Reflections on Death
Reflections on Death
Abstract and Keywords
Changing concepts of death.
Definition, Breaking the Taboo, and Mystery
There was a time in Western societies, not very long ago, when one didn’t talk about sex in polite company. Sexual fantasies and behavior, either interpersonal or personal, tended to be very private and often guilt-ridden. Psychiatrists frequently encountered people in whom sexual anxieties had become manifested as conversion symptoms, such as impotence and frigidity, sometimes with actual paralysis. Now in most circles men and women can speak of sexuality with reasonable openness and sensitivity without being viewed as depraved or vulgar. Women can view being orgasmic and desiring sexual interaction as indicators of good health. In some circles even people committed to celibacy can experience occasional orgasms with gratitude rather than feelings of failure and guilt. Increasingly some people can now even honestly own both heterosexual and homosexual fantasies without undue self-doubt, regardless of their choice of adult sexual identity.
While sex may be seen as “coming out of the closet,” the closet door still tends to be tightly closed for many of us when it comes to death. The topic still often remains taboo, surrounded by vague fears and muddled thoughts. Some of us still view death as an unpleasant (p.127) event that sometimes happens to other people. Many prefer to not even begin to come to terms with the awareness that everyone who has ever lived on this planet has eventually died and there is a very high probability that each of us will also die someday.
What then, we may ask, is death really? Observed from without, we picture a human body that ceases to function. The heart slows and stops beating. The breathing ceases. The skin grows cold. Rigor mortis sets in. Soon the faint sweet scent of decomposition begins as the walls of cells begin to collapse. The person with whom we could once interact with speech and gestures is gone, never to return. Grief intensifies.
If the intuitive knowledge of mystics is taken seriously, what then might the experience we call death be like for the person who we declare “dead”? If consciousness is really indestructible, what adventures might await us? As one who has pondered this question with many different terminally ill people who have suddenly decided that the topic is of importance, I can report that there is a considerable range of expectations.
Some expect awareness to simply end, like “a lightbulb going out,” and may even express some anxiety that this might not be the case. There are those who feel they’ve had enough of life and would rather not have more of it, eternal or otherwise, joyful or painful. They are weary and exhausted with constricted awareness and simply aren’t interested in exciting new adventures. Others hope to move through different states of consciousness, realms of hell, purgatory, or heaven, or all three, perhaps to deal with judgment of how this lifetime has been lived, perhaps to reunite with beloved relatives and friends, ancestors and religious figures, who have lived before. Some hope for simple peace and heavenly bliss, at least for a while; others who take reincarnation seriously may imagine physical rebirth and “doing the diaper thing again.”
The Bardo Thodol, the sacred text known as the Tibetan Book of the Dead, treats the changes of consciousness after the body stops functioning very much like a psychedelic experience. How one responds to the changes in consciousness, especially in terms of focused attention, acceptance, humility, trust, and courage, it is believed, may well influence “what happens next.” In many Christian circles, it is believed that if one entrusts one’s life to the archetypal Christ, or, more simply (p.128) expressed, if one “gives one’s heart to Jesus,” one is indeed “saved” and all will ultimately be well.
The five-letter English word “death,” like the three-letter word “God” is one of those sounds we emit in speech that can have significantly different meanings for different people. If consciousness is truly indestructible, death simply is a word for transition, or perhaps for “waking up” to a more vivid awareness of our spiritual nature. This was the point that the Russian novelist Leo Tolstoy sought to communicate in his short story The Death of Ivan Ilyich. He described Ivan’s experience of the moment of his death as follows:
“And death? Where is it?” He tried to find his former customary fear of death, and could not. “Where is death? What is it?” There was no fear, because there was no death. In the place of death was light! “Here is something like,” he suddenly said aloud. “What joy.” For him all this passed in a single instant, and the significance of this instant did not change…. “It is over! Death!” he said to himself. “It does not exist more.”
What would civilization look like if most of us no longer feared death? What if “life” were understood to include states of consciousness expressed both in the context of normally functioning physical organisms and in energetic fields of awareness quite invisible to ordinary sensory perception? What if the everyday consciousness of most people was sufficiently enlightened or awake to include awareness of both the temporal and the eternal dimensions of a greater reality? This awakened awareness is of course a goal of many people dedicated to meditative disciplines, both Western and Eastern.
It sometimes seems as though we tend to be “afraid of not fearing death,” anxious that, if death is not intrinsically evil and to be avoided whenever possible, we might all suddenly become more prone to suicide or homicide. Some might tend to magnify these fears by recalling images of tragedies of the past, such as the multiple deaths at the compound in Guyana led by Jim Jones, the harms inflicted by suicide bombers, or the carnage in battlefields throughout history.
