FEAR OF DYING VS FEAR OF DEATH

Today I heard Terry Gross interview Susan Sonntag's son, who wrote a book about his mother's dying. Christopher Hitchens writes in memory of this great intellectual, who leaves quite an intellectual legacy. The son said his mother was afraid of dying, which he really didn't quite understand and seemed somewhat surprised because she had been in Sarijevo when people were being randomly shot and in constant danger of her life. He could not explain the incongruity, but I suggest that fear of dying is not necessarily fear of death, but the process of dying.

Susan Sonntag was a true atheist to the end. She was not afraid of a hereafter. There are many of us who believe that we go through this life once and death means oblivion. The thought of oblivion does not strike fear in my heart. Susan Sonntag had cancer three times and suffered great physical pain. Her dying was painful through treatments and her body's reaction to them. I would thus suggest from my own clinical experience, in therapy with many patients over the years, that those who do not fear a hereafter fear the process of dying, not death itself.

In that process they lose total control of their lives, of living. Once the term terminal illness is invoked, there is no hope for a future that continues to allow all the things one may want to accomplish to continue. Ms Gross played a tape of an interview with Susan Sonntag before her death in which she spoke of the pain her illness was causing those around her whom she loved, especially her son, and that grieved her. As only those who have intimate experience with Hospice or a dying loved one have experienced, when one knows there is a limited time to live, there is little psychic energy left to be a mentor, caretaker, advisor, or any of the roles one may have had in life. Loved ones may feel unloved and deserted if they don't understand this, hurt and disappointed and pull away from the dying person.

The fear, then, of dying is the reaction to the knowledge that when you die you will cause sadness and suffering to those people who cared for you in life. The person not only has to deal with their own thoughts and adjustment to death, but the pain of all those around who are grieving as well, trying to hold on, angry at the dying person for leaving them, and lots of other somewhat less rational reactions. Some people die without pain but that is not the usual picture. Lots of people die in excruciating pain, which our laws only recently have allowed physicians to alleviate properly. Palliative care covers pain and also takes away energy and the ability to carry on the mental tasks one might wish to perform. Some suffer with cancer or illnesses causing dementia, loss of memory, loss of speech or physical movement, and worse.

Until laws no longer prevent people from choosing to end their own suffering, alone or with medical assistance, I assert that it is greater fear of dying and not death, which religious people think will unite them with loved ones who have preceded them in death.