Showing posts with label Authors. Show all posts
Showing posts with label Authors. Show all posts

Monday, March 29, 2010

Ed Gungor: On Death and Dying

PHYSICAL SIGNS OF A FAILING BODY

The Death and Dying Process

A Last Resort


I wish there were a place for gracious dying
A high place with a distant view
Where we could gather for a celebration
Of life and death and friendships, old and new.

I’d like a place where there would be good music
Good food and wine—and laughter, games and fun,
And quiet talk with friends, and good discussion
Of what will happen when this life is done…

-Helen Ansley At Age Ninety


When it comes right down to it, if we’re honest and willing to go there, most of us are at least a bit curious about the manner in which we will die. Many of us would even prefer to know specific details of our final moments. And, if we are caregivers for a terminally ill loved one, the more we know, the more equipped we feel to face each uncertain day. Because we have no role models to walk with us along death’s journey, no end-of-life midwife who has personally labored through the dying process, answers can be hard to come by. Many answers are simply beyond our grasp.

“Death,” it has been said, “belongs to the dying and to those who love them.” Just as in the birth of a new baby, the moment of death is such a beautifully intense event, that if an observer were to quiet himself long enough to listen to the unseen presence in the room, he would gain a glimpse into a grand celebration. The one who has died is the guest of honor and a great cloud of witnesses is the cheering section. Such thoughts are comforting, but they won’t wipe away every tear. Saying goodbye to someone we cherish is never easy.

Nurse practitioner Joan Furman who has devoted her entire career to providing care for the dying, as a young nurse had a near death experience. While in the hospital suffering with severe laryngitis, she was exposed to a lethal gas that caused her severely irritated throat to swell and her voicebox to close. She remembers feeling terrified, gasping for air, and then suddenly watching her own resuscitation efforts from the corner of the ceiling. Here’s how she describes the moment:

"My limp, unconscious body was on a hospital bed facing me, with two doctors and a nurse on my right side…I felt so at peace, so surrounded with love and safety that I had no desire to return to my body. In fact, I had a detached curiosity about it all. I liked it there at the corner of the ceiling…I understood with all of my being, not just intellectually, that I am more than my body. My body was a vehicle, and I had literally left. Being out of it produced less sentiment than trading in an old car."

Reentering her body, Joan felt tremendous fear, desperation for air, and wondered why it had to happen…why she had to go back. She soon thereafter recovered fully and chose to dismiss her experience as a hypoxic hallucination. It was only after similar stories began to emerge in medical journals that she allowed herself to trust what really happened. Now, absolutely convinced that life continues after the death of the body, Joan shares her story in hopes of easing the fears of her dying patients. She describes the process of death as a journey toward complete wholeness and permanent healing, something that we need not fear. Although for many, this is not the case.

American surgeon, author of How We Die, and professor of bioethics and medicine at Yale University School of Medicine, Sherwin Nuland, believes that our uniqueness in life extends to the way we die. As a physician, Nuland has witnessed countless deaths, each one happening in a distinct way. Some die suddenly and unexpectedly. Some die after a prolonged battle with a disease. Others, although it is technically unacceptable to label as such, simply die from old age. “Every one of death’s diverse appearances is as distinctive as that singular face we each show the world during the days of life.” Even in death, people hold true to their personalities. It is highly probable, therefore, that we will deal with our own dying just as we have handled all other challenges in life.

When we become familiar with the wide range of diseases and the innumerable outcomes of their ways, perhaps the dying progression will become less frightening and the decision-making process less “charged with half-knowledge, anxiety, and unjustified expectations.” Although we do not know the exact details of when and in what way death will occur, we have gained sufficient wisdom through observation to state with assurance that no one need enter his final moments with fear and pain . We do recognize the physical signs of impending death, but only God knows the specifics.

How Do We Die?

If we were to categorize death, the most simplistic way of doing it would be to say there are two kinds of death—a fast death or a slow death. Having a fatal accident or heart attack would result in a fast death when one is alive, then the next minute has died. A slow death happens after a prolonged battle with a terminal illness, or as a result of old age. Thomas Jefferson, at the age of seventy-one, wrote a letter to

John Adam who was seventy-eight at the time. The letter said, “But our machines have now been running seventy or eighty years, and we must expect that, worn as they are, here a pivot, there a wheel, now a pinion, next a spring, will be giving way; and however we may tinker them up for a while, all will at length surcease motion.”

There is not one system of the body that is immune to the aging process. Even cells with the capacity to rejuvenate gradually and eventually shut down. Medical advancements are tremendous, but many in the health care community, as Nuland says, “simply miss the point.” Scientists cannot eradicate the dying process; they can only prolong the inevitable.

In centuries past, people were accustomed to death because it visited them often. The general attitude was one of acceptance and ars moriendi or belief in the “art of dying.” During those days when symptoms appeared, the only choice was to simply let dying take it’s course and to do it in the best way possible—at peace with God. Physicians were ones who practiced the art of medicine, using their skills and knowledge to guide patients with dignity to their final breaths. Today, physicians in their rescue saving efforts have, by and large, lost touch with their limitations as mortals.

The philosophy of hospice care is different. Hospice workers emphasize dignity and do what they are able to alleviate pain, offering terminally ill patients the opportunity to live their final days to the fullest. Culturally, westerners are reluctant to talk openly about death, and are certainly reticent to accept a terminal report. It is a very uncomfortable subject because something in us wants to maintain control of our destiny. We value youth, beauty, competition and individuality. Death to us represents physical weakness, loss of power and uncertainty...none of which we appreciate. Our cultural bias interprets death as a failure.

Other more traditional cultures, however, treat death as an extension of living, bearing testimony of a well-lived life and as an opportunity to begin again. The dying are given space to resolve conflicts, to celebrate, to prepare for their final journey, and to acknowledge that their life had great meaning. Fortunately, hospice care has done a tremendous job in reshaping our ideas of the dying process and how one navigates it well. It is indeed possible to die well, if we so choose.

