The   Art   of   Dying   Well     
  A contemporary “Artis Bene Moriendi”  
    Introduction

In this section, we’ll look as the experience of dying from the start of the withdrawal and dissolution phase onwards. We’ll do so, not from the perspective of an outside observer – the hospice nurse, the family friend, the minister of religion – but, instead, from your perspective as the person who is “doing the dying”:

    Death: Friend or Fiend?

Wouldn’t it be nice to turn death aside, to suggest when the Grim Reaper comes knocking at your door that he’s got the wrong address, that you’re too busy with life, that the time is not yet right. But, as he will assure you, ever so politely, he never attends the wrong address, your busyness is to him a matter of complete indifference, and the time is fitting, is meet, is condign, is now; as Emily Dickinson recalls in her memorable poem:

*Because I could not stop for Death,
He kindly stopped for me.

Yes, he is always very considerate in that way – as a force of nature he provides the same service for one and all, irrespective of race, creed, or colour.

No, you cannot turn the Grim Reaper away from your door, but you can – as the proverbial tales all tell – strike a bargain of sorts. Instead of making a futile attempt to bar the door, you can invite him in. His demeanour always mirrors the welcome that he receives. Whether he appears in the guise of a menacing lusus natura, a fearsome, imposing fiend, one come to drag you off kicking and screaming to some place of perdition, or, instead, appears in the guise of a courteous guest, as a gracious, benignant friend who guides you on your way to some Elysium is ultimately down to you, and not to him.

So, putting the metaphor aside, you can choose, at least to some extent, the experiences that will unfold as you die; you can, in some measure, choose the style and manner of your departing.

    Religious or Secular – A Neutral Framework

Many religious traditions have manuals on now to die. Perhaps the articles in this section could be said to serve as a contemporary Artis Bene Moriendi (“The Art of Dying Well”, a text composed by a Dominican friar in 1415).

However, I am only too well aware that death is an issue where those with different religious beliefs and those with none often hold – in a fervent, unbending, and trenchant manner – antithetical and divergent views. So, I’ll attempt to ensure that the framework presented here is neutral with regard to religious belief (but, if you do have a religious belief, then you’ll readily find appropriate places within the framework where you can add in material relevant to your own belief system).

Should I fail in this “formidable” endeavour, let me apologise in advance for any offence that may be caused!

    What Is It Like to Die?

We’ll have a look at the different mental states that you might experience during the process of dying.

Dreams of Dissolution

You already have some small-scale experiences of what it’s like to die! You are familiar with the state of mind that you have at present as you read this article, a state of mind that is probably possessed of a reasonable level of lucidity and stability – what we might call the “dream of the day”. You are also familiar with the “dream of the night”, one characterised by a lower level of lucidity and a considerable degree of instability. As dying progresses, the dreams of the day and the dreams of the night merge and become one, leading to a sequence of dreams – dreams of dissolution – that exhibit pronounced variations in both lucidity and stability; for example:

*If the switch in your mind that normally separates the day dream from the night dream stops working in its accustomed manner, you might perceive what could be called an “augmented reality”: perhaps a family member is visiting and you can see her perfectly clearly sitting by the bedside; but equally, you can also see perfectly clearly standing at the foot of the bed your long-dead grandmother; and you can converse with both parties with equal ease (for the youthful amongst you, think of Pokémon Go, but without the screen).

Those of you possessed of a secular bent might classify this experience as a delusion; those of you who have a religious belief might see in this experience a raising of the veil between this life and some other state of existence. However, neither interpretation negates the experience.

Novel Mental States

The reshaping of normal mental functioning during the dissolution phase can generate novel mental states – well beyond anything you may have experienced in the past, even if you have taken psychedelic drugs or have suffered from a mental disorder. These dreams of dissolution can be far more intense than ordinary dreams and can incorporate bizarre sense perceptions and can manifest ecstatic, chimerical states of being – even if you possess a secular view of the world, you might still find yourself experiencing states that bear some resemblance to those found in the spiritual writings of mystics and hermits.

    Will Yours Be a Good Death?

