The purpose of this research is to examine the existential and humanistic approach to death and dying. It will briefly discuss attitudes toward death throughout the history of man’s various civilizations and religions. Primarily, the paper will deal with the ideas concerning death which have been held by existentialists who have been involved in the treatment of the dying and others who have been involved in death solely as members of mankind – and therefore as ones who must face it at sometime themselves.
The idea of immortality has been common to most of man’s answers regarding the consequences to the dead person of having died. The ancient Mesopotamians believed in a dismal underworld full of misery. The ancient Egyptians, on the other hand, believed that death could contain all the comforts and amusements of the earthly life. To that end, they filled the tombs of their pharaohs with paintings and sculptures of servants, animals, festivities and sporting events; when the wandering ka returned to the body of the dead man, he would then have all the things around him for his pleasure. The Etruscan forerunners of the Romans also sculpted tools and foodstuffs into the stone of their burial mounds – which were carved out to resemble houses. They laid their dead on beds. In the tombs of the richer people, the beds were located in a room behind the apparent main “living” area. These tombs often had servants’ quarters near their entrances. In this way the families and their servants could continue after death with a similar life to the one which they had enjoyed on the earth.
Christian concepts of death, too, have centered around the existence of an afterlife. The soul of the dead person may find bliss or punishment in the traditional Christian afterlife. Death is therefore the door to eternity, the way in which one is “born unto eternal life.” Death is frightening in the Christian concept, as it means that the person will be judged. Because man has been taught that he is sinful, he will most probably have to suffer for some indefinite length of time directly following his death.
In Hinduism there are several variants of the afterlife and the soul’s role in it (Long, 1975). The Upanishads teach that the self departs through some aperture of the body, leaving behind lifeless matter. It then enters upon a rebirth cycle, which continues until the self realizes its oneness with the Universal Self. At that time it enters a state of physical and spiritual liberation. The Gita has a slightly different outlook on the soul’s doings after leaving the body. There is not a stressed doctrine of rebirth. Instead, “death is conquered and mortality is achieved by identifying oneself with the personal, all-knowing, all-loving God, Vishnu (in the form of Krishna) in the spirit of faith and in strict obedience to his will.”
Buddhism also contains several doctrines concerning the condition of the self after death. Basically, each birth is seen as a rebirth – which may have occurred directly following death or a set number of days thereafter, depending on one’s particular beliefs. At any rate, the human self is known to be a shifting consciousness, composed of the passing impressions of moments. The “imagined ‘self’ who thinks in terms of ‘I’ and ‘mine’ does not survive from one moment to the next and hence, does not transmigrate.” Death to the Buddhist is inevitable and to be faced peacefully. It may lead to Nirvana or to rebirth.
One of the great virtues of the traditional religious approaches to death has been that they tend to bring the living together around the dying, and to help the survivors to overcome the pain of separation through death. For instance, the Jewish tradition (Heller, 1975) brings families and friends together with the dying person. It “confronts death directly and specifically views the period of terminal illness . . . and dying . . . as a time when loved ones should surround, comfort, and encourage the patient.”
In Alaska, among the Indians, the aged person is active until death, taking the major role in the events which precede his death (Trelease, 1975). One aged Indian woman, Old Sarah, for instance, called upon a preacher two weeks in advance of her death to ask him to come on a specific date with members of her family. The day which she had arranged was filled with religious festivity. That evening she died.
Most of the literature about death, at least among psychologists, has centered on the effects of the death, of separation which results from death of a family member or loved one. The necessity of completion of the grieving cycle is emphasized. Freud, too, has dealt largely with the effect of separation on the bereaved in his discussions of death. He found that incomplete grief often manifested itself in anger at the dead, the self, God, or some other agent who could be blamed for the death far into adulthood in the cases of those adults whose parents had died during their childhood (Bowlby, 1969). Studies have shown that incomplete grieving can effect the relationship of the bereaved child with others for the remainder of his life. It may make him unable to complete any projects he might begin; it may even result in his suicide as in the case of the poet Sylvia Plath (Koch, 1977). Plath’s own poetry and her novel, The Bell Jar, attest the awful dominant effects of her father’s death on her later years. She tried to kill herself at the age of twenty and again, this time successfully, at the age of thirty. She herself recognized these as anniversary reactions.
However, it is really the effect of dying on the individual who is faced with that task which is here at question. It has been necessary for the philosophers and psychologists who have dealt with being, with existence, to ultimately come to the matter of dying, of – perhaps? – ceasing to exist. Martin Heidegger, a controversial existentialist philosopher, had much to say in the concern of death. He easily pointed out that loss through death is a loss for the survivors (Kaufman, 1959). The personal nature of death is readily denied. A person says that “one dies,” he admits that death is a fact of nature for all animals, including man; however, although “one dies,” “I” do not. Confrontation with death, “Being-toward-Death,” says Heidegger, “is essentially anxiety” (Angst). He sees death (Grimsley, 1960) as the “impossible possibility” of the Dasein. It is the sole ultimate possibility of the individual. It is like existence in that existence and death share the characteristics of being “mine.” However, in order to protect himself from fear, the individual impersonalizes death.
