Philosophy OF Death

[Nick Capozzoli]

I don't think you have had much experience with the elderly dying. They adapt very well and they might require pain killers depending on the affliction. But they die in acceptance, serene, and waiting for it. Of course there are a few mentally ill that raise a lot of hell. But they are very few.

Some do and some don't, and I say that based on having been around dying folks, both young and old. You are right about the need to alleviate pain, which is one aspect of dying that we have the ability to do something about. We do have potent drugs to alleviate pain (and anxiety), and we should offer these to the dying, along with whatever other forms of comfort we can provide. That's what Hospice Medicine and Palliative Care is all about.

Death is inevitable. We all die sooner or later. And death, for a living body, is final, which is to say that it is the end of one's life as a living organism. That is unless you believe in the idea of a Soul that has some sort of existence independent of the body.

Given the inevitability and finality of death, dying folks will approach death, and "accept" it differently. Kubler-Ross described a series of stages in the psychological "response" to news of one's impending death, beginning with anger and ending with acceptance. It's a neat intellectual construct that is generally accepted as true. For all I know, it may be an accurate "ideal" description of how the mind deals with impending death. I can tell you that it doesn't always follow the K-R schema. Some folks do get to the final stage of acceptance, but others do not. Many "do not go gentle into that Good Night" but continue to rage against the dying of the light...

BTW, Dylan Thomas's poem says little about his father's attitude towards death, and says a lot about the poet's own feelings about his father's death.

[mal4mac]

Given the inevitability and finality of death, dying folks will approach death, and "accept" it differently. Kubler-Ross described a series of stages in the psychological "response" to news of one's impending death, beginning with anger and ending with acceptance. It's a neat intellectual construct that is generally accepted as true. For all I know, it may be an accurate "ideal" description of how the mind deals with impending death. I can tell you that it doesn't always follow the K-R schema. Some folks do get to the final stage of acceptance, but others do not. Many "do not go gentle into that Good Night" but continue to rage against the dying of the light...

Kubler-Ross may be describing stages that some ordinary people follow, but it doesn't seem at all "neat" to me, and it isn't generally accepted as true.

You seem to be implying that people should just not bother thinking about death, and just react to it when it comes. So if they get angry, depressed, get drunk and and go around shouting "Wo is me! Wo is me!", and never accept it, then that's perfectly alright. Personally, I'd rather avoid such dramatics & mental torment, if possible.

The great philosophers (Socrates, Seneca, Montaigne...) began & finished with total acceptance, and didn't get angry (if accounts of their deaths are to be believed, and there is no reason to doubt them.) They also left a legacy of understanding, suggesting that we can face death in the same way, if we read them properly and apply their techniques. Dylan Thomas was an intemperate drunk who had a way with words; Plato would have exiled him, with good reason... read "the Republic" to see his reasons...

[Delta40]

I look forward to turning back into stardust. I just hope the experience is not one of terror.

[mal4mac]

I look forward to turning back into stardust...

Sorry, stardust isn't a given. It might be worm s**t for a few billion years, then swallowed by a black hole...

[Delta40]

Sorry, stardust isn't a given. It might be worm s**t for a few billion years, then swallowed by a black hole...

Don't forget the maggots! Whatever the process I won't care in death but while I'm living It's exciting. Somebody might inhale my atoms one day.

[qimissung]

For my part, if someone's going to inhale me I hope it's the big Lebowski as I plan to be cremated so as to turn into worms*** all the faster, my dear.

[Paulclem]

Some do and some don't, and I say that based on having been around dying folks, both young and old. You are right about the need to alleviate pain, which is one aspect of dying that we have the ability to do something about. We do have potent drugs to alleviate pain (and anxiety), and we should offer these to the dying, along with whatever other forms of comfort we can provide. That's what Hospice Medicine and Palliative Care is all about.

Death is inevitable. We all die sooner or later. And death, for a living body, is final, which is to say that it is the end of one's life as a living organism. That is unless you believe in the idea of a Soul that has some sort of existence independent of the body.

