Psychological support at the last stage of life path of human. Илья Андреевич Басов
then the external frightening attributes appear in a more voluminous form, and not only as a "sign of trouble". Achieving such a level, of course, requires from a person the actualization of hermeneutic (internal) resources, the manifestation of the completeness of the "human" and their direction to the building of meanings, such work is an act of great human courage (and more than in youth or adulthood). As F. Petraka accurately said "old age is a time of exposing the meaning of all human goals, demonstrating their nobility or insignificance."20
"Pragmatic" classification of types of death
Further in our study, we will adhere to a less academic line21 of presentation (which does not mean less scientific value of the work) both because of some "absurdity" of attempts to pack the content of the sacrament of the last stage of a person's life path into the "dry" language of science, and in order to increase the practical applicability of labor, making it more "alive".
We can offer, let's say, two author's classifications of types of death with access to a certain empiricism, pragmatism:
1. Sudden, i.e. the one that a person does not expect, does not predict. For example, it can be a heart attack, a car accident, a "brick on the head". And here, from the perspective of the ongoing research, we can only say that "a wise person thinks about those things that a fool prefers not to think about (is afraid of)." Unpacking the thesis, one can gain an extremely important, essential understanding that a person does not really know whether he will live tomorrow, we only assume this and one day we make a mistake. Understanding the finiteness of our stay on earth gives both sadness (obvious, staying on consciousness) and joy (subconscious), liberation; as well as, when carrying out the work of comprehension, it gives concentration on what is really important and puts things more vain, perishable in their proper positions. In our vision, the essential, priority is the content of the noetic dimension: the products of understanding the experience gained and self-knowledge. Regarding the psychological support of relatives in case of sudden/unexpected death of a person, information is provided in the relevant section below.
2. Painful, accompanied primarily by physical suffering and pain. It is normal for a person (his "earthly" component) to try to avoid pain. So, few of us go to the dentist with joy, and more often they should go there when the tooth already hurts or in fear (prevention) of the expected pain. At the same time, it is the negative that potentially brings the greatest gifts of awareness and before escaping from pain and suffering, you need to touch it, enter it, understand what for (not why and for which) it came to you. But there are also levels of pain of such strength that it is simply not possible to remain conscious (most often these are neglected options that came to a person earlier in much weaker signals, to which he chose not to pay due attention22). History knows examples when person endured inhuman trials, so one general played chess with a friend while a doctor amputated his arm without anesthesia. However, most likely this is not about you and me, my dear reader, in any case, the author does not consider himself to be such titans.
3. Meaningful and not (in our opinion, this is a critically important aspect of death and dying). This is an option when a person has a premonition, is consciously preparing for death. At one of the meetings in the group, which "successfully coincided" (semantic synchrony) with Mother's Day, we worked out two of the four givens of I. Yalom's23 existence, one of which was death. The participants of the venerable age recalled how their grandparents passed away and the gap between the current attitude to dying and "that" was felt almost palpably. If "then" a person had a premonition that he would soon leave, then he lay down on the bed, gave the last orders, said the last, important words, said goodbye and left this world (and without any regrets from anyone, without fighting for life with the help of resuscitation, without "take the children away", with all understanding and respect for the moment); then "now" it is perceived as something extremely undesirable that needs to be hidden in the ground as soon as possible (like a cat who crawled under a rug and thinks that since he sees nothing, then he is not visible), and feelings and experiences remain misunderstood, unreacted (they try to comfort, not to be sad and to hear tears). Both "then" and now it is possible to observe different, diametrically opposite positions. For example, thoughtlessness ("well, it will be and it will be", "why think about the bad"), or on the contrary, like a samurai, to consider death a key moment of existence, which if you waste, then the whole life is reset, its value is leveled. Accordingly, the conditionally negative edge of the spectrum does not involve work on comprehension, it is rather an escape from the existential tasks of being and from oneself (efforts to forget). The opposite part of the spectrum requires a very significant inner work from a person, attention to himself in the noetic dimension, connection with what can be designated as the Soul. Here it is required not to run away from death and everything connected with it, but to consciously24 go to meet it – this is freedom, choice, courage, acceptance, understanding. You have drunk the cup of life, solved the tasks that it set for you, you have learned a thousand and one things; understood what needs to be understood in joy, understood what needs to be understood in sorrow, comprehended the beauty of loneliness and the beauty of meeting; necessity and non-necessity … now it remains to take the last step, it is inevitable, but everyone has freedom in what state to make it, in what depth of understanding – this is the most basic.
