“Ultimate” separation
Does the fear of death arise out of the ultimate separation, whether it is related to the people we love or our own demise? This question came up in my conversation with Tina as if out of the blue or maybe not. The fear of losing her parents has been on her mind for a while. She is preparing for this possibility, as both her parents are celebrating their 95th birthday this year. On top of that, I recently told her I was going to travel overseas. These two anticipated separations prompted our discussion on a topic we usually don't talk about. After our dialogue, I decided to write this fourth "installment" about separation and thus close the circle.
Fear and anxiety are separated from each other by the illusion of time. While fear is considered the mental representation of physiological and behavioral reaction to an immediate (present) threat to life, anxiety is mostly a cognitive operation about threats (to life and otherwise) that exist as potentialities situated on the linear timeline that extends into the future. If we accept this differentiation, which is not always easy to make, between fear and anxiety, we can classify “ultimate” separation as an anxiety-producing event, where uncertainty about the certainty of death is looming large, often casting a shadow of darkness on the life we are living right now. It pulls us away from the joy of life as it is, creating an image of reality that is not in reality.
Generally speaking, death anxiety is related to the natural existential angst of the annihilation of life as we know it. It is unavoidable for us to have it because we carry the awareness that one day we shall seize to exist. This feeling is rooted, not in the present (all is well now) but in anticipation of what is to come. Not an easy burden to walk around with. For many of us, this “unbearable heaviness of being” is too much to endure so we try to alleviate it by using common defense mechanisms. For some of us, one of these “inner workings of the mind,” the denial (partial or complete) becomes fully operational, disguised as a belief that death does not exist.
Denial
I recall the manifestation of this type of counterphobic attitude in my teenage years when I used, you might say, a daredevil response to an event I observed. During the long hot summers, I spent many days on the shores of the Sava River at Slavonski Brod, Croatia in fun activities at the city beach Poloj. From time to time, I heard of drownings most likely caused by swimmers' over-confidence, strong currents, or riptides. These stories “hit home” when I witnessed the tragedy and saw the dead body of a drowned young man. Later, at his funeral, I felt viscerally the agonizing pain of his family expressed through their inconsolable crying and wailing. This experience left me with a lasting impression. So what did I do to deal with it? I decided to swim across the Sava River alone without letting anyone know about this risky business. It was something that wasn't typical of me. I was usually a cautious guy who avoided harm’s way but not at that juncture. I went to a secluded area away from other beachgoers and without much delay jumped into the river and swam across it. On the other side, I sat on the bank of the river and watched the distant figures barely hearing the noise of the crowded beach. At that moment I felt anxiety arising in me. My "hothead" cooled by the water came to a realization about the danger of my action but it did not prevent me from swimming again. Thankfully, or with the assistance of something beyond my understanding, I came back to the beach completely exhausted and fully conscious of the stupidity and dangerousness of this act of defiance against death.
There is another event that goes even further in time, to my pre-teens. It involves a different kind of witnessing - the one in the movies. There was a western by the name The Hanging Tree. In this film, the main character played by Gary Cooper was carried to the hanging tree and a rope was put around his neck. I am sure I was a very impressionable little boy and as I watched that scene, I put myself in the place of the hanged man. It must have created a dread in my mind that I couldn't bear. So what did I do this time? I tried to hang myself. There was a tree next to the house where I lived. My memory is fuzzy on the logistics that led to my attempted hanging, but apparently my brother and mother were there to rescue me from the maladaptive ways of my mind.
The power of denial goes much further and reaches into the intersubjective realm of cultural beliefs that are as old as our awareness of mortality. In their action, the ego defenses, by using the mind’s capacity to create stories, claim that death is just a transition (life after life) to a different mode of existence. Many (if not all) religions are grounded in this premise of immortality (1) using concepts such as soul, spirit, reincarnation, or even nirvana (2). I wonder if this was one of the reasons why Karl Marx stated that religion is the opium of the masses, they can turn to ease their suffering. One of his predecessors was more specific when he claimed that religion derives from our feelings of finiteness based on the knowledge of our mortality (3). You heard the aphorism "There are no atheists in foxholes" that points to our anxiety-driven tendency to look to religion in the face of extreme threat to life.
