The School of Life

Dying of Nostalgia; Thomas Dixon Explores Homesickness

Dr Thomas Dixon, writer of the excellent History of Emotions blog, recently interviewed Professor of History at Weber State University, and a leading historian of emotions in the United States, Susan J. Matt. Her first book, Keeping Up With the Joneses, was a study of envy in modern consumer society, and her latest work tackles another emotion: homesickness, in a book titled Homesickness: An American History (Oxford University Press, 2011) which explores how homesickness and nostalgia were transformed from deadly maladies to allegedly un-American emotions. 
 

 

Thomas Dixon [TD]: Hello, Susan, and thanks for talking to us. Perhaps I could start by asking you what got you interested in homesickness?

Susan Matt [SM]: The original impetus was that my own emotional experience of mobility didn’t match up with the mythology of American restlessness. Commentators like Tocqueville and Frederick Jackson Turner as well more modern observers all claimed Americans were naturally restless, that somehow it was in our cultural DNA to leave home. I didn’t find it so effortless or easy to move, and began to wonder if I was alone. Perhaps there was a flip side to American mobility–a hidden history of homesickness. Homesickness also interested me because it seemed in many ways to be the opposite of an emotion I had just been studying–envy. Envy sparks aspirations, pushes people forward, often causes mobility. Homesickness pulls backwards. Both emotions play a role in modern individualism in the U.S.. Americans are encouraged to repress homesickness so they can leave home, be independent, seek more of the world’s goods, act on their envy.

TD: It’s interesting that it was your own emotions that fuelled your desire to revisit their history. I suspect many historians of emotion are in that position. So, what surprised you most about what you discovered when you started digging around in the history of homesickness?

SM: First, how prevalent the emotion was. I thought it would be difficult to unearth, but instead, evidence of homesickness was abundant and easy to find in just about every archive I worked in. Secondly, and perhaps more provocatively, I was surprised at how many Americans died of homesickness, or nostalgia as it was called. I knew there had been European epidemics of nostalgia in the seventeenth, eighteenth, and nineteenth centuries, but didn’t know of American ones. But indeed, the disease of nostalgia was widely known in the United States–during the Civil War, there were 74 deaths from it on the Union side, and more than 5,200 cases of it in the Surgeon General’s records. 

SD: It became such a problem that army bands were sometimes prohibited from playing “Home, Sweet Home,” which at that time, was the most popular song in the country. In peacetime, civilians suffered from nostalgia as well.  The prevalence and intensity of nostalgia and homesickness throughout U.S. history – from the colonial era to the present - ultimately led me to question whether we were and are the individualists that we are so widely reputed to be. I think we’re not.

TD: I’ve been struck too by the great power of the passions in earlier periods – to cause illness, madness or even death. Medical sources of the eighteenth and nineteenth centuries abound with fatal bouts of emotion. Is it possible to pinpoint a date after which this changed – when homesickness and nostalgia became mere feelings rather than powerful and potentially fatal mental conditions?

SM: It gradually disappeared as a dangerous disease in the first half of the 20th century. The U.S. Army provides a useful gauge in its records. One soldier in the American Expeditionary Force reportedly died of nostalgia during World War I. Increasingly during the War, however, many of the symptoms associated with nostalgia came to be defined as signs of the newly established syndrome of shell shock. While the diagnosis of nostalgia stayed on the books up through World War II,  and while there were many reported cases of it among soldiers in that war, there were no deaths. In short, from the early twentieth century on, the number of cases of deadly nostalgia declined, although less lethal cases of homesickness continued (and continue) to abound. It seems worth noting that as nostalgia’s cultural meaning underwent this transformation, the tolerance for the acutely homesick declined, since their condition was now seen as less dire.

TD: Historically you clearly have a really fascinating story to tell about nostalgia and homesickness as modern emotions experienced, as all emotions always are, within a particular geographical and cultural situation, in this case in modern America. I wonder what you think about the contemporary importance of this research, and also of research into the history of emotions more broadly?

