Lord Byron on his death-bed. Credit: Wikimedia. Public Domain.
"Emergency first aid in the Middle Ages: from amputations to enemas."
Finding myself with an hour to spare before an unsurprisingly poorly-attended lecture in St Giles’ Church in Norwich, I wandered around the cloisters of the nearby cathedral during choral evensong and was drawn to a full-size skeleton etched on a wall. Beside it was a plaque with an inscription commemorating Thomas Gooding who died 400 years ago:
“All that do this place pass bye
remember death for you must dye
As you are now even so was I
And as I am so shall you be.”
In the course of my work as a psychologist I once met another man named Tom who believed he was dead, so I suppose the inscription wouldn't apply to him. Tom couldn't provide a rational explanation for why he thought he didn't exist, and no amount of logical argument, physical evidence or medication could persuade him otherwise. He had worked in the British civil service for over two decades and was in his early forties when all things came to an end—including, as he saw it, his own life—though he couldn’t recollect precisely when he died, how, or what it was that killed him.
Somewhere in this pile of years he vaguely awoke to the fact of his death and to the strangeness of things around him: people seemed unfamiliar, objects unreal, and the world colourless. He became depressed and reclusive, and with nothing but the clothes on his back began to wander into the wilderness as might a ghost. He increasingly referred to others as ghosts too, abandoning his family, home and possessions. Following a suicide attempt that left him with a scar around his neck—sewn up with a large sackcloth needle, judging by the necklace of puncture marks—Tom found himself in psychiatric care.
Mounting despair led to two further suicide attempts within the first two years of his hospitalisation, one that mangled the tendons in his right arm and left him without the use of three of his fingers. But whilst there was some measured success through medication with regard to his suicidal tendencies, his delusory thoughts proved largely unresponsive to anti-psychotic drugs or electroconvulsive therapy, and he was subsequently shunted into a long-term locked ward. Having no regard for his life (why would he?) and given the way of his thoughts, he spent his earthly occupancy within the confines of this forbidding place.
It was difficult to imagine his suffering. He was convinced but confused, and almost constantly in deep despair. Facts and rational argument merely placed him in a painful effort of thought, if not severe stress. When agitated he hunched up and shut down, pressing his wrists to his ears. In time, tolerance, though not quite acceptance, emerged as a working arrangement, and as a result his days passed a little more peacefully.
I played chess with him in those quiet times, and Tom often triumphed. During our games I stole glances, watched him studying the pieces on the board, saw his eyes in fixed concentration and his mind several moves ahead, and sensed the relief he felt to be involved in this small theatre of schemes and strategies as though returned on a temporary pass from the place of the dead—pulled away for a while from his experience of emptiness.
Tom belonged to what I saw as a rare, almost mythical species poised on the brink of existence—a view that was shared by some of his fellow inmates. He gave the distinct impression of knowing something the rest of us didn't or couldn't know, and there seemed no way through the language barrier. Left alone, he would spend his days almost trancelike walking the length of the ward, his lips moving as though speaking in prayer, with a lost tribe of other residents shuffling along behind him.
Perhaps they saw in him a ray of hope, though he didn't seem to notice them. Each time he reached the end of this well-worn linoleum-covered road, he calmly repeated the futile exercise of trying the door to the outer corridors and grounds. I had no doubt he would just as calmly and determinedly walk over a cliff, and perhaps his disciples would follow him.
In retrospect, it seems to me that Tom’s symptoms fit ‘Cotard’s Syndrome:’ an unusual condition popularly but erroneously described as a zombie-like state in which the sufferer believes that their vital organs are missing or that they themselves are dead. Whilst such a diagnosis might have drawn more attention to his case, however, it would have made little difference to his treatment.
