Psychological support at the last stage of life path of human

Existential and psychological aspects of death

In the mass consciousness (and our culture is no exception), the topic of death is tabooed and presented as something unambiguously negative, and the process of dying, let's say, is treated without due respect. At the same time, death is an inevitable part of the life path, and has a huge semantic potential, many of the layers of which will be presented in this chapter.

As we noted earlier¹, the attitude to death (unpacking its meanings) at a late age is one of the main existential tasks. Let's focus on it in more detail.

S.A. Belorusov considers the deep and hidden feeling of fear of death as what makes a person to be human, and overcoming it, meeting with it, as the way to a genuine, meaningful and fulfilling life. Meeting with this fear hidden in the depths of the soul always happens one-on-one; science, culture, ideology, "thoughtful" reasoning cannot save and help.

According to S.A. Belorusov, the world is fleeing from the meaning of life and death into "senseless mechanical acceleration with a complete blunting of the feeling of spiritual hunger"², turning it into a problem, not a mystery, which it is. The outstanding philosopher M. Heidegger wrote about the mystical meaning of death: "Death causes anxiety because it touches the very essence of our being. But, thanks to this, there is a deep awareness of oneself. Death makes us individuals."³

S.A. Belorusov distinguish three types of death:

–biological (termination of physiological functions of the body);

–social (loss of place in society);

–spiritual (conscious rejection of oneself, the world and God).

The rupture of habitual ties (when our abilities, health, children, colleagues, friends are separated) in adulthood deeply hurts, but frees a person for inner growth, and the encounter with death (when beloved and dear people leave) pulls out of the abyss of everyday life, makes you think about life, its true secrets (for example, the antinomian truth spiritual sphere), to get closer to our true essence (that which is not subject to death is gaining strength).

V. Frankl wrote that a person should be open to everything that awaits him on the way, and without suffering and death, life is incomplete, flawed. S.A. Belorusov writes that conscious acceptance of the fact of one's own finiteness is a criterion of spiritual maturity, revealing four meanings of death:

1. it humbles a person, freeing him from pride and establishing a dialogue with the world and God;

2. ennobles life, not allowing you to drown (lose yourself) in the hustle and bustle, teaches you to accept all the gifts of being (which may be conditionally negative: failure, illness, loneliness, etc.);

3. death unites, makes it possible to realize the deep involvement in humanity and allows you to sum up, reveals the true, non-corruptible meanings of life. As V. Frankl wrote, who put the search for the wash of life by a person as the basis of psychotherapy: "In life a person is always in the process, in becoming. At every moment, one can only say about him that he "was", he is no longer the same as a moment ago. Only at the moment of death he "is". He is who he was in this life."⁴;

4. "The meaning of death is to overcome it. Death is overcome by love."⁵ S.A. Belorusov consider this meaning to be the main one, thus emphasizing that the transcendent meanings of life lead a person to true maturity, blessing, overcoming death itself.

The individual attitude to death, its understanding and the degree of acceptance largely determines the attitude to aging. Entering the last of the ages can be negative (fear, "hide-and-seek" with death, flight from old age, self-deception) and positive (resignation to the fact of fatigue from life, acceptance of completeness, letting go of life, refusal to burden it and oneself with duty, removal from the hustle and bustle of everyday life). In a negative scenario of aging, a person directs energy to the outside world, proving his need, trying to adapt to the fast rhythm of life, exhausting resources in the harassing pursuit of youth, coming to a sense of hopelessness, despair, helplessness. And on the contrary, in a positive scenario, a person realizes life itself as a transpersonal existential good that does not require a bygone social demand and activity. "The benefit of old age … is that old age helps a person, at least in the last years of his life, to get rid of his neediness… The existential possibilities of old age lie not in the plane of the "race for time", but in the special proximity of the elderly to eternity… They are needed precisely because they are not with us."⁶

In the study of the elderly and old age of G.Abramova, three interrelated, intertwined existential tasks can be distinguished. Along with summing up the results (the meaning of the years lived), which colors the days and days with feelings, there is the task of waiting for death, fearing which (consciously or unconsciously) a person sums up the moral outcome of his life, and "the ability to say goodbye to life without despair and horror, with a sense of completed work – this is another meeting of a person with his own existentiality; the meeting, which is a great mystery."⁷