SM: The history of homesickness explains a great deal about modern American culture and our national identity. Adults in modern America have learned to repress overt expressions of homesickness, for it has come to connote immaturity, a lack of ambition, and failure. It is out of step with the ethos of modern capitalism, which prizes mobility and individualism. However, while they may not discuss their homesickness publicly, in daily habits and behaviors, American make their feelings about displacement manifest. From ethnic groceries that sell the tastes of faraway homes, to sports teams which symbolize loyalty to a hometown, to our addiction to Facebook, cell phones, and emails, Americans routinely show their preoccupation with staying connected to distant places and people. While we may think of ourselves as an individualistic society, our everyday lives suggest otherwise. And our history – full of people suffering and sometimes dying of homesickness - makes clear that mobility has in fact never been an innate trait of Americans. Instead, they had to learn to leave home, and they have still not completely mastered the art of rugged, restless individualism.

The history of the emotions offers historians and the public a new set of tools to assess the past. Rather than merely judging history on the basis of external behaviors, we can bring in people’s motivations and intentions. These often provide a completely different understanding of social life and revises many of our longstanding narratives about national identity.

 Dr Thomas Dixon is Director of the Queen Mary Centre for the History of Emotions. 

Image: American sheet music of ‘Home, Sweet Home’ arranged for piano and violin, c. 1870s. Source American History Online

David Baker on Reflecting on Death

Last Saturday was the Jewish Day of Atonement. For 24 hours, from sunset to sunset, we neither eat nor drink, we don’t wear leather (a sign of comfort and luxury), and we don’t wash or bathe. Synagogues are full – many non-observant Jews attend on this day – and the liturgy and music are raised to new heights of intensity.

Yom Kippur, as it is known in Hebrew, comes ten days after the Jewish new year, and during that time we are encouraged to reflect on the mistakes we have made in the previous 12 months – the friends we have fallen out with, the resolutions we haven’t kept, the dreams we didn’t act on – and consider ways of doing things differently in the year ahead.

As I sat through the services, a little spacey from the fasting, I found myself reflecting on what stops us acknowledging mistakes in “real” life and how it sometimes takes something as significant as an awe-filled religious festival to bring our lives back into focus. We all have dreams, plans, good intentions, and at the time we make them they seem so full of promise. Yet let them lie for a few days and they tend to get swept aside by the minutiae of life, so we find another 12 months has passed without having given them a chance.

I think – and this is a personal view – that our clumsiness with good intentions comes from being just a little too comfortable, which makes us risk-averse. Why bother changing jobs when our current one is “kind of” OK? Why get in touch with someone we have fallen out with when we have enough friends as it is? Why take up a new hobby when we have so many half-hearted ones already?

Steve Jobs, who died just before Yom Kippur, gave an inspiring speech to Stanford University students that is very much worth taking 20 minutes to watch in full on YouTube. In it he quoted the Whole Earth Catalog’s advice to “stay hungry, stay foolish”, and on Saturday I found myself making a resolution to try be a little hungrier and more foolish in life myself. I think one leads to the other: if you have less to lose, you will risk more. And more risk, in the end, means more reward.  

The prayers on Yom Kippur return again and again to the inevitability of death and our absolute inability to know when it will come. Jobs, whose death has unleashed an almost Diana-like wave of grieving, seems to have understood that lesson more than many. “Remembering that I'll be dead soon is the most important tool I've ever encountered to help me make the big choices in life,” he told the Stanford students. “Because almost everything – all external expectations, all pride, all fear of embarrassment or failure – these things just fall away in the face of death, leaving only what is truly important.”

We shy away from thoughts of death, for obvious reasons, but perhaps Jobs’ own death gives us a chance to transform its influence in our lives from a terrifying prospect into a powerful motor for change.  As the old adage goes, we won’t look back on our deathbeds and think, “Thank goodness I stayed those extra hours in the office.” But do we really know what we will look back on with joy and satisfaction? Perhaps it’s time to give that some thought and engage with those things that will make our lives a little more meaning.

