Author: Kelly Kleiman

Yesterday would have been Mark’s 69th birthday. I don’t have any eulogistic sound-bites to offer; he was too important to me for that. And somehow, every time someone pares off a Mark anecdote, it feels like there’s less of him left.

As this was Mark’s blog, it’s only fitting that he have the last word(s). These particular words are from 20 years ago, the first time he encountered a life-threatening illness. A familiar phrase for bravery is “conspicuous gallantry,” but Mark made it a point to keep his gallantry inconspicuous, and always wrote about his situation in the most matter-of-fact way. As you’ll see, though, that’s not because he wasn’t thinking about it as profoundly as he thought about everything else. Take a deep breath, though: it’s looooong.

A travel report from the Valley of the Shadow

The colloquy with Harold and Mike about the impact (vel non) of religiosity and religious observance on health outcomes reminded me of my own brush with a possibly-fatal diagnosis. The result wasn’t to make me any more or less religious (that is, it didn’t make me any more religious, and I could hardly have become less so) but it did occasion some reflections on the fear of death: in particular, to my discovery that — much to my surprise — I wasn’t afraid of dying.

At the suggestion of my friend Gary Emmett, I had set up a primitive email list-serv to keep my friends updated on my condition. (A practice I heartily commend to anyone undergoing a medical crisis; not only does it spare you the boredom of recounting the same medical developments dozens of times, and allow your friends to know as much or as little as they want to know without their seeming culpably incurious, but the positive effects of keeping a journal in the aftermath of a stressful situation are well documented in the literature.) As a result, I have a contemporaneous record of my thoughts as the time; it’s very lengthy, so I’ve pasted it in below the fold. Other than some format changes and fixing one arithmetic error (1979-2000 is not thirty years), it’s just as I sent it.

To put the note in its context: I had been sick since September and very sick since January, but wasn’t diagnosed with cancer until April. It then took about a month to nail down the diagnosis, which turned out to be the most favorable possible one under the circumstances: Hodgkins Disease, which is highly curable (about an 85% chance of survival, though I was sufficiently far along to somewhat reduce those chances). The alternatives were the more common Non-Hodgkins Lymphoma, with less than 50% survival, and anaplastic carcinoma, which is medical Latin for “curtains.” Even after the diagnosis, it wasn’t clear that I was going to make it. So this is a travel report from the Valley of the Shadow, addressing the question: “Being where I am, why am I so damned cheerful?”

Non-medical notes: Chiefly about equanimity

I keep coming back to the question of equanimity. Bad days are bad days, and discomfort is discomfort, and the Prednisone and lack of sleep were making me seriously edgy for a while, but I’m still pretty damned cheerful and unworried, considering. It can’t really be normal, even for a policy analyst, to react to the statement that his chances of being cured of an otherwise fatal disease are 70% rather than 92% by asking for more data.

But it’s not just that I’m not terrified; I’m in a good mood, much better than usual for me. Again, that hardly seems natural: when having cancer makes you feel better, it’s not hard to figure out that your previous behavior pattern might have been just a tad sub-optimal somewhere, but even allowing for that there seems to be something to be explained.

So we have two psychological facts: that a mortal threat isn’t making me anxious, and that being really sick and all that goes with it have greatly improved my sense of well-being. Objective: to find explanations for those facts.

One possibility is that the facts are not as reported. Early on, two or three people assured me, in one form or another, that I wasn’t really cheerful or unafraid: I don’ think anyone actually said “denial,” but that seemed to be the general idea. The threat must not have really sunk in, and I better get ready for when it did.

Of course, that sort of analysis has a rather bullet-proof quality to it; there’s no real force to my denial that I’m in denial. And there’s no real assurance that my spirits would hold up in the face of a flat medical death sentence, as opposed to a cluster of probabilities.

But six weeks into my knowing that I have a disease with “oma” somewhere in its name, I’m simply functioning much better than I have in past periods when I faced either bad news or major uncertainty. I’m not obsessing, I’m not thrashing, I’m not losing sleep to anxiety, I’m thinking about and working other things, I’m not noticeably difficult to be around. Moreover, the overall experience of passing time is pleasant rather than unpleasant, not merely better than one would expect under threat but in fact much better than my average.

Moreover, this is coming off a base — since I moved to sunny LA and collegial UCLA from frozen Boston and Hobbesian Harvard — which itself is way above my long-term average. Ever since I moved here, friends have been remarking on how [comparatively] relaxed I seemed. My current condition is a major cut above that.

