Dr. Raveen Hanwella draws from existential psychotherapy to deal with this reality of life I will again interrupt my discussion on ways of coping with stress to discuss another important topic which became topical for me with the sudden death of a colleague. I was on my way to Kandy to attend our annual scientific [...]

The Sundaytimes Sri Lanka

Death, why does it scare us so


Dr. Raveen Hanwella draws from existential psychotherapy to deal with this reality of life

I will again interrupt my discussion on ways of coping with stress to discuss another important topic which became topical for me with the sudden death of a colleague.
I was on my way to Kandy to attend our annual scientific sessions when during a stopover at Ambepussa I got a call from a friend. He informed me that Dr. D.V.J. Harischandra had passed away that morning just as he was due to appear on a television programme. I was deeply saddened and shocked by the news. I had known Dr. Harischandra (DVJ) for the past two decades, initially as one of my teachers, later as an examiner, and finally as a colleague and friend. He was known among the medical profession for his wonderful and at times mischievous sense of humour. Whenever DVJ was in a gathering, be it at a scientific conference, or the airport waiting for a flight, he kept us in fits of laughter with his stories and anecdotes. So it was with some sense of despondency that I resumed my journey.

Perhaps ironically my topic at the conference was on the very subject of death and was titled, ‘Coping with the Fear of Death: lessons from Existential Psychotherapy’. I thought I would share with you some insights I gained while preparing for my lecture.

Existential psychotherapy is a form of therapy pioneered by the Emeritus Professor of Psychiatry, University of Stanford, Irwin Yalom. Yalom does not claim that his insights are unique but he is perhaps the first to have used the philosophical insights on existentialism to develop a practical and coherent form of therapy. What was the reason for my despondency on that beautiful Friday morning on my way to Kandy? Was it only due to sadness for my friend or was there a deeper anxiety? Was I thinking that I too (and my loved ones) am mortal and would one day die?

Yalom says that there are four fundamental ‘givens’ of existence that human beings worry about either consciously or unconsciously. They are death, freedom, aloneness and meaninglessness. I will briefly discuss the latter three fears and come back to the most important fear -death.

You may think it rather odd that freedom should be a cause for anxiety. We normally view freedom as a positive concept but in the existential sense freedom means a lack of structure and design. It is a sense that you are entirely responsible for your destiny and that beneath us there is no ‘ground’ but a bottomless abyss. Indeed a rather terrifying thought.

The other given of existentialism is aloneness. This is perhaps a bit easier to understand. We may have many friends and relatives and loved ones but when we come into this world and finally have to face illness and death we do so utterly alone.

The third existential reality is meaninglessness. The Universe we know is a large place. Earth is just an insignificant planet in this vast cosmos. An individual human being is even more insignificant and what he or she does has little or no impact on an indifferent Universe. Therefore humans strive each in their own way to give meaning to their lives. So, freedom, isolation and lack of meaning are all important existential realities that make human beings depressed and anxious. However the greatest and the most anxiety provoking of all givens is death.

Death is the most obvious and most easily comprehended ultimate concern. We are here one day and are gone tomorrow and there is no escape from it. Great thinkers down the ages, usually in the latter half of their lives, have written about it. If you think carefully death does not simply follow life. In biology, the boundary between life and death is precise and finite but psychologically life and death blend into one another. As Montaigne said in his famous essay on death, “Why do you fear your last day? It contributes no more to your death than each of the others. The last step does not cause the fatigue, but reveals it”.

Death and life co- exist intermingled with one another and are interdependent. If we were to confront this fact, rather than causing great anxiety, can it give us freedom from the fear of death? This is what existential psychotherapy aims to do.

Martin Heidegger, a German philosopher, was a pioneer of existential philosophy. He believed that there were two fundamental modes of existence in the world. They were: a state of forgetfulness of being and a state of mindfulness of being. Most of us spend the greater part of our time in the first state. We immerse ourselves in the day-to-day routine of life and worry about the way things are. When we enter the second mode of existence, the state of mindfulness of being, we marvel not at the way things are but that they are. For example we may at times become annoyed at the behaviour of someone we love, the way things are, but in the state of mindfulness we would simply be glad that they are there and be happy in their mere presence. Unfortunately it is not easy to move from a state of forgetfulness to a state of mindfulness. There are certain urgent experiences that jolt us and shift our mode. One such important experience is having to face death.

Yalom has worked for many years in group therapy with patients terminally ill with cancer. Almost all his patients reported startling shifts in their view of life. These shifts are so important that I will write them in full as given by Yalom. These patients reported a sense of liberation, a re-arrangement of life’s priorities and a trivialising of the trivial. They had an enhanced sense of living in the immediate present rather than in the past and postponing life until retirement. They had a vivid appreciation of the simple things of life. They started communicating at a deeper level with loved ones and finally had fewer interpersonal fears with less concern about rejection and a greater willingness to take risks. Their only regret was that they had to wait till they were diagnosed with a terminal illness to make these changes.

I will end with a story told by a student of DVJ, Dr. Harshini Rajapakse, now a consultant psychiatrist and senior lecturer in the University of Ruhuna. My friend DVJ was 75 years old when he died. When he was 65 years and having retired from the University he went to the local undertaker and inquired as to whether he could pay in advance for a funeral. The owner said he would be glad to oblige and asked him for whom the funeral was. DVJ smilingly told him it was for himself. “I am 65 years old and I have just retired, it has been a good and happy life and everything else that comes after is a bonus”! Truly he was man who had attained existential awareness and was not afraid of death but lived his life to the full in a state of mindfulness. We should all take an example from him. May this Sunday be a great day and all the days that follow for all you readers.

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