The very process of aging (and dying⁸), according to N.F.Shakhmatov, is primarily associated with a decrease in physical capabilities, and old age (and death⁹) is reflected in the consciousness of an elderly person as a predominantly physical ailment. However, as we age, the attitude to the physical condition varies significantly: from debilitating experiences about health, to a tolerant or indifferent attitude to physical ailments. Such reflection by the time of late age finds, according to N.F. Shakhmatov, acceptance or non-acceptance of senile existence (dying). Internally, in a harmonious (positive) version of the development of old age, a person comes to a contemplative, calm, self-sufficient life position by revising the attitudes, views, values and meanings born in past ages. This position, born as a result of active creative work, that brings with it satisfaction with the present and with oneself. "The attitude to one's own aging is an active element of a person's psychic life at a late age. In fact, this is the principle by which it is possible to distinguish between favorable and unfavorable forms of mental aging. Good health, the moderate nature of age-related changes, the preservation of an active lifestyle, the presence of a family, material prosperity, as well as past achievements, awards, titles, are not the key to realizing old age as an interesting, full-fledged period of life"; as well as understanding the mystery of death, preparing for it. "And in the presence of all of the above, a person in the period of late adulthood and old age can consider himself flawed, deprived, sick, miserable and unhappy," and perceive his death as frightening, dividing, meaningless, putting the final end (hopelessness and the lack of the possibility of overcoming it). "Acceptance of one's own aging (and hence death) is the result of active creative work on rethinking life attitudes and positions, revaluation of life values."¹⁰

A holistic approach to the device of personality

Here we need to digress from the stated topic, since further material will be based on a number of theses, without at least a brief coverage of which its consideration is difficult (they (theses) were presented in more detail by us at the LIX International Scientific and Practical Conference "Worldscience: problemsandinnovation"¹¹).

We believe that it is correct to consider a person's personality as a threefold structure: body-thoughts-feelings (it is obvious that we think something – we can observe thoughts; we experience something, for example, love, resentment; and we do something (click the mouse, scroll through the pages). These intersecting dimensions form a personality, where, in particular, our complexes, attitudes, roles live; and (and in this we see the relationship, unity) manifest themselves through the body, thoughts and feelings.

The mind and feelings have a dual structure; so, the fundamental property of the brain is the ability to justify anything¹², in the sense that no matter what position a person takes (for example, "for" abortion or "against") it will bring arguments and will insist on them. In reality, for every thought and feeling in a person there is an opposite belief and desire (which go as a set), but in consciousness in one period of time a person perceives one thing and identifies himself with it.

The stronger the disharmony of cognitive components (which can be designated as a war of the poles of the same scale), feelings/states (love-hate, joy-sadness, anger-benevolence, attraction-rejection) the more strongly it affects the body (psychosomatics, diseases, injuries). Also, the stronger the internal disharmony, i.e., the more a person insists on the truth of one side (his half-truth), the more he condemns the adherents of the opposite (and in fact feels guilty to his own rejected part).

In general, we can confidently state that if there really is an intention to understand something root (fundamental) about what is happening to a person, then we need to look for a mismatched duality, and the way out (including from suffering) is the harmonization of duality (understanding the importance of both sides, the transition from enmity to cooperation).

We believe that a clear vision of the mechanics of the work of personality dualities and the transition from "the game is played by you" to the position of free choice is possible only through the noetic dimension, through those higher meanings and values that are there. To such a meaning (or a non–transferable, win-win value) we refer awareness – a clear understanding of oneself ("who you are and why"). I.e., to consider a human only as a person (ego), as a set of certain physical, mental, sensory components and variables, it means to humiliate him, put him in a Procrustean bed and deprive him of the most valuable, important, perhaps life itself in its deepest understanding – to transfer him from the sphere of life into existence.

It is the view from the noetic dimension that provides us with understanding and answers to the most difficult and painful events in a person's life (for example, the loss of a child, the collapse of life values, the experience of a terminal illness). If we consider a person only as a body-mind-feelings structure, designated here as a personality or ego, then the answers will be explanatory, superficial.

In readiness and transition to a contemplative position, it is not difficult to see a somato-psychological unity that creates harmony of the physical and psychological, allowing an aging person to calmly relate to the past, present and future. Against the background of a decrease in physical strength, a constant feeling of physical malaise, on the eve of the end of life, such a position reflects "… the main questions about the meaning of human existence, self-knowledge … such a turn of psychological life during late adulthood and old age turns out to be a happy form of psychological aging for a person, providing "consent" with senile changes in physical and mental states, satisfaction with today's life, full acceptance of the environment."¹³

