Hide-and-seek with a two-year-old: further experiments in cognitive science

Playing hide-and-seek with small children is fun but also a chance to learn about how they learn. As we play with our grandaughter Betty, who is approaching two-and-a half, I think back on when we played with Alexander, who was three at the time. https://richardswsmith.wordpress.com/2018/01/28/hide-and-seek-with-a-three-year-old-an-experiment-in-cognitive-science/

There’s no doubt that children like playing hide-and-seek, but they like playing all games. It’s their work, how they learn. We’ve played with Betty before, so she instigates the game. “Play hide and seek. You go, Grandad.”

I hurtle into the front room and have almost no time to hide as Betty and Lin count to ten in the kitchen with hands over their eyes. “Ready or not, here we come.” The game has an element of mystery and can be scary. What if Grandad leaps out? What if we can’t find him at all?

As an adult you recognise that there’s almost nowhere to hide a man of nearly six foot in our front room, but that’s less clear to a two-year-old. Betty looks under cushions. I’m cheating slightly, hiding just outside a door. But Betty, with a little help from Lin, finds me.

“Betty do it,” she says. Lin and I count to ten and head off. Betty is sitting on a chair with a cushion in front of her that covers neither her face nor her legs. I’m sure that she thinks that she’s invisible.

“Granny do it.” Betty and I count, while Lin enters the front room. We follow her into the front room, and I can immediately see Lin, crouching behind the sofa and holding a book of paintings by Emile Nolde in front of her. Much of her is visible, but it takes Betty a goodly while to see her.

“Grandad do it. Betty do it. Granny do it.” We play the game many times. Small children love repetition, and Betty is enjoying herself. She does her lovely smile, but at the same time there’s tension, some suspense, some uncertainty, a job to be done. That’s what makes the game such fun.

I look forward to playing hide-and-seek with Marina, Thirza, and whomever may come thereafter.

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The struggle to create a new craft of dying: what is medicine’s role?

“Lyn Lofland’s The Craft of Dying (1978) is one of the most important books on post-WWII death and dying practices that almost no one has read,” writes John Troyer, director of the Centre for Death and Society at Bath University. He thinks that everybody interested in death and dying should read the book. I agree. Potentially that means that every human being should read the book—because who cannot be interested in death, arguably the most important thing about us. Plus The Craft of Dying is short, easily read, full of compelling stories, and constructs a clear argument.

“Death can neither be “believed” nor “magicked” nor “scienced” away,” writes Lofland in her first line. But we can’t stop ourselves from thinking about it: “Everywhere and always humans think about it and develop beliefs regarding it and produce emotions toward it and do things relative to it. What they think, believe, feel, and do is, of course, variant. But that they think, believe, feel, and do is a universal.”

Every culture has developed beliefs and customs around death, but human death, argues Lofland, has changed dramatically in the past 60 years. Until that time people died mostly of infectious disease and injuries. The period of dying was short, and it was clear when people were dead. Medicine had little to offer. Now people die mostly of chronic disease, and the length of dying is long. Death is not easily defined, and doctors have much to offer, including long-term ventilation, heroic operations, and drugs, some of them extremely expensive.

“In the past few decades, medical science has rendered obsolete centuries of experience, tradition, and language about our mortality, and created a new difficulty for mankind: how to die,” writes Atul Gawande in Being Mortal, published in 2014. Lofland wrote something similar in 1978: “There exists currently no widely accepted, fully articulated, well-integrated dogma that gives “being dying” its meaning or its place in the larger scheme of things.”

A cultural vacuum has been created, and inevitably attempts are underway to fill the vacuum. We have entered a new age of what Lofland calls “thanatalogical chic”: in the contemporary cliché “death is the new black.” We have to decide how to die, where to die, how to dispose of the dead, how to mourn, and, most difficult of all, what death means.

One response has been what Lofland teasingly calls “the Happy Death Movement.” It is an inchoate social movement with many practitioners, strands, and different views, but Lofland sees patterns that were emerging in the 70s and are still emerging.

Firstly, a social movement needs an enemy, and the enemy of the Happy Death Movement is death denial, death as the great taboo. Lofland defines the enemy: ”America is a death-denying society…death is a taboo topic…death makes Americans uncomfortable so they run from …death is hidden in America because Americans deny it….” For America, Lofland’s home, we could substitute any high-income country—or even any high-income group within a poor country. “The consequences of all this denial and repression are,” continues Lofland, “asserted to be quite terrible: exorbitant funeral costs and barbaric funeral practices, inhumane handling of dying in hospitals, ostracism of the dying from the living, inauthentic communication with the fatally ill, an unrealistic, mechanical, non-organic view of life, and so forth.”

Lofland is dismissive of the idea of death as taboo: “One might consider it somewhat odd that the statement that death is a taboo topic in America should continue to be asserted in the face of nearly a decade of non-stop talking on the subject.” Talk, writing, and storytelling about death has continued unabated ever since and probably increased. It is probably fair to say, however, that there is much less familiarity with the experience of death: dying people, the signs of death being close, dead bodies, and the disposal of the dead.

A social movement also needs something to shoot for, and for the Happy Death Movement it’s some form of idealised premodern death, with the dying person at home surrounded by loved ones and calmly bidding them goodbye. Lofland is dismissive of this as well, including in her book stories of the dying being buried alive (in Samoa) and ignored while families party (in Tahiti).

As you would expect, the attempts to create new behaviours and beliefs around death reflect broader cultural trends, which Lofland identifies in the United States as “ ‘humanistic-counterculture’ denouncement of modern society in general, which denouncement emphasizes the Western world’s dehumanizing, unemotional, technologically dominated, inauthentic, and constricted character.” That cultural trend is alive and flourishing in most Western societies. “Why not,” asks Lofland, “with Carl Jung, speak of “the achievement of death” and view dying as the final creative task of our lives?” A director of spiritual services (what used to be called a chaplain) I met recently in a hospice told me of the tremendous pressure on people to have a “good death.” This immediately evoked for me the pressure on mothers to have a “good” or “natural” birth.