Barbara Karnes, an award-winning hospice nurse and end-of-life educator, is considered a hospice trailblazer in America. Having walked through the dying process with countless patients and even alongside her own parents, Barbara’s observations are now considered an authority when it comes to caring for terminally ill loved ones. Barbara teaches that dying a gradual death, whether from old age or from disease, is very similar to infant development. It happens gradually and with fairly predictable markers. Time plays an important role—death from old age usually takes longer than death from disease—but ultimately, the outward physical signs of the dying process are the same. A person dying of a disease may display such signs for months; whereas, a person dying of old age may display signs for years.

The Signs

With a terminal disease or old age, significant physical changes begin to develop one to three months prior to death. Such changes are often reflected by food intake, increased sleep and decreased social interaction. These three areas are fairly reliable indicators of the amount of time a person left.

The true reason we ingest food and water is to live. If our body is dying, it will have less and less need of either, so it naturally refuses both. One to three months prior to death, the body will begin weaning itself from food by rejecting proteins such as beef, chicken and fish. Next to go are fruits and vegetables. Eventually, the only kinds of food a dying person wants to eat are ice cream, puddings and cream soups. At the end, food will be rejected entirely. Upon entering this phase, death is only weeks away.

The final element to go is fluids. At this point, no bodily system is functioning as it should and is in the process of permanently shutting down. Many assume that dehydration is painful and causes significant suffering. This is a myth. When a person becomes dehydrated, calcium levels in the blood naturally rise. When calcium becomes too high, a person will simply close his eyes to sleep and not wake up. Most people, if given a choice, would prefer to die in their sleep. Excessive calcium in the blood allows that to happen. It is a God-given anesthetic that brings comfort to the dying and enables the process to occur painlessly.

Food and water connect us to the earth. By letting them go, the body is preparing to die. It no longer wants nourishment, hydration or the energy they provide. Naturally, it is very difficult to watch a loved one die of disease but to see him waste away from starvation or dehydration feels completely unacceptable. However, force-feeding and/or hydrating actually cause the dying process to become more complicated. The best response, no matter how emotionally difficult, is to simply let it happen. It is better for your loved one.

Increased sleep is a second indicator as to where a person is in the dying process. It begins with the addition of an afternoon nap and soon progresses to both an afternoon and morning nap. Then, the dying person naps in the morning, afternoon, evening and all through the night. Eventually he is asleep more than awake and becomes non-responsive. Because he is sleeping around the clock, it is very easy for him to become confused and disoriented, unable to distinguish between reality and the dream world. It is not uncommon for him to talk about things unfamiliar to us…people and places from his dream world.

The third indicator, social withdrawal, occurs two to four months prior to death. The dying person becomes disinterested in the outside world, from current events, sports, etc. This disinterest then turns into a withdrawal from people—refusing to see visitors and limiting interaction with family or close friends. It is as if the dying person is loosening his ties to the people in his life in order to move toward a new home in eternity. It is also likely he is doing this to protect himself from the emotional pain of saying goodbye. In his final weeks, he may even become antagonistic and push people away so “it won’t hurt so much.”

Sometimes it is helpful to read how more traditional cultures view the dying process. Although we do not adhere to Buddhist teaching, it does offer an interesting perspective as to how the body gradually shuts down.

The Labor of Dying

The process of dying is often compared to the labor women endure when bringing a new baby into the world. There is no magical length to the birthing process, nor is there with dying. Some women have quick labors; others may labor for a day and a half. “So it is with the labor to leave this world. Some of us get out of our bodies more easily than others.”

Labor to leave our bodies usually takes one to three weeks. Some of the signs that your loved one is in labor are: he sleeps with his eyes partially open rather than closed (keeping eyelids closed or open requires energy); his breathing patterns change (also known as start and stop breathing); when resting, he puffs by blowing air out through his lips; he becomes restless and picks at his clothing or sheets (a sign of fear); his body may develop a fever or become cold and clammy; mottling sets in (bluish black discoloration of the hands and feet that progresses to a ring around the knees, often with splotches across the back); incontinence or loss of bladder and bowels; and non-responsiveness.

Fear, pain and unfinished business make it much more difficult for a person to die peacefully. Fear can create tension and extend one’s dying process, as can unresolved conflicts or guilt. All of these are like ropes tying our loved one to the earth and prolonging his labor. Physical pain locks up the body and does not allow the dying to relax. By alleviating pain, your loved one is able to simply rest and let go.

There is no need to worry about drug addiction when a terminally ill patient is taking strong dosages of narcotics for pain relief. It simply is best to take medications on a regular schedule, rather than wait until pain becomes severe and very challenging to get back under control. It is much more difficult to manage this way. We gain nothing by waiting and it is unnecessary to suffer when medicine is available.

In the final sacred moments of dying, your loved one will be breathing very slowly. He will be non-responsive and his eyes will be partially open. His arm or shoulder may slowly move. He may make a frown. These small movements are usually followed by one or two long breaths. It may seem as if there will be more breathing, but then he will gasp and let out one or two final breaths, expelling the last bit of air in his lungs. And, then the end has come.

In the twenty-four to thirty-six hours prior to death, after days of labor, for no known reason, your loved one may appear to temporarily recover or rally. He may wake up with energy, request food, receive visitors, and seem to be doing much better. Then, his time to die comes and the hopefulness that he has recovered is gone. No one can explain why this happens. We can only contemplate. Perhaps it is God’s way of allowing us to have a few final good days together to say the things we need to say, and to remind ourselves that the path of death leads to a new day and complete wholeness.

