Value in Aging and Death

Death has always been an important undercurrent in the psychic experience of human life. It has been a contentious point in the philosophies, religions, psychologies, and medical communities in the west. Obviously there is a suicidality that should be considered a medical emergency in states of severe depression, and we should recognize this as a treatable medical condition. However, as with any hard wired psychological function, our obsession, denial, and fear related to death leads to significant suffering. It is no different from suppression of drives for sex, aggression, and power. The more we avoid conscious confrontation of the drive to contemplate and consider the nature of our mortality, the more we will be driven unconsciously towards suffering related to this drive. Death and even Aging hold some of the greatest stigma of all concepts in our culture. Stigma creates a stark contrast, both giving great importance to a topic, and trying to remove all value from it by trying to hide or ignore it. This creates a stark contrast of significant value both in a positive sense and in a negative sense obscuring the true substance. Philosophy, religion, and psychology have dealt with this conflict in various ways and in the west, denial of death is the key construct.

There is plenty of valid criticism of Freudian philosophy on the subject. His understanding of the sexual drive, or at least his theoretical model of it, was reductionistic and full of gender bias and other obvious flaws that should not be overlooked. However, to ignore the powerful subconscious content related to mortality is just as foolish as imagining all women desire a penis or that all people deeply wish to die. No, the truth of our psychic functions related to death are far more complex than the Freudian supposition, and especially the pop-psychology understanding of the death wish. In western society, this reactionary avoidance of death, its place as a societal taboo, has led to a significant worsening of our ability to cope with it in the process of mourning and even our ability to find peace in natural aging. 

Mortality rises dramatically near the time of retirement. We don’t like to discuss it as a society, but death from all causes including suicide rises dramatically in later middle age, especially for those who worked full time (men historically, but becoming more gender inclusive over time). Even for people who are excited to retire and have sufficient savings to do so in comfort, at the age of retirement there is an increase in mortality out of proportion to simple increases in age. The mortality curve is a relative straight line with a bump up at retirement followed by a return to a relatively straight line. Analysis shows that about 11,000 American deaths per year are associated with this transition point beyond what accounts for age and medical disability alone. 

Similarly, the risk of death shortly after the death of a spouse is well documented. Men are 70% more likely to die in the year following the death of a spouse than in matched controls who did not lose a spouse, even when accounting for other forms of grief, bereavement, and depression. Women fare better, with only a 30% increase in the year following the loss of a spouse. This accounts for another 10,000-20,000 deaths per year in America alone. These deaths aren’t from suicide by and large, but degeneration of other health conditions such as heart disease, lung disease, and others. 

While it has never been, and likely will never be, proven that the cause of this is our culture’s avoidance of accepting mortality, to those who study deeper psychological mechanisms the connection is clear. Our identity as workers and as spouses being ripped from us without ceremony clearly has some important connections. Every other life transition is seen as a growth to a new stage. We celebrate birth, starting school, graduating each milestone, starting the first job, and each major promotion. We celebrate marriage, anniversaries, and each family event. But then there is a watch or a small cake, everyone congratulates you, and then what?

Worse, with the loss of a spouse, you are so busy calling everyone, organizing the funeral, and figuring out finances that you don’t have time to even grieve until the dust has settled and you realize you’ve been alone for a month. Or else, a big family does much of the work around the funeral, and everyone speaks in hushed tones until the last person leaves and you are left with an empty home and a dread that thinking about it will make it more real. No one wants to talk about it out loud, but you see the look on their faces.

In other cultures, especially in ancient times, retirement and death are seen as the ultimate graduation. When someone reaches an age where labor is done, they become an elder or a sage, or they move to the woods to contemplate their beliefs. In death, they are revered. They are now one of the grandfathers, the spirit guides. It was still a loss, but it was equally a gain. It was not shameful to discuss, but often celebrated as much as a birth. Obviously, this was not always the case, but in cultures that celebrate retirement and natural death, the psychological health of the elderly is generally considered to be better than in cultures that hide from or ignore the reality of it. 

In the west, to talk about death and dying, or even finishing a career, is treated as taboo. Strong people work, and strong people survive. In another culture, coming to a place of peace about one's mortality is divine, but in the west it could be considered “giving up” or failing. This is wrapped up in a puerile myth of the hero’s journey, but a distorted one. In the true hero’s journey, the hero inevitably dies. The distorted and childish version ends when the hero gets the girl, defeats death, and becomes a king. The king has no story, but the story ends there. In the west, we have no gurus, only the forgotten. We keep portraits of our heroes, at the height of their hero’s journey, ignoring the aftermath of their fall. None of us want to think about working hard until the day we die, but we never really have any map for an alternative option other than “failure”. 

And we have more suicides than the rest of the civilized world. As I discussed, we have more deaths in later life transition points than many other civilized cultures. In all of our denial of death, we fall into it with surprising regularity. 

In reality, the human brain, the human psyche, has always had a mechanism for considering, adapting to, and resolving conflicts related to death. While suicide is almost always a result of pathological depression, an existential fascination with or even desire for death is part of the health human phenomenon. As a taboo, there is no clear data on the number of people that think about death, but in the world of psychology it is seen all the time. In some existential psychotherapy disciplines, and in analytical psychology, true maturity and psychological wellbeing cannot happen until the concept of death is considered, and the complex resolved. We will not know more about how denial of death and avoidance affect us psychologically until the taboo is removed and we can discuss it more openly and honestly. 

With retirement, we discuss the money you must earn to win the game of retirement. However, we do not prepare people for the inevitable quiet. People never learn to sit with their own thoughts, consider their own hopes outside of a career, and design a retirement built around exploring pleasure and peace. This was once managed by the elders or the religious leadership, but our elders are in a nursing home and our religious leadership has lost credibility. The only mechanism we have left is the psychotherapy consulting room. 

I often tell people that I can see it coming. Maybe they have developed abnormal movements, or feelings as if they are in a fog. It starts about 5 years before a planned retirement and slowly escalates while they are evaluated for ulcers, tremors, and pains. Intentionally or not, their job becomes taking their pills and seeing their doctors. They spent every waking hour trying to maximize their 401ks, just so they could go on a few cruises and then sit on a couch waiting for the next doctor’s appointment, dreading the reality that they will eventually need to be in a nursing home.

This is not always preventable, but in many cases preparing for retirement can be a journey that keeps the body and mind more active and engaged. Slowly letting go of responsibilities for work and family, can be replaced with new intellectual and physical hobbies. To start a discussion about the physical symptoms of existential angst, how to recognize the architecture of your persona as hero, and how to prepare for a life after the battle, request a consult today.