Given the inevitability and finality of death, dying folks will approach death, and "accept" it differently. Kubler-Ross described a series of stages in the psychological "response" to news of one's impending death, beginning with anger and ending with acceptance. It's a neat intellectual construct that is generally accepted as true. For all I know, it may be an accurate "ideal" description of how the mind deals with impending death. I can tell you that it doesn't always follow the K-R schema. Some folks do get to the final stage of acceptance, but others do not. Many "do not go gentle into that Good Night" but continue to rage against the dying of the light...

BTW, Dylan Thomas's poem says little about his father's attitude towards death, and says a lot about the poet's own feelings about his father's death.

What you're saying seems to resonate with my own small experience of people dying, but more significantly my wife's - who worked as a nurse for some years. She reported some reaching a serene acceptance, but many did not. As you say pain relief helps.

Interestingly, my wife dislikes Dylan Thomas' poem. She sees it as very negative - what is the point of raging against the inevitable? I agree with her, and agree that it says more about Thomas.

[mal4mac]

What you're saying seems to resonate with my own small experience of people dying, but more significantly my wife's - who worked as a nurse for some years. She reported some reaching a serene acceptance, but many did not. As you say pain relief helps.

How did the ones reaching a serene acceptance achieve that?

I'm certainly not arguing against pain relief, but surely "mental attitude" and "mental training" is also important? I've listed some of the great Western philosophers & writers who had something to say on this matter. Are they all just blowing hot air? Do we all just forget philosophy, and scream in mental agony when the time comes? Unless we happen to be born serene...

[Paulclem]

How did the ones reaching a serene acceptance achieve that?

I'm certainly not arguing against pain relief, but surely "mental attitude" and "mental training" is also important? I've listed some of the great Western philosophers & writers who had something to say on this matter. Are they all just blowing hot air? Do we all just forget philosophy, and scream in mental agony when the time comes? Unless we happen to be born serene...

I asked my wife and she indicated that one notably calm lady - who was quite young in her 50s and with a young adopted child and so with lots of reasons to feel aggrieved, angry, worried etc - was a calm person anyway. It seems to imply that already being calm helps. This is the message from the Dharma too - death takes preparation, and that may be why there is such a variety of responses - according to my wife - to impending death.

You talk about forgetting philosophy, but what philosophies do people aspire to? I suspect that if you asked ordinary people, their philosophy would be more concerned with living life to the full, doing good etc etc - all focused upon life. You can hear it in the eulogies of people when tragedies happen - they invariably say they were full of life or lived life to the full etc etc, as if their life before transcends death.

One message is clear - that pain relief is essential to calming most people before death. Mental attitude and training would be important to those who do it, but who does? I don't see any philosophy programmes instructing study groups on how to deal with death. I am sceptical that just reading about it can have any effect when the crisis occurs.

Do we all just forget philosophy, and scream in mental agony when the time comes? Unless we happen to be born serene.

I'm not sure what planet you're talking from here. That's why there's pain relief, but beyond that, what preparation are you expecting people to have done? There are Buddhist practices as we know, but very few people practice. Most people are unprepared for death mentally, and certainly will not appreciate the pain that is involved as the body begins to decline.

[mal4mac]

I asked my wife and she indicated that one notably calm lady - who was quite young in her 50s and with a young adopted child and so with lots of reasons to feel aggrieved, angry, worried etc - was a calm person anyway. It seems to imply that already being calm helps.

But how did she get to be calm? An unfair question really, not many modern Western philosophers seem to ask these questions, so why should hard-pressed nurses?!

You talk about forgetting philosophy, but what philosophies do people aspire to?

The modern philosophers have mostly deserted the field, so there's not much for people to aspire to. Maybe why New Age religions are doing so well... There are some rare exceptions, Pierre Hadot, for instance.

I suspect that if you asked ordinary people, their philosophy would be more concerned with living life to the full, doing good etc etc - all focused upon life. You can hear it in the eulogies of people when tragedies happen - they invariably say they were full of life or lived life to the full etc etc, as if their life before transcends death.

This seems a major error; Plato, Seneca et. al. all stress the importance of contemplating death in order to have a full life!