Emphasising that the Happy Death Movement is still forming, Lofland identifies how the movement will make dying better. Firstly, it’s essential to talk about it. For example, the Order of the Good Death, an organisation founded by a Californian mortician, has eight tenets—and three of them concern talking about death http://www.orderofthegooddeath.com/:

“2. I believe that the culture of silence around death should be broken through discussion, gatherings, art, innovation, and scholarship.

3. I believe that talking about and engaging with my inevitable death is not morbid, but displays a natural curiosity about the human condition.
4. I believe that my family and friends should know my end-of-life wishes, and that I should have the necessary paperwork to back-up those wishes.”

Secondly, death must be rearranged, moved from hospital to hospices and the home. Death in hospital is failure. Thirdly, we must legislate death with advanced decisions and assisted dying.

Lofland also identifies emerging components of the new craft of dying. Expressivity is essential, but it’s also important to not just embrace death but to celebrate it. (I’ve done this with my talk, delivered once at the Edinburgh Festival, “Death: the upside.”) Finally—and for me surprisingly—the Happy Death Movement wants us to believe in immortality. Lofland describes how Elisabeth Kübler-Ross, who might be called the doyen of the Happy Death Movement and whose hugely influential book On Death and Dying proposed in 1969 the five stages of grief (denial, anger, bargaining, depression, and acceptance), came to believe in immortality. The pursuit of immortality, long a dream and arguably the unique selling point of Christianity, now attracts serious people and serious money. https://richardswsmith.wordpress.com/2019/09/23/the-pursuit-of-immortality/

The other two components of the emerging craft of dying are expressivity and positivity. Talk and write about your dying and coming death and celebrate your coming death and the death of those you love. New rituals will be needed, and some like “living funerals” are beginning.

Lofland is a sociologist, an academic, an observer, but you feel that she is not in fully sympathy with the Happy Death Movement. Indeed, she conjures the idea of a Dismal Death Movement to counter the Happy Death Movement: “If expressivity comes to be widely accepted as the only way to achieve a decent death, the emotionally reticent will find themselves under great pressure to “share.” If the idea that death and dying provide new opportunities for self-improvement becomes common currency, the chronic under achiever will find himself facing one more opportunity for failure. Not “getting off” on death may become as déclassé as sexual unresponsiveness. Then perhaps, a “dismal death” movement will rise to wipe the smile from the face of death and restore the “Grim Reaper” to his historic place of honor.”

There is a little about medicine and health care in Lofland’s book, and nor does the Order of the Good Death have much to say on the subject. But I wonder how much medicine and health care—gigantic, well-funded enterprises—might come to fill the need for new ways to die. Ivan Illich certainly argued that that was the case in his book Limits to Medicine, published at about the same time as Lofland’s book. Death “is now that point at which the human organism refuses any further input of treatment…Health, or the autonomous power to cope, has been expropriated down to the last breath. Technical death has won its victory over dying. Mechanical death has conquered and destroyed all other deaths.” Indeed, it is by taking on death that “health care has become a monolithic world religion.”

All those who read Lofland’s book agree that it could have been published in 2018 not 1978 and be equally relevant. The struggle to create a new craft of dying is far from over, and those of us in medicine and heath care have a particular responsibility to think and act on medicine’s role in the struggle. Almost certainly its role should be smaller.

You can read other quotes I took from the book on the website of the Lancet Commission on the Value of Death: https://commissiononthevalueofdeath.wordpress.com/2019/10/02/extracts-from-the-craft-of-dying-by-lyn-h-lofland/

 

 

 

 

 

The Ravenstonedale and Smardale Walk in sunshine

The weather forecast was for rain every one of the three days we were in Ravenstonedale, but no rain fell on Saturday and the sun shone. The taxi-driver, who used to drive “the wagons,” told us he had no confidence in the weather forecast. Perhaps still in the rain shadow of the Lake District and cowering beneath the Pennines, Ravenstonedale has its own microclimate.

We set off to do the Ravenstonedale and Smardale Walk, which I had found on the web and strongly recommend to everybody. https://edenriverstrust.org.uk/things-to-do/ravenstonedale-and-smardale-walk/ Indeed, I’d say two nights in the Black Swan, with its superb food, and the walk would be a treat for anybody—and could be combined with a ride on the Settle to Carlisle Railway, a treat in itself.

Ideally Chicken would walk three miles on road, and I would walk seven to eight miles across country. By luck rather than good judgement the Ravenstonedale and Smardale Walk fitted the bill exactly. We could walk South together along very quiet roads, looping back to the hotel, and then I could do the four miles to the North across country.

We were out of the village in seconds with the high empty moors to our right and even higher and emptier moors ahead of us. It’s as well that we were on the road because the fields were waterlogged after yesterday’s heavy rain. We passed Piper’s Hole, where supposedly an injured Jacobite abandoned in Bonnie Prince Charlie’s retreat in 1745 had defiantly played his bagpipes until cut down. Now the farm makes excellent goat’s cheese. Later we saw Lockholme Hall, the home of the Fothergills, the most famous of whom, Eleanor Fothergill, helped a wounded soldier in the Monmouth Rebellion, only to be betrayed by him and executed. (“She was a bitch,” a descendant told us later.) Death seemed to be the theme of this first part of the walk despite the sun and freshness of the air.

Halfway through the first half of the walk we came to the Fat Lamb and went in for two undrinkable coffees. The bashed, grubby, fading pub is a stark contrast to the flourishing Black Swan. The proprietors of pubs like the Fat Lamb must either invest wisely or slowly die. Most have no money to invest, and even if they did they face a great risk in being able to create something that will attract and keep the fickle public.