So there’s a residual between actual observations and a reasonable guess about what my mood would be given the situation I’m in, and the residual has a positive sign: I’m better off psychologically than would reasonably have been expected. Take that residual as the explicandum of this analysis.

I’ve been told by a physician that cheerfulness is a characteristic of cancer patients, notably by comparison with sufferers from other severe diseases. There might, I suppose, even be a biochemical basis for this: maybe cancer cells make something psychoactive, or something psychoactive is made in response to them. If the reported difference is a fact, it would seem to
deserve exploration, but it’s not the kind of research that wins big grants from the National Institutes of Health or gets tenure at med schools.

(The alacrity with which NIH has relegated all study of mind-body interactions to an “alternative and complementary medicine” ghetto — poorly-funded, ill-placed bureaucratically, and subject to huge political pressures from the health-food and natural-remedies industries and their allied lunatics — may be inevitable, given the spectacular success of molecular biology, but it has its costs. It’s not just that making people happier seems as if it ought to be a legitimate goal of medicine: it’s almost certainly the case that happiness and related phenomena have direct and powerful effects on objectively measurable clinical outcomes, including mortality. Yet manipulating those variables is simply not part of “medicine.” as now practiced and taught. Is it any wonder that patients are flocking to naturopaths in droves?)

But back to our problem. Four questions naturally arise.

* What’s going on here?

* To what extent can it be preserved as I get healthy and get back to a normal life?

* Whatever is producing my cheerfulness and lack of fear, would it, or some elements of it, be a good thing for (some?) people not facing mortal risk?

* If so, can it (and how can it) be made available to those who would benefit?

The answers needn’t be the same for the two phenomena (cheerfulness and lack of fear of death), but I’ll consider them together.

Let’s start with the cheerfulness, and with the obvious. I’m on vacation. I’m working less practically not at all — if you don’t count these essays — and consuming more. (Ignoring here my absorption of medical services, which costs huge money but which isn’t really part of my consumption bundle.) Lots of people, paid and unpaid, are putting lots of effort into making me more comfortable, with great results. For one important example, without making less mess or spending more time cleaning up, I’m living with much greater order around me. For another, I eat and sleep according to the demands of my body and my own whims, and not according to any externally set schedule, and I don’t have to be anywhere at any particular time. (Astonishingly for someone who has always suffered from a long body clock and therefore hated getting up early, the result has been substantially earlier retiring and earlier rising.)

Better yet, I’m not doing anything I don’t want to do, and I’m not worrying about the fact that the things I don’t want to do will have to be done eventually, and I don’t have anyone annoyed at me about the stuff that I don’t want to do that I’m not doing and don’t plan to do.

(In fact, with one exception, I haven’t had to confront anyone seriously pissed off at me in six weeks. Over the same period, I haven’t been seriously pissed off at anyone, either. Makes a huge difference.)

Nothing is late, no deadlines are looming, I’m not feeling guilty or anxious about anything undone or to be done. I know that some people are capable of entering this state temporarily by pronouncing the mantra “vacation,” but it never worked for me. I’ve never had much of a boundary between work and life and would have told you that I liked it that way. But now I’m on vacation, for the first time since 1979. It’s probably one of those things you should do every twenty years, whether you need it or not.

Add to all that the fact that everyone who has affection for me now has a complete license to express that affection, in words and action, and that the result has been a flood of good wishes and highly effective good deeds directed my way. Yes, I would have told you that I had great friends — both admirable human beings and devoted to me — but the actual experience is something else, enough to make even the Grinch cheerful.

I do have a lingering sense of unease about how much is being done and sacrificed for me, but it’s not worrying me as much as it might. As my friends have a license to give, so I have a license to receive, outside the usual bounds.

Being on the receiving end of so much help would be harder for me to accept had it not been for an experience I had last summer. About twenty people, linked by individual friendships and by devotion to a common task but not strongly bound as a group, spent about ten days together: first, some high-energy tourism in Israel in late August, then a scientific meeting. One of the group was a revered and beloved senior figure, largely wheelchair-bound due to a chronic illness. In the absence of an Israelis With Disabilities Act, having him along involved a substantial amount of portage, including some long, steep hills and some shorter, steeper staircases, under the Israeli August sun. Everyone helped, taking turns according to no schedule, and there was never a shortage of volunteers.

