Word: weisman
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Dying people are surrounded by a "conspiracy of silence, denial and dissimulation" that dehumanizes them and increases instead of easing their psychological suffering. That is the conclusion of Harvard University Psychiatrist Avery Weisman, one of the experts in the rapidly growing science of thanatology-the study of death. In an effort to break that conspiracy, Weisman has written a perceptive book, On Dying and Denying (Behavioral Publications; $9.95), which he hopes will help human beings to face death "with clarity, equanimity and acceptance...
Because man "is frightened to death by the specter of death," he tries to pretend that it does not exist, at least not for him; in the subconscious mind, "it is other people who die." Studying 350 terminal patients, Weisman found that denial can take many forms. Often a gravely ill patient, alarmed at being in a hospital, may say, "My doctor wants to be sure I don't have anything serious." Sometimes a sick person, worried about his loss of weight, may go on a diet to have a reassuring reason for the loss...
...always knows the truth. Discouraging him from talking about it puts him under great strain. Even when his knowledge is unconscious, it is generally so close to the surface that the struggle to suppress it only compounds his anguish. When the struggle ends, the patient is "fortified, not undermined," Weisman says. He cites the case of a patient close to death who asked a hospital social worker how to find a nurse to look after her "when she went home." Because the patient had earlier talked freely about her death and her fear of dying, the social worker decided...
According to Weisman, psychological suffering cannot be relieved until physical pain has been eased. Yet doctors may refuse sufficient medication, sometimes on the ground that they fear addiction-a meaningless concern on the eve of death. Too little medication lets the doctor pretend, subconsciously, that the patient is not sick enough to die and may betray the doctor's unwillingness to admit to himself that he is not a "magic healer" who can save every patient...
Permitting patients to make such choices helps prevent despair, Weisman believes. Hope requires only a degree of autonomy, a "conviction that we can change the world a little bit." One way of supporting a sick person's autonomy is to let him refuse "heroic" treatments that demean him by causing him to suffer "without adding significant survival." Another way is to let a patient plan his own funeral if he wants to. He should also be allowed to talk about his grief at dying and the probable reactions of his survivors without being told that he is morbid. Lastly...