The road back was even quieter, not a single car passed us. This was just as well as the muddy road with grass down the middle (always a sign of minimal traffic) was so narrow that a car could not have passed us. We descended into Ravenstonedale and separated, Chicken to talk to the owner of a gallery for an hour and me to press onto Smardale Viaduct.

It was good to feel grass under my feet and soon I was striding across a field with a view of Smardale Bridge beneath me. We crossed the bridge when walking the Coast to Coast, and I remember with great pleasure the early morning walk on my own from Ravenstonedale to Kirkby Stephen. I can still hear the curlews. https://richardswsmith.wordpress.com/2019/05/28/coast-to-coast-day-seven-alone-to-kirkby-stephen-up-nine-standards-across-high-and-featureless-moor-tea-with-the-children-of-the-yorkshire-shepherdess-and-so-to-swaledale/

This time instead of climbing the hill towards Kirby Stephen I climbed a stile and headed towards the disused viaduct. I looked down on the fast flowing Scandal Beck and felt like a king. So far we hadn’t passed a single person on our walk, but now I met an Irish woman going the other way. She told me that the walk over the viaduct was supposedly closed because of work being needed on the unsafe railings. She had ignored the warning, and I decided to do the same.

Coming close to the far end of the viaduct I passed a family group of about 20 Indians and reflected how I’d heard on the radio that the National Parks want to encourage more visits from ethnic minorities. I climbed onto the viaduct and was soon over it, reaching the abandoned limestone kilns. This is an industrial landscape rendered beautiful by time, abandonment, and weather. Once dozens, perhaps hundreds. of men would have worked here, and an enormous amount of labour—and probably some deaths and injuries—would have gone into building the high viaduct.

After a while I left the railway track and descended again to Smardale Bridge. After crossing another stile I walked upwards across a field, admiring the ridges known as Giants’ Graves. In fact they are artificial rabbit warrens built by monks in the middle ages to ensure a supply of fresh meat. I soon descend again to the banks of the beck, which is in full spate. Anybody falling in would be swept away, knocked unconscious, and drowned. I pass a flock of sheep, who seem to be waiting for something—I know not. Soon I’m walking back up the hill to the Black Swan for a half-pint, sandwich, bath, and a read. A fine walk that I hope one day to repeat.

A soaking walk in which I fail to reach the top of Green Fell

My walk begins in heavy rain and continues in heavy rain for all two and a half hours. I’m trying to climb Green Fell from Ravenstonedale in Westmoreland (or Cumbria, as it’s now called).

I start from the Black Swan, an extremely comfortable hotel with superb food. Inside me is as good a breakfast as I’ve ever had, including black pudding from Stornoway. I’m wearing light blue linen shorts (“You fool,” says my wife, “they’re for summer wear.”) and my 100% waterproof anorak, which is about to be properly tested for the first time since I bought it 18 months ago. Unfortunately it reaches only my waist, and I can’t stand either to have the hood up or have it zipped up as high as it will go. My boots are good.

Having waved off Chicken in a taxi, I walk up the main street with its dark stone houses and a water running down the hill. After about 150 yards I have nothing ahead of me but empty fells. I cross by a bridge over a stream that would carry me away in seconds if I were to fall into it. I find a weathered wooden signpost that says “Footpath to Green Fell.” The path starts well, broad and stony, although wet. Ahead of me are a range of hills, some covered in cloud. I’m not sure which is Green Fell, but I know it’s the highest—at about 2000 feet. I have a map, but I’m reluctant to take it out in the pouring rain.

The path winds gently upwards. I pass a post with a sign on it indicating which way to go. Unfortunately it’s fallen out of the ground, and I cannot tell which way it was pointing. I approach a stone wall, and suddenly the path vanishes. I try walking to the left, hoping I can pick up the path. I can’t. I decide that the path must continue on the other side of the wall, and so I go that way. But it’s soon clear that I’ve lost the path. Indeed, I don’t believe that there is a path.

I’m not doing well. It’s pouring with rain, my socks and shorts are soaked, water is creeping into my neck and my  boots, I’ve lost the path, and I’m not sure which is Green Fell. The cloud on the top of the hills comes and goes, but I decide that the high hill to the right must be Green Fell. I know that there is a triangulation station on the top, but I can’t see it.

My best bet, I decide, is to climb left onto a ridge and then work my way to the right across a col to start climbing Green Fell. First, I have to climb a high stone wall with a wire fence on top. The wire is an annoying extra barrier, but it also gives me something to hold onto. I imagine myself tripping, falling off the wall, knocking myself unconscious, and lying there for some hours. It’s not cold enough for me to freeze to death.

 

 

 

 

I survive the wall and climb the hillside at an angle. I’m breathing heavily, but at the top I burst into song:

True love, true love

Don’t lie to me,

Tell me where did you sleep last night?

I slept in the pines

Where the sun never shines

And I shivered with the cold, the deadly cold.

With the water now in my boots, I climb up from the col. At the top I see that I have another 300-400 feet to go to reach the top. The wind is stronger, and the rain hasn’t let up at all. Thinking of the pleasure of feeling a road rather than wet grass and mud under my feet and being in my bath reading John Le Carre, I think that maybe the time has come to give up. All the way I’ve been able to look back on where I have come from, although every so often the view disappears behind cloud, and I decide that my best bet is to head west and walk down a ridge.

I make my way across the side of the hill, recognising that my right foot always being below my left foot is tiring. I feel like a crab. Reaching the ridge, I begin to walk down it. Eventually I’m back on a path, not much of one, but clearly some sort of four-wheeled vehicle has used the path. The problem with the path opposed to the grass is that it’s muddier and slipperier. I come to steep drop with a fast-flowing stream at the bottom. It’s flooded where the path crosses the stream, so I deviate to the left-and find a spot where I think I can jump the stream. If I fall back I won’t be drowned, but I’ll be wet through. At the moment my anorak is working and my jumper and shirt are dry—in the middle if not at the top and bottom. I wonder about taking a run-up but in the end just jump. I make it.

