I'm goint to ask a series of questions anbout certain
unpleasant states. I'm nosaying we should not have
strong feelings or preferences about them. Nevertheless
from these examples we can begin to get a clue; and
when we have a clue we can see more clearly what we are
doing in practice. Here are the questions:

*If I am told told "Joko, you have one more day to
live, " is that OK with me ? Or if someone told you
that, is it OK with you ?

*If I am in a sever accident, and my legs and arms have
to be amputated, is this OK with me ? It that were to
happen to you, is it OK ?

*If I were to never again to receive a kind and
friendly encouraging word from abyone, is this OK with
me ?

*If I, for whatever reason, have to be bedridden and in
pain for the rest of my life, is this OK with me ?

*If I make a complete fool of myself, in the worst
possible circumstances, is this OK with me ?

*It the close relationship that you dream of and hope
for never comes to pass, is this OK ?

*If for whatever reason I have to live out my life as a
beggar, with little food and no shelter, exposed to the
cold, is this OK with me ? With you ?

*If I must lose whatever or whoever I care for, is it
OK with me ?

Now, I can't answer OK to any of these. And if you're
honest, I don't think any of you can either. But to
answer OK is the enlightened state, if we understand
wht it means for something to be OK. For something to
be OK, if doesn't men that I don't scream, or cry, or
protest or hate it.

Charlotte Joko Beck - Everyday Zen

The instinct of most of us in times such as these is to
keep our heads down and hang onto our pleasures and
possessions and bear our pains as best we may. We wish
to run no risks in a world with chance so badly skewed
against us. The result is that we are trapped, closeted
with our fears while the storm rages worse outside.
Here in this tight space dread grows, and the
possibilities for remedy are few. On television
maniacally cheerful people contrive to sell us
happiness. Buy! Enjoy! Experience! Out on the streets
glowering zealots paste up posters urging struggle,
war, confusion, and the death of their enemies -- after
which, presumably, mankind will enjoy bliss.
Civilization appears to be spiralling down into awesome
decadence, and the fall of Rome comes to the minds of
those not altogether oblivious to history. It's an
unpleasant thought, so we take shelter in our small
delights or else in the blandishments of psychological
and religious quacks who -- for a fee to defray the
costs of their own indulgences -- will tell us anything
we want to hear. Do we feel guilty? It's probably
someone else's fault. Are we tempted by vice? Go ahead,
fulfill yourselves! Will we have to give up anything to
achieve happiness? Oh, never! Perish the thought! A
golden age is dawning.

Leonard Price

Being alive means taking risks. Each breath we take everyday
is a risk. Getting up in the morning is a risk. Will we burn our
breakfast and set our house on fire ? Going to work is a risk.
Will some one cross the median and plow into us ?

Being around others is a risk. Walking up stairs is a risk. We are
confronted everyday by risks. even if we hid ourselves away in a
mountain cave there is a risk of a cave in or being flooded.

Try as we may, we simply cannot rid our selves of risks. There is a
risk of getting sick or injured or dying everyday.

Yet we try to remove them by surrounding ourselves in big houses
in gated communities, driving big expensive cars, running our selves
into the ground, taking all sorts of vile potions and making laws to
eliminate these risks.

We try to eliminate the risk of being in business or working or having
a relationship.

Now some risk management is certainly a good thing. Requiring that people
know how to operate a vehicle in a safe manner, making killing, and stealing
an illegal act are wise and good things to do.

But anyone who pays attention to the news knows that these things as
a total prevention of the risks imposed are not as effective as we would like
them to be.

We make laws to prevent the use of certain drugs but we all know how
effective that has proven to be. We even made the use of alcohol illegal.
Ask some people who lived in the 1920s and 30s just how effective that
was.

And here is my point. We cannot legislate risk away. People will still
engage in activities that are risky to themselves and to a certain
extent, to other people.

And we certainly cannot legislate activities that we ourselves find
unpleasant or uncomfortable for whatever reason. It just does not
work.

I myself do not like alcohol and do not go to bars or nightclubs to hang
around drunk people. It's not my thing. But I will defend you right to do so
if that is what you wish to do. (Though I would be rather upset if you attempted
to drive afterward.)

