Death de-mortified

11 June 2018

There is one statement that I can make with absolute certainty – we’re all going to die. Indeed our individual deaths will be as unique as our individual lives, but ultimately death is the final phase of life. Said in another way, all roads lead ultimately to the grave.

Of late there has been a noticeable increase in suicides around the globe. I am told that there are even choice venues for committing suicide. So much so that the paths leading to the cliff edges are covered with signage advising the potential suicidal where to seek help to avoid the final act. This state of affairs has driven me back to re-read the research on the subject of suicide and death in general. I had had the need to try and understand suicide as an entity apart from accidental or illness-based death. But after reading everything I could lay my hands on, I came to the conclusion that suicide is no different from the other causes of death when seen in the broadest context.

Let me take you, the reader (presumably you’ve stomached the concept and the discussion so far) to the work of a great man, my inspiration in much of my work, Viktor Frankl. Prior to being interned in a Nazi concentration camp, Frankl occupied the seats of neurology and psychiatry in Vienna. What is not well known is that Frankl created a unit for the intervention of depression among students as well as suicide prevention. During Frankl’s tenure, suicide rates were the lowest that they had ever been at the university.

This remarkable human being found himself a victim of the murderous Nazi regime and was transported to a concentration camp in the middle of his tenure. But such was the nature of the man that he continued to observe, learn and intervene where he could in the midst of hell itself. Frankl perceived that pivotal to life was meaning and purpose. This was to become the cornerstone of Logotherapy. Since Frankl was living with the individuals that he was studying and wherever he could, doctoring, he was uniquely placed to identify clear trends and their consequences. Emerging therefore from his observations, Frankl noted that those who lost meaning and purpose and defaulted into despair (which I termed hopeless-helpless in my studies) succumbed in one or other identifiable way: Either they weakened, lost the will to engage and work and were exterminated or they weakened and developed a fatal infection. Without knowing it at the time, Frankl had recognized what was to become psychoneuro-immunology (PNI) – the influence of mind states on immunity. If immunity is impaired we become vulnerable to both infection and tumor formation as well as tumor metastasis.

This is a profound observation. Many studies later we have come to recognize that the mind state of hopeless-helpless not only impairs immunity but creates states of chronic inflammation. Chronic inflammation has been shown to underpin the development of heart disease, Alzheimer’s disease and many forms of cancer, amongst other conditions. But as elucidated by Frankl, this despair or hopeless-helpless is a mind state akin to throwing in the towel – a terminal state emerging out of the total absence of meaning and purpose.

Let’s review this mind state of hopeless-helpless in more detail. The ‘hopeless’ component refers to a subjective perception that life is devoid of meaning. The afflicted individual sees no purpose to continued engagement. They derive no gratification nor fulfillment from their engagement with life. They see no value to themselves or to others close to them, from the engagement. The ‘helpless’ component denotes a subjective belief that their situation is unchangeable – an entrapment situation with no way out.

In this way the afflicted individual gets sucked into the vortex of the increasing darkness of a terminal existential life crisis. The vortex derives its energy from the increasing hopeless-helplessness which subjectively blocks out more potential light. This mind state either gives rise to immune suppression or severe chronic inflammation, both of which will lead to a potential terminal event, or they end their own life and thus the suffering.

I would propose therefore that suicide reflects the malignant mind state of a terminal existential crisis. It differs from death by other causes only in its mode. The intervention therefore is no different for the potential suicide as it is for those that I counsel in regard to diagnosed illnesses associated with a malignant mind state.

The intervention for this mind state can be summarized in the form of three questions:

1. Why are you ending your life? Answer: Because I see no further meaning or purpose in my life

2. Are you confident that you have looked at all possibilities in the search for meaning and purpose? Answer: Yes/no - If ‘no’, then here is a potential access point for coaching intervention

3. Are you prepared to re-look at your life through new eyes? Answer: Yes/no - If ‘yes’, then here’s another potential access point for coaching intervention

In life we are all going to go through mini-existential crises. That’s inevitable. Some will have the intrinsic wherewithal to reason their way out of the vortex and transcend; some may experience repeated vortices through no fault of theirs – the potential for transcendence is after all part and parcel of who we subjectively are; and then of course there are those where either the summation of vortices or the emergence of one overpowering vortex moves them into the terminal malignant mind state.

When all is said and done, we each have our ‘sell by date’ and ‘expiry date’. It is built into the nature-nurture product. It shall arise at the appropriate time, with or without intervention, for it is a product of all that we are. But we have also been imbibed with life-enhancing functions in various proportions – sensory gratification, reward gratification, curiosity, sensitivity and the faculty of reason. The art of living is therefore to apply and exercise our life-enhancing functions so that meaning, purpose and gratification are sustained. I would suggest that we live life in the present with an eye on the last feeling that we’ll have before the lights go out permanently, knowing that if the last feeling is not a good one, there will be very little we can do at that point to change it.

Vortices shall inevitably arise and they will ask of us to answer the three questions. By definition, if we recognize the pathways to new light, the vortex shall be no more. But if we arrive at the terminal darkness of the final vortex, we are asked to accept it with fortitude and respect as we succumb. Day is done, the subjectivity of a life lived is celebrated as the final curtain falls.


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