Just before the path reaches the road, there’s a dip which is flooded. I try to find a way through but fail: my feet sink into water and mud. At last the road. I’m not sure exactly which road it is, but I’m confident that if I follow it down I will reach a bigger road that will take me back to Ravenstonedale. After 50 yards I pass a sign that signals a foot path to Ravenstonedale, three-quarters of a mile. But I have no appetite for going back into the wet and mud. I follow the road, which is streaming with water.

I sing again and am soon back to the pub I recognise, up the hill to the Black Swan, and in no time naked in a warm bath with two cups of tea and my John Le Carre. That was a fine walk in its own way, and I reflect that I’ve experienced in under three hours all the rain we did not experience in our two weeks walking the Coast to Coast.

 

 

 

 

Why are doctors sticking themselves to government buildings?

On the day that a United Nations report said that ”Climate change is devastating our seas and frozen regions as never before,” https://www.bbc.co.uk/news/science-environment-49817804 I joined a protest with  Doctors for Extinction Rebellion https://www.doctorsforxr.com/, playing, I must confess right away, a minor part.

I wasn’t involved in the detailed planning, but I knew that our destination was the Department of Business, Industry, and Energy, a good target as the UK government subsides fossil fuels by €12 billion (£10.5 billion), more than any other country in the European Union https://www.theguardian.com/environment/2019/jan/23/uk-has-biggest-fossil-fuel-subsidies-in-the-eu-finds-commission. In contrast, it spends only €8.3 billion (£7.3 billion)  on renewable energy.

The group of about 30 doctors assembled by the café in St James’s Park at about 7.30 in the morning. There were older doctors, but most were young, two with babies. The doctors had come from across the country and many different specialties. We’d been asked to wear surgical greens and stethoscopes. I’d searched for my stethoscope and eventually found it in my sock draw; but then I’d forgotten to take it, an inefficient rebel.

When I arrived people were already gathered behind a 30 foot long banner saying “Government inaction will cost countless lives.” I joined the group, and multiple people photographed us. We then gathered around our leader, who explained what would happen. Two “stickies” would stick themselves to the doors of the department, while two “jumpers” assisted by “lifters” would jump up onto a porch above the doors and attach posters. The rest of us would enter the forecourt of the department, so trespassing, and unroll the banner. Selected people would speak, while others would live-Tweet the protest and hand out leaflets. We would probably have a die-in. Once the police asked us to move, those of us who didn’t want to be arrested would move into the street, where it is legal to protest.

People were encouraged to provide the contact numbers of next of kin and lawyers in case they were arrested in the fray. The stickies and the jumpers, who knew they would be arrested (“arrestables” in Extinction Rebellion jargon) were prepared, some with the numbers written on their arms.

Tensions rose as we came nearer our mission, and we were invited to gather round, close our eyes, breathe deeply, and feel our feet on the ground. One of the jumpers read out the vision of Extinction Rebellion: “Our world is in crisis. Life itself is under threat. Yet every crisis contains the possibility of transformation…. We catch glimpses of a new world of love, respect and regeneration, where we have restored the intricate web of all life….And so we rebel for this, calling in joy, creativity and beauty….Our vision stretches beyond our own lifespan, to a horizon dedicated to future generations and the restoration of our planet’s integrity. Together, our rebellion is the gift this world needs. We are XR and you are us.” It had a religious feel.

Then we were off, walking through the park to our destination. We were a ragged army. I chatted to one of the live-Tweeters, but my mouth was dry. I wasn’t exactly scared but apprehensive. I didn’t want to be arrested because I had an important meeting to chair that afternoon, and I’m not yet ready to be arrested, although I’ve played around with the idea. https://richardswsmith.wordpress.com/2019/04/19/should-i-become-an-arrestable/ I feel that I should be one if I can muster the courage. A friend didn’t want to be arrested because he wanted to get to his book club that evening.

As we approached the DBIE offices we were told that there were only two security guards, and when we arrived it went easily: the two stickers were struck in seconds, and the jumpers were up on the porch roof and beginning to stick up their posters. The rest of us entered the forecourt and unrolled the banner.

A microphone and amplifier were produced, and doctors began to make speeches. They emphasised that with our scientific training we understand the seriousness of climate change and that the effects are not just in the future but now. Despite scientists warning of climate chaos for 30 years governments have been slow to act—and the little that has been done is wholly inadequate. That’s why doctors have been driven to civil disobedience. We are rapidly running out of time to avoid catastrophic damage to life and nature.

Both the stickies spoke passionately. They didn’t want to be stuck to a government building. They would rather be doing their work, caring for patients, but desperate circumstances require desperate measures. Few people stopped to listen, although four Japanese lingered, looking bemused.

While the doctors spoke we began a die-in. I lay as dead on the stone floor. I felt relaxed, although I could feel the cold of the stone. It was impossible to see what was happening, and I wondered how long it would be before the police took some action. After about 20 minutes we abandoned the die-in and returned to holding the banner.

Two policeman had arrived moments after we had. They used their walkie-talkies, and soon others arrived. Eventually a minivan with perhaps 10 policemen arrived. The police were presumably prepared to carry us all away if we resisted. About 45 minutes after we arrived, a man accompanied by two policemen came and told us that we were trespassing and that if we didn’t move we would be arrested. We moved out into the street with our banner, and a policeman asked us politely not to block the pavement.

After a while I left, but most of the doctors continued the protest, moving later to outside Parliament. That evening I saw a video of the jumpers being arrested, and as I lay in comfortably in my bed that night I thought of them in cells and admired their commitment and courage.