Yet the evidence from psychedelic research provides little support for such fears. People who lose their fear of death typically appear (p.129) to live more fully, to respect their own lives and the evolving lives of others, and to treasure the time that remains in interaction with family and friends. Some cancer patients may choose to forgo final experimental procedures that have little probability of offering extended duration of qualitative life. But as long as pain can be managed and meaningful communication is possible, which is usually possible with modern medical care, they appear eager to continue to do whatever is required to keep their bodies functioning. From this perspective it would appear that the reason to keep our bodies functioning for as long as meaningful life is possible is not to avoid the horror of death, but rather to fulfill our destinies as completely as possible. For some, that may entail completing creative work, cleaning up the messes we have made, preparing those we love to continue their lives without us, or simply savoring every moment that is given to us in the world of time.
A Personal Encounter with Death
After debating within myself how self-disclosing to be in this book, not wanting it to be self-indulgent or excessively autobiographical, I have decided to illustrate this discussion by describing the death of Ilse, my wife for twenty years. The mother of my two sons, Ilse was a psychiatric nurse from Germany who often worked with me in psychedelic research. Together we had interacted with many cancer patients, their spouses, and their children in the context of providing brief counseling assisted by one or two sessions of alternative states of consciousness facilitated by LSD. Ilse herself had received LSD and had experienced exquisitely beautiful and meaningful states of consciousness as part of her training when we first moved to Baltimore to pursue research at the Spring Grove Hospital Center. In those days, on-the-job training for new personnel who would be involved in clinical research with psychedelic substances always included one or two personal experiences with LSD. Ilse had also earned a diploma from three years of study at a Baptist theological seminary in Zurich called Rüschlikon and had pursued graduate studies in the psychology of religion in the United States at the Andover-Newton Theological School in Newton Centre, Massachusetts.
(p.130) Thus, when she was diagnosed with breast cancer at age forty, we looked at each other in shocked bewilderment, but then affirmed that, if any couple was prepared to cope with this situation, we must be. During the next decade she lived fully and courageously as various surgeries, courses of radiation, chemotherapeutic regimens, and even a trip to Mexico to obtain an experimental substance we called “black goop” came and went. Finally, however, we reached that point where the image of her skeleton during the bone scan lit up with multiple metastases and we could feel with our fingertips the hard nodes of cancer advancing in her clavicles. We knew it was time to prepare our sons, then eleven and thirteen, for her approaching death and did so together as sensitively as we could.
A few weeks later, after the accumulating fluid in her pleural cavity had been drained for a second time, we knew that death was imminent. She was still ambulatory, did not require narcotic pain medications, and was fully present with us in our home. We had opted not to accept a final highly experimental offer of chemotherapy that might well have provided slightly more quantity of life at the expense of quality.
She walked upstairs for the last time and, lying in bed beside each son, one at a time, reaffirmed all those things a son needs to hear from his mother. One son tape-recorded his final conversation, including, “I wish you didn’t have to die, Mommy,” evoking the response, “I wish I didn’t either, but we have to accept life as it is.” I then tucked our boys into their beds and lay beside her as the moment of death approached. Her final words were “Herr, Herr, Herr” (Lord, Lord, Lord) and she then entered into progressively deepening coma and the cessation of her bodily functions. Those final words suggested that, in spite of her advanced knowledge of comparative religions and transcendental states of mind, the simple faith of her Christian childhood effectively manifested itself at the moment of death. Steve Jobs, in a contrasting variation of words on the threshold of death, was reported by his sister to have uttered, “Oh wow, Oh wow, Oh wow.”
Though inevitably painful—griefwork is never fun—Ilse’s death occurred with negligible depression and anxiety, and with close communication with those she loved. She did not understand why it needed to occur at age fifty while our sons were still young and she still had many plans for this lifetime. Yet, possessing the knowledge from the (p.131) mystical experiences in which she had participated, she lived with an intuitive conviction that there is a bigger framework of understanding where all makes sense and all is well.
This is one of many examples of a “good death,” at least one approached with the openness, honesty, and courage that seem to promote fullness of living, prior to death for the terminally ill person and after death for the friends and family members who survive. There are many people who have never had mystical experiences or opportunities to receive entheogens who, on the basis of their belief systems and interpersonal connections alone, manifest a similar sense of peaceful integration on their deathbeds. However, there are also many who approach the end of their lives with notable anxiety, deep depression, and withdrawal from meaningful interaction with life companions. For the former, the vivid memory of mystical consciousness could well further enhance their sense of well-being on the threshold of death; for the latter, it might open up the possibility of finding meaning and dramatically decreasing emotional and physical distress.