David Baker is a new faculty member of The School of Life.  His next session will be How To Balance Work With Life – 20 October and How to Find a Job you love – 22 Oct.  If you're keen to take stock of this and consider how we think about death and approach life, come to our next 'How To Face Death' class on the 15th November.

Head to www.davidbakeronline.com for some more.

 

Roman Krznaric on How to be a Muslim, a Hindu, a Christian and a Jew

There is an intriguing thesis at the heart of Steven Pinker's new book, The Better Angels of Our Nature. The Harvard psychologist argues – contrary to popular opinion – that humankind has become progressively less violent over the past few thousand years. We might feel surrounded by terrorism, civil wars and gun crime today, but murder and warfare is in fact on the decline. And the reason? One of Pinker's key explanations is the rise of empathy as a force for social change: we are now more likely to look at the world through other people's eyes, and consequently take action on their behalves.

What I find missing in Pinker's worthy tome – and books which make a similar argument, such as Jeremy Rifkin's The Empathic Civilization – is a clear steer on how we can expand our capacity to empathise in everyday life. How exactly can we get better at it? And how can we integrate it into the way we approach the art of living? An answer lies not in the musings of psychologists or all those neuroscientists who have become obsessed with finding the empathic hotspots in our brains, but in the ideas of one of the great empathic adventurers of the twentieth century, Mahatma Gandhi.

His philosophy of empathy is embodied in what is known as 'Gandhi's talisman':

I will give you a talisman. Recall the face of the poorest and weakest man whom you may have seen, and ask yourself if the step you contemplate is going to be of any use to him. Will he gain anything by it? Will it restore him to a control over his own life and destiny? Will it lead to swaraj [freedom] for the hungry and spiritually starving millions? Then you will find your doubts and yourself melting away.

The talisman contains a moral framework that each of us can choose to live by: to consider the perspective of the most marginal members of society when making decisions on ethical issues, and to ensure they benefit in some way. Gandhi challenges us to imagine ourselves into the lives of people whose everyday existence might be vastly different from our own. Beyond this, the talisman is a guide to confronting our existential difficulties. When we feel paralysed by doubt or entangled in personal problems to the extent that we don't know what to do, we can find liberation and direction through an act of empathetic imagining. The talisman may provide clarity in our state of confusion or indecision. 

Gandhi lived out his empathic ideals. He worked as a nurse in South Africa as a young man: during the Zulu rebellion in Natal, he nursed Zulus who had been flogged and left by the British, whose regular nurses refused to attend them. His experiments living on ashrams were also an exercise in stepping into other people's shoes. 'Our ambition was to live the life of the poorest people,' he said. That's why he tended goats and cleaned toilets, alongside leading the resistance against British rule in India.

But his great originality was to stress the importance of empathising with one's enemies. During the growing conflict between Hindus and Muslims in the years leading up to independence in 1947, he declared, 'I am a Muslim! And a Hindu, and a Christian and a Jew'.

The half million deaths that occurred during partition in violence between Hindus and Muslims showed that the moral challenge of empathising with one's adversaries was too great in that turbulent moment in history. But I still think we can learn from Gandhi's approach. Trying to look through the eyes of those whose views we don't agree with – whether it is a nasty boss at work, an argumentative sibling, or a neighbour who does not share our religious creed – has the potential not only to challenge our own prejudices and forge social tolerance, but can create new and nurturing human bonds in our lives.

Roman Krznaric is hosting The School of Life's Curry With Gandhi on 25 October. His new book, The Wonderbox: Curious Histories of How to Live, will be published by Profile Books in January 2012. He blogs on empathy at www.outrospection.org

We All Need Words on Status (update) Anxiety

Rob is sipping prosecco and munching crostini in Tuscany.
Molly ran 10km in a new record time.
Rob has booked a boutique hotel in Baja California.
Molly bought some shoes half price in Selfridges. 
Rob loves his job.