One message is clear - that pain relief is essential to calming most people before death. Mental attitude and training would be important to those who do it, but who does? I don't see any philosophy programmes instructing study groups on how to deal with death. I am sceptical that just reading about it can have any effect when the crisis occurs.

Pierre Hadot stresses the importance of not "just reading" philosophy, but actually "living it" as a spiritual exercise, and as the ancient philosophers recommended. Having just read Seneca for the nth time, I know he certainly recommends doing more than just reading - among other things, he recommends digesting a few major authors, taking notes, putting things in your own words, until you have absorbed the message.

Do we all just forget philosophy, and scream in mental agony when the time comes? Unless we happen to be born serene.

I'm not sure what planet you're talking from here. That's why there's pain relief, but beyond that, what preparation are you expecting people to have done? There are Buddhist practices as we know, but very few people practice. Most people are unprepared for death mentally, and certainly will not appreciate the pain that is involved as the body begins to decline.

I'm assuming the pain relief can solve physical pain, but mental pain? I'm really thinking about Dylan Thomas here... he's not in physical pain, he's raging is some kind of self induced mental torment. There are Buddhist practices, but there are also Western practices, which might go down easier with a Western audience.

[Paulclem]

Pierre Hadot stresses the importance of not "just reading" philosophy, but actually "living it" as a spiritual exercise, and as the ancient philosophers recommended. Having just read Seneca for the nth time, I know he certainly recommends doing more than just reading - among other things, he recommends digesting a few major authors, taking notes, putting things in your own words, until you have absorbed the message.



I'm assuming the pain relief can solve physical pain, but mental pain? I'm really thinking about Dylan Thomas here... he's not in physical pain, he's raging is some kind of self induced mental torment. There are Buddhist practices, but there are also Western practices, which might go down easier with a Western audience.

But how did she get to be calm? An unfair question really, not many modern Western philosophers seem to ask these questions, so why should hard-pressed nurses?!

From what my wife says, she was calm from the beginning - calmness had become her way? More than that it is impossible to say. You do meet the occasional calm person.

The modern philosophers have mostly deserted the field, so there's not much for people to aspire to. Maybe why New Age religions are doing so well... There are some rare exceptions, Pierre Hadot, for instance.

Yes - don't hear much about them. When we ran classes, we came into contact with New Age ideas and people. I wasn't very impressed to be honest. They seemed to be an amalgam of not very useful ideas.

This seems a major error; Plato, Seneca et. al. all stress the importance of contemplating death in order to have a full life!

I agree. I think in the west it is a cultural failing. Death is neatly packaged up now with minimal contact with the reality of it. By focusing upon the trimmings - casket, flowers, funeral etc - I think it takes the human element away - which doesn't matter if you have awareness/ practice, but is not useful if you don't.

Pierre Hadot stresses the importance of not "just reading" philosophy, but actually "living it" as a spiritual exercise, and as the ancient philosophers recommended. Having just read Seneca for the nth time, I know he certainly recommends doing more than just reading - among other things, he recommends digesting a few major authors, taking notes, putting things in your own words, until you have absorbed the message.

Again I agree. perhaps the type of philosophy doesn't matter - in terms of coping with the death process - but I don't know anyone except Buddhists who have any kind of process of dealing with it before it is needed.


I'm assuming the pain relief can solve physical pain, but mental pain? I'm really thinking about Dylan Thomas here... he's not in physical pain, he's raging is some kind of self induced mental torment. There are Buddhist practices, but there are also Western practices, which might go down easier with a Western audience

Yes - not helped by physical pain, but a philosophy, awareness, a contemplation of death needs to have been done in order to be able to cope at all.

Interestingly - which I forgot to include in my last post - my wife tells me that often the dying person becomes very tired. Their breathing becomes weaker, and this may contribute to the person being calmer. This seems to make sense considering that breath control and an easing of the gas does calm down the mind. My Dad was like this. He moved from an extreme fear to a more calm demeanour - but this went along with the gradual deterioration of his heart etc, and the pain relief.