Triggers
Triggers for awakening death anxiety vary. The most common are related to finality reminders such as accidents, aging, poor health, death of people we love or are related to, exposure to death, and events that make a person aware of time passing such as birthdays, holidays, anniversaries, etc. In this regard, the turning point in my life occurred after my 60th birthday. I realized that I have a limited supply of time left in this life. This awareness evoked anxiety and a sense of urgency to use the remaining period of existence wisely and deliberately. On the face of it, nothing had changed because I was still doing what I was doing before. However, deep down in my psyche a mental shift took place and there was no reason in denying it. I decided to face this new perspective with my eyes wide open and ready to embrace what lies ahead of me. From this “moment of truth,” I grew a desire to create a legacy of my life experiences, and the genuine expression of my existence in this world through writing.
For my daughter, Simone, another birthday, this time the 70th birthday of her mother has sparked anxiety and sadness. She was thinking about the impermanence of life and how her parents' lives were gradually moving toward the end. She shared with me that her biggest fear was the anticipated death of her mom and me. She has lived in this anxious state of mind for a long time. In my files, I found a reference to this topic. In December 2011, I was exchanging emails with Simone about the one-year anniversary of my father's passing. This is what we wrote to each other:
Me: “Yesterday I thought that today is the first anniversary of my father's death. Later on by looking at the announcement of his funeral, I realized that he actually died on 12/9/2010. But when I went to bed my mind was influenced by my previous thoughts related to my father, so I had a dream in which my father was alive. He entered the room, I believe in the house where we lived from 1960 until 1965 in Foča, with the plate with food. He set down and started eating and watching TV. I was thinking about him being alive, which means while he was in the morgue without food for several days before his funeral, his metabolism was so slow that he could survive without food and now he was hungry. He looked good.
Simone, I wanted to share this dream with you, how our dream mind incorporates residues of the day (as Freud first recognized) as well as wishful thinking into dream work (a very creative process). One year without my father is coming to an end. I accepted his death as natural. Someone said that the opposite of death is birth, not life. So that means that everything and everybody that is born needs to die one day but our energies that exist will continue to exist (energy is always present and is indestructible, just transformed). So when the time comes for me to die, I hope that you will accept it as natural as I was able to accept my father's death even though in my dream apparently I wished that he was alive.
Simone: “I was thinking about him last night too, and I was imagining that he was a ghost of some kind watching over me now because he never really knew me that well in real life. I also had a dream about you a couple of nights ago that you had a heart attack and I freaked out and called the ambulance, but by the time they came, you had died, and I was so scared and sad when I woke up for the first five minutes. Today I found out my English teacher had a heart attack. Tata, I don’t think I can accept your death because you and mama dying are my biggest fears ever.”
Me: “I am sorry that your English teacher had a heart attack. How is she doing? Would you be able to visit her? Also, I am sorry Simone that you have strong fears about mama and me dying. I don't intend to die soon (I don't live high-risk life and I take good care of myself) but dying and death are natural. I am glad that we are talking about it though because I didn't have too many conversations with my dad about this topic before he died. People in our culture avoid talking about death. I think it is important to do that and not pretend that it will not happen to us. The presence of death makes this life meaningful. Every moment becomes important, and every decision counts. So Simone choose wisely and live a fear-free life. That is my wish for you today and for the new 2012.