Spiritual and existential understanding of life, its individual stages leads a person to cope with the fear of death, to "outgrow" the idea that it negates any successes achieved and efforts made. Filling life fragments and its lived parts by the meaning, understanding their value, creates a subjective feeling of correctness, truth of the path in a person. It also opens up certain fragments in the future, building internal connections that were not initially manifested for the personality, which largely support the desire to live and interest in oneself (i.e. considering access to spiritual meanings as an existential task of late adulthood and old age, we can see the manifestation of its solution in the inner harmonious state of personality, acceptance of existential givens). The fulfillment of the existential task of understanding one's life (general principles and an example of understanding life, in a popular science format, are also given in Appendix No. 2) includes understanding the inherent meanings and those fragments of life that a person evaluates negatively as dysfunctional. But when we subjecting them to secondary (tertiary, etc.) semantic processing it will lead us to acceptance of our personality and life in general (i.e., including death). We come to the conclusion that "all this was not in vain", "it was not in vain". Such comprehension (the discovery of the not obvious significance of some moments of life), a kind of pilgrimage to one's own Self, of course, requires a developed reflection and experience of self-contemplation from the individual, and failure to fulfill this task deprives a person of existential fullness and existential joy.

As we noted earlier¹⁴, by carrying out the spiritual work described here and further, a person creates the following: as he learns about himself, he outgrows the boundaries of the ego – connects his deep essence with something greater than himself, "with the superhuman beginnings of his nature, changes the scale of self-perception and forms a new attitude to his deeds, choices and life in general. Every grain of self-knowledge gained is experienced by him as a step in the direction of personal growth, congruence of the Self and the world. Such self–identification and the discovery of the value of the Self, the need for oneself in being – a significant condition of human existence – is one of the foundations of experiencing inner well-being."¹⁵ As M.M. Bakhtin wrote, "to be aware of oneself actively means to illuminate oneself with the upcoming meaning,"¹⁶ which can be found beyond the visible limits of death (the cessation of the functioning of the physical body).

I.S. Pryazhnikov refers to the personal neoplasms of the elderly as a change of value orientations with access to existential questions, the search for meaning in a new life activity, summing up (revealing the meanings) of a life lived. With retirement, a person can come to a special happiness, for some people, it may consist in "the desire to calmly comprehend the whole life lived" (in this case, self-determination will be retrospective, awareness of the meaning of the life lived). The personal neoplasm in this case will be a sense of integrity and harmony, or, if the meanings are not found, a sense of inharmonicity, incompleteness.

During the period of old age itself, one of the leading activities of I.S. Pryazhnikov is the preparation for death, which can be expressed in the preparation of a will, introduction to religious or esoteric knowledge. Personal neoplasm has a dual character: "either it is a strengthening sense of self-worth when an old person finds an important meaning of his life for himself in spite of all circumstances, or it is a feeling of despair when such a meaning is not found and an old person wastes his strength in small things, literally "fading before his eyes"."¹⁷

All the moments of awareness of the unattainability of the fullness of self-incarnation that are becoming more frequent during late adulthood and old age are closely related to thoughts about death (the inevitable existential reality of existence). When a person constructively overcomes the "crisis of aging", then with a retrospective immersion in the past, he experiences the "fulfillment" of the meanings of life, finding in it moments of happiness, self-actualization, moments of self-embodiment and fullness of being. If the fear of death overwhelms the personality, then the appeal to the past occurs rather forcibly, in order to find excuses for not embodying meanings, there is a projection of self-condemnation on others, on inherited circumstances and leads to negative experiences, a sense of subjective distress.

Thus, both the "crisis of aging" and what can be designated as the "crisis of death", a person fixes in a sense by himself, – as a line when there are no resources, time and effort to implement something conceived that gives a justified meaning, and life will pass without it. But in order for this to be experienced as a tragedy, it is necessary to reinforce it with ideas about the insolvency of a past life (about "wasted and pointlessly wasted time") and the inability to comprehend a certain critical value of the semantic spectrum of death. However, the first still does not happen so often, because rethinking the life path, referring to past experience, always has a chance to find valuable, important, right in life, at least acceptable meanings, "versions of yourself". In this regard, it would be appropriate to quote the words of Sapogova: "youth can be correlated with an existential "willingness / courage to become" (in potency – everything a person wants and can do), maturity – with "willingness / courage to be" (that is, to live the way he has become, or change to be again), then the subsequent ages – with "willingness / courage to understand", to take place in their already "become" quality and accept the realized meanings of their becoming and being."¹⁸

When a person comes to the perception of old age, dying and death as a "gift presented to himself"¹⁹, then the external frightening attributes appear in a more voluminous form, and not only as a "sign of trouble". Achieving such a level, of course, requires from a person the actualization of hermeneutic (internal) resources, the manifestation of the completeness of the "human" and their direction to the building of meanings, such work is an act of great human courage (and more than in youth or adulthood). As F. Petraka accurately said "old age is a time of exposing the meaning of all human goals, demonstrating their nobility or insignificance."²⁰

"Pragmatic" classification of types of death

Further in our study, we will adhere to a less academic line²¹ of presentation (which does not mean less scientific value of the work) both because of some "absurdity" of attempts to pack the content of the sacrament of the last stage of a person's life path into the "dry" language of science, and in order to increase the practical applicability of labor, making it more "alive".

