety disorders clinic at Saint Boniface Hospital in Winnipeg.

‘People who have thought about what might happen after death … often sit in a more comfortable place when facing their own death,’ says Dr Kerrie Noonan.

“For example, having experienced deaths of four close family members or loved ones in one year or perhaps a series of difficult health issues in themselves and loved ones.”

Death anxiety isn’t recognised as a disorder in the US’s Diagnostic and Statistical Manual of Mental Disorders, but fear of death can be classified as a specific phobia (thanatophobia), and Menzies says there’s growing evidence that death anxiety is a transdiagnostic construct – something that causes or worsens a range of mental health disorders.

Furer agrees, but says a lot of research is needed to understand how it works across categories used for different diagnoses.

“I think it’s probably more of a concept or attribute – like we talk about perfectionism,” Menzies says.

A 2019 study led by Menzies found a strong relationship between death anxiety and worse severity of symptoms in 12 disorders including alcohol use disorder, depression, and social anxiety.

“Death anxiety was also significantly associated with a person’s number of hospitalisations, how many medications they’re on for their mental health, and how many different disorders they’ve had across their life,” Menzies says.

The risk of death anxiety worsening mental health conditions is particularly relevant now, Menzies says.

As an example of the sort of effect this might have, Menzies refers to a study where people with obsessive compulsive disorder were asked to complete personality questionnaires.

Those whose questionnaires included two questions about death spent more than twice as long washing their hands afterwards (more than 20 seconds compared to less than 10) than those who had two questions on dental pain.

Managing catastrophic thinking

If death anxiety is at the root of a mental health disorder, many current treatments may not be as effective as we think, Menzies says.

“If that underlying causal factor of death anxiety isn’t addressed, people might just return to health services with different conditions years later. Say they get effective treatment for OCD, but later develop health anxiety or a specific phobia.”

Menzies cites the case of Anna, 34, who came to Menzies having suffered health anxiety for 15 years and had seen several psychologists.

She often asked her GP for tests for fairly benign symptoms, such as headaches or minor skin irregularities, then worried they had missed something, asking for more tests and second opinions.

“Her worries focused on death-related outcomes, such as dying of cancer, and she made catastrophic interpretations of benign symptoms, for example assuming a headache was a brain tumour,” Menzies says.

“It became apparent that Anna also avoided things: flying, for fear of plane crashes, or driving long distances in case she had an accident. When asked about her general health, Anna mentioned she avoided any exercise as she worried the change in her heartrate may be a sign of a heart attack.”

Cognitive behaviour therapy (CBT) focused on exposure is the most evidence-based treatment for death anxiety, Menzies says.

But there’s a twist.

“Standard CBT for most disorders generally won’t touch on death at all, and if it does, it’s trying to disprove the person’s estimate of the likelihood of death: for a fear of flying, you’re trying to get them to see that dying in a plane crash is very unlikely,” Menzies says.

But as life comes with a 100% likelihood of death, says Menzies, reducing someone’s fear of dying from a specific cause won’t help. Instead of trying to convince someone that planes don’t crash, Menzies would suggest exposing that person to death-related situations, like writing their own obituary or planning their funeral.

In Anna’s case, therapy included books and TV shows featuring death, and gradually reducing her GP visits each month. Over time, she returned to work, and could see sick loved ones she had avoided visiting before, Menzies says.

Or you could also have your phone remind you five times a day that you’re going to die – which is what Menzies does. She has the app WeCroak and recommends it to clients to help normalise death.

“I often find I’m stewing on something or worrying about a deadline, then the notification comes up and helps put things in perspective.”

Furer also says writing a list of death-related fears can identify exactly what people are afraid of.

“For example, some people fear the process of dying, some people fear missing out on life after they are dead, some fear leaving loved ones behind.”

Finding joyful activities can balance out the more difficult exposure tasks, she adds.

“Fear of death can result in people limiting their lives and spending all of their time focused on their worries. Shifting at least some of their energy to building positive and satisfying activities into their day-to-day lives can be helpful.”

On the positive side, Furer says patients who were already working on death anxiety are feeling “particularly well-equipped” to manage current pandemic fears because they already had coping strategies – such as managing catastrophic thinking – in place.

Are we warming up to death?

Dr Kerrie Noonan, who researches community behaviours around dying, says death-related groups and public activities have bloomed in the last decade.

“There are weddings and community events in cemeteries, Coffin Club in Tasmania where you build your own casket, festivals like We’re All Going To Die,” says Noonan, a clinical psychologist and social researcher at Western Sydney University.

But it’s too soon to know whether this will lead to death anxiety easing in individuals, Noonan says.

“All this interest could speak to the fact we’re really anxious about dying, but we’re often educating ourselves in these events and that could help our fears decrease.

“In my experience [in palliative care] people who have thought about what might happen after death – whether they’re religious, spiritual, or have no religion – often sit in a more comfortable place when facing their own death.”

While first-hand experience around death can be agonising, it does appear to help us and others.

People experiencing loss often find a “mentor” in their family or friends who have experienced bereavement before, Noonan says.

“If we can deal with our fears about death and dying, we will be better at supporting our families, our friends, those who are dying and bereaved. We all need to be better at that – for ourselves, and for each other.”

Complete Article ↪HERE↩!