With all my love TATA”
Eulogy
While my mother was alive and her health was deteriorating, I tried to talk with her about death. She couldn’t. It was too scary for her. After she passed, I was unable to attend her funeral, but I wrote the eulogy and asked my brother to read it. This is my farewell to her:
Dear mother, with these words your sons say goodbye to you and your earthly life. Sadness and sorrow are inside of us, as is the relief that you no longer suffer. Your life was long, but not joyful, especially after the death of our father and your husband. You have found meaning in the family and in the upbringing of your sons. The memories of days of a happy childhood are in us as an everlasting testimony to you and your motherhood marked by selfless love and kindness. As we grew and developed our "wings," we were always able to rely on your presence and care.
You didn't want our childhood to resemble your own. You told us about the early death of your father, whom we did not have the opportunity to meet. You were only eight years old when you were left alone with your mother to deal with the world events that soon followed. The Second World War forced you into exile, leaving an indelibly traumatic mark on your sensitive young being. You have not had an opportunity to attend school despite your strong desire to be educated. You had to find a job and work under difficult circumstances until your marriage to our father, despite opposition from your immediate family. The desire to start an independent life with the man you have chosen has made you courageous and resilient to the many adversities that have followed you.
Leaving the familiar surroundings and life of the wife of a military officer with small children in your care was not a joke. You were very young and inexperienced, with no family around to help and with your husband who was often away due to his military duties and schooling. Despite this, you were able to create and maintain a warm home for your husband and us, your sons.
It was especially hard on you when something bad happened to us, your sons. This circumstance would mobilize you so much that you would concentrate entirely on our well-being. We remember your attention during the frequent illnesses that marked our childhood. A particular memory of your loving care is especially vivid. Because of the fever, we were lying on a bed in the kitchen, snuggled under a blanket with a favorite book or magazine in hand. Oranges and hot teas were readily available as "immunity boosters." You rubbed our bodies with alcohol to bring down the temperature. It was the time when we "enjoyed" the role of the patient because of your care. This concern for the well-being of others has inspired your youngest son to devote himself to the profession of health worker, a vocation he has successfully pursued to this day.
You were frequently sick too, especially after arriving in Pančevo. Air pollution did not suit you, nor did the consequences of the accumulated stress caused by different living conditions. Fortunately, the military clinic was on the first floor of the building you lived in, so you had access to quality health care. Chronic diseases and multiple surgeries affected the quality of your life, but you continued to live as best you could.
After your husband and our father died unexpectedly, you never recovered. His death occurred following your 60th wedding anniversary. You spent almost all of your life together sharing good and bad. It was not easy for you to carry on living without him and you felt a lack of his presence each day. Then 12 years later, death came to you. With tenderness, it took you in your sleep and brought you to an unknown place where the souls of the departed reside and meet the souls of loved ones. From the bottom of our hearts, we wish you to meet all those who have crossed over to the other side of existence before you, and for limitless divine love to fill you with light.
Body reaction
More recently, I experienced unexplained body pains as a hidden manifestation of separation anxiety after the death of my mother. Initially, it was unexplainable abdominal pain that was hard to locate. At first, I thought I had shingles with no rash. The superficial burning pain was similar to the one I had a long time ago in an emotionally challenging situation, so I chose to wait. But the pain didn't go away, so I became concerned about the “state of affairs” of my abdominal organs. Thoughts about cancer populated my mind. I decided to see a doctor. After extensive assessment, she was convinced that it was a kidney stone that was causing my pain. She ordered an abdominal CT scan. Luckily, it was reported as normal. All lab test results were also normal. After that, my abdominal pain subsided and vanished within a few days. But my ordeal was far from over. Soon after, I began to experience severe chest pain radiating in my left arm. I was worried that I was going to have a heart attack. However, because of my previous experience with abdominal pain, I was inclined to think that the pain that resembled cardiac pain might be a psychosomatic manifestation of death anxiety. The chest pain went on and at one point I was getting ready to go to the emergency room. Instead, I decided to do a maneuver that I learned at the conference I recently attended. It was supposed to activate the parasympathetic nervous system and increase coherence between the heart and the brain. It worked. The chest pressure went away, and I was able to deliver the presentation scheduled that day without any discomfort. After a few more chest pain attacks, I realized that my pain had a symbolic meaning. It represented the language of the emotions stored in the body at the time when the feelings of the mind were not available to me. The loss of my mother triggered first abdominal and then chest pain, symbolically representing difficulties in “digesting life” and “holding on to a deep-seated fear of being hurt.” (4) The insight I gained and the intuition I followed helped me heal my emotional body without a “million dollars” workup to rule out heart disease.