We played chess during what turned out to be our final meeting, one of the few games where he found himself repeatedly put in check, and whilst I would like to think my skills were improving I fear my win was simply a consequence of his deteriorating interest in this, his last refuge. Not without some irony, following a fatal move he broke the prolonged silence: ‘I am now in a place where I’m as good as dead.’ I pretended to interpret this comment as a reference to the game rather than to the world of the ward. ‘Never say die,’ I told him as I moved my knight into position, knowing full well the game was over.
Does Tom’s story have any relevance for the rest of us? It seems to me that in the midst of life we are also in death, though not always as we might expect. The writer Vladimir Nabokov described the existence of Ivan Ilyich, the career-minded character in Tolstoy’s immortal novella, as a ‘living death’—an awareness that grew as his last day drew closer. There’s a parallel train of thought in the philosophy of Andre Gorz, who was keen to stress that the experience of life under capitalism was for many people a kind of social death, a view that may have its source in the existence depicted by Tolstoy of a life spent in pursuit of ultimately meaningless things. For Gorz, Tom’s life would just be the lives of others taken to extremes.
Ever fearful of a Gorzian existence I’ve sometimes wondered if the hour will come when I look back with regret on time spent deciphering self-assembly instructions for Ikea flat-packed furniture, fixing computer glitches, and working into the evenings and weekends following the stillborn language of audit trails, baselines and performance indicators—preparing to meet demanding deadlines dressed up as urgencies that were in the end irrelevant. Is it possible to avoid this fate?
One way is to prepare more actively for death by becoming more conscious of what makes life worth living. I’ve often wondered what, if any, outpourings of memory might rush by in the final moments of life. In an effort to address this question I set myself a three-minute exercise of meditating on death, allowing the final thoughts, life highlights, experiences and regrets to float freely to the surface in a mesmeric dream journey where the subconscious was given free rein to come through. Time-jumbled memories tumbled out, each triggering another. It’s an exercise I now do regularly. Simply putting myself in the position of considering what I might recall if I was just about to die brings me rushing back to planet earth, gulping for air. Beautiful earth, beautiful skies, and well worth actively preserving.
There’s no shortage of studies on death. Thanatology is constantly expanding. Several UK universities offer a Masters degree in Death Studies. There’s a Death Studies journal and an increasing number of books on the subject—notably Timothy Secret’s ‘The Politics and Pedagogy of Mourning’ and Judith Butler’s ‘A Precarious Life.’ Transformation ran a whole series of articles on the social context of death in 2016. This literature poses some fundamental questions: What counts as grief in life? Who counts as human? Whose lives count as lives and what makes life worth living?
Against the backdrop of inequality and suffering, but also of solidarity and a meaningful life, these authors question the motives behind extravagant ceremonies of solemn commemoration, noting that in death, as in life, the existence of some people is acknowledged whilst that of others is routinely ignored. From the point of view of moral and political philosophy, what we think of death and how we value the dead are inextricably bound up with how we value life and the living.
A growing body of evidence suggests that simply thinking about death can play a pivotal role in rebooting our self-awareness and the motivation to achieve the highest level of human-beingness that’s possible—a process described by humanistic psychologist Carl Rogers as inherently pro-social. Several studies such as Kenneth Vail’s ‘When Death is Good for Life’ support this healthy lifestyle choice. Vail found that people were more likely to be kinder to themselves and more helpful to others following an increased awareness of their own mortality, and that both close relationships and wider social bonds were intensified as a result.
The stoic and former Roman slave Epictetus counseled thus: ‘Let death be daily before our eyes.’ This approach to the good life isn’t popular in today’s death-wary Western cultures. Most people don't want to be reminded of the 400 year-old words of Thomas Gooding etched in the walls of Norwich Cathedral. In fact most don't want to talk about death at all, and those who do are urged to ‘get a life.’ Yet far from ‘raging against the dying of the light,’ deep reflective thought about death, rather than its disavowal, can bring us closer to self-compassion and concern for the well-being of others. It’s perhaps the best two-for-one offer most of us will ever get.