Walking through the painful process of watching a loved one age or battle a terminal illness is undeniably heartbreaking. Yet, in the midst of the natural emotions associated with dying, “remember, the dying process is an inevitable and largely passive one. Massive intervention at the eleventh hour will only prolong a physically and emotionally painful process. It may eke out a few extra hours or even days of suffering for your loved one, but the end will be no different.” Each person ought to have the opportunity to die well and with dignity. The more we know about the process, the more likely we will be able to achieve that end. When we clearly understand the signs, wise decisions will help us make the very most out of the time remaining…a gift to our loved one and to ourselves.


Summary of the Death and Dying Process


Timeframe: Physical Stages of Dying

One to Three Months Prior to Death
• Withdrawal from the world and from people
• Decreased food intake
• Increased sleep
• Going inside self
• Less communication

One to Two Week Prior to Death
• Disorientation
• Agitation
• Talking with Unseen
• Confusion
• Picking at Clothes

• Physical Changes
1. Decreased blood pressure
2. Pulse increase or decrease
3. Color changes; pale, bluish
4. Increased perspiration
5. Respiratory irregularities
6. Congestion
7. Sleeping but responding
8. Complaints of body feeling tired and heavy
9. Not eating, but taking few fluids
10. Fluctuating body temperature hot/cold

Days or Hours Prior to Death
• Intensification of 1-2 week signs
• Surge of energy
• Decrease in blood pressure
• Eyes glassy, tearing, half open
• Irregular breathing, stop/start
• Restlessness or no activity
• Purplish knees, feet, hands, blotchy
• Pulse weak and hard to find
• Decreased urine output
• May wet or soil the bed

Minutes Prior to Death
• Fish out of water breathing
• Cannot be awakened

Ed Gungor: On Death and Dying

The Grief Paradigm

"I tell you the truth, you will weep and mourn
while the world rejoices.
You will grieve, but your grief will turn to joy.
A woman giving birth to a child has pain
because her time has come;
But when her baby is born she forgets the anguish
because of her joy that a child is born into the world.
So it is with you: Now is your time of grief,
but I will see you again and you will rejoice,
And no one will take away your joy."

John 16:20-22


A Time to Grieve


Grief is a difficult concept to comprehend because—far too simply put—it’s painful. We would prefer for it to pass by as quickly as possible, or better yet, be something more along the lines of a singular response to a loss followed by a short period of sadness. But, truth be told, grief is much more complex than that. It is as diverse as the people who bare it. It takes on many expressions and cannot always be contained in a small box of systematic phases. Rather, “grieving is the entire emotional process of coping with a loss, and can last a very long time.” It hurts.

Grief, according to scripture, is a part of the human experience. We come from the land of broken toys where we wear out, we break and we die. Loss is inevitable in our land, just as labor and delivery are inevitable to a woman full term with child. We labor through a dying process, we die, and then we, according to Christian belief, live again. This place of grieving between death and resurrection is a painful and lonely. Nevertheless, it is part of our journey. Each of us will walk through the “valley of the shadow of death” as we say goodbye to a loved one, and when we ourselves die. Yet, our hope in the midst of unwelcome grief is that our pain will one day carry us to a place of eternal and unquenchable joy…a joy no experience nor person can take from us.

Learning to grieve well is a life-long process, just as is persevering under hardship. Grieving well through a full spectrum of emotions requires gentleness and patience with our selves. We cannot expect pain to simply disappear overnight; it takes time. There is no single answer to our grief; nor is there only one way to grieve. We each process experiences differently. The common denominator though is that every one of us needs support and understanding. Attempting to go at it alone and unprepared will only prolong the process. Grief can be a very lonely road, so we need to know our loved ones are with us. And, it’s helpful to seek out knowledgeable professionals who are able to provide information and definition to our experience. These two positive elements create an environment for us to grieve well.

To clarify, it’s important to note that the terms grief, mourning and bereavement are often used interchangeably; however, each has a different meaning. Grief is one’s inner and personal experience of and response to loss. Mourning is the outward expression of that grief, in addition to cultural and religious customs and rituals surrounding death. Mourning is also defined as the process of adapting to loss and adjusting to the death of a significant person. Bereavement refers to the state of having suffered a loss and to the experiences that follow the death of a loved one. It is the time after a loss during which the person experiences grief and exhibits mourning.

Grief is a “process that occurs over time and involves a wide range of emotions, as well as thoughts, behaviors and physical sensations.” It is normal to feel “a sense of shock, emotional numbness, sadness, despair, anxiety, guilt, loneliness, helplessness, relief and yearning.” Grief affects our entire being. It would not be unusual to think that our terminal news is inaccurate, that it couldn’t possibly be happening. Or, to feel confused, disoriented, have trouble concentrating, or even temporarily think you are “going crazy.” Tightness in the chest and/or throat, nausea, dizziness, fatigue, vulnerability, trouble sleeping, uncomfortable in social settings, irritability, aggressiveness, restlessness, lack of interest in everyday affairs…all of these are very normal responses to a loss.

The Lance Armstrong Foundation, www.livestrong.org, provides an informative perspective on the concept of loss and how it affects our whole persons. Losses impact our physical bodies, our emotions, our relationships and well as, in practical terms, our finances. Such losses are spelled out in the following chart:

Physical Losses
• A part of your body or a body function
• Changes in your ability to have sex
• Energy
• An ability or skill to perform certain activities
• Physical comfort
• Fertility

Emotional Losses
• Sense of security (in your health, in your future)
• Sense of control or independence
• Self-esteem or sense of identity
• Self-confidence
• Goals, hopes or dreams
• Faith or spirituality
• Your sense of life as safe and predictable
• Habits, such as changes in daily routines, or life “the way it used to be”

Social and Relationship Losses
• Relationships with friends, family members or co-workers
• Sexual relationships
• Your ability to have your own biological child
• Loss of certain roles (For example, you can no longer earn money for your family, or you can no longer prepare all of the family meals.)
• Loss of other terminal friends

Financial Losses
• Job or job opportunities
• Financial security
• Insurance
• Ability to work

Throughout the remaining pages of this chapter, we will focus our attention on the term grief as it relates to our inner and personal experiences as patients responding to a terminal diagnosis. It is our hope that these honest, although painful, discussions will enable us to navigate through our final acts of living with dignity, peace and hope.