About now Molly could also be telling you she loves her kids and how much they love her back. If she had some. And if Rob was a dad he might've even swapped his profile picture for a snap of his little ones.
We can make up all sorts of status updates because neither of us is on Facebook. I know, I know... young(ish), cosmopolitan(ish) things like us, not on Facebook? We might as well pack up our quills and cast ourselves into a social wilderness. But most of the people we know are on Facebook, so we can't help being a part of it and hearing highlights about friends-of-friends' lives. Sometimes we think we're the last to know everything. "Did you hear that…?'' "Yes, I saw it on Facebook."

That'll teach us for being such luddite stuck-in-the-muds.

Granted, everyone loves to see what everyone else is doing. But we've noticed something else about the way people respond to Facebook. A niggling feeling that everyone is having a better time of things than they are. While friends' walls are covered in snaps of their little one's first smile, or learning to walk, your baby is crying his or her precious little eyes out. And won't stop. If you've been made redundant there's nothing worse than seeing friends' holiday photographs, or reading that someone has been on a shopping spree. It's even weirder still to hear what an amazing time your 967th friend (whom you haven't seen since you were at school in 1993) is having compared to you.

Status anxiety is as old as Mark Zuckerberg. The School of Life's founder, Alain de Botton, wrote a book all about it and coined the term in 2004. And there have been others like Oliver James's Affluenza too. Even the London riots were blamed on this growing desire, not to mention a gaping gap in wealth, to have things that we can't have.

So it's all the more surprising that people (especially advertisers of flashy mobile phones) talk about social media with words like 'connections' and 'communities'. You'd imagine that Facebook (and social media sites like it) are a wonderful utopia where people share ideas and are supportive of each other. Some of that does happen, of course, just look at the response to the London riots. But a good portion of Facebook's walls are still plastered with a montage of our best bits. A tightly managed, airbrushed version of what we want people to think of us. We're all in public relations now, whether you're updating your CV on LinkedIn or seeing who can make the funniest jokes about X Factor. And like those celebrities on the covers of gossipy magazines, it's hard not to be left feeling a bit empty by all this online one-upmanship.

The other day we were talking to the  artist Grayson Perry (there’s a status update for our non-existent Facebook page) about status update anxiety. He dreamt up a brilliant antidote to it: Arsebook, a socially-dysfunctional, alienating site where we share all the crappy misfortunes and bad things that happen to us. One-downmanship, perhaps...

Rob's fingernail broke.
Molly's fingernails fell off. All of them.
Rob broke his leg.
Molly broke both her legs.
Rob's hair went grey overnight.
Molly's head fell off.
Rob's only got one friend (and her head fell off).

Rob Mitchell and Molly Mackey are running our Words for Life class this Saturday (and in December).
They'll be tackling all the wordy things you're never taught to write: CVs, dating profiles, complaint letters, and yes, Twitter updates.

Utopiascope

A string of articles that share a startling pair of words have appeared in the press recently: 'Capitalism' and 'Failed'. Communism, of course, is a word we easily associate with the word failure. Our gut reaction to the prospect of communism is similar to that that we might have to an over-enthusiastic choir leader rushing into the street and calling on us to spontaneously fall into perfect song. The result will, of course, be atonal, and we can rightly accuse the choir leader of having no understanding of human nature.

Capitalism on the other hand is more often presented as holding up a mirror to human nature. As Guy Sorman has written, “the free market is finally only the reflection of human nature, itself hardly perfectible.” Human nature can certainly be flawed, but it cannot fail -- it isn't a system that we artificially impose, we don’t have an assortment of other options. To say that something is in our nature is essentially to say that it's our base condition, our lot in life.

So, if capitalism can fail, then far from being in our nature, it follows that it is instead an ideological system that requires belief on our part. We may have thought that we were behaving as perfect cynics, ruled by our instincts, but in fact we were closet idealists. If capitalism has failed, then it means it never was in our nature. And that leaves us with a daunting and terrifying question: if the secret to economic and social harmony lies in living according to our nature, how do we routinely fail to live according to our nature?

