Weekly Review Issue No. 25

On engaging with the terror; on reimagining bereavement care and being-towards-grief and what if you're already living the life you want?

Hello and welcome back to another Review. I hope you’ll at least one thing you find interesting, useful or enjoyable. If something particularly resonated, I’d love to know about it.

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What’s alive for me

I had a wonderful week this week facilitating a workshop with a blend of public with lived experience (of caring for a loved one at the end of life) with healthcare professionals and researchers. We did a lot (probably too much in the 4-hours if I’m honest), but we aimed to try and dig deeper into the systemic issues around how people receive mental health care when they are living with a terminal diagnosis, or at the end of life. It was about looking the iceberg under the surface, mapping the undercurrents and forms of myths, values and stories that cause us to have less than ideal experiences. It was also good to think ahead and dream of ideal futures. A good week to be a designer.

I also finished reading a book that has long been on my list: Irvin Yalom’s Staring at the Sun. I’ve been reading around his work for years, and sitting down with his beautifully written stories was just one ‘aha’ moment followed by another. Here is wonderful summation early on in the book:

It’s not easy to live every moment wholly aware of death. It’s like trying to stare the sun in the face: you can stand only so much of it. Because we cannot live frozen in fear, we generate methods to soften death’s terror. We project ourselves into the future through our children; we grow rich, famous, ever larger; we develop compulsive protective rituals; or we embrace an impregnable belief in an ultimate rescuer.

Some people—supremely confident in their immunity—live heroically, often without regard for others or for their own safety. Still others attempt to transcend the painful separateness of death by way of merger—with a loved one, a cause, a community, a Divine Being. Death anxiety is the mother of all religions, which, in one way or another, attempt to temper the anguish of our finitude. God, as formulated transculturally, not only softens the pain of mortality through some vision of everlasting life but also palliates fearful isolation by offering an eternal presence, and provides a clear blueprint for living a meaningful life.

But despite the staunchest, most venerable defenses, we can never completely subdue death anxiety: it is always there, lurking in some hidden ravine of the mind. Perhaps, as Plato says, we cannot lie to the deepest part of ourselves.

I love the feeling when I am connecting into larger bodies of work, and feeling my way through what my (small) contribution could be. It’s an act of alignment more than anything. This work - this engagement with the terror - is where I’m heading. Wish me luck 😂

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Research on the edges

😌 Bereavement care reimagined

Julian Abel is a wonderful human being and someone I have always enjoyed talking to. He’s this glorious mix of antagonism and compassion. He fights a good fight - to upend how we care for and mourn for the dead and dying. As a retired clinician his go-to words are ‘love’ and ‘connection’ and its always so refreshing to be in a room with him. This is his latest on his approach to reimagining bereavement care.

Bereavement, a specific kind of grief in response to a death, has been embedded in human history, in cultural patterns, with ritual, ceremony, and community kindness being the mainstay of grief support. The advent of professionalised grief counselling has seen the increasing domination of professional support as the best way to support someone bereaved, with a consequent loss of the varied forms of community support. The availability of professional grief counselling is limited, with only a small percentage of bereaved people accessing it or needing to access it.

🔚 Contemplating anxiety and the fear of death

This is wunderbar. A great overview on death anxiety. You might notice I come around to this a lot, and I always enjoy reading the issues distilled into digestable pieces because it is a) so deeply part of what it means to be human it seems obvious but b) not really tackled in any meaningful way apart from intense existential psychotherapy. This needs to change in my opinion.

As a psychotherapist attempting to support a particular person, it is helpful to determine which aspect of death is the most frightening. Sometimes Woody Allen’s words, “I’m not afraid of death; I just don’t want to be there when it happens,” capture the fear that may be related to having watched grandparents or parents suffer a painful dying process.

Or the focus might be on contemplating the loss of all that life entails. The idea of the end of the sights, sounds and tastes of everyday existence can be painful. And more painful is contemplating the loss of the relationships, the loves of family and friends, the connections that make life worthwhile. Almost paradoxically, it has become clear to me that the best antidote to these lonely contemplations is to engage as fully as possible with one’s community of loved ones during whatever time remains.

🍂 Being-towards-grief: rethinking death awareness

A meaty piece, and something to get your teeth into when you have the time. Throwing in Derrida and others, this outlines another way - like Abel above - to re-think our approaches death and dying. I really enjoy when people step back and integrate wider philosophical ideas to help underpin and get to the foundations of such a potent topic.

One might certainly object then, that the point of the existential attitude towards death is not so much a positing of it as a future ‘event’, but the indirect impact that my finitude will have on my lived life today. I experience the present differently and live my life ‘in the light of death’, so to speak. I have argued that my life certainly is lived in the shadow of death, but that this is the death of the other. Inspired by Levinas and particularly Derrida, I suggest that the only way death can be thought of as possible is in the form of grief. The other dies. I experience the death of the other, not just as a witness to his or her life but as an evaporating interpersonal being. And, borrowing the fundamental ontological structures from Heidegger, I would now like to expand this notion into a more general structure of Being-towards-grief that encompasses the shared vulnerability that a mortal and relational life involves. Being-towards-grief is an essential feature that encompasses both the fact that death figures as a horizon for the lives we lead, and that we are relational beings that become who we are through these others.

⏰ Time for a radical rethink in how we deal with death

The Lancet Commission on the Value of Death, which was published in 2022, is for me the culmination of the last 10 years of incredible research, development and network building around how we might change how death and dying is seen, supported and transformed in society. Libby and Richard have set us up, collectively, to really create meaningful change. Their work links up above to Abel in the first link, and really posits a way for us to shift death and dying out of the hands of the clinical world, and re-distribute it amongst every community. This is a good primer if you haven’t heard of the report.

Improvements will not come by simply changing the health system, which is probably true of all healthcare. Government interventions alone will not improve health care, change will depend on mapping, understanding, and changing death systems within communities. it will require changing mindsets, the goals and the rules of the system, and information flows. There are many examples of change under these headings that are already underway.

These changes should lead to end-of-life care being led by families and communities with support from health professionals, many of them working in the community. Power will shift. The goals and nature of care will be different not because governments and health authorities want them to change but because power relationships and the system have changed.

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🎧 Listen

Don’t get me wrong, I love Brian Eno. I love his entire oeuvre. His generative and ambient music have inspired me for years (in fact, was a deep foundational inspiration for us when we made Cove).

But it’s so nice to hear him making some upbeat, poppy songs in the Here Come the Warm Jets vein. This collaboration with Hot Chip is just catnip for my ears. I hope you enjoy!

🎶 We’re all looking for a line in the sand 🎶

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🤔 Last thought