Despite a little bit of worry about my back, I did at least my pro rata share, and I think probably quite a bit more; I’m somewhat closer than the group average to the person in question. (The possibility that I overestimate my contribution cannot be ruled out.)

The odd thing was that I wasn’t doing it because it needed to be done, but because I wanted to do it; if someone had said to me, “Look, don’t risk your back; I’ll take your share of the work,” I would have been more than actively unwilling to comply; I would have felt seriously deprived. Of course it was partly the camaraderie of a joint effort, the same thing that keeps people rowing crew, but that sort of thing wears out pretty quickly for me.

The basic fact, for me and I think for the others (I could be projecting) was that carrying the great man around was not only a way to have him with us but a way for us to express our affection and esteem, and therefore a source of active joy. We all wanted him to know how much we loved him, and here was a way of saying so without embarrassment on either side.

(Of course it was physically much rougher on him than on any of the helpers — he’s never really out of pain, anyway — and his gallantry made it that much easier on everyone.)

The cases are miles apart in degree: I wouldn’t think about comparing my merits, or my sufferings, to his, and the effort we all expended was really rather trivial by comparison with people flying across country to tend me. Still, the experience makes it easier for me to accept the notion that the benefits of helping aren’t always entirely one-sided, and that in turn makes it easier to be on the receiving end.

Okay, so I’m on vacation and being love-bombed, and not really feeling especially sick, so my mood is better. Take that, if you will, as an adequate provisional explanation for my cheerfulness. (Or maybe the mortal threat is helping bring smaller issues into focus, as Near-Death Experiences have been said to do. Query: if that is the case, are there less drastic ways of producing the same effect?)

That leaves the question of being in the Valley of the Shadow of Death and fearing no evil. When I’m really anxious, as some important uncertainty is about to be resolved, nothing cheers me up, or keeps me from obsessing about possible outcomes and last-ditch ways of influencing them. (I’m simply not fit company in the fall of a Presidential election year.) None of that is happening now. As the song says, “I’m not scared of dying.” Why not? And can we bottle it?

For the purposes of this analysis, we can treat “death” as comprising three separate fears:

1. The fear of the dying process, and especially of a painful, lingering death;

2. Anticipated regret at the potential loss of life-time and the opportunities and pleasures it brings, along with concern about the losses to others incident on one’s dying at a particular time;

3. Fear of what comes after death.

Start with #1. I’m as averse as anyone I know to the prospect of dying slowly and painfully; having hurt a lot for a long time, I’m not at all eager to hurt more or longer, but I expect to be able to avoid that through technical or quasi-technical means. That doesn’t mean that if someone says the words “metastatic to bone” I won’t shudder, but right now I don’t seem to be under that kind of threat. The same is true of the threat of having to live with long-term pain or disability; as far as I can tell, my persistent dread of the consequences of stroke hasn’t diminished a whit, and I wouldn’t expect to be nearly as calm if I were told that I had a 15% chance of being paraplegic or aphasic rather than merely dead.

As to technical and quasi-technical means: it has been asserted — I haven’t looked into it — that those who are truly dying can stop eating without being hungry, and that the resulting death by inanition is fairly quick and painless. Despite the well-documented practice of American physicians of undertreating pain — a practice encouraged by various regulatory agencies — I’m confident that I won’t be much subject to it when the end comes. There are advantages to having an advanced amateur knowledge of psychopharmacology.

[Did you know that adding some stimulant (e.g., amphetamine) to the mix both increases the pain-killing value of narcotics administered for chronic pain and reduces the drowsiness and listlessness they can induce? Neither did I, when my back was giving me fits, but I do now, and I expect to be tough enough to make that knowledge stick.]

In sum, then, I regard the risk of a slow, painful death as truly fearsome, but I’m confident that it I’m not facing it.

As to #2, I can think of a lot of good uses for the next twenty or thirty years; I’m all set up to enjoy them, and to do some useful work. If I think of those years as potentially to be lost if the news is bad, that’s a major threat, equivalent even at low probability to a huge financial loss. (Would I give up my net worth in return for the assurance that the lymphoma won’t kill me? Sure.) A risk this size doesn’t ordinarily paralyze me, but it certainly costs me sleep. Yet this risk isn’t doing that.

