With the End in Mind: Dying, Death, and Wisdom in an Age of Denial

by Kathryn Mannix

People are not limited so much by their illness as by their attitude to it. The illness may present physical challenges, but the emotional challenge is often far more important.

CBT intervention, the core principle is that we are made unhappy by the way we interpret events. Distressing emotions are triggered by disturbing underlying thoughts, and helping a patient to notice these thoughts and to consider whether or not they are accurate and helpful is key to enabling them to change.

These stories have shown different ways in which people cope with difficulties: trying to keep control; avoiding the truth; sinking into helplessness; simply accepting whatever fate has in store; using resilience to adapt to events; and becoming anxiously preoccupied with the threat of the situation. Which of these patterns do you recognise in yourself? You may have more than one style.

These are friendly, informal gatherings at which people can mull over various aspects of death and dying over a comforting warm drink and excellent cake. There are death café meetings in more than forty countries,

Euphemisms like ‘passed’ or ‘lost’ have replaced ‘died’ and ‘dead’. Illness has become a ‘battle’, and sick people, treatments and outcomes are described in metaphors of warfare.

Sometimes, if the bad news is broken only to the patient, or only to a family member, that individual can find themself with the burden of knowing a truth they dare not speak. This can lead to a whole conspiracy of silence that isolates people from each other at the very time they need to draw upon each other’s strength and support.

Sonia is on the brink of deciding that Patricia has died, when with a deep, shuddering breath the fast, shallow panting starts all over again. ‘This will be the breathing pattern now,’ Sonia explains. ‘Fast at first, then slower and slower, then a long pause, and then the pattern starts again.’

Bereavement is the process that moves us from the immediacy of loss and the associated grief, through a transition period of getting to know the world in a new way, to a state of being able to function well again. It’s not about ‘getting better’–bereavement is not an illness, and life for the bereaved will never be the same again.

I know that the thoughts that trouble us most, our deepest fears and darkest dreads, are usually suppressed and buried, to allow us to get on with daily life. It is only when they break the surface that they trigger our emotional responses.

‘So, how long has she got?’ I hate this question. It’s almost impossible to answer, yet people ask as though it’s a calculation of change from a pound. It’s not a number–it’s a direction of travel, a movement over time, a tiptoe journey towards a tipping point.

There is a sense of fellowship amongst this disparate little community of people, all assembled here by the irresistible summons at life’s end.

We know what the processes of both birth and death look like when they are proceeding smoothly–clear phases, predictable progression, needing companionship and encouragement but not interference: almost like watching the tide advancing up the beach.

The flower has been born, quietly and while no one was watching, a force of nature reaching its inevitable conclusion, without help or company.

At birth and at death, we are privileged to accompany people through moments of enormous meaning and power; moments to be remembered and retold as family legends and, if we get the care right, to reassure and encourage future generations as they face these great events themselves.

She leaves a dim light on by Sanjeev’s bed, and draws his curtain slightly to screen it from the other ‘passengers’, because she knows that darkness compounds disorientation, and that being able to see familiar objects is calming.