Is civil disobedience effective? I’m currently reading the letters of Bertrand Russell, and involved in many protests he came to conclude that it did hasten change. He was strongly in favour of votes for women, but at that stage in his life he did not support the suffragettes who took direct action. Later he came to conclude that they had been essential for the cause to triumph, and when years later he campaigned for nuclear disarmament he supported civil disobedience, upsetting some of the leaders of the Campaign for Nuclear Disarmament.

Civil disobedience has a long history stretching back to Antigone and has been used by many groups in many countries, most famously by Gandhi in freeing India from the British and by the civil rights movement in the United States. Shelley is said to have a first enunciated the principles in his poem The Mask of Anarchy written in response to the Peterloo Massacre. Gandhi would often quote the poem when motivating the Indians.

 

“Stand ye calm and resolute,
Like a forest close and mute,
With folded arms and looks which are
Weapons of unvanquished war.

And if then the tyrants dare,
Let them ride among you there;
Slash, and stab, and maim and hew;
What they like, that let them do.

With folded arms and steady eyes,
And little fear, and less surprise,
Look upon them as they slay,
Till their rage has died away:

Then they will return with shame,
To the place from which they came,
And the blood thus shed will speak
In hot blushes on their cheek:

Rise, like lions after slumber
In unvanquishable number!
Shake your chains to earth like dew
Which in sleep had fallen on you:
Ye are many—they are few!”^[4]

Civil disobedience is most effective when it uses different methods, and doctors, some of the most trusted people in society, taking direct action adds to the armamentarium of Extinction Rebellion. Think about joining the next major rebellion on 7 October.

 

The pursuit of immortality

I have written this essay for the Lancet Commission on the Value of Death. It is one of many background papers posted on the website of the Commission: https://commissiononthevalueofdeath.wordpress.com

I hope that you might like to subscribe to the site, encourage others to do so, and even comment on the papers that are there.

The Commission’s work is in progress, and we are keen to hear from others.

Our aim is to complete our work by the end of the year, submit it to the Lancet, and, we hope, publish it in June next year.

The pursuit of immortality

Consciousness of death is one of the attributes that sets humans apart from other animals, and the dream of overcoming death and living for ever may be as old as the consciousness of death: with the realisation came the dream. The world’s oldest story, the Epic of Gilgamesh, tells how Gilgamesh sought immortality, and the Ancient Egyptians believed that they could achieve immortality. The dream of immortality has stayed alive ever since, and Steven Cave, the philosopher, has identified four stories of immortality. https://bigthink.com/design-for-good/the-four-immortality-stories-we-tell-ourselves Modern technology and aspirations have boosted all these stories, and serious people with substantial resources believe it possible to achieve immortality.

Immortality Story I: The Elixir Story

Almost every culture at every time has a version of the story that some sort of magic elixir will not only allow us to live forever but keep us young.  Leoš Janáček’s opera The Makropulos Affair tells the story of Elina Makropulos who in 1585 was given a potion that kept her young for 300 years and allowed her to become a great singer. But after 300 years she recognises that a shorter life offers a sense of purpose and transcendence that she has not had. As the effect of the potion fades she ages rapidly and offers the secret of the potion to a younger singer, who burns the parchment that contains the formula. The philosopher Bernard Williams used the story to illustrate his argument against mortality: for Elina her unending life has come to a state of boredom, indifference and coldness. Everything is joyless.” For her “singing and silence” are the same. https://wmpeople.wm.edu/asset/index/cvance/williams

Modern medicine has many variants on this story, with favoured technologies being nanotechnology, genetics, biological engineering, and regenerative medicine. For example, Robert A. Freitas Jr of the Zyvex Corporation writes about how with nanotechnology tiny robots will pass through our bodies, removing cancer cells, killing disease bacteria, and repairing any defects. http://www.rfreitas.com/Nano/Microbivores.htm#Sec5

Ray Kurzweil, who was once head of technology for Google, is co-author of Transcend: Nine Steps to Living Well Forever in which he argues that a combination of the right diet, vitamin supplementation, physical activity, and preventive medicine could keep us going until science has cracked the problem of immortality: “if you stay on the cutting edge of our rapidly expanding knowledge, you can indeed live long enough to live forever.”

Aubrey de Grey, Chief Science Officer of the SENS Research Foundation and Vice President of New Technology Discovery at AgeX Therapeutics, Inc, argues that humans can be kept going indefinitely just  like cars by replacing parts as they wear out. William Haseltine, Chief Executive Officer of Human Genome Sciences, claimed in 1999 that “death is nothing more than a series of preventable diseases.” The Chan-Zuckerberg Foundation created by Mark Zuckerberg, the founder of Facebook, has a mission of curing all diseases. https://www.businessinsider.com/mark-zuckerberg-cure-all-disease-explained-2016-9?r=US&IR=T

The leaders in the pursuit of immortality are mostly well-funded companies from the West Cost of the United States. Such a pursuit sits comfortably alongside other HAGs (“hairy audacious goals”) like capturing all knowledge and building colonies on Mars. Success is far from guaranteed, and the endeavour seems like hubris to many—but these are serious people with large amounts of money pursuing immortality..

Immortality Story II: The Resurrection Story

The Resurrection of Christ is the most familiar version of this story, and it was Christianity’s promise of eternal life for all not just emperors that drew Romans away from their traditional gods to the new religion.

The Alcor Life Extension Foundation, https://alcor.org/ for example, has 151 “patients” with their heads or bodies deeply frozen, ready to be “resurrected” when medicine is able to cure the disease that killed them.

Cloning, which has already been done with sheep, is surely possible with humans and is another form of resurrection, although unless another method is found to achieve immortality will need to be repeated every 60 years or so. Cloning is medical science’s version of reincarnation.