Elisabeth Kubler-Ross

A handful of researchers over the past 50 years or so have helped to define grief. They have given words to our experience by collecting and categorizing common responses to tragic personal loss…responses that are as innate to human beings as breathing.

Perhaps the most well known thanatologist, Elisabeth Kubler-Ross, in 1969 published a book titled On Death and Dying: What the Dying Have to Teach Doctors, Nurses, Clergy and Their Own Families. The book is a collection of research that Kubler-Ross and four theological students gathered by observing and interviewing terminally ill patients. From this research, she developed a five stage grieving paradigm, which articulates common occurrences of terminally ill patients. It also clearly communicates how other tragic personal losses—the untimely loss of a job, a divorce, drug addiction, etc.—can create instances where grief is present.

After hundreds of conversations with terminally ill people, Kubler-Ross noted five phases of grief that were frequent among the patients:

1. Stage One: Denial and Isolation
2. Stage Two: Anger
3. Stage Three: Bargaining
4. Stage Four: Depression
5. Stage Five Acceptance

These phases, she claimed, do not necessarily occur in the order listed, nor are all of the stages encountered by every patient. However, according to her observations, each patient will at the very least go through two of these stages at some point in his journey. “Often, people will experience several stages in a ‘roller coaster’ effect, switching between two or more stages, returning to one or more several times before working through it.”

Kubler-Ross described these five phases of grief as “coping mechanisms” that commonly overlap as we manage our loss. This process is a highly personal matter; therefore, words such as “you should be over this by now” or “you’re taking too long,” or “you haven’t waited long enough” ought to be cautiously and meticulously avoided. We should never feel pressured to progress through the grieving stages in a set amount of time based upon another’s opinion of what is or is not satisfactory. Instead, we need to hear words of hope—even with a terminal diagnosis—that it is possible to live to our last day with purpose and significance. Such hopefulness is the very thing that will sustain us through prolonged suffering.

The ultimate goal in the grieving process is to move into a place of peaceful acceptance of our terminal condition. This requires energy and labor. By letting go and allowing a shift to take place in our hearts and minds, we will be able redirect our energies from the struggle to survive to our struggle to end well.


Stage One: Denial and Isolation


When we first receive the news that without a miracle we will die, it is quite common to respond with “That’s impossible. You can’t be talking about ME! It cannot be true.” Kubler-Ross terms this universal reaction to devastating news the Denial and Isolation phase. Almost all patients from time to time use denial as a coping mechanism. Just as we do not have the ability to gaze at the sun for long periods without damaging our eyes, we also cannot spend every moment of every day facing death. Denial acts as a shock absorber and provides space for us to gather ourselves so that, in time, we are able to respond appropriately. We all occasionally need a break where we are able to contemplate more cheerful things, to daydream about happier places and unlikely aspirations. It just helps.

While in denial, some of us may put on a happy face to disguise our growing depression. We may briefly talk about our situation, but then abruptly change the subject. Every terminal patient at times needs denial to cope, particularly at the beginning when numbness sets in. Ultimately, though, this numbness will fade and we will begin to recuperate from the shock in order to move towards embracing our diagnosis. It helps to face our fear of death “when it is still miles away” rather than “when it is right in front of the door.”

Stage Two: Anger

Denial for the majority of people will eventually turn into anger. After questioning how this terminal illness is possible, the most natural question to ask next is “Why me?” followed by, “Why couldn’t it have been someone else?”

Anger is usually quite difficult for family members, close friends and health care providers to understand. Such individuals are frequently on the receiving end of our bursts of anger. When released, we direct our anger at the ones closest to us. It sprays out unexpectedly, like a machine gun firing in all directions without a specific target. “This doctor is no good! The treatment isn’t doing what it’s supposed to do! The nurses are lazy! Can’t they see I’m in pain here?” Every little thing makes us want to explode internally and externally for no apparent reason. Everywhere we look, we find aggravations and something to complain about.

No one is perfect. That being said, what we as terminally ill patients need most from our loved ones and caregivers when passing through our struggles with anger, is for them to remember that what we are really angry about is our sickness, not them. We need multitudes of grace because what we’re experiencing is the most difficult battle of our lives. Considerate loved ones will try to put themselves in our shoes for a time, and then perhaps understand the source of our anger. They’d be angry, too, if their plans were permanently interrupted; or, if all of their dreams for the future would never be possible. They’d also be angry if the rest of the world just seemed to carry on without them as if they had already died…but they hadn’t.

We know our anger is often irrational but by allowing us to express it, we will eventually calm down. When we receive kindness, respect and attention we feel understood and significant—still human beings who just happen to be living inside a body with a terminal sickness. Anger is a natural part of our journey.

Stage Three: Bargaining

Anger eventually will give way to a third coping mechanism called bargaining. This stage is helpful because it allows us to temporarily evade reality…but only for short periods of time. Otherwise, if prolonged, bargaining can become unhealthy to our souls. This phase comes after we have told ourselves that it is impossible for us to be terminal and after our bouts with anger…when reality has settled in. In this phase, we are very much like a child bargaining with his parents who have denied a wish. After a couple failed attempts to persuade them to change their minds, a child may rethink his strategy and try another way, such as make promises to change or to do more.

As a patient who uses bargaining, we may say something like, “If God has decided to take me from this earth and he did not respond to my angry pleas, he may be more favorable if I ask nicely.” The rationale becomes a hope that if we enter into some sort of private agreement with God that he will perhaps postpone the inevitable. Bargaining is a tactic we know is farfetched but we do it anyway, hoping to be rewarded for good behavior, granted an extension of life or a few days without pain.