Far from being fated to live by instinct, as sceptics or as cynics, it would appear that we are fated to live as idealists, dreaming and designing a new society just as our current model begins to reach its limitations. There is no perfect political system, but instead humans are involved in a process of imagination named utopia in order to uncover the values that they use to develop their political and economic systems. Human society runs into trouble when this process of imagination is discouraged and labelled avoidable.

Over the next few weeks, meandering through the philosophy of Walt Disney, le Corbusier, Plato, Orwell, Borges, and Ayn Rand, I will endeavor to show how our concepts of love, happiness, community, work, death, sex and family change shape as they pass from the hands of different social architects. Odds are that we won't find a single utopia that we would like to call home; but in visiting them, we may find the perfect therapy for a society that is undergoing great upheaval and change.

John Lidwell-Durnin is a writer and regular contributor to The School of Life.

Robert Wringham on Collecting Data About Ourselves

I sometimes fantasize about a rather square afterlife: a dataporn epilogue in which we're given a wealth of terminal data about our lives. It’s a kind of existential debriefing.

Sometimes I visualise this afterlife as an austere 1970s science lab, with ranges of analogue counting wheels, each halted eternally at their final numbers. Other times I imagine it as a live TV event: an enthusiastic presenter delivers a piece-to-camera from the top of Telecom Tower, finger pressed to her earpiece and declaring that, “Yes, the results are in!”

In this great auditing house in the sky, every metric is recorded: the number of times we went to the bathroom, the number of hours we slept, the number of good or bad decisions made, the number of moral victories or ethical betrayals.

Some of the metrics won’t really matter. Number of blinks or heartbeats are beyond my control and do not mean much either way. But some of the metrics in this Valhalla databank will be causes of pride or shame.

A statistic for which I—the editor of New Escapologist, a magazine about the exercise of free will (whether imagined or actual)—would take pride in being high would be number of days of freedom. Every day spent living freely is a victory. If the celestial auditors are indeed watching, I hope they’re able to record that the total number of these victories outweighs the number of days spent serving forces other than my moral will.

A statistic I would like to keep low is "Number of intentions unrealised". It’s very acceptable to abandon something deliberately, or to reform a plan partway through. But there's nothing more shameful than when a plan falls to the wayside, is forgotten about, or is simply never taken seriously as a possibility.

Alas, there is probably no afterlife and we’ll never be given such a cache of perfect data (and if we are, it’ll be largely pointless once our lives are over). If we want to collect data about our living patterns, we must simply resolve to document more. A longhand journal will provide qualitative data. A tally against certain metrics will provide the quantitative. At the end of a given period, we can analyse the data we've gathered; draw conclusions, make predictions, and make changes to our habits.

To measure my “unrealised intentions” and to keep this statistic small, I have started maintaining a “Maybe Someday” list. Any ideas I have, whether big or small, go onto this list. I will later incorporate them into my plans or decisively obliterate them from my ambitions once and for all.

I’m also trying to reconnect with things I enjoyed in childhood: dinosaurs, chemistry, puppets, astronomy, fossils, wildlife. Maybe this way I can identify some early ambitions never acted upon, and have them scored from my shameful tally of forgotten plans.

There is something vaguely perverse about analyzing such water under the bridge. It’s like making notches on a bedpost, or examining the fresh contents of a handkerchief. But so what? A toilet that analyses one's poop for nutritional excesses and deficiencies would be a wonderful thing. There's no such thing as "TMI" when making changes to our lives is concerned.

So what data would you record? What would you like to change?

