Age's Stealing Steps

Michael Wolff has written a gripping but narrative-heavy article about the troubles he has experienced in addressing his mother's worsening dementia. It is hard not to feel for him and his family. Still, I think there are two perspectives which his piece underemphasized:

1) Many debilitated but cognitively intact individuals do have a good quality of life. For example, in a recent survey of 62 seniors with an average of 2.4 daily living dependencies and fairly good cognitive well-being (≥ 17/30 on the MMSE), 87% reported that they had a quality of life somewhere in the fair to very good range. I consider this to be a testimony to the resiliency of the human psyche. Also, it makes me worry that people will read the article and think that LTC insurance is only useful for those with dementia, which Wolff implies, when that is far from the case.

2) Why is it that many of the doctors depicted his story seem so unhelpful? There's little doubt that fear of litigation plays a role. For example, in a Mar '12 study, over half of the 600+ palliative care physicians surveyed reported being accused of euthanasia or murder within the past five years. In many respects this is a legislative issue, and I wish his article had discussed that angle more.

Many pointers in this post go to the excellent blog GeriPal. 

The Valiant Never Taste Death But Once

After reading this interesting excerpted article from Dick Teresi's book The Undead, which discusses the difficulties in defining death by a single, consistent set of criteria and the social qualms that stirs, I decided to check out the Amazon reviews. The associated ratings were (and still are) quite shockingly bad! They follow the classic "so bad it's good" distribution, with 5 5-star ratings, 1 3-star rating, and 33 1-star ratings. So, given that I am always up for a good controversy, I decided to read and review it myself. Ultimately I mostly side with the critics, giving it two stars. If you are interested in the subject matter, I'd suggest instead Kenneth Iserson's Death to Dust, which is a bit older but much more level-headed and thorough treatment of similar issues. 

Mortality Salience and Violent Feedback

Jesse Bering at Scientific American recently wrote an interesting article about research from Germany showing that those primed to think about death were more likely to be nationalistic. As the article notes,

[T]he evolution of self-consciousness in our human ancestors came with a heavy price, which was the awareness that they were mortal. This awareness of death brought a crippling sense of anxiety... that interfered with our ancestors’ otherwise adaptive, everyday social behaviors. To cope with this anxiety... our species evolved a suite of psychological defenses that allowed us to accept the unavoidable reality of death while assuaging our existential fears and to get on with the business of being alive.... [M]ost people tend to endorse their own prevailing cultural worldviews because culture serves as an anxiety-reducing buffer against thoughts of death. Contribute meaningfully to this system, or at least defend it, and a part of you will live on in the cultural ethos even after you turn to dust.

Once violence erupts in a region, there are many reasons to think about your own death as people you know die or are seriously injured. In these cases, terror management causes us to be hold more in-group tendencies and be more patriotic. This leads to more prejudice and hatred, which leads to more violence, and thus more mortality priming, etc. This is a nasty feedback loop that may be responsible for compounding the initial effects of violence throughout generations.

Yet another reason that we should strive to stop violence between cultural groups before it starts, and be thankful (at least in the US) for our current relatively peaceful society.

J.K. Rowling's Last Metaphor

One of the reasons that the Harry Potter series has been so successful is Rowling's ability to illuminate problems with her society by portraying slightly altered versions of the same issues in the her fantastical wizarding world. For example, wizards who are not direct descendants of other wizards are considered "half-bloods" if one of their parents is a Muggle (the wizard term for a non-wizard) or, worse yet, "mudbloods" if both their parents were Muggles. This problem is absurd to the reader, which is partly Rowling's point because such name calling is shockingly similar to much of the racism that occurs in our real world. Countless other such metaphors are found in the series, exploring the issues that she finds important in her life through the fictional lives of Harry and friends.

While most of these metaphors make a lot of sense, the one thing that I have never understood is the reason why many in the wizarding world are unwilling to call Voldemort, the main "bad guy," by his real name. They prefer to call him "You-Know-Who," or if they are very serious about the whole thing, "He-Who-Must-Not-Be-Named." Harry never believed in this taboo about Voldermort's name, prefering instead to follow Dumbledore's advice that "fear of the name only increases fear of the thing itself." Rowling obviously included this phenomenon for a reason, for yet another social commentary, but I had up until now not been able to figure out why.

It took the death of an old classmate of mine about two weeks ago to enlighten me. While pondering how sad it is that he died, I've reflected upon how we as a society don't really discuss death until it affects us immediately. I've been lucky in that I haven't had to experience much death in my young life, but this classmate was one of the first people my age who I had known for a long time, whose house I had been over to, and who had made an impact upon my life. I think there are many reasons why death is such a hushed topic, one of which must be a fear that it will lead to unnecessary melancholy.

Through this reflection I believe I understand Rowling's last metaphor, the most convoluted yet one of the most powerful points in her series. Fear of a "name," or fear of talking about something, will only increase fear of the thing itself. The less we talk about death publicly, the more we will fear it privately. Do you agree?

Ways to offset the fear of death

I believe that each of us has a fear of death not because, as Dumbledore puts it in Harry Potter, "we fear the unknown," but instead because evolutionarily we have been programmed to fear death so as to help our survival and increase the chances that we will reproduce and continue the species. Thus far we have come quite a long way in our evolution, but we still have not learned how to become immortal, meaning that at one point each and every one of us will face death. We should all expect to die.

But that doesn't mean that we have to fear death. There are a few ways that we can overcome our fear of death or at least quelch it slightly:

1) Curiosity: one way to overcome the fear of death is to actually look forward to it because we wonder what will happen to us once we die. While this can be brushed aside and simply be looked at as foolishness, the fact remains that there is really no way to know what we will experience after we die. Will there be some sort of afterlife? Will we regain a former conciousness and be able to look back upon our life and the decisions we made before starting a new one (that would be sick)?

2) Single-mindedness: If we can remain very focused on whatever we plan to accomplish in life, then I believe that we can mitigate the fear of death. People that strive very hard for a goal don't care about their death because they don't have enough time to ponder it. I would say that this is a risky strategy because once you do begin to fear death it could consume you.

3) Belief in an Afterlife: Pascal's Wager aside, believing in an afterlife of any kind (religious or otherwise) in which you retain your worldly conciousness is certainly something that could mitigate your fear of death, although it undoubtably requires a certain number of leaps of faith in order to do so, since there is by definition no way to prove the existence of God. It seems that more people radiate towards this as they become older, but certainly not everyone. This also can be somewhat dangerous to other people. For instance, some young men believe that suicide bombing gives you a first class ticket to the best form of afterlife. That is a scary thought, for this world, and that version of the next.

4) Apathy: Some people seem to just not care (or maybe not believe) that they will one day die. Much like how the last belief has more old people, this belief seems to have more young people. I would argue that this can lead towards some rash decision-making.

There are certainly others, and I will add them if I think of them. Ultimately this stuff doesn't matter too much, because we're all going to die anyway.