Forcing others to bend to our wishes simply because we don' like what
they do will not remove our own risks. However we also need to extend
some common courtesy to others who may not appreciate our activities.

We need to all be more tolerant of others and their chosen life styles and
realize that we ourselves are responsible for our own life.

Or do we really want to live in a risk-less world of Aldous Huxley.

C
 
 

The story is told that one of the elders lay dying in
Scete, and the brethren surrounded his bed, dressed him
in the shroud and began to weep. But the elder opened
his eyes and laughed. He laughed another time, and then
a third time. When the brethren saw this, they asked
him, saying: "Tell us, Father, why are you laughing
while we weep?" He said to them: "I laughed the first
time because you fear death. I laughed the second time
because you are not ready for death. And the third time
I laughed because from my labors I go to my rest." As
soon as he had said this, he closed his eyes and died.
~Desert Hermit Zen~

When you were born, you cried
and the world rejoiced.
Live your life
so that when you die,
the world cries and you rejoice.
~White Elk~

We most certainly do no rejoice at our own death. In fact it is
quite unimaginable.

Our own death is indeed quite unimaginable, and
whenever we make the attempt to imagine it we . . .
really survive as spectators. . . . At bottom nobody
believes in his own death, or to put the same thing in
a different way, in the unconscious every one of us is
convinced of his own immortality. (Freud 1953, pp.
304-305)

Our own mortality has become such a fearsome boggy man
that it nearly controls all our lives whether we are aware of
it or not.

According to Becker, "everything that man does in his
symbolic world is an attempt to deny and overcome his
grotesque fate. He literally drives himself into a
blind obliviousness with social games, psychological
tricks, personal preoccupations so far removed from the
reality of his situation that they are forms of
madness." Even our character-traits are an example of
this, because they provide an automatic response to
situations. These sedimented habits are a necessary
protection, for without them the e can only be "full
and open psychosis"; to see the world as it really is
"devastating and terrifying" "it makes routine,
automatic, secure, self-confident activity
impossible... It places a trembling animal at the mercy
of the entire cosmos and the problem of the meaning of
it." Thus the bite in Pascal's aphorism: "Human beings
are so necessarily mad that not to be mad would amount
to another form of madness." For Becker this is
literally true: what we regard as normality is our
collective, protective madness, in which we repress the
grim truth about the human condition. Those who have
difficulty playing this game are the ones we call
mentally ill. Schizophrenics are suffering from the
truth. Psychoanalysis reveals the high price of denying
this truth about the human condition, "what we might
call the costs of pretending not to be mad."

And we ten to lead our lives this way. We have even come
to expect the medical establishment to be able to extend our
lives nearly indefinitely.

The old truism was more readily apparent in societies
unexposed to the chemistry of birth-control pills and
the mechanics of a triple coronary bypass. Even an
extended stay in an American hospital during the first
half of the twentieth century didn't hold out a higher
chance of recovery, and for most illnesses the
treatments were therapeutic, not diagnostic; doctors
relied on common sense, on the natural resilience of
the human body, and the hope that by tomorrow morning
the patient would show signs of improvement. A medical
practice was likely to consist of five or six doctors
who answered weekend and late-night telephone calls,
knew the names and ailments of their patients, tended
to think of their profession as a public service.
Doctors making rounds in public-hospital wards adopted
the attitude that Rudyard Kipling describes in his
lecture to the students of Middlesex Hospital's medical
school. It was understood that sooner or later even the
most artful physician must acknowledge the presence of
death, "the senior practitioner," whose opinion brings
with it the fall of the capital city. In the face of
the inevitable defeat, nobody was in the business of
performing miracles; what they did perform, the
patients as well as the doctors, were the acts of
kindness tempered with courage, knowing, as did Seneca,
that the strength to confront suffering was to be found
in the thought that "you will not die because you are
sick but because you are alive."