**

Robert Wringham is a humourist, travelling performer, and the editor of New Escapologist: a magazine that celebrates 'flight' over 'fight'. The sixth issue of this publication is now available, as well as a growing wealth of related online content at www.newescapologist.co.uk

NOWNESS interview Geoff Dyer on America

The cultural observations in eclectic author Geoff Dyer's recent freewheeling speech debunking Anglo-American stereotypes at London's School of Life are captured in these illustrations by Paris Vs New York's Vahram Muratyan. In a typically irreverent sermon straddling literature, comedy, etiquette and language, Dyer combined his encyclopedic knowledge with witty digressions into high and low culture. The author of four novels of genre-defying fiction, including Paris Trance and the savagely comic Jeff in Venice, Death in Varanasi, which traces a disaffected journalist's cocaine-fueled trip through the Venice Biennale, Dyer has also written discerning essays on everything from photography and haute couture to donuts and Andrei Tarkovsky. The writer told NOWNESS: “There's a great essay by D.H. Lawrence where he ends up in New Mexico and says, ‘something in my heart expanded’—I get that when I see the American West, the sense of endless possibilities.” Here the reluctantly London-based Dyer muses on the best aspects of life on the other side of the pond.

Unfulfilled dream
My life is a total failure because of my failure to live in San Francisco. To me San Francisco is where that project which I think of as being American—combining individual freedom with civic responsibility—has been taken to some sort of furthest point. It really is like experiencing what life is like a few rungs higher up the evolutionary ladder. 

American literature
I got turned on to reading contemporary fiction through American writers. Salinger, Kerouac, and Joseph Heller: On the Road, The Catcher in the Rye and Catch 22. There's been something about that American voice, the demotic richness of American language that is not at all class-bound, and is so varied. 

Walker Evans
Walker Evans really established the paradigm of how America looks. From an early age you're so exposed to America in films and television, that there's this weird thing that happens when you go there: it seems so different to England but at the same time exactly like you've always pictured it. When we see pictures of old American towns, or old American cars, I wonder, did it always look nice? Or did we start to think it was nice because Walker Evans photographed it? 

Comedy central
One of the ways we console ourselves with living in England is that we like to say Americans have no sense of irony. There's a beautiful irony in that comment because America is the country that has produced Woody Allen, Seinfeld and Larry Sanders, some of the great ironists of our time. I find Don DeLillo screamingly funny. The irony is raised to such a level that is seems both sincere and funny at the same time.

Service culture
Americans are friendly. It's not just friendliness, it is some sort of daily manifestation of American democratic principles. The first time I heard the expression "You're welcome" was in America. I really noticed the transaction being wrapped up in a nice social exchange. You can't help but notice the way that social ripples––friendly, American ripples––extend way beyond the immediate interaction that created them. I'd go for that “have a nice day” superficial friendliness over deep-seated English hostility any day of the week.

Read the interview with some fabulous illustrations by Vahram Muratyan at NOWNESS.COM

Our next sermon will be Professor of Space Exploration, Lawrence Krauss on 16 October 2011. For tickets and more details, click here.

 Photos ©Stephanie Wolff 

Life is not a Rom Com: Finding a Partner in the Real World

What is love supposed to be like? How will we know when we meet our ‘perfect’ partner?

Hollywood, in the form of romcoms, has given us very strange ideas about what is appropriate when it comes to meeting and mating with potential partners. The rules which they whimsically lay out for us, through the vehicles of overconfident men and spineless, dithering women, would end up in disaster if applied in real life. For the record, for most non-sociopathic men, if you say you’re not interested, he is going to believe you; don’t be surprised if he actually leaves you alone, rather than showing up outside your bedroom window with a boom box!

When we are looking for happy, compatible, long-term matches, we don’t tend to meet them the way they do in romcoms, whether it is someone whom we have made bets with our friends about, have pretended to have kids in order to meet, or have been found by our 8 yr. old son from a call in radio show.

In this blog, I will discuss two, of the nine important steps, from my course, ‘Finding a Perfect Partner.’ Two important factors to consider when searching for well-suited matches are commonality and proximity. 

Commonality is critical in our quest to find a partner. While the well-known saying, ‘opposites attract’ is an old favourite, is it actually true? Probably, not. Instead, it should be ‘attraction increases as similarity between partners increases’. People tend to be attracted to people who are similar to themselves.^[1] It is even advantageous to the relationship that our partner also enjoys seven-course tasting menus at poncy French restaurants, or would rather sing karaoke than go to a jazz club. By them sharing similar outlooks and interests, it helps to legitimise our preferences. It also increases the ‘we are on the same wave-length’ appeal or, if you are a die-hard romantic, the ‘soul-mate’ ideology.