Another medical variant on the story is the use of ECMO (Extracorporeal Membrane Oxygenation) to resuscitate people after a cardiac arrest. Sam Parnia, an intensive care specialist, writes in The Lazarus Effect “It is my belief that anyone who dies of a cause that is reversible should not really die anymore. That is: every heart attack victim should no longer die…heart attacks themselves are quite easily managed. If you can manage the process of death properly, then you go in, take out a clot, put a stent in, the heart will function in most cases. And the same with infections, pneumonia or whatever. People who don’t respond to antibiotics in time, we could keep them there for a while longer [after they had died] until they respond.”

Immortality Story III: The Story of the Soul

The concept of a soul, which St Augustine described as “a special substance, endowed with reason, adapted to rule the body” is common to many religions. It can survive the death of the body, and the modern version of this story is to “download” the contents of the brain into a computer. Carboncopies, https://carboncopies.org/mission/ another organisation based in California, aims to use whole brain emulation (WBE) so that “our thoughts and feelings will be able to exist on a variety of processing substrates. In that sense, we then have a substrate-independent mind (SIM). With advances in neuroscience and neural engineering we will be able to choose brain and body, much as we can choose winter or summer clothes to suit our needs.”

Immortality Story IV: The Legacy Story

This is perhaps the most familiar route to immortality—writing a great symphony or novel, winning a crucial battle, or making any great achievement that mean we will be remembered and celebrated for ever. A modern version of the story available to everybody is to create thousands of words and pictures on Instagram, Facebook, or any social media site. This may not allow the same immortality as painting the Mona Lisa, but it’s something.

A still more modern version is to create a “digital avatar” in which every bit of data from you (all that you’ve written and said, all words on you by others, etc) is used to create an avatar that will exist electronically and to continue you after you die. The more data the more the digital avatar will be “you.” The advantage of a digital avatar over a diary or a Facebook account is that gives you a continuing existence: you will be able to take place in family discussions, be interviewed on the radio, or even vote. A great many companies are in the business of creating digital avatars, although not simply for the preservation of individuals.

The idea of a digital avatar also opens up the possibility of “resurrecting” great minds of the past. The more data you have on a person the more likely that you will be able to resurrect the person: if we fed all the words of Aristotle, all the poems and plays of Shakespeare, all the poems and letters of Emily Dickinson into a computer we might create digital avatars of those great people. Perhaps too the data from Johann Sebastian Bach’s music, Titian’s paintings, or Alexander the Great’s battle plans would allow digital avatars of them.

A less grandiose vision of immortality

Cave argues that although it is natural to fear death it is not rational. He quotes Ludwig Wittgenstein: “Death is not an event in life: we do not live to experience death. If we take eternity to mean not infinite temporal duration but timelessness, then eternal life belongs to those who live in the present. Our life has no end in just the way in which our visual field has no limits.”

Cave advocates thinking of life as a book that has the covers of birth and death but an infinity of possibilities within.

The Happy Death movement and immortality

The sociologist Lyn H Lofland  in her book The Craft of Dying describes  how what she calls the “Happy Death Movement” adopted immortality as one of its three components for giving meaning to death—the others were expressivity and passivity. Formed in the 60s the movement initially hinted at immortality but then adopted it wholesale. Perhaps surprisingly Dr Elisabeth Kübler-Ross, the doyen of Happy Death, believed in immortality.

“Dr. Elisabeth Kübler-Ross who has counseled thousands of terminally ill patients, is convinced that “people don’t really die.”

The 49 year old Swiss-born psychiatrist, author of On Death and Dying and two other books on death, says she knows “beyond the shadow of a doubt” there is life after death.

“This is not just the spooky stories of someone who has worked with too many dying patients, she said. “It is a good feeling to be able to say after many years that people don’t really die.” [“Specialist on Dying Says People Don’t,” Sacramento Bee, October 16, 1975]

Conventional medical research and immortality

Most of the organisations that talk explicitly of extending life and achieving immortality are companies, many on the West Coast of the US. But what about more conventional research organisations like the National Institutes of Health, the Medical Research Council, or the Wellcome Foundation? They don’t talk of achieving immortality, but at the same time they do talk of preventing and curing disease—and they don’t exempt any diseases. It is rational to think that their ultimate aim is to prevent or cure all diseases, including old age, which many researchers argue must be seen as a disease. Questions thus arise about whether, when, and how we will die. We asked some leaders of medicine and medical research for some answers, and some responded. (Table I)

Before considering their answers it’s worth noting that in 2014 (the last date for which complete data are available) Britain spent 0.13% (£3.24m) of its total spend (£3 billion) on end of life research compared with 16.9% on treatment, 5.27% on detection and diagnosis, 2.48% on prevention, and 34.69% on aetiology. http://hrcsonline.net/wp-content/uploads/2017/09/UK_Health_Research_Analysis_Report_2014_WEB.pdf

The answers from the leaders of medicine and medical research are politic.  They are not as grandiose as to say that they are trying to cure all disease, but there are no diseases that they are not researching. When it comes to death and dying they have clearly thought little about them: their attention is elsewhere.

It is surely logical for members of the public who hear day after day medical researchers announcing new breakthroughs to think that eventually all diseases will be cured and that we will all live forever.

Critique of the pursuit of immortality

The most obvious criticism of the pursuit of immortality is that we already live on a planet that is unable to support all people in the lifestyle of those in high-income countries. We are not short of people, and do not need more needing feeding and consuming carbon.

This critique doesn’t, of course, apply to the notion of downloading brains or digital avatars. They would not need feeding and would consume minimal carbon (none at all with sustainable energy), but would we want the dead, including the long dead, to still be around? My daughter did not seem keen when I suggested that a digital avatar of me might continue to argue at the dinner table. The resurrected Shakespeare would surely be a diminished Shakespeare.

