Lucretius and Philip Larkin Talk about Death

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I hadn’t read Philip Larkin’s stunning poem Aubade until Sissela Bok quoted it in her post about Seamus Heaney. I found Larkin’s evocation of the fear of death especially chilling. What terrifies him is a vision of nothingness, not any belief in an afterlife of torment:

The mind blanks at the glare.

Not in remorse…

But at the total emptiness for ever,

The sure extinction that we travel to

And shall be lost in always.

Not to be here,   

Not to be anywhere,

And soon; nothing more terrible, nothing more true.

The poet refuses to be talked out of his terror. He dismisses religion as “a vast moth-eaten musical brocade/Created to pretend we never die.” But he directs his strongest firepower against efforts to persuade us that fear of death is not rational:

And specious stuff that says No rational being

Can fear a thing it will not feel, not seeing

That this is what we fear—no sight, no sound,   

No touch or taste or smell, nothing to think with,   

Nothing to love or link with,

The anaesthetic from which none come round.

I’m not a literary scholar, but I’m guessing that Larkin’s “adversary” here is Lucretius. In book 3 of De Rerum Natura (On the nature of things) Lucretius makes a famous argument about why we should not fear death. Here’s John Dryden’s translation of the “specious stuff” that Larkin finds so unpersuasive in its effort “to pretend we never die”:

 WHAT has this Bugbear Death to frighten Man,

If Souls can die, as well as Bodies can?

For, as before our Birth we felt no Pain…

 So, when our mortal frame shall be disjoyn’d,

The lifeless Lump uncoupled from the mind,

From sense of grief and pain we shall be free;

We shall not feel, because we shall not Be.

And since the Man who Is not, feels not woe,

(For death exempts him and wards off the blow,

Which we, the living, only feel and bear)

What is there left for us in Death to fear?

Larkin and Lucretius are in a kind of dialogue about how we humans should contemplate death. Neither believes in an existence after death within which one might be punished or rewarded. Both envisage death as a blank nothingness. In relation to ourselves, when we’re dead we simply aren’t. There’s no “me.” But despite their fundamental agreement about what death is, they’re in utter opposition about how we should respond.

Their “dialogue” reminded me of experiences in my psychiatric practice. Sometimes when I applied cognitive therapy techniques, which involve challenging “faulty beliefs” that underlie depression and anxiety, patients railed against what they saw as arid intellectualization (“specious stuff”). Like a cognitive therapist, Lucretius is reasoning about death. He points out that since we’re not horrified by our non-existence before birth, why should we be horrified by non-existence after death? And given that there’s no post-mortem self to experience death, it makes no sense to be afraid. He’s making a logical “refutation” of our fear.

But fear isn’t a logical argument. Larkin doesn’t use logic to “refute” Lucretius. He escalates the horror that death evokes. For Larkin, emotion trumps reason. For Lucretius, reason trumps emotion.

In clinical work, there’s no surefire resolution of the conflict between reason and emotion. If Philip Larkin were a depressed patient, a skillful therapist might step back to explore the recalcitrant emotions, as by asking “what is most horrifying about no sensation/no thought/no love?” Sometimes a deeper understanding of the emotions ultimately alleviates the symptom(s) being worked on. A patient in a group I led, who suffered from chronic pain, put it this way: “The pain in my back hasn’t changed, but it causes much less suffering now.”

But sometimes no form of interaction is effective. That’s when “physical” interventions like medications may be crucial. In my own experience I had patients who, after taking antidepressant medication, said, “I don’t see the world differently than I did before, but it doesn’t make me depressed/anxious any more.”

For me the “dialogue” between Larkin and Lucretius supports the movement to use literature in health professional education. The two poets embody the alternative ways in which those who do not believe in an afterlife (according to a Pew Forum survey, 74% of U.S. adults do believe in life after death!) can think about death. If it fits into the curriculum for the medical ethics class I’ll teach again this spring, I’ll give the students Aubade and excerpts from Lucretius and ask them – who do you agree with, and why?

James Sabin, M.D., 74, is an organizer of Over 65, a clinical professor of population medicine and psychiatry at Harvard Medical School, and a Fellow of the Hastings Center.