Proximity is also important when finding a good match, because when we are near these ‘like-minded’ people, the number of interactions we could have with them increases. Another benefit from frequent sightings of the cutie in red, is that we will like him or her more. Research has shown that we prefer people whom we see more often, even if they are strangers. This is called the ‘mere exposure effect’^[2]

So, while commonality and proximity are important factors, the ideal is when they overlap. We often find people whom we have things in common with are already in our immediate proximity. They are sitting at the table next to us at our favorite restaurant, they are doing a downward facing dog in the row behind us at our local yoga studio, and they are in the same queue while buying vegetables at the neighborhood Saturday market. Open your eyes, the people whom you are well-matched with, are doing the same things that you’re doing, and most likely, in your proximity. Your own neighborhood is the best place to begin your search. So this weekend, I recommend sitting outside your favourite cafe: when looking for love, you need to see and be seen!

Jean Smith is a cultural and social anthropologist – an international expert in human attraction, body language and how we flirt with one another.  She will be leading 'How To Find the Perfect Partner' on 27 September and 7 November at The School of Life.  For more details and to book, click here.

 

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^[1] Byrne, D. (1971). The attraction paradigm. New York: Academic Press.

^[2] Zajonc, R. B. (1968). Attitudinal effects of mere exposure. Journal of Personality and Social Psychology, 9, 1-27.

Dr Mark Taubert on How To Think About Death

“Where was it?” said he to himself. “Where was it that I read of a condemned man who, at the hour of death, says or thinks that if the alternative were offered to him of existing somewhere, on a height of rock or some narrow elevation, where only his two feet could stand, and round him the ocean, perpetual gloom, perpetual solitude, perpetual storm, to remain there standing on a yard of surface for a lifetime, a thousand years eternity! – rather would he live thus than die at once. Only live, live, live! No matter how, only live!”  - Raskolnikoff in Dostoevsky’s Crime and Punishment

This particular passage in the novel 'Crime and Punishment' captures perfectly that very chilling fear of death. I sometimes think of it when I see people as part of my work as a palliative care doctor. What must it be like to know that time may be short, that death is close and to live with this notion day-in, day-out?

I work in a hospice. At the time of writing this, I have finished seeing fifteen people on my ward round. Of these, some may have years to live, others months, some only weeks or days. We work to try and address a lot of the symptoms people can get when their illness advances. But we would not be doing our jobs well if physical symptoms were all we dealt with. There is a whole person here, with often a whole host of other people around them and they are of course frightened, have a lot of baggage and have questions upon questions. “How long have I got left to live, Doc?”. Our team have to address this very common and reasonable question daily. Rarely is it phrased that clearly or said in quite that straightforward a way, and unpicking what someone is really asking requires skill and time.

For many reasons it is a difficult question to answer. Every illness is different, although it may be called by the same name. Every individual is different. Every treatment has the potential to have a different response. Add in the newspapers that will inform of a new miracle cure on their front pages about once a week and you have more questions and sometimes dashed hopes. The truth is that no one really knows the right answer, no one is perfect at predicting the outcomes of a terminal illness other than to say that it is likely to lead to death at some point in time. If I personally were to find myself in a similar situation, as a patient or as a carer, I would ask exactly the same searching questions of whichever professional I was seeing. It is a natural thing to want to know. And it is not uncommon to discover that there is another, underlying question to the one above. Often the real question is "Are you someone who will listen to me and who will be frank and honest- when I am ready?".

How important this supportive communication is, was highlighted by a nurse who was dying of breast cancer. Days before her death she wrote: “There are so many questions, concerns and problems to face in the lightening ball mirror. To overcome the sense of powerlessness the traveller runs through a maze seeking someone who might actually listen to their pleas for help, someone who actually knows that the traveller is there.” (Bushkin E. 'Signposts of survivorship' Onol. Nurs Forum, 22(3), 537-43 1995).

