Yet it is dreadful to recognize that we all die, and that death can come at any moment. Human beings are unique amongst living creatures in that we are “aware of our existence”- we can objectively contemplate ourselves! Almost 200 years ago, Kierkegaard (1983) postulated that as a result of this we experience two emotions: “Awe” and “Dread”. A peace that can come from what Frankl (1959) called the main task of dying, which is to relieve our Existential Guilt.Īwareness of our Existence: A Cause of Fear of Death and Existential Guilt Existential or even spiritual wisdom that allows us face death with a sense of peace. The question is whether we can blunt it with medications, or overcome it with wisdom and attitudes we adopt with the aid of our very large forebrains. So as human animals we will always have this “fear” response. What is biologically produced in the face of the threat of death is a rush of adrenaline induced intense fear. So in the face of danger and the threat of mortal harm or death, our nervous system goes off like an alarm and floods our bodies with catecholamines that force us to “flee or fight”. We human beings are human animals, with a biology that is hard wired to fulfill our primary existential obligation: survival in order to procreate. I believe I have learned much, but wanted to concentrate on one aspect of dealing with the fear of death, and that is the need to first deal with “Existential Guilt,” To explore Existential Guilt as a way to accept the life that one has lived, thus allowing one to face death with some sense of peace and equanimity. The question is have I succeeded have I learned anything that could be of use to me or others who face death.
#No guilt in life no fear in death plus
I have been on a quest of 30 plus years to find a way to not fear death. Like all acts of “Care” my mission was to aid others, but also to aid myself. The “who” that I was becoming in the world was someone who could have an impact on existential suffering and in particular fear of death. I needed to place myself at that “nexus” between life and death, and dwell there and learn all I could from my fellow human beings (who we call patients) through conversation, observation and ultimately research. I needed to understand how a human being could continue to live with the knowledge of their death being very real and even proximate.
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The question was always “what tragedy has befallen us? Who died?” So it was not merely my passion for science and medicine, or my deep desire to understand the human psyche, or use my intellect in the service of others, it was something more basic and existentially oriented. When the telephone rang after midnight in my childhood home it caused panic. I not only learned that death was real, I learned that it could happen to “us” and that it could come at any moment, irrationally, violently, senselessly. Stories of death, loss and suffering filled my home. Having grown up as a child of Holocaust survivors, I was constantly exposed to and aware of the reality of death. The exact circumstances, events, family legacies and other influences may be relatively diverse and unique, but ultimately it is a desire, a drive, a need to understand “how does a human being live a finite mortal life?” How is it possible to live, and retain that will to live, knowing that this is all finite, temporary? How does a human being live with the knowledge of death-in the face of death?” And ultimately “how can one live such a life without being overcome, panicked, paralyzed, or overwhelmed with the meaningless of life, by the fear of death?” I believe that many of us have come to palliative care to find some of these very same answers.
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If I truly take a moment and contemplate about what brought me to work as a psychiatrist caring for patients with advanced cancer, I’d likely come to a realization that I believe is shared by many of my colleagues in psycho-oncology and palliative care.