The consolations of philosophy were no match for the
wonders of medical science raked from the ashes of
World War II. Newly armed with antibiotics known to the
trade as magic bullets, among them sulfa and
penicillin, a new generation of physicians found itself
capable of cures for syphilis and tuberculosis as well
as for typhoid and scarlet fever. Surgical skills
acquired to address battlefield wounds led to further
development of the means with which to repair,
rehabilitate, and reformulate the human body.
Infirmities that John Donne regarded as "perplexed
decompositions" and "riddling distempers" began to be
seen as factory errors subject to recall in the manner
of a malformed Ford Explorer.

Affiliated with the several theories of American
exceptionalism and entitlement, the great expectations
also were a product of World War II. Prior to the
advent of the atomic bomb, answers to the question,
"Why do I have to die?" were looked for in the
teachings of religion and the languages of art, in
Plato's discourses and the music of J. S. Bach. The
experiments conducted at Hiroshima and Nagasaki
referred the question to the politicians in charge of
the nuclear weapons and to the research scientists
clearly destined to discover that death is a
preventable disease. America's military and economic
command of the world stage fostered the belief that
America was therefore exempt from the laws of nature,
held harmless against the evils inflicted on the lesser
nations of the earth. For the last sixty years, the
intimations of immortality have supported the habits of
magical thinking that enable the country's codependence
on both its military-industrial and its
medical-industrial complex. As America's
enemy-in-chief, disease serves as a body double for
godless Communism, the doctrine of mutually assured
salvation as a stand-in for the doctrine of mutually
assured destruction.

Yet disease is part of the human condition and death the
epilogue.  Our response to it to to deny and delay at what
ever cost.

We have now diagnostic techniques, surgical procedures,
pharmaceuticals and life sustaining machines that seemed
like something from a science fiction novel when I was young.
We even have emergency paramedics - some with what
amounts of a mini trauma center on wheels to treat you
at the scene and transport you immediately to a bevy
of trauma specialists who will do nearly anything to keep
you alive.

Is it any wonder that we have nearly considered ourselves
as immortal ?

But happens when all the medical magic can no longer keep
death at bay ?

A physician friend recently shared an insight he gained
from a 68-year-old woman. Four years ago she was
diagnosed with leukemia and initially responded to
chemotherapy, which gave her some good years. Then she
stopped responding to drugs, and finally underwent a
bone marrow transplantation after total body
irradiation. Unfortunately, she never recovered from
the transplant, and with no more options for a cure,
she was having repeated infections and other
increasingly severe symptoms.

One day, when my friend visited her, she looked at him
and said, "You got me into this mess, now get me out of
it. Please help me die."

"It made me realize," my friend said, that we
physicians and our technology had put her in a
condition unknown just 50 years ago. We gave her some
good extra life, but now she is in a medically induced
state of extended suffering. And, he added, "she's
right, we are the ones who are responsible for her
present condition, and for how she is dying."

Today, most people die under medical management. Except
for those who die suddenly, as from trauma, stroke or
heart attack, most of us have life extended beyond the
time we would have died naturally. Although we would
rather die at home, most of us die in hospitals or
other medical facilities.

And, after a series of medical decisions have changed
our course over months or years, the great majority of
us die following a specific medical decision, such as
stopping a mechanical ventilator or antibiotics, or
increasing a painkiller or sedative.

Few of us will die naturally. Medical decisions,
commonly made by physicians in consultation with the
patient and family, determine when and how we die. No
one wants to revert to a state of nature without
prolonging life when we first encounter our last
illness, but in this bargain with modern medicine we
have to understand that someone -- a human person(s) --
makes the final decisions about when and how we die.

Why shouldn't that someone be the person who is dying?
Why must a dying person's final weeks or months be
subject to decisions made by medical treatment
protocols, the personal beliefs of individual doctors
or the dictates of ideologies?

Or we lock them away in a nursing home or some other
facility. Maybe paying cursory visits when not inconvenient.
It reminds us too much of our own fatality. And we cannot
handle it.
 
As I pointed out in my previous post on this subject

Fear may be exacerbated by the way death unfolds in
modern America. Over the last several generations,
death's place in society has changed radically.

"Death was always public," wrote Philippe Aries in "The
Hour of Our Death," his landmark 1981 history of
Western civilization's changing attitudes over the last
thousand years. "Death was not a personal drama but an
ordeal for the community."