The second criticism is that all these technologies are expensive and would increase the gross inequality that currently exists in the world. The rich will live forever, while the poor may die younger in a world filled up with the immortal rich. Peddlers of immortality may argue that the technologies will become dramatically cheaper, allowing the rich and the poor to live forever. They might argue as well that it is both impossible and wrong to stand in the way of the human need to keep exploring, experimenting, discovering, and creating.

The critique of increasing inequality certainly applies to conventional medical research. The cost of health care consistently rises faster than inflation, meaning that health care costs consume an ever-larger proportion of gross domestic product—and innovation rather than aging of populations is the main driver of the rising cost of health care. Since the development of universal health coverage—for example, the NHS—the hope has been that the cost of care will come down, but it never happens. Because the cost constantly increases the “best care” is available to only a few—indeed, a shrinking few.

The possibility of immortality drives us back to consider the value of death—personal, human, social, cultural, philosophical, religious, economic, ecological, commercial, legal, and medical. Assuming that we can create for all some version of immortality, do we want to? Would we be creating heaven on earth or would it be hubris resulting in nemesis?

 

Table: Views of medical leaders on whether all diseases can be cured and how we will die

 

People and position	Do you think that the long-term aim of medical research is to cure all diseases?	If so, how do you think that we will die?
Aisling Burnand Chief Executive Association of Medical Research Charities, UK	10,000 diseases. 500 treatments. Medical research offers hope to millions of people and there is certainly work to do. Yes cures for some but patients tell us they want a greater focus on quality of life improvements to help them live with their conditions. Essentially they want to live life well unencumbered by their illnesses.	More research needs to focus on living well with multiple conditions as we age. It’s about quality of life not quantity. We will all die of something eventually.
Andrew Goddard President, Royal College of Physicians,UK	I think medical research should be to improve health rather than cure all disease. My understanding of survival curves of populations over time (Chris Whitty gave a fantastic Harveian oration on this a couple of years ago – http://www.clinmed.rcpjournal.org/content/17/6/537.short) is that they have pushed towards the top right corner of the graph with time but that the point of crossing the x-axis hasn’t moved much in the past 100 years. Thus we only get to live for our 100 years or so and that prolonging it much beyond that is not yet possible.   Over time we have made good progress in treating infectious disease (although AMR and climate change may undo that) and more latterly cancer so in the developed world the generations are now left with the diseases of degeneration. As I understand it we will all get senile amyloid eventually as we age, and its deposition in the heart is probably the terminal event in the truly ancient.   I think many would say that that there is a quality of years/quantity of years balance that needs to be met. I’ve had kidney cancer so was delighted medical research allowed that to be cured. However, if my remaining kidney was to succumb to another primary in 20 years time I would not want a lifetime of dialysis. Now if there were stem-cell grown kidneys available that would be another matter…..	My answer to the first is no so 2 becomes defunct.
Derek Bell, President, Royal College of Physicians of Edinburgh	No and probably not possible	I don’t need to answer but is the question here not disease but senescence
Jeremy Farrar Director Wellcome Foundation	No. Aims should be achievable and to cure all diseases (those known and those unknown to us now) is unrealistic and probably undesirable. Some may not be curable, although we may not know which are and which are not. Prevention is much more critical than cure. Undertaking research across all conditions is justified, as we cannot know in which conditions prevention or cure is possible without research and in parallel understand how we might use that research to benefit the maximum number of people in the most equitable way possible.	I answered no, so not sure the question applies.   But I would say – With dignity, respect and with well-being and quality of life paramount.
Robert Lechler, president of the Academy of Medical Sciences	Although medical research is looking to cure individual diseases, our bodies will still age and no amount of research can ever prevent the fact that we will all die of something. I think the aim of medical research is to ensure the years we live are spent in good health, and that when we reach the end of our lives we are supported to die as well as we possibly can. “Death is something we will all experience, yet many people are uncomfortable talking about it, including doctors. But that shouldn’t stop us from doing medical research with the aim of understand how to care and support people to live well at the end of life. The Academy of Medical Sciences recently carried out an ambitious public engagement project which attempted to break the taboo and encourage a national conversation about death and dying. It involved opening a shop called The Departure Lounge in a busy shopping centre. Here we were able to share information on end of life research and care in imaginative and engaging ways to encourage conversations about death while people were well, rather than when faced with the approaching death of a loved one. “The Departure Lounge was a space where we heard time and time again that people valued a ‘good death’, over a longer life with time spent in poor health. This tells us that medical research needs to focus on improving quality of life at the end of life and narrowing the gap between wellness and death well before any attempts at a ‘cure for all’.” (Full response attached as an appendix)	“Alzheimer’s disease and other dementias claim the most lives in the UK. Out of the four leading causes of death, the mortality rate for dementia is the only one which has shown continual increase over the last decade.   “Multimorbidity, living with multiple serious, long-term health conditions, is also on the increase. Growing numbers of patients spend the last years of their lives struggling to manage several conditions at once. The global burden of people living with multiple serious illnesses must be urgently addressed. Without a better understanding of multimorbidity, it will not be possible for any country to plan future healthcare resources and redesign services effectively.”

 

Table: Views of medical leaders on whether all diseases will be cured and how we will die.

 

Appendix:

Full response of Robert Lechler, president of the [British] Academy of Medical Sciences

• Do you think that the long-term aim of medical research is to cure all diseases?

“Although medical research is looking to cure individual diseases, our bodies will still age and no amount of research can ever prevent the fact that we will all die of something. I think the aim of medical research is to ensure the years we live are spent in good health, and that when we reach the end of our lives we are supported to die as well as we possibly can.

“Death is something we will all experience, yet many people are uncomfortable talking about it, including doctors. But that shouldn’t stop us from doing medical research with the aim of understand how to care and support people to live well at the end of life.