Death is a certainty and we know it is inevitable. But some events in life bring it into much closer focus. The death of a friend or loved one, or being told you have a terminal illness, are just some examples. Health professionals can rely on the latest scans and blood tests to tell us what is happening within someone’s body at a given moment in time. Add to that some intuition, as well as past experience with similar pathologies and we might hazard a guess. Weeks, perhaps, days, not months? We are often inaccurate in our predictions, as research has shown. But what we can do is listen, discuss and maybe help the person to achieve what is important to them in whatever time they have left.

I try to explore what people are most frightened of: dying or death itself. The process of dying is for some the most distressing thought. Will there be suffering, pain, agitation, breathlessness? Then there is the perceived loss of control in those final hours or days. For a few, even the final years seem unbearable, knowing that the illness will catch up with them eventually. How futile an existence that must end soon! Then there are those with the overwhelming fear of death itself as a construct, that sheer panic when someone realizes that their essence, their being, their self will at one point no longer be there. Void? Nothingness? What? Yet again these are issues that need to be explored in the context of an individual and the people closest to those in this terrifying situation. And talking about it openly helps.

Let me join other writers on this site by inserting a quote from someone famous; Bob Dylan said “Those not busy being born are busy dying.” This wisdom in part depends on your outlook on life. Here in the hospice, we meet a broad spectrum of people who know they will die at some point in the not too distant future. Of course, they all have different outlooks and personalities. Some spend the last days/weeks/months/years of their lives focussing on living, some on dying. Most do a little bit of both. What makes me most happy is to see those people who know they are living with dying be able to lapse into moments of fulfilment and contentedness; to this effect we try to help fulfil some of their wishes, some of the things that make life worth living. Pain-free time with loved ones, enjoying a meal without feeling nauseated, organizing a trip or even just going back to their local pub for a drink or two are some examples of what we can try to achieve. Some think of hospices as dark and miserable places, but only yesterday I arrived on the ward and there was laughter, a patient leaning over the nurses station and telling staff and fellow-patients a joke (it was rude). No one was thinking about dying.

Sometimes, open discussions about what happens at the end can help people prepare, and they can address questions like where they would like to be in the final days and hours and with whom. Hopefully this collaborative approach means that less of us will feel like Dostoevsky’s afore-mentioned condemned man on his rock, but can prepare for death, with support, comfort and knowledge about what may happen, by living, not dying to the end.

Dr Mark Taubert  - Consultant in Palliative Medicine, Marie Curie Centre Penarth, Cardiff, Wales

Limited tickets are still available for the 'How To Think About Death' class on Wednesday September 26 at The School of Life, Russell Square. Click here for more details

Geoff Dyer on Our Fear of Conversation

For a while, on flights back across the Atlantic from America to Euroland,  we are under the spell  of America. Instead of plonking ourselves down next to someone without a word  we  say, “Hi.”  Maybe even indulge in a little conversation, though this American readiness to chat is counterbalanced by the fear that once we’ve got into a conversation we might not be able to extricate ourselves from it. By the time we’re mid-ocean a kind of preparatory freeze has set in.  As the flight stacks up in the inevitable holding pattern over Heathrow we begin to revert to our muttering and moaning national selves.  But, for a week or so after landing, a form of what might be called Ameristalgia makes us conscious  of a rudeness in British life - a coarsening in the texture of daily life - that had hitherto seemed quite normal. 

Geoff Dyer is author of several novels including the recently published collection of essays ‘Working the Room’ and the wonderfully titled: ‘Yoga for People Who Can’t Be Bothered To Do It’. http://geoffdyer.com/

Join us for the first of our autumn sermons on Sunday 18 September that will challenge our engrained ‘British’ ways of approaching life. For further details about this and the rest of the autumn series, click here.

Image: Ryan Bartaby at YCN