Living with death

Death seems to pervade many aspects of life. Some people feel that all of activities are without meaning and others lose themselves in seemingly ceaseless activity to distract themselves. The earlier post entitled, ‘Death Drive’, dealt with the self-destructive impulse but this entry is more about how death seems to touch all of our lives anyway.


The importance of the interpersonal


Dahlia

You would think that the most important thing for dying people would be getting better or not dying. It turns out though that most important thing for the dying is the effect that they have on other people. Not only that but people will put themselves at even greater risk of death just to protect their way of relating with these people. Even their relationships with people with whom they are not particularly close.



In his book, The theory and Practice of Group Psychotherapy, Yalom illustrates this with a number of examples of his patients. One of his patients planned to give a large evening social function when she learned that her cancer, which she had believed to be contained, had metastasized. She kept this information a secret though and went ahead with the function. Another of Yalom’s patients with a severe heart disease had a pacemaker and a ventricular defibrillator inserted. His main anxieties concerned possible humiliation that ventricular tachycardia in front of his friends might entail and not that death could come at any moment.

http://www.amazon.com/Theory-Practice-Group-Psychotherapy-Fifth/dp/0465092845

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Yalom says that while the death physically destroys us as an idea it serves to save us.In many of his books Yalom uses the same Otto Rank Quote which goes as follows – ‘some refuse the loan of life to avoid the debt of death.’ This idea relates to my own ideas about life and death. In the last entry on death I suggested that often in living one experiences  a sort of symbolic death either in relationships that are too close or in the absence of such relationships. I suggested that the death drive was part of a more regressive tendency and that it was often an attempt to break out of some sort of symbolic death in life. This idea of the symbolic death in life is something I want to return to now. Symbolic death is captured by a psychological phenomenon known as Repetition Compulsion (http://en.wikipedia.org/wiki/Repetition_compulsion).



Repetition Compulsion relates to a situation where a person repeats a traumatic event or its circumstances over and over again. It can also be taken to refer to behaviour and life patterns more generally. In  In Treatment,the HBO drama about therapy, we are given plenty of examples of this phenomenon during the course of several fictitious therapies. There is Mia, for example, who defends medically negligent men in an attempt to defend, over and over again, the father that she has idealized. This removes some of the vitality from her life as she cannot see the reality of her father because she would rather live with the unreal image of her father.



Paul West, her therapist, also evidences this phenomenon in his own therapy. In one session Paul accuses Gina, his own therapist, of being judgmental and provokes her to the point of an angry outburst during the session. Gina suggests that Paul got what he wanted. He pushed her into playing the role of his cold and rejecting mother. Paul asks her why on earth he would do that and she responds with a motivational rationale for repetition compulsion. Because it is comfortable. Because it’s familiar. These recapitulations of earlier events and relationships then are symbolic forms of death which provide us with some form of comfort.



In another book, Staring at the Sun: Overcoming the Terror of Death, Yalom talks about an ex-prostitute and heroin addict. She reflected with nostalgia about her life on the streets and suggested that her concerns were more simple back then. This woman, who had turned her life around, was so comforted by this comfortable symbolic death that she failed to mention the friend she had seen murdered on the streets or the three attempts on her own life. Such is the power of this impulse towards repetition or recapitulation.

http://www.amazon.com/Staring-Sun-Overcoming-Terror-Death/dp/0470401818

If we accept the notion then that people’s patterns of relating are shaped by their earliest relationships we can see how this can become a sort of infinite regress. Relationships become themselves these symbolic forms of death. So let’s operate with the presumption that our patterns of relating are tying us to past relationships and events. This is where the notion of actual physical death and its attendant notions of transiency can help us.

In a sense we are confined by our patterns of relating. In another sense, however, the transiency of all events and relationships attaches a great importance to the Here-And-Now. In the Here-And-Now while may still not be able to see in our relationships in a different way we may still see that the way in which we see our relationships does not represent the reality. In his book, momma and the meaning of life: Tales of Psychotherapy, Yalom discusses his experience of leading a daily therapy group for five years on a psychiatric ward.



He talks of the frustrations that he experienced with these inpatient groups. He says that ‘the landscape of […] in patient groups was nightmarish – the continual rapid turnover of members; the frequent psychotic outbursts; the conning, manipulative members; the patients burned out by twenty years of depression or schizophrenia who were never going to get any better; the tangible level of despair in the room.‘ These groups come to represent death with their transiency and their sense of despair. These different people in in patient groups are thrown together for a particular moment of time. In these groups we are dealing with people who feel like they are a burden, who feel like they are unable to relate to others and who feel like they have nothing to offer. It is in these groups, however, that people can paradoxically  discover that they still have things to offer others in the group and by extension the rest of humanity. They can experience in those symbolic moments the interpersonal effect that they are having on all other people. An awakening experience or an awareness of death in life more generally will perform the same function.

An awareness of impending death forces us to appreciate that all of our experience represents our lives not just the parts that accord with our expectations. In an episode of House entitled One Day, One Room a patient teaches House MD this lesson.

In watching 50/50 recently I saw a similar thing. In that film the main character, played by Joseph Gordon Levitt, is handed a diagnosis of cancer and a likelihood of dying soon. He takes advantage of the situation to accept his overbearing mother and change the way that he relates to her. He gets rid of unfaithful girlfriend who didn’t treat him well and he makes friends with the people that happen to be in the room getting chemotherapy with him. One particular clip brings a smile to my face. In that scene Levitt’s character is deciding whether to accept a new pet dog. Many things are wrong about this pet. He is too old, he is too big, etc. He is, however, also perfect in that he provides Levitt with comfort and consolation throughout the film. The dog represents that the messy experiences and the experiences that we think won’t work end up being some of the most enriching (and often it takes the spectre of death for us to make this realization).

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