A lesson for health worriers.
One customarily speaks of life being precious – equally precious to everyone; but it is not so.
Taking the life of another human being is considered everywhere to be a heinous crime; but the punishment for infanticide in many countries is less than that for the murder of an adult. The implication is that the child’s life is worth less than that of an adult. Many would object vehemently to such an idea. It is not that way, or, at least, ought not to be that way, they assert. They understand that in times past people were killed just because they were mentally retarded. Deformed children were abandoned on a hillside to die. In some cultures the very old or very sick were left to starve to death, as if their lives were less valuable than that of the young and healthy. But these were barbarian practices contrary to every ethical principle and every religious belief – at least every current religious belief.
Some people go further and believe the sanctity of life begins with conception. Here there is no consensus. Others think life really begins with the implantation of the embryo in the uterus since very many embryos never implant. Certain religious practices suggest life begins at quickening, around the fifth month of pregnancy, when the fetus can be felt to move. Other people, of course, consider life to begin at birth.
Similarly, there are some who consider all life to be sacred and should never be purposely ended, even when an individual has been unconscious for years, or in intractable pain, and even when that individual has expressed the wish to die. Others think it is ethical to hasten such an individual’s death. These beliefs are controversial now. Even in situations where it might seem obvious to one person that life is no longer worth living, there are others who will disagree. Many people mourn terribly the loss of an abnormal pregnancy, when others would not. Some would mourn similarly over the death of an aged parent who had faded away years before because of Alzheimer’s disease. Particular deaths may be very painful. On the other hand, how often do people say: “It is good that mom (or dad) died now without suffering longer?” They judge their parent’s life to have lost its value.
The right to life, however it may be defined, is and ought to be explicit in our constitution and in the laws of every civilized society.
Nevertheless, however equal everyone may be under the law, society makes the uncomfortable judgment that some lives are worth more than others. Men in the secret service are trained to sacrifice themselves, if necessary, to save the life of the President. The effects of a presidential assassination are so dire that most people see this as appropriate. Policemen and firemen, and soldiers too, routinely risk their lives to save others; and there are times when they knowingly give up their lives to do so.
Ordinary people make similar sacrifices. The fact is that people’s lives are valued differently in our culture depending on a number of circumstances. Similarly, the value someone places on his or her own life changes over time in a way consistent with these societal views. Almost always, elderly parents would sacrifice their lives for their children, and some have done so. Those adult children might very well sacrifice their lives for their own children, but not for their parents. The death of a young parent is more tragic than the death of an old man or an infant. Drawn in such stark terms, a person’s life may be said to be more valuable at certain stages of life than at others.
In the health anxiety clinics we have run, the greater number of our patients have been young. Very few were old. Men and women who are old worry less about developing a fatal illness because their lives are worth less to them! They do not ordinarily speak in such terms; but, if asked, they would agree that that is so. I know because I have asked them.
Three overlapping factors determine just how valuable someone’s life is, particularly the life of an older person:
- How much longer that person might reasonably be expected to live. A 70 year old man told that his cancer might return 10 years later worried very little because he thought he might not live another 10 years in any case. When he was 30 he had worried much more over medical problems that were much less severe.
- How much responsibility that person may have. A health worrier who worries about dying primarily because she thinks her orphaned children could not manage without her has no reason to worry any longer if her children are now adults with children of their own. In general, the arc of responsibility is highest at a time of first becoming a parent. The death through accident or violence of such a person is especially poignant because the role he or she plays is so important. On the other hand, someone who is elderly and who no longer works, or is unable to work, counts himself, or herself, as less important. And society in general agrees. Yet it is this shrinking responsibility that frees older people to do other things and accounts in part for their being happy. The possibility of dying calls up fewer concerns for the aged because what they do is less critical.
- How good or how bad is the quality of that person’s life? Life is precious to someone who is enjoying it. At the other extreme are those who are disabled or in intractable pain. As in the case of those who are clinically depressed, someone can feel so miserable and so hopeless that life takes on a negative value, and suicide seems preferable to continued struggle. The tragedy of suicide is that only a few weeks after taking medicine the perspective of the depressed person can change radically.
As time goes on, though, and old people become very old and are often lonely and unhappy in myriad other ways, they speak of it being “time to go.” Usually they confront their impending death without bitterness and with equanimity. Thinking back on their lives, as they often do, they are content. Dying is less awful for the aged because there is less satisfaction in living.