Kaufman feels that Heidegger has been much influenced in his thoughts by Tolstoy’s novel, The Death of Ivan Illych. In it, the novelist describes the death of a “successful” judge who, once faced with death, realizes that his life has been nothing. The reader experiences the anger, despair and loneliness of dying along with Illych. Those around him do not want to discuss the imminence of his death; they do not want to believe in it or to suffer with him. He has only one servant who is willing to face it squarely with him, and for that Illych is happy in his company. There is a distinct stage of separation and grief for the dying man. For Illych, as for too many persons faced with death, the separation begins long before natural circumstances ring it to pass. His friends and family force it on him; he lies dying while being forced to listen to their gaiety and rowdiness in another room.
Freud also recognized this tendency of man to deny the fact of personal death. In 1915 he wrote (quoted by Kaufman): “In his unconscious, every one of us is convinced of his immortality.” One of the methods which he cited as impersonalization of death is an emphasis on the cause of death. Death is not natural: it is forced on the person by some accident of health or circumstance. However, one must realize that confronted with a certain set of circumstances, the most natural thing for a body to do, indeed the most appropriate thing for it to do, is to die. Simply stated, just as a cough is the natural and appropriate reaction under a certain set of circumstances, death is the natural and appropriate reaction under another.
Other existentialists have also discussed death in its relationship to existence. Jean-Paul Sartre points out that death is as absurd as life, as meaningless in itself. But, just as the self gives meaning to its life, so it gives meaning to its death (Grimsley, 1960). In itself death is a single fact amongst many others.
Death is essentially individual. No one can have the experience of death unless it is his own. Karl Jaspers (Grimsley, 1960) pointed out that death does not destroy the essential existence of one’s friend; it destroys only the essential existence of oneself.
Over the past decade or so, the humanistic approach toward death has been particularly studied by Elisabeth Kubler-Ross. She has been quite successful in winning the attention of the everyday person over to the plight of the dying. Although we have made great progress in the struggle to overcome disease in our modern medical technology, it seems, reading Kubler-Ross’s On Death and Dying (1969), that modern man has forgotten to attend to the needs of the dying. Those needs are not only a struggle for his life and more medication to overcome his pain. He is confronting the greatest loss, the greatest mystery and fear, of his life. He is leaving his familiar body and life as well as everyone and everything he loves to – what? Kubler-Ross, in her study, talked with the dying patients of hospitals over much of the world to learn their needs and to try to help.
From her experiences, she came to distinguish five distinct stages of preparation for death. After battling with antagonistic doctors and nurses, she found that the terminal patients themselves were relieved and pleased for someone to allow them to talk about it.
The first stage which she found was that of denial and isolation. This stage is exemplified by the person, on hearing that he has a terminal illness, who goes then from doctor to doctor, from lab test to lab test searching for the opposite opinion, for the news that the x-rays were wrong, for anything which will grant reprieve. Indeed, it is quite a good idea to double-check on so grave a matter; the double-checking can, however, be carried to the extreme. This is the stage of “it can’t happen to me.” During it the patient finds himself confronted with the contradiction to his belief in his own immortality. All patients use at least partial denial. Just as one cannot look into the sun all the time, one cannot at all times face death. Even the dying must spend some time living. It may happen that the dying person can face this at one moment in a completely realistic way; the next moment he may be contradicting himself and reaching for some new claim to life. This is natural, and, Kubler-Ross has pointed out that denial crops up from time to time throughout the rest of the dying process.
The second stage which she identified is that of anger. In it the patient bursts out with a “why me?” attitude. His frustrated rage lashes out toward everyone. The doctors are incompetent; the nurses neglect him; his family is indifferent. Here the danger is that these victims of his feelings may take him seriously and personally. He is really angry with his circumstances, not with the people he confronts. Those persons have to consider the tremendous psychological pressure the patient is under. They must stand by, as that is what he really needs.
The next stage is a typically childlike one: bargaining. The patient’s anger has been ineffectual and instead of it, he now tries a new tactic, “being good.” He becomes cooperative and helpful to the utmost; perhaps, he seems to feel, if I am good, I’ll be forgiven and be granted a reprieve.
But there is no reprieve available, as h will then realize. He becomes depressed. Kubler-Ross cites two forms of depression common to dying patients: reactive and preparatory. The former can be lightened somewhat by the cheerful presence of friends and family. For instance, the mother who is terminally ill will be relieved to hear that her young children are safely and contentedly playing at the neighbor’s home while their father is at work and that they will be safe and cared for after her death. But these things will not alleviate preparatory depression. The patient is about to suffer the greatest loss of his life. What he needs during this period is patient company, someone, perhaps, to hold his hand and sit quietly with him. Probably he will cry some and not talk very much. However, it would be wrong for any visitor to attempt to cheer him up, as he needs most to complete his grief.