For centuries, friends, family and even passersby would
gather in the bedroom while the dying person said final
goodbyes, asked forgiveness and received sacraments.
After death, bodies were laid out in parlors while
people visited.

In the 19th Century, that began to change in the United
States.

The modern hospital came into being. Caring for the
dying at home began to seem dirty and unpleasant.

In prosperous Western societies, medicine and hygiene
largely eliminated childhood death, once mankind's most
common encounter with mortality. Death disappeared into
medical institutions.

As far as the community is concerned, "You don't see
anything," said Daniel Callahan, director of the
International Program at The Hastings Center, a
bioethics think tank.

We have hidden it away and treated it like a malady in and of
itself. That if you die, it's you own fault for not taking car of
yourself.  It's the consequence of being poor or stupid or
self indulgent. Regardless of you age, gender or race.

Referring back to Lapham again.

Iain Bamforth's essay finds a foreshadowing of the
attitude in Thomas Mann's novel The Magic Mountain. The
precious invalids assembled in the sanatorium high up
on a Swiss Alp look upon their therapies as stations of
the cross, enduring their sorrows, as did the
soon-to-be-ascending Christ, "with a sense of
exaltation and even elation." To the degree that the
affluent American society as a whole imitates their
refined example, "The magic mountain is no longer a
retreat or social height; it is our everyday."

Which isn't to suggest that our doctors forswear the
Hippocratic Oath, or that our politicians abandon hope
of squeezing the pus out of the healthcare system. But
where is the blessing to be found in the wish to live
forever? A substantial fraction of the annual tithe
collected by the medical-industrial complex is the
invoice submitted ($528 billion) to payees in the last,
often wretched, year of their lives. The corpses in
waiting serve as sacrificial offerings placed on the
altars of the god in the ATM. Plato thought it
"shameful" to provide medical help "not for wounds or
some seasonal illnesses" but because one "is filled
with gases and phlegm, like a stagnant swamp, so that
sophisticated Asclepiad doctors are forced to come up
with names like 'flatulence' and 'catarrh' to describe
one's diseases." Socrates in the dialogue with Glaucon
compounds the argument with the observation that it is
wrong to prolong lives no longer "profitable either to
themselves or anyone else." Medicine, he says, isn't
intended for such people, "not even if they are richer
than Midas."

I know that dying is un-American and nowhere mentioned
in our contractual agreement with Providence, but
absent some sort of renegotiation of the country's
arms-control treaty with death, I don't know how we
avoid dismembering the American body politic with the
electromagnetic scalpels of our computer-generated
fear. Any system that construes medical care as
profit-bearing merchandise is by definition
dysfunctional. The attempt to mark down the gifts of
the human spirit to the measure of their weight in gold
is an idiocy along the lines of the nineteenth-century
attempt to cure tuberculosis by removing one lobe of an
infected lung and filling the vacancy with ping-pong
balls.

I fear that in pursuit of nearly eternal life that humanity is
becoming as cold, impersonal and robotic as the machines
that will keep our bodily functions going even as our minds
have long since ceased to.

And any attempt to interfere with this promise of life at any
price...scares people to death.

 
C

"You will learn that the distance between life and death
is but a single step," Master told him.  "Our life is one
long series of steps.  We go through life, step over step until
one day we die.

"Each step brings us great joy and adventure as well as the
possibility of death.  But you can not simply stand still in
fear of meeting death upon the road.  Walk boldly along the path
of life.  Enjoy the wonders that are there for us all to see.
So that when the day comes when you you do meet death, you will
know that you have not shrunk from life, but embraced it.

The fear of our own mortality is probably the the most intense emotion
we have. As Anthropologist Ernest Becker (1973) notes :

"the idea of death, the fear of it, haunts the human
animal like nothing else; it is the mainspring of human
activity-- activity designed largely to avoid the
fatality of death, to overcome it by denying in some
way that it is the final destiny for man"

And even more so than sex - this fear of death has made more
people more money than anything else. From MGM to Roger
Corman.  From the snake oil salesman to the big pharmaceutical
companies. From the small clinic to Johns Hopkins medical center.