We’ll help you assess whether you’re likely to have a good or a bad death – whether your experiences of dying are likely to tend towards the terrifying or the blissful.

While experiences of dying will vary very much from one individual to another (and will be influenced by the nature of your terminal disease), what you are likely to experience will depend to some considerable extent on how you view death, and on what you believe happens after death. As Prince Hamlet would have us contemplate, “What dreams may come, when we have shuffled off this mortal coil?” Well, that is a question for you alone to answer, not that you will have much say in the matter – for we don’t choose our beliefs; our beliefs choose us:

*Perhaps you belong to that ever dwindling minority who see in death something that is, at worst, benign or, at best, auspicious? If your beliefs surrounding death are heartening and have proved to be faithful friends over the years, then all you have to do is to hold onto them steadfastly (in the memorable words of Polonius, “Those friends thou hast, and their adoption tried, grapple them unto thy soul with hoops of steel.”).

*But if your perspective on death is bleak, if life’s harvest has proved barren, if the Grim Reaper is indeed seen to be “grim”, then you might have to work very hard to glean even a measure of equanimity.

However, irrespective of the category to which you belong, there are a number of practical steps that you can take to improve your experience of dying.

    A “Dry Run” at Dying!

We’ll have a look at how you can “preview” some of the states of mind that you may experience when dying, a sort of “dry run” of dying as it were, so that you will have some idea of what to expect. The focus will be on states of mind that are pleasant – perhaps better than anything you have experienced in life – with the objective of making the prospect of dying less bleak, and possibly, for some, even beguiling.

    Directing the Way You Die

Most importantly, we’ll have a look at the skills you can develop and the techniques you can deploy to exercise some measure of control over the process of dying (the operative word here is “some” – short of decades spent meditating in solitary retreat you’re very unlikely to be able to shield core mental awareness from the “tug of war” occasioned by physical decay).

Dying may well be a somewhat chaotic affair, but, like a flash flood, your mind when dying prefers to flow through well-worn channels, to take the paths of least resistance. We’ll show you how to fashion these channels so that you can choreograph, in part, the ballet of dream appearances and phantasms that may arise to mind.

Changing Expectations

You will enter the withdrawal and dissolution phase with a certain set of expectations, expectations that will fall somewhere between the very negative and the very positive, and to some extent the experiences that follow will be driven by these expectations. So, one sound strategy for improving your experience is, as the song says:

*You’ve got to accentuate the positive
Eliminate the negative
Latch on to the affirmative
Don’t mess with Mister In-Between

In other words, you need to try to shift your expectations in the positive direction:

*Increasing Certainty: If you have a view regarding death that is positive, but the view is not strongly held, then making an effort to strengthen it is a good idea (by, for example, re-engaging with a previously neglected spiritual practice).

*Generating Distraction: If you have a view regarding death that is negative, then you may be able to dissipate its negative impact to some extent by focusing your mind on topics other than yourself and your current “prospects”.

*Increasing Tolerance of Uncertainty: Human beings have a strong aversion to uncertainty, an aversion which stems from a sense of self-concern. If you feel uncertain about what lies ahead, then you may be able to dissipate its negative impact to some extent by focusing on weakening your sense of self-importance (though, as your score on the Narcissistic Personality Inventory is based on what is very much a stable personality trait, doing so is likely to prove difficult).

Modifying Reactions to Dream Events

The course of a particular dream is strongly dictated by how you react to the events that occur within that dream. By changing the way you react to these events, you can influence the course of the dream, and, in particular, you may be able to prevent it from following a negative trajectory, in which negative events generate yet more negative events, events that get steadily more negative as the dream progresses:

*Increasing Lucidity: The pre-eminent characteristic of dreams is the failure to realize that they are, just that, “dreams” – the dream appearances are not real people or real places. By increasing your lucidity, you can make your dreams less immersive, so that dream events are less confusing and dream appearances are less frightening. While it is extremely difficult to consistently achieve complete lucidity, with persistence it may be possible to obtain some measure of depersonalization or derealization (you may still be viewing the “battle”; you may still believe that it is actually taking place; but your discomfort may be closer to the attenuated discomfort that comes from viewing it on a TV screen, rather than the heightened discomfort and sense of existential danger than comes from actually being present on the battlefield).