 

14 Responses to “Lucretius and Philip Larkin Talk about Death”

  1. Carol Eblen

    If you could work up such a class, Dr. Sabin, wouldn’t you have to bar from your class the Christians, Jews, and all of those students of other faiths who might believe in a God of Retribution and/or a God who promises eternal afterlife, paradise, or heaven. Or, have all psychology students at Harvard generally declared themselves to be agnostics or atheists?

    I have always admired and envied my Christian friends who are devout in their faith and who really believe that they will see their loved ones again. Faith beyond reason and beyond any proof of the existence of God is in itself a blessing and reward for the true believer –whether or not what the person believes is true or not, isn’t it? True and abiding faith for the Christian in the Trinity does take away the fear of death, if not the grief over being separated from loved ones.

    But! would such a class lead to am honest discussion about the “fear of death” between agnostics and atheists when your students, I assume, who are young and not in any danger of death in the near future, could only engage in objective discussion of their fear of death because it is so agonizingly fearful for them to believe in the agony and reality of nothing more after death —- or because it is so irrational to be fearful about their belief in the reality of nothing after death –as long as in either instance, one does something “moral” with one’s life before death.

    I think of myself as a Christian but, of course, at 86, I still pray mostly for “faith” and I do think about death a lot these days because of a hard experience I had with a physician and hospital who for reasons of fiscal expediency must have deemed that my late husband was better off dead because they cooperated to place a covert unilateral DNR Code Status in his hospital chart.

    I believe, of course, that all mentally healthy human beings (no matter their age) have an instinctive fear of death when death is threatening and imminently in view. I believe that all human beings can be objective about their own deaths and other people’s deaths when these deaths are not imminent –And! yet! I believe that advanced directives, which The Hastings Canter promotes, are dangerous for elderly Medicare/Medicaid and the chronically disabled, when there are no procedural protections for these patients against those who will remove the autonomy of these patients to decide, themselves, whether or not they are better off dead.

    I have joined this Blog with the hope that the academics who specialize in bio ethics and health care policy will engage in discussion and/or investigation of my concerns about unilateral DNR code status that is misused to limit reimbursement for treatments to hospitals/physicians when these treatments are deemed to be over treatments, mistakes, errors, or the complications thereof.

    Thank you for the “poetry” treat. When I was very young and first thought about my “faith” and has my first doubts about my faith, and wondered how one could live without faith in God, I also had my first thoughts about death. I read Edna St. Vincent Millay’s “Renascence” and was amazed that this young girl could sum it up with “Ah, awful weight, Infinity –Passed down upon the finite, Me! Sometimes, I think I have never gotten beyond this!

    • James Sabin

      Dear Carol

      Thank you for your rich and thoughtful comment. I want to respond to two components.

      With regard to DNR Code status, I know from reading and from my hospitalist friends that physicians are concerned about the way dramas represent resuscitation as unfailingly restoring persons to full health. In some circumstances, the likelihood of resuscitation having a positive result is close to nil. But imposing a DNR order covertly would be unethical. If physicians believe that for reasons specific to an individual patient that DNR status is the most appropriate approach to the patient’s care, they should discuss that with the patient (if possible) and family and come to a mutually agreed upon plan.

      With regard to your questions about mixing believers and non-believers in class – in my experience the medical students I work with are wonderfully open to and interested in the varied perspectives within their group. We’ve been able to discuss emotion-laden topics in a spirit of respect and curiosity. Cultivating that capacity is probably at least as important in their development as any specific content learning.

      Best

      Jim

      • Carol Eblen

        Thank you for your kind response to my comments. I am pleased that you consider that covert and overt (default) unilateral DNR Code Status imposed by the hospitals/physicians is unethical —at least!

        I assume that you would consider the “unethical DNR” that is primarily a defense by the hospital/physician to non-reimbursement by CMS and the private insurers for any further indicated treatments –and not merely a matter of “compassion” and “medical futility” — to be not only unethical but also unlawful under existing Medicare law.

        Both EMTALA and the 1991 PSDA forbid discrimination against patients in emergency situations because they have no money or insurance and in situations in which the patient is hospitalized and hasn’t elected to shorten life to shorten suffering under the provisions of the 1991 PSDA.

        It is my belief that the hospitalists employed by the hospitals or on contract with the hospitals (a somewhat new arrangement)with whom you speak are a direct result of the over treatment of patients by treating specialists in both the outpatient and inpatient setting.