And then, in the end, everyone does die. The meaning of life – the purpose of life – cannot be sought in permanent things. People do not last. The things they accomplish in life do not last forever. Over the span of hundreds of years everyone is forgotten. People cannot be committed simply to living as long as possible. The meaning of life has to be found in the things people do every day. Life may be a struggle, but plainly most people enjoy it. Most people are happy most of the time. Besides the ordinary physical pleasures familiar to everyone – walking about on a pleasant day, listening to music, looking at a painting, dancing – there are those activities that tie us to other people. Human beings are social animals. What matters most are family, friends, and the larger human community, of which we are a part. Therein lies most of life’s pleasures. The extraordinary grip of our ties to other people cannot be explained except to say that it is inherent in the kind of creature we are. The day we make someone else laugh, or help someone up who has fallen, or teach something to somebody, is a good day. A day spent worrying over some imaginary danger, such as the fear of an obscure, but deadly disease, is a wasted day. Too many wasted days can spoil life altogether. Most people do not worry about dying because death seems remote. But there are many people who do not seem troubled even in the face of imminent death.
A famous example is Socrates, whose last thoughts before dying were not of escaping a death sentence, which he could have done, but of repaying a small debt which he owed. He was calm and scolded his friends who had gathered around for not being calm also.
The term “gallows humor” refers to the very real phenomenon of the condemned making jokes just before a noose is slipped around their neck. Many people die without warning and without having to think about the process of dying, but those who die slowly over a period of time usually enter a stage of acceptance where they are not worried about dying. They worry instead about the effect of their illness and death on their families or about some unfinished and important work. They are more the rule than the exception. What allows these people to face death with equanimity? Is there a lesson here for health worriers?
These thoughts are a recommendation to health worriers and for that matter, to others who are caught up day after day with particular concerns, whether it is making money, or climbing up a corporate ladder, or driving one’s children to do a little better academically than their neighbor’s children, to step back for a moment and consider what is really important. Not uncommonly, those who have suffered a heart attack say it was the best thing that ever happened to them. Instead of being driven by what seems now to be a pointless struggle to do something that turned out not to be doable at all, they had the chance to rethink their lives and reorder their priorities.
Health worriers, in particular, can lose themselves with unceasing attempts to ward off disease, They have to find time to stop for a little while to think about a larger purpose. It should not be necessary to grow old to grow wise.
Those people who are not concerned about dying have not stopped caring about everything; they care very much about some things, more than life itself. Socrates thought of himself as an honest man, willing to speak the truth whatever the consequences and unafraid of the disapproval of others. If he were to have run away, he would have given up something more important to him that his life; he would have been untrue to the person he had always striven to be. Those who laugh at their executioners are making a statement; "you can kill me, but you cannot make me cower.". In laughing, they achieve a kind of victory over death.
Many ordinary people are determined to maintain their dignity in the face of death. They know they would be upsetting their family and friends, and embarrassing themselves, were they to slide into hysterics or shake their fist at God. But the truth is they do not feel hysterical. Most people relax when they know once and for all what will happen to them. They are not inclined to rail against the absurdities of life-that nothing we struggle to do lasts– that life itself does not last. Like all animals, we have built in the wish to survive, but unlike other animals, we know we cannot. With the end of struggle in view there is acceptance and peace. Usually.
This, then, is the lesson to learn. A medical crisis, like any crisis, allows for change. It is a time to stand back from the ordinary preoccupations of life that take up so much time and energy and decide what really matters. Every person has an idea of himself, or herself, that is worth living up to, or sometimes, dying for. “I am worthwhile” each person must be able to say, “because I do these particular things that are worthwhile. I have accomplished this much in my work. I have had a good effect on people. They can count on me to help them and care about them. I am a good parent. I always try my best. I am reliable. I have tried to protect myself and the people I care for. I have made a difference in the lives of other people. I stand for this. I am committed. This is who I am. Whatever happens to me tomorrow, even if I should get sick and die, these things still count. Whether I live or die matters less because these other things matter more.”
No one can be indifferent to the prospect of dying. The pain of dying is shared by anyone close to the dying person and for that reason alone cannot be dismissed by any trick of the mind. But it is possible for someone who is relatively young and vigorous to do what someone who is close to death usually does, that is, to take stock. Illness, even serious illness, occurs from time to time. It is part of the human condition. The rest of life must not be given over to lamenting this fact. If health worriers can find meaning in who they are and in what they do, it is possible with that new perspective to live sensibly and joyfully. (Excerpted from “Worried Sick? The Exaggerated Fear of Physical Illness.”) © Fredric Neuman Follow Dr. Neuman's blog at fredricneumanmd.com/blog