How Our Attitude About Death Affects The Way We Age
Should we confront it, avoid it or something in between?
I belong to a tennis club in Woodstock, N.Y. that until recently had a membership with a median age of 65. Largely based around the members' advancing age, several of the club's participants have died over the past two years.
For me and some of my friends, this scattering of deaths triggered a host of thoughts regarding one's attitude about the inevitability of death.
One of my friends at the club, Steve Josephs, who is 78, was crushed by seeing several of his tennis buddies dying. It made him confront his own vulnerability and mortality. He also said that knowing that life is temporary alters your entire attitude toward living.
Now we're immersed in a pandemic, where death seems to be hovering and looming over many of us, more closely than ever.
Despite the assurance of death as the end point of life, I started to wonder what the healthiest attitude is to take regarding it. Is ignoring it acceptable, while staying in the moment and living day-by-day? Or if one comes to grips with death, what realizations happen?
Authors and palliative care specialists whom I interviewed recommend that coming to terms with death and planning for it are the healthiest options. Avoidance of death's inevitable reality is sheer escapism and holds people back from preparing for it. Yet spending too much time dwelling on death is often counterproductive.
Too Much Focus on Death Isn't Healthy
Arthur Caplan, a professor of bioethics at NYU Grossman School of Medicine, deals with a host of patients daily including those who are terminally ill and facing impending death. He's empathetic to those who consider death "too terrifying" and would rather avoid thinking about it.
"Thinking about death for the average person isn't worth a huge amount of time."
In fact, for most people dwelling on death isn't that productive. "Thinking about death for the average person isn't worth a huge amount of time," Caplan said, adding that life depends on friends, family, hobbies and work, which need to take precedence.
"Dwelling on anything that is bad diverts you from various life projects and goals," he said.
But people who are blind to its inevitability avert what Caplan calls "the management issues" of dying: planning for funeral arrangements, taking out life insurance, discussing organ donations or how to take care of their family if they were to die unexpectedly.
The Stages of Acceptance
BJ Miller, who co-wrote "A Beginner's Guide to the End: Practical Advice for Living Life and Facing Death" and runs Mettle Health in San Francisco, an online palliative care service, explains that the acceptance of one's mortality comes in stages.
Miller pinpointed the first stage as "coming gradually to accept the reality that one day you will die, not denying or fighting it." He described acceptance as a "capacity that you build over time, a tolerance or conditioning."
Miller described the second stage as coming to terms with death, calling it a process. "It's active, experiential, and the basic idea is to get the reality of your death into your bones, so you're not surprised to learn that you die," he said.
Once achieved, this evolves into a feeling of almost letting go. "The effect tends to be lightening," Miller said. "Once you realize that you die, and life keeps going on, it ultimately puts you in touch with the power of seeing life outside your self." And that's a very liberating feeling.
Miller has stared death down personally. At 19, he suffered an accident while attending Princeton University and became a triple amputee. Now 49, Miller said, "It introduced me to mortality. I'm less likely to squander any time, and realize now that life keeps going even after you die."
Ira Byock, a palliative care physician based in Gardena, Calif. and Missoula, Mont. and author of "Peace and Possibilities at the End of Life," said that "None of us gets out of this alive. It turns out that death is the backdrop of all life."
Byock noted that most people fear death, "so we spend a lot of energy avoiding it and suppressing it. The primary question that life asks is whether we are going to live in fear or love."
Facing Practical and Emotional Issues
People who don't confront death pay a price for their denial or avoidance, said Byock. "You rob life of its richness. The best way is to think about it and prepare for death, in a defined way," he noted.
Confronting death also leads to people "getting their affairs in order," which Byock said includes preparing for it. He recommends a series of actions: writing a will; assigning your estate's executors; letting your heirs know about your will; and creating a storage box that includes copies of your will, the deed of your house and automobile ownership, information about your bank account and your Facebook and social media passwords.
After attending to the practical details, deal with the underlying emotional issues. For instance, what is left unsaid between you and your loved ones? "If you were to die suddenly, is there anybody who you need to tell something to?" Byock asked.
"If you were to die suddenly, is there anybody who you need to tell something to?"
According to Caplan, too many people delude themselves into thinking they can overcome mortality. He deals with affluent people who "think they can live forever and view death as an option." They concentrate on exercise and diet, and opt for interventions including stem cell therapies, which can be effective in certain cases, but won't prevent death.
But Caplan thinks that they're carrying some of these treatments to extreme. "It's a way to be deluded and get ripped off. And no matter what you're doing, you're still going to die," he said.
Some people come to terms with the inevitability of death when they're touched by the reality of it or encounter impending signs. When people deal with "the death of a relative, the death of a pet, retirement, loss of children, start getting aches and pain or begin to lose mobility," those are telltale signals that mortality is lurking, explained Caplan.
Caplan has treated a number of patients who became adept at dealing with their own impending mortality. Some were death deniers who had led their life oblivious to its inevitability, but then gradually came to terms with it.
Often, family members helped them; so did reading about death, either through nonfiction books or novels. Some reviewed their life in their photos and made sure to touch base with their grandchildren to "close a chapter." Others found solace in religion.
Live Your Life for the Moment
The medical care system, which can now keep people alive on machines, dictates that coming to terms with death is more important than ever, noted Miller. "If you don't engage in self-advocacy, you're on the default of the medical system that will keep you on machines," he said.
There's no template for the ideal attitude for coming to terms with one's own demise. But experts recommend these steps:
- Live your life for the moment and feel fulfilled with as many things that bring you joy. Said Caplan: “Being fulfilled makes the prospect of death easier to accept.”
- Leave nothing unsaid, urged Byock. For example, tell your parents what they’ve meant to you, and express pride in your children for what they’ve accomplished.
- Take stock of your life, Miller advised. Come to terms with the fact that death is going to happen to you. Determine what you most care about, what you can let go of, start trimming your sails over time to stay current with yourself and tend to all of your primary relationships.
- The best attitude toward death is one of “defiance,” Byock implored. “The fear of death is embedded in our genes, but I’m not going to let that determine my quality of life.”