Renowned existential therapist and one of the most distinguished and popular authors writing about psychotherapy, Irvin D. Yalom took the title of his new book, Creatures of a Day: And Other Tales of Psychotherapy (Basic Books, February 24, 2015) from Meditations, the private scribblings of second-century Stoic philosopher Marcus Aurelius on how best to live:
All of us are creatures of a day; the rememberer and the remembered alike. All is ephemeral—both memory and the object of memory. The time is at hand when you will have forgotten everything; and the time is at hand when all will have forgotten you. Always reflect that soon you will be no one, and nowhere.
Recently I was stunned to hear public radio's Radiolab show The Bitter End about the dramatic difference in doctors' and lay peoples' wishes for medical interventions in order to be kept alive no matter how badly injured they are. After my mother died on a respirator—having neglected to (or chosen not to) transfer her living will from one doctor to another—I did my own living will. However, until hearing the Radiolab piece, I was not fully aware of the torture (something akin to waterboarding and being raped) of being put on a respirator, and now I feel even more strongly about my living will. I have no death wish, but, since death is inevitable, I'm curious: I want to know from people who are dying whatever they want to share: how they feel, what they want—any wisdom they might offer. Yalom's book is a font of that wisdom.
Given our natural will to survive and our general anxiety about death, Dr. Yalom decided to tell ten riveting stories about his patients' and his own struggles with our chronic mortality. Yalom, age eighty-two, has been treating patients for fifty years and freely shares that he continues "to thirst for answers to the question of what really helps" people. And in this compelling new book, the reader gets to be a fly on the wall, observing the private therapeutic relationships and learning what helps: honesty and shared presence with another human being.
Whether we are twenty-five or ninety-four, conscious or unconscious of it, we all have issues with death. Writes Yalom: "Far more patients grapple with existential issues than is generally thought. The patients [in Creatures of a Day] deal with anxiety about death, about the loss of loved ones and the ultimate loss of oneself, about how to live a meaningful life, about coping with aging and diminished possibilities, about choice, about fundamental isolation."
In the incredibly moving opening story, a mysterious eighty-four-year-old who has hired Yalom for one consultation reveals his deepest desire: to simply be witnessed. Other patients grapple with what's real in their illusive lives, whether they are good enough people, how to deal with devastating pasts, and what they are really afraid of. In Creatures of a Day, Yalom and his patients are generous pioneers. They are facing what we all will face and reporting back to us. The fact that many of them are over seventy makes their journeys all the more helpful.
The following abridged excerpt is from the chapter titled "Get Your Own Damn Fatal Illness: An Homage to Ellie." Ellie was "about five foot two, apparently inattentive to her appearance, with tangled hair that cried out for a brushing, loose, shapeless clothing, and no jewelry or makeup . . . a faded, wistful flower child, a refugee from the sixties." She was a woman dying from terminal ovarian cancer. Yalom alternates Ellie's writing (summaries of her therapy sessions) with his own:
Gradually, over the course of several months, my death anxiety diminished, and I grew more comfortable in my work with terminally ill patients.
This life experience made it possible for me to be so present with Ellie, and there is no question that she was appreciative of my honesty. Denial was the enemy, and she voiced impatience with any form of it. In one of her summaries, she wrote:
Other people, even others who also have cancer, tell me "You're going to live 30 years." They tell themselves, "I'm not going to die of this." Even Nancy in my support group, so wise and clear-sighted, emailed me yesterday "All we can hope for is to hang on long enough until better treatments are developed."
But this isn't what I want to hear. This is a safety net with an enormous hole right in the middle. Whether I will live a long time or a short time, I'm alive now, at this moment. What I want is to know that there are other things to hope for besides length of life. What I want to know is that it isn't necessary to turn away from thoughts of suffering or death but neither is it necessary to give these thoughts too much time and space. What I want is to be intimate with the knowledge that life is temporary. And then, in the light (or shadow) of that knowledge, to know how to live. How to live now. Here's the one thing I've learned about cancer—it shows you mortal illness and then spits you back, back to the world, to your life, to all its pleasure and sweetness, which you feel now so much more than ever. And you know that something has been given and something has been taken away.
"Something has been given and something taken away." I knew what Ellie meant. It was a single yet complex thought—a thought that must be unpacked slowly. What has been given is a new perspective on living life, and what has been taken away is the illusion of limitless life and the belief in a personal specialness exempting us from natural law.
I'm alive now and that's what matters.
Life is temporary—always, for everyone.
My work is to live until I die.
My work is to make peace with my body and to love it, whole and entire, so that, from that stable core, I can reach out with strength and generosity.
. . .
Often, especially early in the course of her illness, Ellie was plagued by envy of the living and healthy. She knew these mean-spirited sentiments were unhealthy to her mind and body and struggled to overcome them. The very last time I saw Ellie she told me something remarkable: "Now no more envy. It is gone. In fact, I'm able to feel generous. Maybe I can be a kind of pioneer of dying for my friends and siblings. It sounds weird, maybe Pollyannaish, but it sustains me and is a thought that doesn't fade like the others."
A pioneer of dying—what an extraordinary phrase! This took me back forty years, to the first time I encountered this idea in my work as a therapist. In my first group of patients with cancer, I tried hard, week after week, to comfort a gravely ill woman. I've forgotten her name, but I remember her essence and still, with great clarity, can see her despondent, deeply lined face and her sad, downcast grey eyes. One day she startled all of us in the group when she arrived looking bright and revitalized. She announced: "I've made a big decision this week. I've decided to be a model for my children—a model of how to die!" And indeed, until she died, she modeled grace and dignity, not only for her children but also for the group members and for everyone who came in contact with her. The idea of modeling how to die permits one to imbue life with meaning until the very last moment. Over the years, I passed her insight along to many patients, but Ellie's strong language ("a pioneer of dying") gave it even greater force. As Nietzsche said, "If we have our own 'why' of life, we shall get along with any 'how.'"
Irvin D. Yalom is an emeritus professor of psychiatry at Stanford University and a psychiatrist in private practice in San Francisco. He is the author of many books, including Love's Executioner, Theory and Practice in Group Psychotherapy, and When Nietzsche Wept. A new documentary about his life, Yalom's Cure: A Guide to Happiness, will open in New York and Los Angeles in February, and nationwide in the spring.