From a spiritual standpoint, bargaining may be a red flag needed to draw attention to unresolved guilt in our lives. Because we view dying through the lenses of a Biblical worldview, sin, we believe, is the root cause of our death. In order to live again, we must confront it through the cross and repentance. Whether we recognize it as such, bargaining conversations with God may actually be pleas for forgiveness, in which case, a prayer like the following just may be of help:

"Jesus, something in me is nudging me to say YES to you. I want to do that. The Bible says that if I declare you as the one in charge of my life—as Lord of my life—then help from heaven will come—that I will be “saved.” I’m so open to that. Jesus, be my Lord—right here, right now, over my current set of circumstances—be my Lord. Forgive me of my sin. Cleanse me from the pursuits that I know are wrong. I surrender to you and welcome you into my life. I am yours!"

By properly addressing matters of the heart where guilt frequently buries itself, many people have been able to pass through quickly or avoid altogether the next phase, which is depression.

Stage Four: Depression

Once we have waited unsuccessfully for an answer to our bargaining pleas, when we have undergone an additional surgery or hospital stay, or when our symptoms intensify and we grow weaker, smiling is more difficult. Denial, anger and bargaining are replaced by “a sense of great loss.”

Depression, according to Elizabeth Kubler-Ross, comes in two packages: reactive depression and preparatory depression. Reactive depression is an immediate response to a past loss. A woman lost her breasts to cancer and wonders if she is as much a woman as prior to surgery. A man lost his leg in a hit-and-run accident and wonders how he will ever function normally again. A woman caring for her ailing husband reenters the workforce and grieves that her children will no longer have her best hours of attention each day. These are all examples of reactive depression—a response to a loss from a past event. The source of reactive depression is usually obvious to a considerate health care provider, friend or family member who takes time to listen. Such a person can help alleviate guilt or wrong thinking that often accompanies depression, by speaking words of objective truth or by doing small practical things to remove one’s need to worry. Elizabeth Kubler-Ross says this about how to respond reactive depression:

Our initial reaction to sad people is usually to try to cheer them up, to tell them not to look at things so grimly or so hopelessly. We encourage them to look at the bright side of life, at all the colorful, positive things around them. This is often an expression of our own needs, our own inability to tolerate a long face over an extended period of time. This can be a useful approach when dealing with the first type of depression in terminally ill patients. It will help such a mother to know that the children play quite happily in the neighbor’s garden since they stay there while their father is at work. It may help a mother to know that they continue to laugh and joke, go to parties, and bring good report cards home form school—all expressions that they function in spite of mother’s absence.

Preparatory depression is different than reactive depression. It “is one which does not occur as a result of a past loss but is taking into account impending losses.” With this kind of depression, the emotions experienced are actually tools that we use to help move us into acceptance. This kind of depression is necessary and has the capacity to spare everyone greeting an impending loss, a tremendous amount of needless suffering.

When in a state of preparatory depression, it is better that our loved ones and health care providers refrain from trying to get us to look for the silver lining in our clouds. This kind of diversion takes us away from contemplating our coming death, which we need to do. Just as it would be considered inappropriate to urge a grieving son or daughter to see the positive in his or her parent’s passing, it is equally inconsiderate to urge a terminally ill patient to focus on the bright side of things. We need this phase of depression to help carry us through the full grieving cycle and on to a place of acceptance.

Preparatory depression is a time when we are grieving the loss of everyone and everything we cherish. By allowing us to express our sadness in the manner in which we choose, the burden becomes lighter for us. We are grateful to those who will be with us, listen to our words or allow us to sit quietly for extended periods of time. When silent, we are processing our experiences internally, so please refrain from trying to cheer us up. Hold our hands, stroke our hair, pray for us and remember we are thinking primarily of the things to come, not necessarily the past. When you respect our wishes, you are helping to prepare us emotionally to die…and this graciousness is a priceless gift.

Stage Five: Acceptance

With support, we will eventually enter into a frame of mind that is neither angry nor depressed about our soon-coming end. Rather, we will have come to terms with the inevitable, and upon expressing our feelings and mourning the loss of everything meaningful in this life our contemplation will give way to what Kubler-Ross describes as “quiet expectation” or acceptance. Achieving this phase of grief is colossal.

Acceptance ought not be mistaken for happiness. If anything, it is a phase devoid of feeling for us. We have labored through the dying process and through the very painful stages of grief, and are now at a point where we’re ready to let go forever. As one patient shared, this is a time of “final rest before the long journey.” Things of this world matter very little now that we have released it all.

More importantly, at this point, focus ought to be redirected to our family members who are now in a position where they need support saying their goodbyes and contemplating life without us. It is very difficult for them to understand how our ease of dying is directly connected to our ability to disengage from significant bonds with those we care about most. This is why acceptance is so difficult for those left behind.

It is often a challenge for our health care providers and loved ones to know when to push us to keep fighting, and when to let us go. Dying wasn’t a part of the original plan, so we naturally resist it. We especially resist when we don’t want to say goodbye or admit defeat. There are those who fight for life until their last breaths. There are others who resign themselves to defeat even before a terminal diagnosis is given. Regardless, the day will eventually visit every one of us…for some, sooner than later. So, when the time does arrive for us to die, if we persist in the denial or anger phases, it will be only that more difficult to die peacefully. Acceptance is a gift from God that brings us back to the place where we first began...resting peacefully and comfortably in his hands.

Others on the Subject

The field of thanatology has developed significantly in recent years, beginning with Elizabeth Kubler-Ross—who provided a strong foundation upon which many others have built—and added to by individuals such as Bowlby and Parkes, Worden, and Wolfelt...to name a few.

In the 1980’s British psychiatrists John Bowlby, MD, and Colin Murray, MD reworked Kubler-Ross’ five stage grieving paradigm into a four stage cyclical grieving process. Those of us suffering a significant loss may successfully cycle through the stages, but then when a memory surfaces or we experience a trigger—a holiday, birthday, anniversary—we reenter the cycle once more. This can occur many times and unexpectedly.