        The Hospitalists have the duty to have these “end of life” conversations or impose unilateral DNR Code Status to shorten life because so often the treating specialists have over treated elderly patients because they CAN and because they are reimbursed up to the DRG Cap for the treatment by Medicare and the private insurers.

        However, when Medicare and private insurance deems the treatment to be over treatment, or error, and there are expensive complications, Medicare denies reimbursement to the hospital and physician under reimbursement protocols passed in the last ten years. There is a conflict of interest for the Hospitalist who is an employee or an agent of the hospital when the patient’s care will not be reimbursed.

        Shouldn’t the bioethicists be warning Medicare patients and The Congress about this conflict of interest?
        .
        We cannot deny that over treatment of the elderly Medicare for profit has been a terrible problem for the government when we see the criminal fraud actions that The Department of Justice, together with HHS, have filed against Cancer Specialists just recently. .

  2. Sissela Bok

    I very much agree with James Sabin about the importance of using literature in health professional education and, indeed, in professional education more generally. One who has put literature to such use in magnificent ways is Robert Coles, in courses offered to medical student, law students, and others. I would also recommend OLD AGE: JOURNEY INTO SIMPLICITY by Helen M. Luke. Luke offers essays on “The Odyssey,” “The Tempest,” “King Lear,” and T. S. Eliot’s “Little Gidding” to illuminate questions about growing older and fearing death. It is also possible to find these essays on tape, read by Luke herself, in her eighties.

    • James Sabin

      Dear Sissela

      I agree that Robert Coles has pointed the way to using literature for teaching ethics in the broad sense of humane openness. And thank you for the reference to Helen Luke’s book. I’ve requested it from my local library and look forward to reading it. Finally, thank you again for introducing me to Philip Larkin’s wonderful poem!

      Best

      Jim

  3. Steve Moffic

    Thank you, Sissela, for mentioning the psychiatrist Robert Coles, whose work deserves a whole blog on its own. I just recommended his book on raising moral children to someone who wanted literature on how to improve child rearing in our society, so necessary to improve the future. And his series of books on the moral courage of children from different cultures are classics. All have lessons that the elderly can pass on to younger generations and, really, what the children can teach us elderly.

    -Steve Moffic

  4. Daniel Callahan

    A few decades ago there was great interest in “near-death experience,” said by those who returned to life after being pronounced dead to include lovely colors and sounds, an altogether fine experience. That interest gradually faded out as it dawned on people that those who supposedly return from death just had not, by definition, been dead. But then just a few years ago, I blacked out for a time and fell to the floor. It turned out that I had a heart problem requiring surgery. But what I most recall was the sense of pure nothingness while I was unconscious. I thought at the time that “if this is what it is like to be dead, then that’s not so bad after all.” A query: was what I experienced identical to what the dead experience? The only people who might be able to answer my question might be the dead–but they are not a talkative group.

    • James Sabin

      Hi Dan

      I remember Henry Aiken, my irreverent professor, reciting the following jingle when discussing the views of David Hume in a philosophy class:

      We’re like the pigs, who live in the clover,
      When we’re dead, we’re dead all over.

      At the time, I didn’t realize that the jingle was echoing the spirit of Lucretius.

      Best

      Jim

      • Steve Moffic

        Thanks for the humor and lightheartedness, but in all seriousness, the near death experience continues to be researched and written about. Probably the most popular for the public has been the neurosurgeon’s Eben Alexander’s Proof of Heaven. As many critics maintain, maybe Dr. Alexander does not prove anything and, even if he had the best intentions, may be a charlatan. Yet, other researchers like Melvin Morse, M.D.,an Associate Professor of Pediatrics at the University of Washington, has studied near-death experiences of children for 15 years and published quite a bit, including peer reviewed journals. He maintains that death related visions are a normal aspect of the human experience and may have healing aspects to them. More intriguingly and controversially, he talks about “the God Spot” in the right temporal area of the brain. If, and I underline IF, near death research helps us at least to not be so fearful of death, there may be substantial medical and financial ramifications.

        I say all this without being sure of my own beliefs on the subject and not wanting to support any sort of quackery.

        I can’t recall at the moment, but didn’t Shakespeare write somewhere that there is more to this world than we may be able to comprehend?

        Steve Moffic

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