Thanatology: Death & Modern Man

Neither the sun nor death can be looked at steadily.

—La Rochefoucauld

Modern medicine has steadily prolonged lives, slashed death rates and, for many patients, changed drastically the very process of dying. Yet, except for a handful of psychiatrists, medical men have paid only cursory attention to the problem they have thus inadvertently intensified: How are the fatally ill to be helped to face the end?

Medical scientists cannot even agree on the time when death technically occurs. Is it when breathing stops? Or the heart? Or when brain waves cease? Psychologists and psychiatrists assert that fear of death is universal, but disagree about its true nature. Freud compared it with fears of castration. Others believe that patients fear dying itself less than their own helplessness and uselessness in the process. Some believe the fear of death is the instinctual root of all other fears.

Family Attitude. From his own observations in Colorado General and Colora do Psychopathic hospitals, one thing of which Psychiatrist Richard Vanden Bergh can be sure is that patients are sometimes left terribly alone when the end is near.

"All of us," he told a convention of nurses at the University of Colorado School of Medicine, "have seen the patient who is slowly dying of a chronic, debilitating illness and has been placed in the room farthest from the center of the ward. The doctors drop in briefly during rounds, glance at his chart, and leave almost immediately. The general attitude of the ward is: There's really nothing we can do for him—after all, he's dying anyway.' " This attitude is as appalling to many physicians as it is to just about all ministers of religion. But what is to be clone? The first question that arises is whether to tell a patient that he is dying. "Much depends," says the University of California's Dr. Alexander Simon, "on the attitude of the family and the patient's own attitude. There are some whom I would not tell about imminent death because they would panic." Another U. of C. psychiatrist, Dr. Robert D. Wald, believes that the opposite situation is more common: "The assumption is that people don't want to die. From my experience, I believe that—more often than is generally realized—people reach a point where they are willing to die." To Psychologist Herman Feifel of the University of Southern California, who has edited a book on The Meaning of Death, what the patient is told is less important than how he is told.

Who's Afraid? And what about the role of the family, now that so many more deaths occur in hospitals than at home? Psychiatrist Wald says tartly; "At death scenes, doctors and nurses are frightened of families. They feel accused by the relatives because they are revealed as not being all-powerful. Doctors tend to keep families away to protect their own selfesteem, though perhaps not consciously."