It is obvious that to a painful death or realized in a negative deviation from expectations (the picture that a person draws himself in his bright ideas: on satin sheets, surrounded by loving relatives and friends) somehow to take a wise position of accepting the last page is not an easy matter. But on the other hand, when a person feels good and tasty, he is very poorly disposed to deep insights. Therefore, any unfolding scenario is not unambiguously positive or negative. The dominant thing is what is inside – what position, attitude a person will choose for himself, how deep understanding he will be able to carry out.
Another classification of types of death, giving a different (but consonant with the above proposed) semantic and practical content of the topic under study, we can offer the following:
1. Physical. It would be a sin to lose sight of the bodily aspect, especially since it carries a rich resource. So, people who have even a few weeks of life at their disposal will be a great help (value) such a seemingly insignificant detail as the smell of homemade cookies, or the sight of a favorite flower in a pot on the bedside table, or pet a cat, eat a piece of some gastronomic delicacy, etc25. There are options when a person decides to do something what he always wanted to do; i.e., to have time to realize a desire that he postponed or considered impossible26. In such cases, medical contraindications are often a controversial point … what should you talk to a person about and support / understand / accept the choice that he will make.
2. Cognitive (popularly referred to as "vegetable").This is only the position of the author, but the work mentioned here in the boarding house showed that this is the saddest sight. When a person, for example, does not have hands or feet, or they do not exist, or he is completely dependent on outside care, but cognitive functions are preserved, then this is still half the trouble. But when the mind fades, and even if the body is fully functional at the same time, then this is a "pipe". Let's preserve, take care and appreciate the ability to think… and feel… and move. At the same time, if we look from the noetic dimension … we do not know what kind of experience and why the soul of such a person "ordered", but we can assume that this is happening, then for some reason it is necessary27.
3. Social. According to observations, people during a period of physical inferiority either lock themselves up (for example, because they do not want to be a burden) or plunge into "whining" (continuously describing how bad they are28), accusations29 (they say that they are not good, do not respect, do not appreciate the old man, do not care, do not cherish, do not pamper). That is, a person himself creates such an "aura" when being with him for any length of time is fraught with a nervous breakdown. We will
Quoted by Sapogova E.E. Existential psychology of adulthood. – M.: Sense, 2013, p. 723.
The materials are based on our publication: Basov I.A. Fundamentals of psychological support of the dying process (existential and holistic aspects) // Collection of articles of the II International Research Competition "ADVANCEDSCIENCE 2021". – pp. 72-76.
This is not an accusation! Just a direct result of a choice that you need to be able to see.
Yalom I. D. Existential psychotherapy. Moscow: Rimis, 2008.
Not on purpose, but consciously.
I remember a parable when a tiger chased a traveler, and he hung on a branch over a precipice. Above him is a tiger, and below are rocks. And so he saw a strawberry berry, plucked it and ate it … how delicious it was!
Like, for example, in the movie "Knockin’ On Heaven’s Door".
Just the other day (regarding the writing of these lines), our resident "faded away", we could directly see how it happened, because it lasted only a few hours – the fading of consciousness. She won't come to it anymore. I.e., the body is here, but the person, as we knew her, is no longer there.
And we don't question it.
And this we questioning much, hardly and mercilessly.