Here’s one hypothesis. Most risks I face entail either some element of desert or skill on my part or some element of choice on the part of someone else. Facing a loss because I did something stupid makes me feel inadequate and guilty. Facing a loss, or a missed opportunity for gain, because someone else judges me to be less worthy than a competitor damages both my self-esteem and my social standing. Facing a loss because someone else is mistreating me, or, worse, people who owe me help are letting me down, makes me angry and depressed. (In the usual mixed case, where it isn’t clear to me or anyone else whether I deserved to lose out or not, it makes me twice as angry and depressed.)

None of that applies here. I didn’t do anything to get lymphoma, and no one is doing lymphoma to me. It’s just a piece of misfortune, and it turns out that I don’t find bare misfortune that hard to take.

This goes along with my basically Bayesian attitude toward the world, as one of partly knowable random chances rather than fates. Another way to express that same view would be the lack of a belief in a God who can choose. The universal process (physis, Tao, pick your own name for the Nameless) having dealt me, without any special reason I know of, quite a good hand, has just dealt me (maybe) the Hanged Man, reversed. This is no more explicable or inexplicable than my earlier good fortune, and doesn’t much change my self-concept or my concept of the universe I live in.

I have long felt a little bit guilty about all my good fortune. As a prosperous American at the dawn of the twenty-first century, I enjoy command over material resources surpassing that of all but the top fraction of a percentile of all those living or who have ever lived. Even better, the suffering involved in receiving medical and dental care are dramatically less for me than they were even for my parents. I live under institutions that do a very good job of shielding me from official and unofficial aggression while allowing me to participate without any noticeable personal risk in the project of collective self-rule. Moreover, I do so participate, actively and sometimes successfully, and I imagine that doing so gives me great moral dignity.

Now if all that isn’t good luck, what is? Okay, I didn’t get a cheerful heart, but you can’t ask for everything (and expect to get it) in a random world.

I have felt guilty, I say, not because I don’t deserve all this good luck (what would that mean?), but just because I’m not making better use of it. Someone as well placed as I, it sometimes seems to me, ought either to be much happier than I am or be making up for it with really extraordinary production of value for others. I mark myself as something of an underachiever, especially when it comes to happiness but also when it comes to work, and that has been a mild source of continuing unease. (Of course, the capacity for such abstract unease is part of the problem on the happiness front, which can lead to a very bad positive feedback loop when I let it, which I don’t very often.)

But this basic orientation toward the world means that suffering a misfortune doesn’t challenge my self-concept or my ideas about the universe I live in. In a world of luck, I just suffered a piece of bad luck, after a long but not by any means unbroken string of good luck. That doesn’t suggest that my connection with the universe is other than I thought it had been, or other than it ought to be, or that my being is in some need of profound readjustment. Win some, lose some; some days it rains. Shit happens; some just happened to me. It doesn’t make me ask “Why?”

In my case — I don’t know how much this generalizes — the Bayesian world-view is linked to a sense of comedy and of irony. These don’t much blunt my moralistic anger about actions taken for bad motives, but they greatly reduce my expectations about the results produced by acting on good ones, and they buffer certain kinds of disappointment and anxiety.

The basic fact about human existence, as I see it, is that the world is just too complicated. Even that part of its complexity relevant to our choices and actions often overwhelms our capacity to describe and decide. That doesn’t make the effort to describe correctly and decide rightly any less urgent — that’s what it means to live in the world — but the results still have a rather Keystone Kops quality about them, and it’s not really anybody’s fault.

Think about all those poor mathematicians over two millennia going crazy trying to prove the Axiom of the Parallels. How were they supposed to guess at the existence of alternative geometries? As to action, think about the heroic Huguenot defenders of La Rochelle. They gladly gave their lives for the Protestant cause, when it was only their defeat by Richelieu that enabled France to outlast the Hapsburgs in the Thirty Years’ War and thus keep
Protestantism alive on the Continent. [Another time, I’ll tell you why I think The Three Musketeers is a great work of fiction rather than a mere adventure tale for boys.]

If this is what the universe is like, it seems natural for me to think, write, and speak comically and ironically, and so I do. Only in recent years have I realized how much that has cost me interpersonally. It’s a larger part than I had imagined of the reason that I tend to be a slowly acquired taste. People think I’m laughing at them (which is true, though not at them in particular), or interpret what seem like ironic suggestions as seriously intended. Ironic speech is seen as an attack on the seriousness of the topic at hand, rather than as a reminder of our limited capacity to comprehend and to act.