[Nick Capozzoli]

I agree. I think in the west it is a cultural failing. Death is neatly packaged up now with minimal contact with the reality of it. By focusing upon the trimmings - casket, flowers, funeral etc - I think it takes the human element away - which doesn't matter if you have awareness/ practice, but is not useful if you don't.
I'm assuming the pain relief can solve physical pain, but mental pain? I'm really thinking about Dylan Thomas here... he's not in physical pain, he's raging is some kind of self induced mental torment. There are Buddhist practices, but there are also Western practices, which might go down easier with a Western audience

Yes - not helped by physical pain, but a philosophy, awareness, a contemplation of death needs to have been done in order to be able to cope at all.

Interestingly - which I forgot to include in my last post - my wife tells me that often the dying person becomes very tired. Their breathing becomes weaker, and this may contribute to the person being calmer. This seems to make sense considering that breath control and an easing of the gas does calm down the mind. My Dad was like this. He moved from an extreme fear to a more calm demeanour - but this went along with the gradual deterioration of his heart etc, and the pain relief.

These are good points, Paulclem. Death is neatly packaged up now with minimal contact with the reality of it. Quite true. It is common today for folks to die in hospitals, hospices, and nursing homes, when death is expected (i.e. when one is terminally ill). In previous times, people usually died at home, in their own beds, hopefully surrounded by family and friends. Then there were wakes, which also took place at home in the parlor. These home wakes have been replaced by "viewings" at a"Funeral Home" or "Funeral Parlor," terms I assume were coined for that very reason. Death has been medicalized, something to be dealt with by medical personnel in a medical environment. Then when the "patient" dies there, his body is given over to other specialists to be further processed and put on view. The result of all this is that very few folks in the US today who do not work in the medical professions (including EMS personnel), in law enforcement, or who have been in combat rarely see people die. This lack of contact with death today is similar to the lack of real practical understanding most urban folks have about where the food they eat came from, how their cars work, etc.

...my wife tells me that often the dying person becomes very tired. Their breathing becomes weaker, and this may contribute to the person being calmer. This seems to make sense considering that breath control and an easing of the gas does calm down the mind. My Dad was like this. He moved from an extreme fear to a more calm demeanour - but this went along with the gradual deterioration of his heart etc, and the pain relief. This is often true, provided that the patient doesn't experience a sense of suffocation, which is extremely unpleasant and anxiety-provoking. That's one thing medications, mainly opiates and benzodiazepines, can alleviate. Then there is the "Death Rattle" of terminal breathing, which is probably more distressing to those who hear it than to the patient himself. It's due to the accumulation of secretions in the airways. Even that can be "treated" with anticholinergic medications, like atropine. But in general I think your wife is correct: The body has evolved its own physiologic strategies to deal with dying and make it easier when the time comes. Hypoxia leads to lethargy (note the etymology of that word) and somnolence. So does dehydration and starvation...for although they initially produce the unpleasant experiences of thirst and hunger, which are important in driving the organism to sustain life by drinking water and eating food, at some point the body "realizes" that life can no longer be maintained and at that point the lack of water and food produce extreme lethargy. The body switches from a life-sustaining mode driven by thirst and hunger to a death-accepting mode characterized by extreme lethargy and stupor. As your wife says, the dying person becomes very tired...Thus we can say that the body has evolved a kind of "wisdom" in dealing with its own death.

It is important for physicians to understand and appreciate this bodily wisdom. I had a lesson in this when I was a 3rd year medical student rotating through the medical service at the Brooklyn VA 25 years ago. The intern I was working with overnight on the ward had charge of a patient with lung cancer with bony metastases. He was clearly dying and was admitted for comfort care. His pain was being fairly well managed with IV morphine. He was stuporous, and the intern decided to work that up by getting a bunch of lab tests. Well, the labs showed that he had a very high serum calcium level, which we knew was a cause of stupor. The cause of the hypercalcemia was of course his extensive (and painful) bone metastases. So, being bright young doctors-in-training, we decided to "treat" the hypercalcemia (and stupor). It worked! The patient "awoke" from his stupor into
an agitated screaming delirium, which he was still in when the intern proudly presented him to the attending internist at 7AM rounds. Rather than praise our astute application of medical science to "curing" the patient's hypercalcemic stupor, he took us out of the room into the ward corridor and sternly pointed out that we had not done the patient any good, and in fact had caused him unnecessary suffering by "treating" his stupor. We had failed to recognize that in this case the "symptom" we were treating was the body's way of dealing with the terminal cancer. Like the morphine we were giving for pain, the excessive calcium levels were dulling the brain's response to the patient's dying body.