Bowlby and Murray’s Four Phases include:

1. Initial phase: Shock and Disbelief
2. Second phase: Searching and Yearning
3. Third phase: Disorganization and Despair
4. Fourth phase: Rebuilding and Healing

Harvard Medical School psychotherapist and researcher, J. William Worden, PhD, who specializes in terminal illness, suicide and child bereavement, has created a list of four basic tasks for adapting to loss.

These tasks are:
1. Accepting reality of the loss
2. Experiencing the pain of grief
3. Adjusting to an environment in which the deceased is missing
4. Withdrawing emotional energy and investing it into another relationship.

According to Worden, walking through these four basic tasks is what will restore “equilibrium” and complete the cycle of bereavement. It is not necessary that these tasks occur in the order presented. Rather “they can be concurrent, cyclical, or overlapping, and we—the grieving ones—will work on them with much effort until regaining balance.”

Dr. Alan Wolfelt is the founder and director of the Center for Loss and Life Transition (Fr. Collins, CO) and is a well-known grief care provider and educator. He offers a postmodern take on grief: each individual grieves in a manner that is unique to him, and there is therefore little predictability or phases that fairly articulate a universal grieving experience. The griever, as was the case for Kubler-Ross and her team, is the teacher and the support-giver is the learner.

Final Thoughts on Grief

When it comes to grief and it’s affects on human beings, it truly is impossible to institutionalize, categorize and apply common thoughts to every person experiencing a tragic personal loss. There is just no “one shoe fits all” for this deal called grief. As different as each of us is, the ways in which we express our pain and move toward relief, vary even that much more.

For some strange reason, though, we often expect ourselves to grieve as the textbook explains or as a role model, like a parent, instructed us. If we each give a unique expression of our innate talents through work choices—and other examples are in abundance—then, at the very least, we can strongly expect to grieve distinctively.
It does help to hear from grief professionals that there are widespread experiences with sorrow that create common bonds and tie us together. What is still necessary though, according to Darcie D. Sims, co-founder and president of Grief Inc., is to “create a new language for grief…a language that speaks honestly of grief’s pain and crushing despair. We need a language that speaks of the painful promise and of the hope that is cast by the memory of love given and received. We need to create a language of HOPE…” Most importantly, we must learn to be patient with our selves and with each other. Grief is a life-long journey. We may never fully “get over” our losses, but we can rest assuredly that we will be comforted through them. There is an outstanding promise from God that one day our grief will be replaced with never-ending joy. We all have something wonderful to anticipate, and this is the true source of our hope.

Thursday, August 21, 2008

Ed Gungor: What I Hate Most About Christianity

This is Chapter One of Ed Gungor's newest book, Things I Hate About Christianity: Honest Reflections From a Christ Follower. I worked alongside Ed on this book, primarily as a researcher and sounding board for each of his chapters. I read through the chapters as he finished and commented on the ease of reading, areas I felt needed clarified, etc. I also contributed the name of this chapter.

CHAPTER ONE
WHEN GOD PLAYS HIDE AND SEEK


I believe in God most of the time. But I have my moments when I wonder if I’m wrong; times when I have a strong taste of doubt in my soul. Faith is a tricky business. Those of us who embrace it live our whole lives for someone we’ve never seen, and believe in things we are convinced of, but cannot prove (at least empirically).

This could easily be resolved if God were visible. It bothers me that he isn’t. I wish every person could access a peak at him even if it was just once in their lives before they died. I’d even vote ‘yes’ for people to see God while they are kids, and then, like an imaginary friend, when they come of age, they stopped seeing him. Then they could wrestle with whether or not he was real or imaginary—I think that would be better than him being invisible. But invisible he is. And as you study scripture, you discover he is invisible on purpose.

There is a rich tradition in Judeo-Christian thought concerning the “God who hides.” The biblical claim is that God loves to hide—he loves to tuck himself so completely into the backdrop of life and creation that many completely miss his presence. Isaiah comes right out and says it, “Truly you are a God who hides himself, O God and Savior of Israel.” After the resurrection of Jesus, the Bible records that he is with two of his disciples who knew him well, yet, “they were kept from recognizing him.” They had no clue they were walking along the road with the resurrected Christ. He was hiding. God was hiding another time from the biblical patriarch Jacob who exclaimed, “Surely the LORD is in this place, and I was not aware of it.” God often told Israel, “I will hide my face.” The psalmists repeatedly lamented how God was “hiding” from them.

But God doesn’t just hide his presence. When it comes to his message, he tends to cloak it in obscurity, making it fairly inaccessible. In one of Jesus’ prayers he says, “I praise you, Father, Lord of heaven and earth, because you have hidden these things from the wise and learned.” Often Jesus’ own disciples didn’t get what was going on: “The disciples did not understand any of this. Its meaning was hidden from them, and they did not know what he was talking about.” When teaching the crowds Jesus would say, “If you, even you, had only known…but now it is hidden from your eyes.” Jesus claimed, “This is why I speak to them in parables: ‘Though seeing, they do not see; though hearing, they do not hear or understand.” God often hid the true meaning of his message from people.

After Jesus departs and the apostles began to teach about faith, they too alluded to this conspiracy of hiddeness. Paul writes, “We speak of God’s secret wisdom, a wisdom that has been hidden.” Paul repeatedly calls the gospel a “mystery” that “was kept hidden in God” only to be “revealed” at a special time to a special group of people.

WHAT’S THE POINT?

At the simplest level, the conspiracy of hiddenness is like the hide and seek game children play. God hides; those of us who are suspicious of that hiding, seek him. Scripture tells us well over a hundred times to “seek the Lord” or to “seek his face.” The very fact that he asks us to “seek” him implies he is hiding. But God has rigged the game so that the persistent, dedicated seeker always finds him. God promises to those who seek him, “I will be found by you.” Jesus adds, “Seek and you will find.”