Still, whatever its costs, the vision of a universe in which human beings are mostly playing three-carom billiards blindfolded makes the odd caroms easier to accept. Seeing the world as primarily comic encourages laughter, notoriously a good medicine for every evil. Death is right up there with sex as a topic for humor, and since I tend to retain what I hear or read I have a repertoire of what seem to me pretty good death jokes. Over the past six weeks, they’ve seemed — again, to me — much, much funnier, though I’m given to understand that some of my friends found them hard to take in my sepulchral whisper. In my view the Cheshire Cat went out the right way, leaving only his smile behind.

One reader of the earlier essays in this series, a stranger to me until now, reported that she had cried on reading them. I was surprised; they were supposed to be funny. (And I apologize to those who care about me if I caused them pain while intending to spread laughter.) The pathetic aspects of my situation are still largely unavailable to me emotionally, not because I’m incapable of feeling sorry for myself, but because the course of events so far hasn’t been especially bad, viewed from the inside.

On reflection, I can see how much harder it all might be to take from the outside, and especially with respect to the risk of death. The French used to say, “Partir, c’est mourir un peu”: to part is to die a little. In the days of slow travel, that was true: to have a friend leave was like having him die. The modern abolition of distance has changed the meaning of parting; perhaps the lack of experience with small deaths makes big ones that much harder to take.

Of the losses that would result from my dying now rather than later, a very large portion would be borne by my friends. About fifteen years ago, I lost two close friends to early deaths, both from cancer, a couple of years apart. The scars haven’t really healed. I recall my bitter anger at the loss of them, and the bitterness hasn’t much faded, or my sheer unhappiness about not being able to talk with them, work with them, spend time with them. (Neither of them had my objective reasons for equanimity; both had young children.) Perhaps if I were a more empathetic person, my friends’ potential grief would make me dread death more than I do; right now, my thoughts are focused inward even more than they usually are.

Moreover, in my particular case, and with no advance planning (there was no reason to think that I might be dying at 49) things are so arranged that the potential losses to me from dying sooner rather than later are less-much less-than they might be.

Children, it is said, are hostages to fortune. I haven’t given any; my death would leave no orphan. Nor would I leave a grieving spouse or lover. Now I count those lacks as losses, but under these circumstances they reduce the loss in case of a bad outcome.

Fifteen years ago, or even ten, the prospect of dying would have left me with a strong sense of potential wasted and work undone: a huge investment in being ready to produce, never to be collected on. But now I’ve done a solid chunk of my proper work, and would leave behind a good book, four or five ideas worth remembering, some great one-liners, and a collection of people, only some of whom I was being paid to teach, who think about the world differently and contribute to it more effectively because of their interactions with me. That seems enough to leave behind, if leave I must; there’s no sense of tragic waste.

I can also say that I have lived largely according to my own notions, learned what I wanted to learn, and surrounded myself with good company, good music, and objects worth contemplating. Again, I’d happily take another few decades of the same — my life, even before this latest turn, has been getting better and better — but if tomorrow were my last day I wouldn’t have to look back and say that I’d forgotten to live while I was alive.

That brings us to #3, the fear of what comes after death. I don’t recall ever being afraid of what might happen to me after death, but then I seem to have been spared a number of common phobias; I never lost sleep about a nuclear war, either. My parents were and are convinced unbelievers, and the Jewish education to which they exposed me (because their liberalism runs deeper than their atheism, and they thought they owed me the opportunity for informed choice) had nothing to say about an afterlife. The accumulating recognition that I was mortal and that therefore my planning needed to be done with a finite rather than an infinite horizon has always been a chilling one — I fancy that I could make good use of any amount of additional life-time — but in recent years it’s aging, rather than the prospect of dying, that has gotten me down.

So it would seem that I don’t really dread any of the things that “death” means, for reasons largely specific to my background and situation. That’s not the answer I was looking for, since it cuts against the possibility of spreading the benefit around, but it might be the right answer.

Still, I wouldn’t have expected my not dreading the components of death to make me as unmoved as I seem to be by the prospect of dying, any more than a clear intellectual conviction that bungee jumping was safe would enable me to toss myself off a bridge with a cord tied to my ankle. Somehow, the animal fear that ought to be present is (happily) absent.

