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05/14/2015

Raging Against the Dying of the Light

by Craig Klugman, Ph.D.

When do we die? The legal and medical answer is we are dead when we either (a) have experienced total loss of all brain function or (b) cessation of cardiopulmonary activity. The biological answer is that we are dead when as an organism we have lost our ability for integrated function—that is enough parts have ceased to function that the organism cannot be put back together again. That moment we call “death” is in a real way, quite arbitrary. It takes much longer for our tissues and cells to die once the integrity is lost.

I am in the second half of the academic quarter, teaching a course on Death & Dying. Students have learned the causes of death, diagnosing death, the biological process of bodily decay, autopsy, the “life” of cadavers as well as about advance directives, hospice and palliative care, funerals, grief and mourning, and cross-cultural perspectives on all of this. Perhaps the most interesting idea that I have learned is that death and dying are two distinct things.

Yes, death is all about the biology and the medicine. But dying is about the social process of preparing to leave this world and enter some other one (whether real or imagined). In The Social History of Dying, Allan Kellehear, sociologist, presents the relationship between death and dying throughout human history. He begins with the Stone Age where death was common at all ages. Most of the rituals about death happened after a person had died. Dying practices centered on making sure that the soul traveled to the afterlife, a journey that required assistance from the living.

The most recent “age” is that of the Cosmopolitan, where dying starts before death—we create last wills and testaments and living trusts. We move people who are old or sick to hospitals and long-term care facilities. He quotes people in such facilities who may be quite healthy but feel like they are supposed to have begun the journey toward death. Death is viewed as something to get through, a stigma and something to be embarrassed about. Thus, we set it aside where people do not have to view it.

At the same time, I went to a reading by Martha Holstein, a scholar of ethics and aging, who recently published her book, Women in Late Life: Critical Perspectives on Gender and Aging. Holstein argues that traditional social roles of women are ageist and sexist—either they are viewed as (1) the young women trapped in an old person’s body or (2) frail people who need to be protected and coddled. Holstein states that society has made an effort to “demonize” the notion of old.

A new show on Showtime called Happyish is about a 44-year-old man who suddenly finds himself as part of the old guard when 20-something hipsters are brought into his advertising agency to shake things up. They want to retire long held advertising icons. They want to choose their clients by the work they feel like doing rather than the work companies will pay to be done. Each episode features different philosophies and is a commentary on the cultural view that newer is better, younger is more innovative, and anyone over 40 just needs to get out of the way.

As a long time improviser, I was surprised to attend a show recently where the request suggestions were for things from ancient history—the 1990s: The years when the people on stage were young children. I was in college and grad school and so probably missed a great deal on the cultural front but the bands, TV shows, and nostalgic references were like a foreign language to me. Have I become “old” I asked my middle-aged self? I first felt that way at 35 when I was presenting my students with the classic deontology thought exercise, “The KGB is knocking on your door…” When I asked if they had any questions before we continued, a student raised her hand and asked, “Yeah, what’s the KGB?”

My sense is that even in the few years since Kellehear has published his book, that dying has moved back to that late 30s. This is when cultural references become outdated. When you realize that advertisers no longer crave your business. When you realize that hip fashions look terrible on you and when you lament how [fill in the blank] the younger generation is. At this point you should have an advance directive, a last will and testament. We are bombarded by images of young, lithe bodies who are running marathons, or wearing devices to track our activity levels, our sleep, and our calorie consumption.

In a society that is so focused on youth, aging comes quickly, when life is not even half done (if you go by longevity tables). And what is one to do when you are no longer the apple of marketers’ eyes? You start dying. You notice your body does not allow you to be active in the same way anymore. You eat less, move more and still gain weight. You complete your advance directive (after teaching about them for 10 years), write a will, and spend Friday nights at home exhausted instead of at a club or the latest fashionable restaurant (crowds, noise, indigestion—who needs it?). And you hold tightly onto your job because some younger person is moving up the ranks real fast.

I see my parents in their golden years. They are healthy but have decided certain things are no longer for them. Each trip overseas is “their very last one.” They look for a smaller place to live, and keep trying to get my sister and I to take their worldly possessions. They have bought a pre-paid funeral plan in a “forever condo.” Every week they go from doctor to doctor even when there is seemingly nothing wrong–just to be sure, their doctors tell them.

In a cultural evolutionary sense, dying has moved from what the community does for us after biological death, to what we individually spend half our life doing, or being forced to do by a society that values only the young and relegates those over 40 to the road to oblivion.

I teach my students in the Death & Dying class that we learn about death so that we know how to live. This week, they had to write their own obituary. They could choose any age at all and any condition for which they would die. The universal response was that this exercise made them realize how they want to live life.

The creeping of dying to an earlier and earlier age is not productive, it simply ignores people who are still active, productive, and wise. Studying death and dying helps us to embrace life. But being in a culture of dying means that those in middle age and beyond are viewed as irrelevant. As Holstein suggests, the project we face is how to reconceive age: “The task is nothing short of reconstructing old age.” Being old means living a different kind of “good life,” not sitting around waiting for death.

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