Guidance by the master
Irvin Yalom has devoted his psychiatric career to helping patients “consumed” by the anguish of death. He wrote about the ontological mode of existence connected with our awareness of mortality. In this "not ordinary" mode we encounter what he calls awakening experiences that allow us to live a life full of engagement, connection with others, and meaning, rather than being preoccupied with physical appearance, possession, or prestige. For him, the most important approach to effectively diminish death anxiety is human connectedness. He writes:
“Our need to belong is powerful and fundamental. We have always lived in groups with intense and persistent relationships among members. Intimate relationships are a sine qua non for happiness. Empathy is the most powerful tool we have in our effort to connect with other people. It is the glue of human connectedness and permits us to feel, at a deep level, what someone else is feeling.” (5)
He has been an inspiring figure in my approach to this important topic through his sincere, revealing, and authentic writing. I was especially taken by his diary-style recording of his inner states while his wife was dying of cancer. In a poignant way, he writes about his anxiety and sorrow at her impending death and the moment of inspiration that came to him through the gift of empathy.
“As I think about life without Marilyn, grief and anxiety flare. My mind is acting primitively: it’s as if thinking about my future without her is a betrayal—a traitorous act that might hasten her death. Traitorous feels like the correct term: when I make plans for my life after Marilyn’s death, it feels like treason. I should be entirely consumed with her, our past, how we spend our time now with one another, and our all too brief future.
A sudden inspiration! I ask myself to imagine how it would be if things were reversed. Suppose it were I who was dying, and Marilyn who was taking loving care of me as she has always done? Suppose I knew I had only a few weeks to live. Would I be concerned about how Marilyn would fare without me? Absolutely! I’d be very much concerned about her and wish nothing but the very best life for her. An instantly therapeutic thought. I already feel much better.” (6)
Life cycle
I will end this writing by borrowing the words of another psychiatrist, in fact, his mother. She intuitively knew how to effectively look at death with eyes wide open and at the same time respond to the inevitable anxiety when we face it.
“My mother had a ritual she practiced every time we attended a graveside funeral. Over the years, these ceremonies involved many friends and relatives, and then in later years closer and closer relatives—grandparents, aunts, uncles, a nephew, and my father. My mother would do and say the same thing at each and every one of these events. After the burial, she would approach me, embrace me, and hold me very close to her so that she could whisper the following into my ear with no one else being able to overhear what she was saying: “Don’t be afraid. Don’t be afraid! Death is a normal part of life. It is the normal cycle of nature, of all living things. Everything, everyone lives and dies. Everyone! So it has to be okay because it is natural. Death is natural. It is inevitable.” And then she’d add the following final note: “But at least today it wasn’t you or me, my love.” (7)
1. Magic, science and religion and other essays, by Bronislaw Malinowski, Greenwood Press, 1948
3. Lectures on the essence of religion, by Ludwig Feuerbach, Harper & Row, 1967
4. The Secret Language of Your Body, by Inna Segal, Atria Paperback, 2010
5. Staring at the Sun: Overcoming the Terror of Death, by Irvin D. Yalom, Jossey-Bass, 2008
6. A Matter of Death and Life, by Irvin D. Yalom and Marilyn Yalom, Redwood Press, 2021
7. On the inevitability of death, by William Breitbart, Palliative Support Care, 15(3): 276–278, 2017
Commentaires