We can offer, let's say, two author's classifications of types of death with access to a certain empiricism, pragmatism:

1. Sudden, i.e. the one that a person does not expect, does not predict. For example, it can be a heart attack, a car accident, a "brick on the head". And here, from the perspective of the ongoing research, we can only say that "a wise person thinks about those things that a fool prefers not to think about (is afraid of)." Unpacking the thesis, one can gain an extremely important, essential understanding that a person does not really know whether he will live tomorrow, we only assume this and one day we make a mistake. Understanding the finiteness of our stay on earth gives both sadness (obvious, staying on consciousness) and joy (subconscious), liberation; as well as, when carrying out the work of comprehension, it gives concentration on what is really important and puts things more vain, perishable in their proper positions. In our vision, the essential, priority is the content of the noetic dimension: the products of understanding the experience gained and self-knowledge. Regarding the psychological support of relatives in case of sudden/unexpected death of a person, information is provided in the relevant section below.

2. Painful, accompanied primarily by physical suffering and pain. It is normal for a person (his "earthly" component) to try to avoid pain. So, few of us go to the dentist with joy, and more often they should go there when the tooth already hurts or in fear (prevention) of the expected pain. At the same time, it is the negative that potentially brings the greatest gifts of awareness and before escaping from pain and suffering, you need to touch it, enter it, understand what for (not why and for which) it came to you. But there are also levels of pain of such strength that it is simply not possible to remain conscious (most often these are neglected options that came to a person earlier in much weaker signals, to which he chose not to pay due attention²²). History knows examples when person endured inhuman trials, so one general played chess with a friend while a doctor amputated his arm without anesthesia. However, most likely this is not about you and me, my dear reader, in any case, the author does not consider himself to be such titans.

3. Meaningful and not (in our opinion, this is a critically important aspect of death and dying). This is an option when a person has a premonition, is consciously preparing for death. At one of the meetings in the group, which "successfully coincided" (semantic synchrony) with Mother's Day, we worked out two of the four givens of I. Yalom's²³ existence, one of which was death. The participants of the venerable age recalled how their grandparents passed away and the gap between the current attitude to dying and "that" was felt almost palpably. If "then" a person had a premonition that he would soon leave, then he lay down on the bed, gave the last orders, said the last, important words, said goodbye and left this world (and without any regrets from anyone, without fighting for life with the help of resuscitation, without "take the children away", with all understanding and respect for the moment); then "now" it is perceived as something extremely undesirable that needs to be hidden in the ground as soon as possible (like a cat who crawled under a rug and thinks that since he sees nothing, then he is not visible), and feelings and experiences remain misunderstood, unreacted (they try to comfort, not to be sad and to hear tears). Both "then" and now it is possible to observe different, diametrically opposite positions. For example, thoughtlessness ("well, it will be and it will be", "why think about the bad"), or on the contrary, like a samurai, to consider death a key moment of existence, which if you waste, then the whole life is reset, its value is leveled. Accordingly, the conditionally negative edge of the spectrum does not involve work on comprehension, it is rather an escape from the existential tasks of being and from oneself (efforts to forget). The opposite part of the spectrum requires a very significant inner work from a person, attention to himself in the noetic dimension, connection with what can be designated as the Soul. Here it is required not to run away from death and everything connected with it, but to consciously²⁴ go to meet it – this is freedom, choice, courage, acceptance, understanding. You have drunk the cup of life, solved the tasks that it set for you, you have learned a thousand and one things; understood what needs to be understood in joy, understood what needs to be understood in sorrow, comprehended the beauty of loneliness and the beauty of meeting; necessity and non-necessity … now it remains to take the last step, it is inevitable, but everyone has freedom in what state to make it, in what depth of understanding – this is the most basic.

It is obvious that to a painful death or realized in a negative deviation from expectations (the picture that a person draws himself in his bright ideas: on satin sheets, surrounded by loving relatives and friends) somehow to take a wise position of accepting the last page is not an easy matter. But on the other hand, when a person feels good and tasty, he is very poorly disposed to deep insights. Therefore, any unfolding scenario is not unambiguously positive or negative. The dominant thing is what is inside – what position, attitude a person will choose for himself, how deep understanding he will be able to carry out.