Calvin Conzelus Moore John B. Williamson  assert that this fear is
universal but how different cultures deal with it is vastly different.
And is a very complex issue.

Because the idea of death evokes a number of fears,
researchers have suggested that the fear of death is
actually a multidimensional concept. Hoelter and
Hoelter (1978) distinguish eight dimensions of the
death fear: fear of the dying process, fear of
premature death, fear for significant others, phobic
fear of death, fear of being destroyed, fear of the
body after death, fear of the unknown, and fear of the
dead. Similarly, Florian and Mikulincer (1993) suggest
three components of the death fear: intrapersonal
components related to the impact of death on the mind
and the body, which include fears of loss of
fulfillment of personal goals and fear of the body's
annihilation; an interpersonal component that is
related to the effect of death on interpersonal
relationships; and a transpersonal component that
concerns fears about the transcendental self, composed
of fears about the hereafter and punishment after
death. Because of the complexity of death fears, some
authors suggest using the term death anxiety to
describe the amorphous set of feelings that thinking
about death can arouse (Schultz 1979). Because of the
complexity of death fears, scholars have debated
whether such fears are natural or whether they are
social constructs. The most common view that runs
through the history of thought on death is that the
fear of death is innate, that all of life tends to
avoid death, and that the underlying terror of death is
what drives most of the human endeavor.

Henry Ebel  goes into the difference between Judaic/Christian
religions and Easter religions on the view of death.

But religions - to use the plural - differ radically in
the degree to which they succeed in calming this primal
anxiety. In general, death seems far less terrifying as
we move eastward on the face of the planet. For the
Buddhist, or the many versions of Oriental religion
that have been touched by Buddhism, life is not defined
by its termination. There is instead what I will call a
"cyclical affirmation," a sense of life's unquenchable
continuity, that appears to approach the exalted state
called, in the New Testament, "faith," and that is
attributed by Jesus himself to young children.

Interestingly enough though, the more religious are person is
the greater the lengths he/she will go to - to avoid their own
demise.

In fact, it is the other way round--at least according
to a study published in the Journal of the American
Medical Association by Andrea Phelps and her colleagues
at the Dana-Farber Cancer Institute in Boston.
Religious people seem to use their faith to cope with
the pain and degradation that "aggressive" medical
treatment entails, even though such treatment rarely
makes much odds.

Dr Phelps and her team followed the last months of 345
cancer patients. The participants were not asked
directly how religious they were but, rather, about how
they used any religious belief they had to cope with
difficult situations by, for example, "seeking God's
love and care". The score from this questionnaire was
compared with their requests for such things as the use
of mechanical ventilation to keep them alive and
resuscitation to bring them back from the dead.

The correlation was strong. More than 11% of those with
the highest scores underwent mechanical ventilation;
less than 4% of those with the lowest did so. For
resuscitation the figures were 7% and 2%.

Explaining the unpleasantness and futility of the
procedures does not seem to make much difference,
either. Holly Prigerson, one of Dr Phelps's co-authors,
was involved in another study at Dana-Farber which was
published earlier this month in the Archives of
Internal Medicine. This showed that when doctors had
frank conversations about the end of life with
terminally ill cancer patients, the patients typically
chose not to request very intensive medical
interventions.

According to Dr Prigerson, though, such end-of-life
chats had little impact on "religious copers", most of
whom still wanted doctors to make every effort to keep
them alive. Saint Augustine of Hippo, one of
Christianity's most revered figures, famously asked God
to help him achieve "chastity and continence, but not
yet". When it comes to meeting their maker, many
religious people seem to have a similar attitude.

Eastern societies have a very different view, however as
Henry Ebel goes on.

Nor is it mere coincidental that these same Eastern
societies are both more community-minded than we are,
far more bound up with each other in everyday life, and
far more humane in their treatment of the elderly, far
less willing to render their senior citizens impotent
and babyish.

Death is the theme that connects these attitudes and
behaviors. The fact that Buddha lived to a ripe old
age, and that Christ died in agony while still a young
man, helps to illuminate the extent to which the
challenge of death, the terror of death, and the
anguished question of death has helped to define the
central concerns of Western culture.