Finally, the patient reaches the last stage, that of acceptance. At this time, he will be tired and weak; he will be void of feelings. It is the time during which he withdraws from the life he has known. At this point he is ready and willing to die. Kubler-Ross cites the example of one patient who had reached acceptance whose husband was insistent on another operation, another attempt to save her. She became increasingly restless and hysterical as the day of the surgery neared; on that day, she became psychotic on the operating table before the surgery began and in that way prevented it. Kubler-Ross had to take the husband aside and explain to him that his wife was ready to die and that she needed to be allowed to do so in dignity. He went to speak to his wife and finally began to understand that all his attempts had been made out of a selfish desire to keep her with him. He had never before listened to what she was telling him.
It is her major point throughout Kubler-Ross’ writing that there is more harm done by avoiding the topic of death with the patient than by being open – albeit gentle – with him. Usually the patient knows he is dying, but senses the delicacy of the topic and will not bring it up. The kindest thing that one can do is to be willing to listen to the patient when he needs to talk. He is about to do one of the most important things he has ever done in his life.
Psychiatrists have noted four types of assumptions basic to discussions about death (Weisman, 1972). The first is the primary paradox: although one knows that death is universal and inevitable, one cannot conceive of one’s own death. How could the world continue, one wonders, without me? After all, each individual “creates” the world from his experiences and perceptions. Should he cease, it must. Secondly, the fear of death which is felt in its contemplation is seldom there when one must face literal death. Talking about death is difficult due to the taboos which have been placed on the subject, as well as to personal anxiety. For this reason, there is often a great deal of anxiety by family members over the telling of the terminally-ill patient of his impending death, or a great deal of worry on the patient’s part over telling his family. Society has, wrongly, led its members to believe that no one wants to die and that to tell him that he is close to death is unkind. The fifty assumption common to discussions of death is related to hope and the acceptance of death. Hope would imply that there is always some potential to change the events of the future. However, at the same time as one hopes, one can accept. One author (Weisman, 1972) has cited the case of a woman who noticed that her doctor was very uneasy tending her and that he was not able to accept her pain and the fact that she was dying. She then minimized her pain in his presence and was cheerful whenever he visited, thus, helping him to deny her situation. She herself had accepted it.
There are certain common fallacies pertaining to death. One of these is that no one wants to die unless he is suicidal or psychotic. It has been noted above that this is not the case. Fear of death is not basic to man; it does not increase as one nears death. “Being-toward-death” is not necessarily anxiety. Societies have glorified death in man’s history. Soldiers have gone to war looking for heroes’ deaths; Martyrs have given themselves for causes; the aged have relaxed into death as a true resting place. Research has tended to show that when confronted with a death for which he has had some time to prepare – hence, not a sudden violent one – a person may welcome it.
”The critical issue,” says Weisman, “is between survival and significant survival.” And this has been the pivotal point for all the ages. Whether it has been a cause or simply the knowledge that one has lived a full life, there is ample evidence from man’s history that he can face his own death with readiness. Perhaps one would wish to concur with Sartre in his assertion that it is the self who, as he has given meaning to his existence, gives meaning to his death. It is far more desirable to die having lived fully and fruitfully (by one’s own definition) than it is to live long and impotently. One author (Kaufman, 1959) points out that Holderlin has said this feeling very clearly in the last line of one of his last poems: “Once I lived like the gods, and more is not needed.”
Throughout history, man has found various ways of easing the thought of death. He has believed in after lives of varying pleasantness or discomfort. Belief in reincarnation has helped him to leave this life by assuring him of another. Some societies have glorified death for causes such as faith or nationalism. The greatest benefit psychologically of the various religious rituals surrounding death has been the closeness of family and friends which they encourage both before death around the dying person and after death when the bereaved need support for their grief.
However, the emphasis of modern medicine has become the preservation of life to the extreme that death represents a medical failure, not a natural event. The needs of the dying person for help with the psychological battle which is being waged within him are not met, by and large, by the medical profession. Taboos and anxiety prevent the family and friends of an individual from honestly dealing with the facts of death. Recent work, particularly that of Elisabeth Kubler-Ross, has shown that the dying patient needs to be allowed to die with dignity and in the honest company of those he loves.
Death is inevitable for man. It is as personal and as meaningful as his existence. The existential philosophers have realized that. Although Heidegger, for example, believed that anxiety is essential to “being-toward-death,” he also recognized that one covers up this fear by impersonalizing death. Research has since shown this fear to be unnecessary.
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