That is a lesson I will never forget.

BTW, I said in a previous post that the Kubler-Ross stages of grief began with anger and ended with acceptance. That was incorrect. the first stage is denial, and the sequence is denial-anger-bargaining-depression-acceptance.

[mal4mac]

BTW, I said in a previous post that the Kubler-Ross stages of grief began with anger and ended with acceptance. That was incorrect. the first stage is denial, and the sequence is denial-anger-bargaining-depression-acceptance.

I suggested that Kubler-Ross didn't provide a good model for a philosophy of death, but that she might provide a good model of how the non-philosopher dies. Digging a little, it seems that there is a lot of evidence for her not even providing that:

http://en.wikipedia.org/wiki/K%C3%BC...odel#Criticism

The extensive scientific studies of George Bonanno show that the Kübler-Ross stages of grief do not exist. Bonanno's research shows that most people who experience a loss do not grieve, but are resilient. If there is no grief, there can be no stages of grief(!) Bonanno's work has also demonstrated that absence of grief or trauma symptoms is a healthy outcome, rather than something to be feared as has been the thought and practiced until his research.

So most people seem to be "adequate" stoic philosophers when it comes to the process of death. I find this comforting, certainly a lot more comforting than Kübler-Ross' pseudo-science.

Bonanno has shown that some practices common in grief counseling, trauma counseling, and among therapists after potentially traumatic events can be harmful, including asking people to talk about a loss or to cry about a loss.

http://en.wikipedia.org/wiki/George_Bonanno

[Nick Capozzoli]

...The extensive scientific studies of George Bonanno show that the Kübler-Ross stages of grief do not exist. Bonanno's research shows that most people who experience a loss do not grieve, but are resilient. If there is no grief, there can be no stages of grief(!) Bonanno's work has also demonstrated that absence of grief or trauma symptoms is a healthy outcome, rather than something to be feared as has been the thought and practiced until his research...

So most people seem to be "adequate" stoic philosophers when it comes to the process of death. I find this comforting, certainly a lot more comforting than Kübler-Ross' pseudo-science...

mal4mac,

I am aware of Bonanno's "resilience" hypothesis. I've read a lot about his ideas along with others (including Kubler-Ross's) and for the past 25 years I have also been practicing medicine and caring for folks who actually were seriously ill and dying. I'm not sure what actual experience you have had interacting with folks who were dying. I've certainly found that reading what the "theorists" or "philosophers" of death have to say about grieving and dying is helpful to me in my work as a physician. I'm grateful for their insights, unlike you I have not been able to say that I have found any of the death philosophers to have revealed the "truth." In my opinion neither KR nor Bonanno has revealed the complete truth about how we grieve or approach death. Your comment that The extensive scientific studies of George Bonanno show that the Kübler-Ross stages of grief do not exist is simply not true and flippant. Referring to Kubler-Ross's pseudo-science is likewise flippant. I'm sure that you are sincere and believe that what you are saying is true, and I really don't like being argumentative. But at this point I have to say that your argument seems to me to not be based on real world experience.

[mal4mac]

mal4mac,

... I have also been practicing medicine and caring for folks who actually were seriously ill and dying. I'm not sure what actual experience you have had interacting with folks who were dying...

This is like a mechanic saying to a good driver, and useless mechanic, in trying to belittle his ability to drive, "I've been a practising mechanic for twenty five years, and fixing cars. I'm not sure what actual experience you have had interacting with cars." Given that you've read a few philosophers you might also be a good driver, but using your medical experience to try and say, "I'm an expert on death" smacks of arrogance, and is beside the point. A philosophy of death no more requires a medical degree than a fish requires a bus pass.