Any thinking person has to ask, why would God do this? Why would God hide from people or make his message obscure? I think there are several plausible answers for this. One is simply that God hides because he has chosen to establish a relationship with humanity through the pathway of faith. And in order for faith to be faith, God must remain invisible and unprovable to the senses. If God were seen as plainly as the sun or experienced as unquestioningly as gravity, faith would not be required—God would just be an undisputed fact.

It is the pathway of faith that locates a relationship with God firmly in the domain of human free will and out of an orbit resembling anything forced or involuntary. Faith can only exist in freedom—where we can choose to believe or not to believe. By God using faith as the only modality for a connection between him and us forces any possible relational connection between us to be the result of choice or free will. The human race remains in control because as we observe phenomena around us we can either interpret it with God in the picture or not. It’s our choice.

Christian theology sees God as Almighty, all-knowing, and everywhere present, and, yet, as One who respects the right of those he created to completely ignore him. He respects our right to ignore him because he only wants authentic relationship with individuals. Authentic relationships require choice—forced friendships or shotgun weddings do not constitute real relationships. But the choice to ignore God would be impossible if God were visible. Why? Because God’s presence is ubiquitous—he is everywhere interacting with us in everything from holding creation in tact, to being the one who chose the time and place where we would live, to being the cause of all the good we know, to being the one who gives us “life and breath.” Only invisibility affords us the choice to ignore him. And only invisibility gives us the option to leap by way of the modality of faith past that invisibility into a relationship with him. The idea of God playing hide-and-seek is so scandalous, yet, so amazingly brilliant.

IN GOLDILOCKS FASHION

Though God is invisible, he is committed to leaving us “clues” that point to his existence. There are hints of his activity all around us. But they are only hints. As you study the biblical record, God’s loves to spill his life into the world through subtle, almost unperceivable ways. In other words, unless you are actively looking for him, you will most probably miss him.

As silly as it sounds, there is a Goldilocks way in which God sneaks around our world. Let me explain. In the children’s story “Goldilocks and the Three Bears,” Mama, Papa, and Baby Bear come home one day only to discover that someone had been eating their porridge, sitting in their chairs, and lying on their beds. It wasn’t till the end of the story that they find out it was Goldilocks.

I think God, in Goldilocks fashion, gets involved with our lives before we notice him. As the creator and sustainer of all life, he metaphorically messes with our porridge, sits in our chairs, and lies on our beds. And though we can see and feel the results, we don’t get to actually see him till the end of the story. The essence of faith is the human commitment to "seek" the clues until they lead us to the hiding One—we may only get to “find” him metaphysically or spiritually, but it is finding him indeed. James writes, “Come near to God and he will come near to you.”

But clues pointing to God’s existence are not proof of God’s existence. No one can argue from biology or philosophy in a way that successfully “proves” God exists. The ones who have tried have had their work mercilessly scrutinized. All attempts end up becoming surefire recipes for the triumph and expansion of agnosticism and atheism.

All the evidence can do is show that a belief in God is not inconsistent with what we see in the world. For example, the amazing order and symbiotic nature of the universe can be explained on the basis of the existence of God as its Creator—that belief is coherent with what we observe in the world. But it is at best a hypothesis, which means another person may hypothesize that the order seen in the world is here is by chance. And their hypothesis would not be any less valid than the one offered by the Christ-follower.

But suggesting that the Christ-follower’s hypothesis is in some way evidence that we are stupid, anti-intellectual, science-haters is not fair either. Often anti-faith attacks are based on the notion that faith is a childish or infantile notion, like believing in Santa Clause or the Tooth Fairy. The inference is that people of faith are like unreasoned children who need to abandon their faith position just as childish beliefs are abandoned once reason-based thinking emerges in a child. However, beliefs in Santa or the Tooth Fairy are based on folklore, not evidence. There is evidence of God’s existence—there are clues. Though some see faith as intellectual nonsense, we can stand on the grounds that, though our beliefs are not provable, they are nonetheless perfectly reasonable to entertain—certainly as reasonable as the “belief” that all things are here by chance.

*The full chapter is available upon request.

Wednesday, August 20, 2008

Ed Gungor: What I Hate Most About Christianity

This is an original excerpt I wrote as a contribution to Ed Gungor's book: What I Hate Most About Christianity

Faith and Reason

There is a woman named Anne Robertson who recently wrote an article titled: Atheists: Define Yourselves. In this article, Robertson says,

Religion and faith are two different things: religion is merely the vehicle that human beings have created to convey the message of faith. It has significant flaws, as one might expect from a human creation, but so do other vehicles in our society. Just because the vehicle is in need of repair doesn’t mean the cargo is not worth delivering. (1)

Robertson does well to distinguish between the terms faith and religion. By and large, the rants of contemporary and influential atheist voices, such as Christopher Hitchens, Sam Harris and Richard Dawkins, focus on the term religion as a man-made institution that is ultimately responsible for most of the world’s problems today. Furthermore, these guys tend to bundle all religions together into one messy package stocked full of heinous historical missteps, culturally irrelevant interpretations of religious dogma, and the like. The true essence of Christianity, however, is not a religion; it is faith—faith in the person of Jesus Christ.

The term faith flows against the grain of any and every professing atheist because reason without evidence is utterly irrational (2). In other words, we may give many reasons for our faith in God, such as a personal encounter or a simple observation of the complexity of nature; yet, those who interpret the data differently render such reasons completely irrational. The existence of God can only be demonstrated; it cannot be proved. That’s why we call it faith.