The Academy of Medical Sciences recently carried out an ambitious public engagement project which attempted to break the taboo and encourage a national conversation about death and dying. It involved opening a shop called The Departure Lounge in a busy shopping centre. Here we were able to share information on end of life research and care in imaginative and engaging ways to encourage conversations about death while people were well, rather than when faced with the approaching death of a loved one.

“The Departure Lounge was a space where we heard time and time again that people valued a ‘good death’, over a longer life with time spent in poor health. This tells us that medical research needs to focus on improving quality of life at the end of life and narrowing the gap between wellness and death well before any attempts at a ‘cure for all’.”

-ENDS-

• If so, how do you think that we will die?
• “The UK is reaching a tipping point. For many years, we have seen the annual number of deaths decrease, as scientific advances improve life expectancy. However, as the demographic bulge created by the baby boomer generation reaches its twilight years we need to prepare for an increase in annual deaths of those in their elderly years.
• “Alzheimer’s disease and other dementias claim the most lives in the UK. Out of the four leading causes of death, the mortality rate for dementia is the only one which has shown continual increase over the last decade. The World Health Organization estimates that the global number of deaths due to dementia will increase by over 40% from 2015 to 2030. Despite the work already in progress, it is clear dementia is an area still crying out for more research into prevention, treatment and care.

“Multimorbidity, living with multiple serious, long-term health conditions, is also on the increase. Growing numbers of patients spend the last years of their lives struggling to manage several conditions at once. The global burden of people living with multiple serious illnesses must be urgently addressed. Without a better understanding of multimorbidity, it will not be possible for any country to plan future healthcare resources and redesign services effectively.”

• -ENDS-

 

The story of a Nigerian growing up in America makes me reflect on the casual, thoughtless racism of my childhood

My friend Lois gave me Tope Folarin’s novel A Particular Kind of Black Man to read. She knows Tope and is thanked in the book. Tope himself has written in the front: “Richard, I hope you enjoy! Tope Folarin  9/1/19 DC. (I have to remind myself that the American-style date indicates 1 September and that all Americans call Washington DC not Washington.)

I’m unlikely to have read the novel if Lois hadn’t given it to me, but I’ve read it in less than a week since she gave it to me—and I’m glad that I have.

The novel is the story of Tunde Akinola, a Nigerian American, trying to find who is—and, I feel, not completing his journey. “In every fiber of my being I feel like I don’t belong here….I’m just not black enough, or American enough, or Nigerian enough.” He lived as a child in Utah, where he and his parents and brother were the only black people. An elderly Mormon woman told him he could serve her in Heaven, reflecting the unreformed Mormon belief that black people would be servants in heaven. He describes how the principal of his first school looked at him on his first day: “It was in her eyes. The way she looked at me. Like I was something scary and unknown. That’s how I knew I was different.”

His confusion was added to by his mother developing schizophrenia. She took him and his brother to a women’s refuge, where his mother beat him. But soon she left for Nigeria, and Tunde spent the rest of his childhood loving and missing her and wondering how she was.

The novel switches from the first to the second to the third person, reflecting the confusion of Tunde. He has double memories of events, meaning he isn’t sure what happened and what didn’t happen. I found this an interesting device and wished he’d developed it further. Another structural device is conversations by phone with his grandmother in Nigeria. He never sees her in the flesh, but he loves her—and she is important in his growth. She tells him: “I want you to focus on you. On the things that make you happy and calm. The things that make your heart beat faster and slower. This is how you will learn who you are, and what you are supposed to be in this life.”

Tunde’s experience of being an immigrant and very different from the people around him is a common experience today, and Tunde (and Tope) resorted to writing to try and make sense of the experience. Others have done the same.

My experience growing up, I reflected, was the opposite. I was born in South London among people who looked and spoke like me and went to school with people just like me. I can’t remember any black or Asian people at either my primary or secondary school between 1956 and 1970. (That empty memory worries me: surely in my secondary school there must have some black or Asian boys, but I can’t remember them.) Indeed, I realise now that I grew up in an environment of casual, thoughtless racism: we talked about “Pakis”; and I can still remember a profoundly racist “joke”: “What is the most dangerous job in the world? Driving the Kitty-Kat wagon through Brixton.” (Why, I wonder, do I remember horrible things like that and forget beautiful things?)

My consciousness rose as I aged, and I left the Greenwich Labour party at 16 because many of the party members were racist. I marched against apartheid. I argued with my father, one of the kindest, most empathetic people I’ve ever known, because he began to be convinced that black people committed more crimes. I explained to him—undoubtedly in patronising tones—that he mistakenly thought that because he worked in Camberwell Magistrate’s Court where most of the poorer people were black and that poorer people were more likely to commit crimes (or at least the crimes that the police pursued).

I was educated out of the racism that surrounded me as a young child, but many people haven’t had the privilege of such an education.

I’ve roamed away from Folarin’s book, but, as Proust says, when we read a novel we read ourselves.

 

Other quotes I took from the book:

 

For my entire life she [my grandmother] was just a voice on the phone, someone I loved but never saw. I’m not sure I’ll ever accept the fact that she will never be anything more.

I didn’t know it at the time, but by modeling myself after these men [black men accepted by mainstream white society] I was choosing to become a very specific kind of person. The kind of black man who was nonthreatening and well behaved. The kind of black man who was successful and benign.

I guess I’ve finally realized that the person I see in the mirror is the person I’m supposed to be, and not the person I actually am.

That’s what memories are for. They are meant to sustain you and refresh you. Always remember that your memories are for today, not yesterday. They change because you change.

I’m pretty sure this is supposed to be a story about my life, where I’ve been and what I’ve done, and I don’t know what I’m supposed to do with the fact that so much of it is unrecognizable.