The Inner Life of the Dying Person, by Dr. Allan Kellehear, is just what the title describes, a depiction of the internal movements of individuals facing death.
Dr. Kellehear’s range of subjects vary from patients living with a terminal illness, prison inmates facing execution, shipwrecked castaways and those who have lived and died in death camps. Not only do his subjects vary in circumstances but also in their cultural and historical contexts.
Dr. Allan Kellehear is a sociologist. Within his scientific lens he is both compassionate and brightly entertaining. He sensitively outlines personal accounts of individuals facing death and organizes these into a recognizable patterns. He also pokes holes at how we have chosen to view death and dying in our culture today. His view is clearly beyond medicine or religion.
He begins his book of ideas with a comparison between humans and all other multicellular organisms, illustrating how we and all other organisms run from death. He explains that all organisms live with a two-response fight-or-flight strategy in respond to threat (death), which actually evolves into at least five or six responses: freeze, flight, fight, and then feign or fright. 1. His outline gives you a chance to get a little closer to yourself, seeing your own patterns.
It is interesting to note that Dr. Kellehear nowhere mentions the trending term, death denying culture, as it appears in his biological reference we are simply behaving naturally.
He concludes within his first chapter, “Fear and defense are positive experiences for organisms threatened by death. Dying and death also play positive and purposeful roles for living in another way.” 2.
His research continues to outline through first-hand accounts of individuals facing death what they struggle with and go through and how their new reality of dying changes them. The majority of his research points to positive outcomes.
“Dying is life affirming in that it forces them to examine again how life is or is not working for them. . . . The multiple core experiences of dying also function as life-building processes." 3.
His approach is academic in that he allows his subjects to be just what they are, the voice of the dying, and avoids as best he can, making assumptions about the inner experience.
“The exact shape of these [early] reactions, however, and the emergence of other subsequent reactions are best understood as dependent on our perceived distance to the threat of death. This explains the common divergence of reactions found between victim and bystander, or patient and caregiver, or by early responses to death by dying people and their later responses. This is why we must stay close to the voices and testimony of the dying themselves in any serious examination of the dying person.” 4.
He has created chapters for the voices of those expressing: Suffering, Fear, Courage, Resistance, Sadness and Anger, Hope and Love, Waiting, Reminiscence-Remembering, Aloneness and Transformation.
In Chapter 2, Suffering, Kellehear quotes a man on death row,
“The first thing you notice when stepping inside any prison cell block is the putrid odor. All cell blocks smell, but they do not come close to death row. We all die a little bit each day on the row, and the odor accumulates and builds to an unbelievable level. There are 60 men in this cluster and we cannot escape the stink of fear, anger, rancid sweat, blood, stale urine, wasted semen, feces and flatulence. . . . Prisons are haunting . . . it is not hard to go crazy from the din. It invades and pollutes our minds. We decay and rot like unpicked fruit.” 5.
The breaking of this man’s spirit is not just for those whose fate takes them to prison.
John Diamond describes life with advanced cancer:
“Worse, though, was the depression. Every apparent step forward, every signpost on the way to possible recovery seemed to induce in me a massive despondency." 6.
The 4th Chapter, Fear, was full of surprises for me. Here Kellehear investigates the fear of death and deconstructs what we assume it to be is really much more various and wide open:
“If we accept the acedemic insight that fear of death is not a fear of the so-called unknown but a signature phrase for a set of our most deeply held personal fears at the end of life, . . . a final threat to their most deeply held and cherished values about their individual selves.” 7. “Their fear is focused on losing a cherished part of the self they did not want to give up--- ever.” 7.
In the 5th chapter, Resistance – Facing the Choices, Kellehear quotes surgeon Sherewin Nuland,
“We live today in an era not of the art of dying, but of the art of saving life.” Hospitals recognize the coming of death only so they can throw as many technological barriers against it as possible, no matter what the age, diagnosis or life expectancy of the patient. 8.
Kellehear does not use this quote to form a criticism on the state of our current medicalization of death, but rather broadens the comment to the various ways we have reshaped our futures throughout modern history by resisting the threat of death.
In chapter 7, Hope and Love – Connection, palliative care physician Derek Dole, muses:
“Friendships have become richer, love even deeper; differences have been resolved, old feuds forgotten, and enemies forgiven; faith has grown and meaning has been found for many of life’s mysteries. … Life reaching its climax, not in social or intellectual achievement or success, but in death!” 9.
Throughout his book Kellehear’s research points towards the highest peak of human experience. His subjects’ voices whether they speak of pain or beauty have a clarity that is astounding. Throughout his book, Kellehear combines the voices of the dying with sources of poetry and literature, using art to speak of universal pain, isolation, hope and inspiration.
Outside of any religious or spiritual explanations, Kellehear examines the doorway towards the mystery of death. He presents the accounts of visitations of predeceased relatives to the bedside of those dying with an open mind, while maintaining a scientific /academic viewpoint.
“No matter what we may eventually discover about the ultimate biological causes of such events and experiences, these visions do provide a strong, historically consistent, and culturally widespread source of personally transforming experiences that go to the heart of personal hope, companionship and transcendence of suffering.” 10.
The many and various accounts of creative and adaptive energy in the final liminal phase of human experience fascinated me. Dr. Kellehear’s research went wider than human to include all organisms:
“Despite many similarities and differences in how we and animals defend against threat, the conduct of dying humans mirrors the dying of all other organic life forms in one unshakable and unmistakable way: dying always seems to have a purpose that is surprisingly positive; it is commonly life affirming, life building and life enhancing.” 11.
Personally I am led towards spiritual healing type books. While Kellehear’s work endeavored to stay true to his science, I found it soberly validating from a spiritual perspective, that the energy that holds us all together is geared to rise above pain and isolation and that love and connectedness are the primary lasting effects of dying. I found it particularly refreshing that his research was not trying to fix, find or prove a problem. That in itself is healing. And what's more, though he was not out to prove it, his work clearly revealed that for most people dying is healing.
1. p. 3
2. p. 4
3. p. 212, 213
4. pp. 12, 13
6. p. 23
7. p. 49
8. p. 50
9. p. 119
10. p. 204
11. p. 13