*Decreasing Attachment and Aversion: Whether perceived as pleasant or unpleasant, your reactions to dream events increase the instability of the dream (and in the case of negative reactions, unpleasant events beget yet more unpleasant events). By using desensitization techniques, it may be possible to decrease your levels of attachment and aversion by repeatedly revisiting the trigger scenarios in your mind (the unfolding dream scenario comes to elicit all the excitement of some tedious TV show, so you just change the “dream” channel, or nod off to the “dream equivalent of sleep”).

Changing Habitual Thought Patterns

Thought, like water, tends to flow along familiar channels, leading to recurring thought patterns and dreams that consist of minor variations on a common theme:

*Creating a Mental Attractor: By focusing repeatedly, hour after hour, on a set of images that generate a powerful, positive emotion, it’s possible to create the mental equivalent of a homing beacon – an emotional anchor, an inner haven, a safe harbour – one to which the mind, when perturbed, naturally returns, of its own accord, again and again. Doing so reduces instability and increases the positive content of dissolution dreams (this combination of an emotional focus and intense repetition is commonly found in religious rituals, so that if you have had a lifelong practice then a mental attractor may already be in place).

Transforming Pain

It’s very hard to avoid varying degrees of physical pain whilst dying, and painkillers often prove only partially effective, or are not administered at appropriate times or in appropriate doses by an overworked, incurious, and indifferent nursing staff (if, as a visitor, you observe nurses behaving badly, then don’t be too quick to judge: when you’re running a production line that takes the living from ambulances at one end and dispatches the dead to a morgue at the other, then a high level of attention to individual needs is not always possible; and both habituation to the job and the need to avoid burnout leads inevitably to a certain emotional distance):

*Creating a Narrative: One approach to reducing the impact of physical pain is to be able to see meaning in that pain, to see it as serving some exalted and meritorious purpose: just as the high adrenalin levels generated during battle can dull the pain of a shattered limb, the intense emotion generated by a meaningful narrative can lead to a copious release of endorphins, natural opiates, within the brain, a release that for some people can completely overwhelm the pain (of course, doing so will be very difficult if you have a secular world view; but, if you have a religious perspective, then you may well be able to create a suitable narrative, one that can be accommodated within your own belief system).

    The Eye of the Hurricane

In the past, you may have been present when someone close to you has been dying, and you may have witnessed the delirium that so often accompanies the dying process. You may well have found the experience very disturbing, even terrifying – a far cry from the customary, though deceptive, portrayal on film, in which following a few sage and insightful words the dying person slips away serenely into that final sleep. But it’s easy to draw the wrong conclusions from this type of experience:

*It’s very important to understand that what others may see and what you may experience can be very different. For example, research shows that family members and other care givers significantly overestimate the distress experienced by patients during episodes of delirium (while doctors and nurses significantly underestimate it) [1].

*Even when the outward signs of delirium are present, that does not mean that the confusion, time and space disorientation, psychomotor agitation, delusions, and hallucinations that are sometimes recalled by a patient when an episode of delirium has passed will be experienced in all cases. Within the eye wall of a hurricane, the wind speed may indeed reach its maximum value, but within the eye itself the wind gives way to a perfect calm. By applying the techniques that direct and guide the process of dying, your centre of awareness may come to dwell within that perfect calm.

    A Light in the Dark

Even if your experience of dying thus far has been intensely distressing and exhausting, that does not mean it will continue to be so: in the process of dying there can be surprises (irrespective of your religious beliefs, or lack of them). Towards the end, even as the darkness continues to gather from without, a light may begin to grow from within; and your experience of dying in those final hours and days may depend on where you choose to rest your gaze:

*For the few, there is a rare and special joy born out of sorrow, a joy that shines with the light of a thousand suns.

    References

[1] Bruera E., Willey J., Paraskevopoulos T., et al., “The impact of delirium recollection (DR) on the level of distress in patients (P) with advanced cancer and their family caregivers (CG)”, Journal of Clinical Oncology, 2008, 26(15S), 9529.