Courageous Conversations: Part 1
Talking About Death
By Suzanne Retzinger, Ph.D., MFT
Death is hidden from public view in the modern world. Even as therapists we don't often address this issue. A recent New Yorker magazine article (8-2-10:36-49) discussed conversations about end of life, stating that family members were far more likely to die in peace when they had these conversations, and family members were less likely to experience major depression following a death. In my experience behind many issues in psychotherapy are hidden issues of death, our deepest fear.
Like many, my family didn't talk about death when I was growing up. No one was comfortable even saying the word. My earliest experience was 1964 when my brother Joey died – he was eight years old. It started as a Whilms tumor on his kidney when he was 4, and took the predicted course – spread to his lungs. No one talked about it in my family. We weren't allowed to visit him in the hospital; in those days you had to be 16 and I was 14. There was no hospice then. It was even before Kubler Ross published her first book “On Death and Dying.” Joey died at the hospital.
Forty-six years later many things have changed, but people still aren’t comfortable talking about death. It's much like the taboo on sex in the 19th century. There's silence and isolation around illness, death and dying. People often feel alone in these experiences. Sometimes people want to talk about dying, but don't know how, or are afraid.
A number of years ago I spoke with a woman I'll call Jane whose mother was dying. She wanted to talk about it with her mother, and I encouraged her. She told me that her sisters were against it because their mother didn't know she was dying and they didn't want her to be afraid if she found out. After Jane's mother died, Jane spoke with the caregiver who said that she and mother often talked about her dying, but mother didn't tell her daughters because they didn’t know and would be sad if they knew. It turned out the mother and the caregiver had intimate conversations, while mother and daughters never did.
There are so many missed opportunities for connection, and intimacy, forgiveness and loving relationships when we avoid the subject. There are a lot of lost possibilities.
The poet Rilke said Love and death are the great gifts that are given to us; mostly they are passed on unopened. It's interesting that he saw the two words together – Love and Death. There are so many gifts we never unwrap. Perhaps each day that we don't contemplate death is a day that is impoverished.
But it is hard to talk about. As Mark Twain said many years ago: The truth will make you free, but first it will make you uncomfortable. Death makes us feel uncomfortable in so many ways: helpless, emotional, afraid, unable to change the course of events – even as therapists.
We often feel emotional unable to change the course of events. It throws us into chaos. We might think we need to "keep it together," be rational, be strong, put up armor, and avoid suffering, or try to save others from this experience. Some of the things I hear people say in my work is, “I have to be strong,” or “I avoid my dying sister because I might break down.”
Because death has been such a closed topic in modern culture, sometimes people really don't know what to say. Often they ask, “What do I say to someone who's been diagnosed with cancer?” Or ask what to say when someone's lost a child or mother or husband. There is no pat answer. Every situation is different. Maybe it's just, “I'm at a loss of what to say.” Maybe people don't want to talk, so you just sit quietly. Or maybe, “I heard it's been a hard year, how are you doing?” Something simple, from the heart.
Unless we, as individuals and as a nation, face our own discomfort with death and all it involves, it's hard to be with others when they're dying or grieving. It stimulates our own fears and vulnerable feelings. For this reason I like the word courage, rather than strong because the root word "cor" means heart – to be in the heart, open to love and other feelings, and have intimate conversations.
The first time I witnessed an intimate conversation about death was when my mother had cancer: I’m standing in the doorway of the hospital room where my mother is dying. Dad is sitting in a chair by the head of the bed, leaning close. They’re holding hands and looking into each other’s eyes, and having a conversation about her funeral. She says she wants an open casket, and wants to be placed next to Joey at the cemetery. She wants her flowered shirt and new black pants on in the casket.
Dad tells Mom that he’ll read her dad’s poem at the memorial, and she says she wants someone to read excerpts from “Song of the Open Road” by Walt Whitman: “However welcome the hospitality that surrounds us, we are permitted to receive it but a little while. What beckonings of love you receive you shall only answer with passionate kisses of parting, You shall not allow the hold of those who spread their reach'd hands toward you…”
They talk about music and decide on the song I’ll Remember You. “In my black phone book,” mom says, “are the names of the people I want you to invite.” It's as if they’re planning a dinner party. Mom says she'll wait for her oldest son Paul to arrive before she dies, but won't wait for her sister. Dad teases her about thinking she has control over turning her life on and off, and they both laugh. Paul did arrive. Mom died the next morning.
Death triggers a lot of emotions. We're empathic creatures. It’s difficult to see someone suffering, or think if we mention death someone will be sad or afraid. Sometimes we don't feel strong enough or brave enough or sane enough, or think that others can deal with it, so we try to push the feelings away. It's exhausting.
In the modern world there are expectations to keep a happy face no matter what we're feeling. We may hear, let's not talk about death, we'll deal with it when the time comes – as if we'll be able to at the time. To be happy all the time is a widely marketed idea, and we buy it. We spend a lot of money and effort to keep suffering away. We distract ourselves with entertainment, TV, shopping, surfing the Internet, excessive exercise, food and thousands of other ways. The advice we hear is "take a pill", "have a drink", "get a grip". Whatever you do, get rid of the feelings. I'm not sure it would be desirable even if we could get rid of them.
We're not often told to move closer to fear, or suffering, or any emotion. We don’t often hear anyone say, “Oh, you’re afraid, let me be with you in your fear.” This is where we connect, in the vulnerability. We connect with each other in the softness of the underbelly, not in the armor. We may need to soften our hearts to let love enter. Death and bereavement are tremendous opportunities for growth, even though it’s difficult. What happens when we just sit with suffering? What happens in the body, in the heart, and with our thoughts?
We may need to allow the space to suffer the suffering that always needed to suffer. Yet this is not an easy task.
Suzanne Retzinger invites any comments, questions or observations that anyone wishes to make.
Suzanne Retzinger, Ph.D., is an MFT in private practice and works at Hospice of Santa Barbara. She is a graduate of the Metta Institute in 2007, and teaches and presents topics on end-of-life.