As those who have grieved or are currently grieving know well, grief is indeed work. And on the level of human biology in the world of time, grief seems to need to run its course no matter how spiritually elevated one’s belief system concerning death may be. As one who has taught college courses in death and dying, I discovered new, experiential knowledge about the process and pain of grieving following Ilse’s death, especially in terms of the physical, somatic manifestations. Grief does appear to be a healing process and, just as childbirth is not without pain, the process of reorienting oneself in the world after the loss of a beloved person does seem to progress in meaningful patterns, especially when one is able to trust one’s own emotions and allow their expression.
The confrontation of unresolved grief and its expression and resolution is a common occurrence during the action of psychedelic substances. Not infrequently, the losses being grieved occurred decades earlier at a time when, whether due to emotional ambivalence, a lack of social support, or other factors, people chose to “be strong,” deny their (p.132) feelings, “put the death behind them,” and rapidly move ahead with life. It appears that those repressed feelings patiently await opportunities for resolution, and while waiting may well engender muscular tensions, tendencies toward depression and anxiety, and psychosomatic distress symptoms for some people. Claims of increased freedom and relaxation are often made following the catharsis of grief, not only for those who have lost loved ones in the past, but also prospectively for terminally ill people who also need to grieve the imminent loss of all they have known in life. The unexpected encounter with repressed grief is one common theme in many psychedelic experiences that become labeled as “bad trips.”
Changing Attitudes Toward Death
Now, what if more of us were to experience our own deaths and the deaths of those we love in ways characterized by honesty, openness, and trust? The implications of such a change in the manner our culture tends to cope with death would be profound in terms of preventive medicine. Many forms of psychological distress either originate in or are exacerbated by unresolved conflicts in interpersonal relationships—words of acceptance and forgiveness that were never spoken. Old hurts and resentments, expressed in anxieties, depressive tendencies, rigid judgments, and tense muscles, often have a way of enduring long after the people who perpetuated them have died.
Many doctors and nurses in recent years appear to have become more comfortable and skilled in honestly discussing issues of diagnosis and prognosis with those who are seriously or terminally ill. This of course requires them to do some deep introspection themselves and to begin to come to terms with their own mortality. I recall an elderly African American cancer patient who learned her diagnosis and prognosis while seated in her hospital bathroom, overhearing her doctor as he spoke to a group of residents in the hallway outside the door of her room, before entering. The first issue she introduced as we began meeting together in preparation for a psychedelic session was, “Should I tell my doctor that I know? Can he take it?”
I often think of how the option of receiving psychedelic therapy could be integrated into the palliative care units of our hospitals and (p.133) perhaps into our hospices. When I was pursuing my doctoral research, a study with DPT in promoting the well-being of cancer patients in close proximity of their deaths, the term “hospice” referred to an innovative experiment being conducted by Dr. Cicely Saunders at a single site she founded for caring for terminally ill people called St. Christopher’s in London. Now, hospices have become accepted social institutions with coverage provided by Medicare and other insurance companies. The National Hospice and Palliative Care Organization (NHPCO) reported approximately thirty-four hundred Medicare-certified hospice providers in the United States in 2012.
Aldous Huxley, on the final day of his life, when critically ill with laryngeal cancer, wrote a request to his wife, Laura, stating, “Try LSD, 100 gamma, intramuscular.” As described in Laura’s memoir, This Timeless Moment, she complied with this final request and administered the LSD to him. When the response appeared minimal, she gave Aldous an additional 100 mcg a couple hours later, just before his actual death. Though this sacramental act may have been personally meaningful to Aldous, who had written in his novel Island about the “moksha medicine” administered at critical life junctures, and perhaps to Laura as well, this final gesture has always struck me as akin to sprinkling water on someone just before he or she dives into the ocean. It makes much more sense to me to integrate a treatment intervention with psychedelics into palliative care (defined as a prognosis of at least six months) or even to offer it as an option to people when cancer or another potentially life-threatening disease is first diagnosed. The longer the time period when one may be more acutely conscious of a larger reality and interact meaningfully with significant others while experiencing decreased anxiety, depression, and pain, the better.
Attitudes toward death are changing. An example is Agrace Hospice and Palliative Care in Madison, Wisconsin, where many rooms open to private courtyards so, if one so desires, one can choose to die under the open sky instead of in a hospital room. There, those who have cared for a person may accompany the corpse, head uncovered, in a procession down the hallway to a hearse at the front entrance of the facility instead of discretely sending it down an elevator in a closed body bag, it is hoped when no one is watching, to the typical rear loading dock. When death is more fully accepted, whether in hospices (p.134) or in private homes, there are many more opportunities for genuine communication and even for music and laughter. After all, what if someone is simply “waking up”? The Buddha, as many know, is the “one who woke up” and perhaps there is a potential Buddha within us all.