[You might want to take a look at the Buddhist perspective
 here. It is quite enlightening]

But of course, the centrality of death in our thinking
goes back even further, right up the two tributaries of
our thinking called "Greco-Roman" and
"Judeo-Christian." Death is obsessively the theme of
the Iliad, the very earliest surviving work of Greek
literature; the theme of being "stricken unto death" is
one that unites such widely-spaced Biblical figures as
Adam, Jacob, Joseph, Moses, Samson, Elijah, Job and, in
their successive historical crises, the entire Jewish
people. Strewn throughout the ruins of the Roman
Empire, in silver or mosaic, are images of reclining
skeletons, often with the words "Know thyself" beneath
them, and the death-obsession of the Roman pagans
points like an arrow to what Huizinga called "The
waning of the Middle Ages" - the period in the 15th
century when European artists vied to outdo each other
in their portrayals of mouldering corpses and grinning
death's-heads. And what European cathedral is complete
without a tympanum in which we can contemplate the
agonies of the damned, skewered by devils as they boil,
roast, and writhe?

*

He then makes a case for how  the media uses this intense
fear of death to it's advantage.

In a culture so saturated with the fear of death, what
can an old person be but a terrifying question mark,
one foot already in the grave, who raises the
possibilities that even our deodorants, our make-up,
and our plastic surgeons cannot resolve? The
evasiveness one still occasionally encounters about
revealing one's true age lies, does it not, in the fact
that the number of years we have survived also suggest
by how much we have approached the day of our death.
And if old people are therefore walking symbols of that
which we are most afraid of, then symbolism - with its
customary elasticity - can also be extended backward to
the first of our wrinkles, the earliest of our grey
hairs.

And "trying not to think about dying" becomes just as
challenging as "trying not to think about an elephant."
The images of eternal youth and horrible old age with
which the media engage so much of our attention are the
paradoxical result. The manufacturers have found - as
empirically as Hitler or Goebbels - that they can
effectively get us to buy their products by suggesting
that the products will keep us out of the grave; that
they are, in fact, the key to a "no-grave" world never
visited by the Grim Reaper. But you don't have to take
a Ph. D. in psychology to realize that the fear of
death, at a deep level, is going to be as much
stimulated as allayed by the suggestion that Coca-Cola
is the elixir of life, that rouge will hide your
deathly pallor, and that a good roll-on deodorant will
keep you from stinking like a corpse.

And we take it all in - hook, line and sinker. Because all of
us...everyone is totally terrified of having to die. Yet we all
know that this fate awaits all of us. Subconsciously we still
believe we are immortal though.

This article by Barbara Brotman in the Chicago Tribune
goes on the give some reason why we now have such an
intense fear, when for a long time this was not the case.

Fear may be exacerbated by the way death unfolds in
modern America. Over the last several generations,
death's place in society has changed radically.

"Death was always public," wrote Philippe Aries in "The
Hour of Our Death," his landmark 1981 history of
Western civilization's changing attitudes over the last
thousand years. "Death was not a personal drama but an
ordeal for the community."

For centuries, friends, family and even passersby would
gather in the bedroom while the dying person said final
goodbyes, asked forgiveness and received sacraments.
After death, bodies were laid out in parlors while
people visited.

In the 19th Century, that began to change in the United
States.

The modern hospital came into being. Caring for the
dying at home began to seem dirty and unpleasant.

In prosperous Western societies, medicine and hygiene
largely eliminated childhood death, once mankind's most
common encounter with mortality. Death disappeared into
medical institutions.

As far as the community is concerned, "You don't see
anything," said Daniel Callahan, director of the
International Program at The Hastings Center, a
bioethics think tank.

Death has become a forbidden subject. The "D" word we dare
not mention and is denied. Our western view of our own
mortality is what is driving this discourse on health care. This
irrational terror of the death has hijacked the discussion simply
because we will got to any lengths to delay, deny and avoid
our own demise.

We need to change drastically our view and come to our senses
as it is the one thing in life that everyone will experience.  If we do
not....we could find that the whole of human existence could be at
great risk.

C