Reduced fear of death is of course one of the classical claims for philosophy (back before its academicization, when that enterprise was understood to be in part about how one should live) and for religious belief, but I’d sure like to see the data. I’m prepared to believe that my increasingly serious reading in Plato and Heraclitus over the past several years has indeed given me some “preparation for a serene dying,” but I’m (a) surprised that it worked as well as it seems to have done for me and (b) skeptical that any substantial fraction of the population could follow that path to a useful end.

Similarly my guess would be that ordinary church-going wouldn’t much predict serenity in the face of death, any more than having taken Phil 101 in college would. A Christian secure in his or her faith presumably has no reason to fear death, at least the “what comes after” aspect of it, but I don’t know of any evidence showing that Americans, with their astonishing religiosity, fear death less than the much-less-observant Europeans. But my guesses on these points could well be wrong, or it might turn out that some denominations or authors or practices had much more powerful protective effects than others. Is there empirical work on this?

Reduced fear of death was also one of the many claims made for the psychedelics back when they were in fashion, and I think there may even have been some evidence on that point. There’s now interest in renewing that line of research. But what about the whole range of routine religious and spiritual practice, from bedtime prayers through meditation to silent retreats? Surely someone must know something empirical about their effects on fear of death, but that knowledge doesn’t seem to have made it into the general culture.

The desideratum is something efficacious that might plausibly be adopted on a mass scale. The cultural barriers to be overcome loom large. It’s not even as if our fear of death were reliably constrained by our announced religious beliefs. To an outsider, the demand of murder victims’ families that the killers be executed as a kind of recompense to the victims — a commonplace in the capital-punishment debate — has a somewhat pagan ring to it, but if any Christian minister has chosen to make that point, I somehow missed it in the din. “Why should the murderer see the dawns his victim will never see?” the families cry. This seems to me, as a non-believer in an afterlife, a perfectly reasonable question: the loss of life-time looks from an unbelieving perspective like a serious loss, and one arguably not commensurable with the losses inflicted by other crimes. But surely if the victim is enjoying the perpetual dawn of Heaven, his loss is overwhelmed in his gain.

So which is it: don’t the relatives believe in Heaven, or do they doubt that their kinsman made it? (Oddly, they never seem to say that it is their own loss that must be satisfied; the claim is always made on behalf of the slain.) Somehow, the prospect of heavenly joy fails to satisfy, either personally or vicariously.

[There’s an old story about a recently ordained Anglican clergyman who pressed the question of the afterlife on an older colleague. “Seriously, what do you expect to happen to you when you die?” “Well, I suppose that I shall see the Face of God and experience eternal bliss with all the saints in Heaven. But MUST we talk of such unpleasant topics over dinner?” The older man was undeniably orthodox in both theology and etiquette, but the two facts would seem to be hard to reconcile. If death equals eternal bliss, then why should talking about it be considered so rude?]

[Just for political balance, I should point out here that the opponents of capital punishment are at least as death-obsessed as the other side. The one legal principle that no one in capital cases questions is that “Death is different,” requiring a higher standard of proof and more elaborate procedural protections. Well, yes, killing someone quickly and painlessly is certainly different from locking that person in a cage for fifty years, but worse? The strongly expressed interest of most death-row inmates in just staying alive has to count as evidence that execution is worse for them than imprisonment, but only a very strong commitment to rational-actor modes of thinking would regard that evidence as conclusive. The integral of suffering over a prison lifetime might be hugely greater than the alternative without overwhelming the purely animal instinct to stay alive one more day.]

Perhaps, instead of asking why a particular patient reports that he isn’t very afraid of death, it might be better to turn the inquiry on its head, and ask why death should hold the terror it so obviously does for most people. There are obvious reasons in evolutionary psychology for a built-in aversion to dying, and maybe it is foolish to seek further explanation. But there does seem to be a profound illogic about fearing death (again, as opposed to dying, or the loss of life-time, or concerns about the sufferings of others as a result of one’s death at a particular time). If nothing comes after — and I, for one, think that asking what happens to the soul after the body dissolves is like asking what happens to the flame after the candle burns out — then surely Socrates is not at all paradoxical in asserting that “nothing” is nothing to fear.