Faith to an atheist, if anything at all, is simply confidence in the present interpretation of evidence gathered, and a belief that the unknown and unexplainable will eventually have a perfectly logical explanation—apart from faith in any creator or unseen god. According to Christopher Hitchens, “If one must have faith to believe something, or believe in something, then the likelihood of that something having any truth or value is considerably diminished.” (3)


Sources

1. http://www.theolog.org/blog/2007/06/atheists_define.html

2. http://shamelesslyatheist.blogspot.com/2007/02/of-definition-of-faith-and-other-things.html

3. Hitchens, God is not Great, page 71.

Ed Gungor: What I Hate Most About Christianity

This is an original piece that I wrote as a contribution to Ed Gungor's book: What I Hate Most About Christianity

Is Good Without God Possible?

A college student once asked professor and author, Dr. J. Budziszewski, if it is possible for one to be “good” (or moral) without God, to which the professor wisely replied:

"A person who doesn’t follow God can sometimes do the right thing. He can sometimes tell the truth, he can sometimes show compassion, he can sometimes set aside his own interests for someone else. The problem is that this isn’t enough. If you think your decency is high enough for God, your idea of God must be pretty low." (1)

Such a low opinion of God is essentially the inspiration behind outspoken atheists, such as Christopher Hitchens, Richard Dawkins and Sam Harris. In fact, each of these men, in their own respects, clearly state that if one has a high opinion of God, then he most certainly must have a rather low opinion of himself. One would not be too far off base to say that each of these men has quite a high opinion of his opinion. It was Christopher Hitchens, in fact, who said that God did not create man in his own image; it was the other way around.

John Stuart Mill in his Autobiography wrote of his father’s aversion to religion, calling it the “greatest enemy of morality”. (2) This is likely the reason Christopher Hitchens quotes Mill—he couldn’t agree more. Hitchen’s book God is Not Great overflows with examples of how religion reeks of immorality, and as the author puts it, “kills and poisons everything”. (3) Interestingly, Hitchens himself demonstrates a keen sense of right and wrong, which he would attribute to having attained a sophisticated level of understanding. Christ-followers, however, would liken it to the pen of God on his heart. Hitchens is good…some of the time.

Dinesh D’Souza in his book What’s So Great About Christianity explains how humans have the capacity to discover morality apart from faith; the source, however, of all good is God. (4) Man’s divinely given moral nature is what separates him from the animal world. It is highly unlikely that mammals, such as chimpanzees, have the capacity to “weigh their own interests against the rights of others…develop a vision of the greater good of society, or feel lifelong guilt about something they should not have done.” (5) Why? Because animals are designed to abide by physical laws, whereas humans abide by both physical and moral laws. Physical laws, such as the law of gravity, are immovable. Moral laws too are immovable, telling us what we ought to do. The only difference is that we are free to violate them if we so choose. (6) And violate them we do!

Dr. J. Budziszewski, author of Written on the Heart: The Case for Natural Law, asserts that morality is universal and unchanging, not unlike the laws of nature. Each human being has a divinely given conscience whereby he or she innately knows right from wrong. The lack of morality so clearly seen throughout history is not the result of the knowledge of right and wrong, but rather of a need to suppress what we know in order to suit our desire “not” to know. Truth is often a great inconvenience to the person with a conscience. (7)

Biologist and author Richard Dawkins has gone to great lengths to discover the roots of morality and to explain how men can have a capacity for good, apart from God. He concludes that, “our sense of right and wrong can be derived from our Darwinian past.” (8) Morality is found at the gene level and is passed on from one generation to the next through a selfish struggle to survive. The “selfish gene” guarantees survival of the fittest by “influencing organisms to behave altruistically.” This, according to Dawkins, explains why mothers are good to their children, why we engage in reciprocal bartering, repay good actions with good, and bad deeds with bad and foster good reputations. (9)

Dawkins has received mounds of criticism from scientists who feel he has taken the “selfish gene” theory entirely too far. Nevertheless, his thoughts have been very influential since he first wrote The Selfish Gene in 1976. He has no doubt influenced the research of neurophysicists Wilder Penfield and Michael Persinger who claim that the right temporal lobe of the brain enables a person to have mystical encounters with God. Some, not all, have a much more sensitive right lobe and are therefore more likely to have religious experiences and to act on them—either morally or immorally, depending on their interpretation of the encounters. (10) This apparently gives a mechanical explanation for the crazy abuses present in some religious communities, and not in others. It is believed that when the research is complete and conclusive the next step is for pharmaceutical companies to develop medications to regulate the right temporal lobe and deal a concluding blow to religion. Wow. Medicate morality. What a thought.

So, is it possible for man to be good without knowing God? Yes, some of the time. And, with medication? Perhaps, more of the time. But what about all of the time? Most certainly not. Why? In conclusion, Dr. J. Budziszewski states the answer quite clearly.

"Trying to do without God has ruined us inwardly. There are still some good things in us, but not one of those good things is in its original healthy state. Not only are we broken, we can’t repair ourselves. Could you perform surgery on your own eyes, or treat yourself for madness? Suppose you tore off both arms; without your hands, could you sew them back on? Our sin-sickness is something like that. (11)

We need God.



Sources

1. http://www.boundless.org/1999/regulars/office_hours/a0000054.html

2. Hitchens, Christopher. 2007. God is Not Great: How Religion Poisons Everything. New York, New York: Twelve Hachette Book Group USA, page 15.

3. Hitchens, page 22.

4. D’Souza, Dinesh. 2007. What’s So Great About Christianity? Washington, DC: Regnery Publishing, Inc., page 226.

5. D’Souza, page 227.

6. D’Souza, page 228.

7. http://www.boundless.org/1999/regulars/office_hours/a0000054.html

8. Dawkins, Richard. The God Delusion. New York, New York: Houghton Mifflin Company, page 245.

9. Dawkins, page 247-250.

10. http://atheism.about.com/library/books/full/aafprGoodWithoutGod.htm

11. http://www.boundless.org/1999/regulars/office_hours/a0000054.html