Another classification of types of death, giving a different (but consonant with the above proposed) semantic and practical content of the topic under study, we can offer the following:

1. Physical. It would be a sin to lose sight of the bodily aspect, especially since it carries a rich resource. So, people who have even a few weeks of life at their disposal will be a great help (value) such a seemingly insignificant detail as the smell of homemade cookies, or the sight of a favorite flower in a pot on the bedside table, or pet a cat, eat a piece of some gastronomic delicacy, etc²⁵. There are options when a person decides to do something what he always wanted to do; i.e., to have time to realize a desire that he postponed or considered impossible²⁶. In such cases, medical contraindications are often a controversial point … what should you talk to a person about and support / understand / accept the choice that he will make.

2. Cognitive (popularly referred to as "vegetable").This is only the position of the author, but the work mentioned here in the boarding house showed that this is the saddest sight. When a person, for example, does not have hands or feet, or they do not exist, or he is completely dependent on outside care, but cognitive functions are preserved, then this is still half the trouble. But when the mind fades, and even if the body is fully functional at the same time, then this is a "pipe". Let's preserve, take care and appreciate the ability to think… and feel… and move. At the same time, if we look from the noetic dimension … we do not know what kind of experience and why the soul of such a person "ordered", but we can assume that this is happening, then for some reason it is necessary²⁷.

3. Social. According to observations, people during a period of physical inferiority either lock themselves up (for example, because they do not want to be a burden) or plunge into "whining" (continuously describing how bad they are²⁸), accusations²⁹ (they say that they are not good, do not respect, do not appreciate the old man, do not care, do not cherish, do not pamper). That is, a person himself creates such an "aura" when being with him for any length of time is fraught with a nervous breakdown. We will all leave someday, but how we do it depends on us³⁰. Communication is extremely important (we believe it is unnecessary to dwell on why it is important), and this is precisely a question of communication, its quality, its humanity, mutual enrichment in it and a mega level – if it takes place at least at times in an atmosphere of spirituality.

4. Spiritual. There is such a terrible expletive in terms of semantic content – "soulless". Denoting something like the following: devoid of humanity, kindness, robotic, insensitive, morally empty, cold, "dead". Probably, this is the most terrible death that happens with (selected by) person during lifetime. We do not know what happens to a person's soul when he becomes a "vegetable"; but we again assume (with greater certainty) that when spiritual death occurs (dissolution, or more correctly, betrayal of the noetic dimension), the soul experiences inhuman suffering. In addition to the person himself, we can talk about Bushichumai³¹, in the aspect of psychological support, it is a "struggle" for the spiritual: a quiet offer to "pray" at the end of life, a kind of reminder by oneself of the priority of the spiritual³².

Separately, we will focus on the issue of freedom to leave life. This freedom itself does not objectively belong entirely to man himself, in the sense that it is subject to the outside world. Actually, that's why there are two camps in the world "for" and "against", who are at war and give their arguments, half-truths. We will not express our intention to maintain this separation, including due to the fact that whatever position (pole) you do not occupy, you will still turn out to be an enemy and continue the war.

In general, we can say that, for example, children are not obliged to agree with their parent's choice to do euthanasia, but also not to recognize such a right to freedom, how is that too? I will cite here the dry residue of my living experience with which I had the happiness-misfortune to come into contact and pass. There is no desire to give examples with people, because it feels like it exposes them, and there is no need to ask for permission; so I will not disturb them. But my conscience will allow me to give a very, very revealing analogy with a hamster. Somehow the beloved and dear to the heart of the hostess pet hamster got sick. Of course, they treated him, took him to the vet, fed him pills, gave him injections… but it didn't help. And the poor hamster experienced such torments, such pains that it gnawed off two paws. Let's feel it please… how brutally much it hurt the animal, how unbearable the suffering was that he bit his paws… Why did the hostess so unwilling to let him go, did not dare to put him to sleep? Was it love and caring for an animal? Or is it attachment, a selfish desire to realize a hopelessly elusive opportunity to once again experience joy and tenderness with an amazingly recovered hamster?.. And if animal advocates intervened, what would be the torment: to leave the hamster alive or to put it to sleep and stop the suffering?

A holistic view of the problems of euthanasia implies an understanding of both poles: on the one hand, we can say that this is an escape from life – the fear of staying; however, if you look from the other pole, then those who remain are afraid to leave. The same picture is in any opposing views (any fragmentary perception), for example: is the one who leaves or those who do not let go selfish? Is it the one who wants to leave does not understand those who forbid him to do it, or are those who prevent leaving refuse to understand the one who resorts to euthanasia?