On Death

My Grandmother died in 2003.  It was a shock and a great loss to her family.  She was in good health and her whole family just assumed she’d get her wish to live to 100.  She was 97. But Fate (or God if you will) had other plans.

In spite of our surprise and distress, her death didn’t make the news.  All she got was a paid death announcement in the local paper.

The average daily US death toll from COVID-19 for the seven days through July 8, 2020 was 599.  That’s a lot of death.  We know that number includes many elderly folks who would have died soon anyway. But that isn’t likely to offer much comfort to those who lost a loved one — a death is a death.

Without disrespecting all the grief and disappointment hidden behind that number of 599 COVID deaths per day, let’s take a step back and look at the bigger picture. Heart disease and cancer are still the leading causes of death. Assuming this is an otherwise normal July, we probably had a little over 7,000 total US deaths per day last week — so over 90% of the mourning is not due to COVID-19.

Mourning is usually personal.  We mourned the loss of my grandmother, but the whole town wasn’t in mourning for this humble lady — whether or not her death was expected. Most individual COVID deaths don’t make the news either.  The unexpected loss of a loved one is a personal tragedy, no matter what the cause of death.  Yet, these days, it seems that all we hear about is COVID.

COVID death statistics are in the news every day.  Why not the more common plagues we’ve learned to live with? After all, no corpse is more dead than another.  The extent of our private grief isn’t changed by naming the disease that killed the deceased. 

Maybe the discrepancy is mainly about novelty.  If COVID became a routine risk, settling in at say 500 to 800 deaths per day over the next year, it probably wouldn’t make front page news any more.  Its risk would still be lower than that from cancer and heart disease.  Maybe our anxieties and morbid curiosity are driven more by journalists than we care to admit.

But another big factor is surely the uncertainty.  There’s a lot we still don’t know about this new threat of sickness and possible death.  We don’t know the odds of getting infected, and we don’t know how sick we’d get — somewhere on a scale from not-at-all to dead.  Meanwhile, effective prevention strategies are unclear, and bombastic and self-righteous politicians just muddy the waters even more.  All that uncertainty feeds a mix of legitimate fears and paranoia. In contrast, most of us have pretty fixed expectations about our chances of contracting or dying from cancer in the next year. Until all this gets sorted out, we’ll likely to continue hearing a lot more about COVID than cancer or heart disease.

Meanwhile, something more insidious is going on. Behind all the technical mumbo-jumbo — the statistics, the epidemiology, the virology lessons, the obsessive attention to the combined impact of disease and economics — the public conversation focuses much more on infection rate than on deaths. Obviously dying is much more significant than just getting sick, but we don’t like to talk about death.

Every sane adult knows that death will come to everyone we know, including ourselves.  Unless we are suicidal or depressed, we don’t look forward to it.  Even when living in extreme adversity, most of us would choose life over death.  We’d rather not think about death at all — “I’ll deal with death when I have to.  Let’s talk about something more cheerful, or at least a problem I can deal with now.”

For traditional Christians (and some others), of course, death is both the final event of life and the beginning of another, usually happier, state of being.  In principle at least, they don’t stress about death because of their optimistic belief.  Nevertheless, I was once told by a cloistered Catholic monk that he often sees elderly monks in their final days stricken by terror at their impending death.  Sometimes a reassuring belief may simply mask underlying, unresolved fear.

The response of the modern scientific age to the perennial anxiety about the one unavoidable fact of our lives has been to promote denial about its inevitability — through exercise, diet, medicine and future genetic engineering, death will be indefinitely postponed or even cured.  Alongside our refusal to think about our future decline and disappearance, old folks are to focus on a life of fun in lively retirement communities and swallow promises that death will be painless. But many of us have lingering doubts about this whole package.  Rationally, we know that those providing all these reassurances don’t know what they’re talking about because they’ve never died.  In fact, we know that death can come unexpectedly to anyone of any age, and, yes, there may be pain and suffering. The dying person may not even be able to communicate with caregivers and loved ones. So there are pretty good grounds for persistent anxiety. 

It was his distress about suffering and death that set the Buddha off on his quest for religious truth.  To this day, meditation upon death is a part of Buddhist and Hindu traditions; some traditional adepts even meditate in the midst of charnel grounds, places where human bodies are left to decay in the open air. Less gruesome practices of meditation upon death and other calamities were common in ancient Greece and Rome, particularly among the Stoics. They regularly practiced contemplative exercises called premeditation of adversity, that have been revived in modern cognitive therapy in a number of imaginal exposure techniques. The general idea is to do the exact opposite of avoiding the subject of death.  Rather, one is to visualize death or some other distressing calamity as vividly as possible, along with its associated anxiety. Far from wallowing in horror, the intent is to become habituated to the prospect of death — typically anxiety diminishes through further repetitions.  The ultimate goal is to make peace with the inevitability and unpredictability of death, or whatever other fearful event is being treated. The practitioner develops emotional resilience against future misfortune. 

I’m sure my grandmother found reassurance in her Christian beliefs concerning the afterlife.  But, whether or not we rely on traditional dogma, we have the potentially more powerful option to confront our anxieties experientially through techniques that have been proven in modern psychology but originated 2,500 years ago. Death doesn’t have to be a subject of fear.

A WORD OF CAUTION: If you are likely to experience excessively high levels of anxiety in exercises such as those discussed here, you should not do so without the assistance of a qualified counselor.

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