A memory arises from visiting Varanasi, the holiest of Indian cities for Hindu people. There I stood beside the Manikarnika Ghat, one of the “burning ghats” where cremations almost constantly proceed on steps that descend into the sacred river Ganges. Hindus traditionally believe that, if one dies in Varanasi (also known as Benares or Kashi), one goes straight to heaven. I watched male relatives sitting in a straight line watching a corpse burn. It had been immersed in the Ganges, carefully prepared with ghee and sandalwood, decorated with flowers, and wrapped in cloth of symbolic significance. It then had been placed on a stack of branches and logs, carefully calculated to provide the intensity and length of heat required to complete the cremation. Often the oldest son, wearing the traditional white Dhoti, ignites a torch at the nearby temple where the eternal flame always burns and carries it to the funeral pyre. After walking around it five times clockwise (symbolizing the elements, earth, air, fire, water, and ether), he ignites the pyre. Sometimes at the appropriate time, he may even take a bamboo pole and crush the skull to ensure that the flames consume the brain.
While this ritual was occurring, which most Westerners would view as incredibly somber, if not grotesque, young teenage boys were running and laughing, joyfully playing cricket in full view of the cremation in the very next ghat, with no barrier between. The acceptance of death as an integral part of life appeared so well established that, if a cricket ball had landed in the cremation pyre, I doubt that anyone would have been unduly upset. After about three or four hours of burning, the ashes and remaining bone fragments are poured into the Ganges and the relatives walk away, traditionally without looking back. Death is part of life and in Varanasi it is common to see grandfather’s body, wrapped in a blanket and strapped to the top of a station wagon, moving through the narrow streets en route to cremation. It is mind-boggling for me to compare this with some of our Western funerary procedures. How often have I stood beside a corpse laid out in an expensive casket in an American funeral home with a rose-colored (p.135) lamp focused on the face to help it look lifelike while people standing beside me awkwardly comment about “how good he looks.” Do we still tend to suffer from denial of death?
In interactions with terminally ill people and their families, I consider it important to respect whatever belief systems or lack thereof one encounters. Insofar as is possible, if one desires to be helpful, the goal is to meet people where they are and to speak in ways that may be comprehensible and supportive. If someone expects nothing after death, it is possible to discuss what that expectation may feel like, just as one may discuss anticipation of hellish or heavenly states of mind or of encountering one’s ancestors. As in any good human interaction, honest, nonjudgmental communication tends to relieve anxiety and facilitate the resolution of guilt and anger, promoting feelings of acceptance, forgiveness, and sometimes even a touch of playfulness. It is reasonable to expect that whatever is or is not going to happen after death will probably occur no matter what our beliefs or expectations may be. What matters is not the acceptance of ideas, but the acceptance of love, perhaps both human and divine.
The counseling process, akin to other genuine interpersonal interactions, also tends to relax muscular tensions that sometimes may have exacerbated physical pain. The meaning of pain often shifts during psychedelic therapy from a threatening herald of death in the central focus of awareness to a sensation somewhere in the periphery of one’s field of consciousness. Following effective therapy, relationships have become central—with oneself, with others, and with whatever one considers sacred. Repeatedly I have heard, “The pain is still there, but it doesn’t bother me like before.”
From the perspective of mystical consciousness, the universe is so awesomely vast that there is room for unlimited variations of immortal life. In the West, we tend to forget that many people in the East take reincarnation for granted with the same lack of discernment that we manifest in usually dismissing it as a realistic option. When it comes to immortality, for whatever it may be worth, I do not feel any need for a “one size fits all” approach. Perhaps some of us do reincarnate some times. Ian Stevenson, a psychiatrist at the University of Virginia, documented some rather convincing case histories for those who are open to the possibility. He interviewed people who claimed to remember a (p.136) prior lifetime and then pursued detailed detective work to try to confirm the information provided.
Perhaps even those who expect nothing after death might get to experience that until it becomes too boring, or until it becomes recognized as the Buddhist “nothingness that contains all reality.” Some of us, whether we expect it or not, may well encounter loved ones and ancestors and archetypal manifestations within consciousness such as angels and demons. The literature on near-death experiences, reports of those who have entered into the physical processes of death and have been resuscitated, contains many intriguing stories to ponder that are often very similar to psychedelic experiences, complete with reports of moving through tunnels, encountering visionary beings, and being drawn toward sacred realms of light. However, regardless of the content that may occur after death, I can report the repeated observation that, with trust, openness, and interpersonal grounding, anxiety often becomes displaced by simple, honest curiosity and a capacity to serenely accept life as it is.