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by Joan Halifax
Shambhala, 2008
Review by Jason Thompson on Nov 4th 2008

Being with Dying

Early in the pages of Being with Dying, Joan Halifax, a Zen Buddhist priest and former medical anthropologist with 30 years experience working with the dying, quotes a story from the Hindu epic the Mahabharata in which a wise king is asked, "What is the most wondrous thing in the world?" The king replies, "The most wondrous thing in the world is that all around us people can be dying and we don't believe it can happen to us."

Few of us can claim never to have experienced the terror expressed by Claudio in Shakespeare's Measure for Measure at the thought of human life's inescapable finitude:

The weariest and most loathed worldly life

That age, ache, penury and imprisonment

Can lay on nature is a paradise

To what we fear of death.

In The Denial of Death (The Free Press, 1973) Ernest Becker famously proposed "death denial" as a primary (though generally unconscious) shaping force in human behavior and the universal fear of death as the driving force of culture and religion. Subsequent researchers inspired by Becker's work, such as Sheldon Solomon, professor of psychology at Skidmore College, report empirical validation of hypotheses related to the "immortality systems" purportedly generated by this death denying instinct.

Halifax's work is a powerful, Buddhist-oriented addition to the growing recent body of literature suggesting that an alternative to denial (which may only serve to compound our fear of mortality) is to develop conscious strategies in the here-and-now that help us to see death on a continuum with the impermanent flux of life and thereby prepare us not only to accept death when it finally comes with greater equanimity but also to live more fully in the years, days or hours we have left. Her approach has some parallels with that of existentialist psychotherapist Irvin Yalom, who in Staring at the Sun  (Josey Bass, 2008) and previous works outlines the effectiveness of focusing on our interconnection with others, present moment awareness, and self-realization, in coping with the fear of death.

Halifax's principal contrast with Yalom's work is in the large set of practical meditative exercises, drawn from Buddhist tradition and her own teaching, which accompany each of her chapters' thematically organized reminiscences and reflections on different aspects of her work with people dying and grieving. Consistent with the non-proselytizing and experiential character of Buddhist thought, Halifax offers both the reflections and exercises in the spirit of a gift, to be utilized to the extent that the readers wishes to try them out and see what works.    

Her first question is therefore: how we do want to die, and what do we imagine as our "worst" and "best" possible deaths? Contemplating the way in which we will ideally end our life is of a piece with reassessing priorities in terms of how we choose to live right now: "We go through a lot to educate and train ourselves for a vocation…So now please ask yourself what you are doing to prepare for the possibility of a sane and gentle death." (Halifax, 8)

The book then moves through reflections and suggested meditative exercises related to impermanence; common cultural myths of the dying process such as the "good death" (and their contrast to the inevitably individual, and often messy, reality of death as it actually occurs); our relationship to pain; self-care for carers to minimize secondary trauma and the risk of burn-out; the psychological pitfalls of unconsciously adopting an archetypical helping role in relation to the dying such as hero, martyr, expert or priest; the centrality of forgiveness and reconciliation for the dying to establish closure on damaged relationships; the actual experience of moving from life to death according to  Buddhist meditative insights; care for the body after death; and help for the grieving.

Many of us fear dying alone. In reality, according to Halifax's several decades of work with people near death, the actual moment of death more often occurs when the family has left the room (perhaps because the dying person feels less "responsible"" to stay alive for his loved ones when they are not physically present at the bedside, Halifax speculates). But the deeper message of Being with Dying is that recognizing our radical interdependence with others --- that "no man is an island", to quote John Donne -- provides a potential path to a less fearful experience of death and a more joyful and compassionate life. This fearless and compassionate life is one in which we come to see our own apparently short, limited life as comparable to one of the jewels in the infinite net of jewels described in the Buddhist Avatamsaka Sutra (Halifax, 101). In this lovely image, each jewel reflects all of the other jewels, and is thus both reflective of infinity and constituted by an infinite network of relationships beyond itself: simultaneously universe and grain of sand. 

Western newcomers to Buddhist thought often find the concept of "rebirth" a major obstacle to fully embracing a code of ethical and meditative practices that appear to offer the potential of psychological and spiritual growth with little of the mythological or supernatural baggage of other major world religions. The idea makes more sense when contextualized by an understanding of the Buddhist conception of the illusory nature of the independent self, which distinguishes "rebirth" from the transmigration of the soul, since nothing can be literally reborn that never existed independently in the first place. In any case, Halifax astutely avoids such philosophical intricacies altogether in the interest of focusing the book on pragmatic questions applicable to people who care for the dying and the rest of us for whom mortality is sadly non-negotiable.

This practical emphasis is wise, partly because Sogyal Rinpoche's bestselling The Tibetan Book of Living and Dying (Harper San Francisco, 1992) -- and the prior Tibetan texts which inspired this work -- cover the "rebirth" material comprehensively, but mainly because the book's wide potential readership of doctors, nurses, hospice workers, therapists and counselors may find a relatively demythologized primer on the Buddhist approach to death and dying much more helpful and accessible than a text that presented a fuller and perhaps off-putting theological picture. That said, Halifax does provide a lucid meditative exercise based on the Tibetan description of the "dissolution of the elements" of body and mind during and after death (Halifax, 170-175), which in the absence of any other universally accepted evidence offers at minimum a plausible vision of what eventually might be in store for us. I'm happy to report that it's far more pleasant than the icy hell conjured in Claudio's imaginings:

You are bliss and clarity. Now the clear light of presence is liberated, the mother light of your awareness.

This is your ultimate great perfection.

This is the actual moment of your death.

© 2008 Jason Thompson

Jason Thompson teaches children with special needs in Oakland, California. He studies and practices Buddhism at San Francisco Zen Center and plans to train as a Buddhist hospital chaplain.