If, however, the afterlife is much less pleasant than this life, either for all (as Homer depicts: “Better to be alive, and the slave of a pauper, than king of all the dead,” the shade of Achilles tells Odysseus) or for some, then fear would be a reasonable reaction. Is that perhaps the root of the problem: the suspicion, even among the formally pious, that they might wind up with the goats rather than the sheep?

If post-mortem judgement and the pains of Hell are human inventions rather than facts about the universe, then I’d nominate that invention as the nastiest trick ever played on humanity. How those beliefs became incorporated into Christianity, and consequently into the fabric of Western culture even for those who are not Christian by upbringing or belief, merits inquiry.

Reward and punishment after death played little role in the pre-Exilic religion of Israel; there are scattered references in some of the prophets, in the Psalms, and in the apocalyptic literature, but the Torah itself is entirely silent on the topic. All the divine threats and promises have to do with longevity and prosperity in this life. (My very favorite divine reward is the one offered the righteous king Josiah, who is promised that all the horrible stuff that will happen to his family and people will happen after his death, when presumably he won’t care about it.)

However, by no later than the first century the Heaven-and-Hell belief had penetrated folk Judaism, whatever the religious leadership thought or taught. (The afterlife seems to have been one of the points of difference between the rabbinical Pharisees and the priestly Sadducees.) The official Jewish line of this period, or somewhat later, seems to be quite optimistic:

All Israel has a place in the world to come, as it is written, “All of My people shall be righteous [or “justified”]; they shall enter into My kingdom.”

Evidence that the grimmer belief was common currency among the Jews is in the Gospel of Luke: the story of Dives and Lazarus assumes Judgement and Hell as matters already familiar to its audience. So where did the Jews pick the doctrine up, to be able to hand it on to the Christians? The classical Greeks, though not Homer, certainly had it in some form — Plato makes fun of it as a clever but dishonest means of social control — and they in turn might have had it from the Egyptians. The Jews, in turn, might have imbibed it from the general Hellenistic culture amid which they lived from the time of Alexander. Or they might have brought it back from Babylon, or developed it on their own.

There would seem to be a serious doctrinal problem for Christianity here; if some apologist has covered the matter beyond the general assertion that revelation is progressive, I’m open to instruction. If the Judgement is a fact, it seems to be a rather important fact. That raises the question of why the Lord didn’t bother to mention it to Moses in one of their many chats.

Without the Judgement, the Redemption becomes at least in part, a solution in need of a problem. (A Christian friend reminds me at this point that the Redemption is from “death, Hell, and sin”; one could desire redemption from the other pair even if Hell were left out of the reckoning. But Hell does seem to be on people’s minds.)

Note that, given Hell as a matter deep in the background of folk belief, the resulting fear of death might be largely independent of professed doctrine, or even intellectual conviction; Hobbes the atheist died, it is said, in fear of hellfire, and Voltaire himself asked for a priest. (When asked, as part of the Last Rites, whether he renounced and abhorred the Devil and all his works, Voltaire is said to have replied, “Now, Father, is this any time to be making enemies?” Surely too good to be true.)

Assuming, again, that there actually isn’t a Hell, how could people be freed from its devastating fear? If conventional philosophy and conventional religiosity can’t do the job (and the professional philosophers, as noted, aren’t even trying), then perhaps more drastic measures are called for. Mystical experience is reportedly prophylactic against the fear of death; that claim is at least as old as Eleusis, and cuts across religious traditions. Somehow the experience of mystical unity seems to be incompatible with belief in eternal torment. “All shall be well, and all shall be well, and all manner of things shall be well.”

As the boomers age and confront mortality, will there be an upsurge of interest in mystical experience as death preparation? The classical means — fasting, waking, silence, long isolation, years of meditation and prayer — all seem like too much work ever to attract a large following, and even then the reported success rates aren’t high. But if the claims made in the 50s and 60s that chemically-induced peak experiences can reliably produce the same results with much less effort could be demonstrated with something approaching scientific rigor, there might be substantial interest. Still, it’s hard to imagine the benefits extending to more than a relative few, even if the drug laws weren’t in the way. The same applies to providing synthetic near-death experiences in hopes of reducing fear of the real thing; it might work, but at mass scale?

[The reader will have noticed my compromise between esoteric and exoteric traditions, between elitism and democracy: to ask why what is good for the few couldn’t be made available to the many. Sometimes there’s a good answer to that question, but I think it always needs to be asked, and purported answers treated skeptically and tested against experience.]

Our current burial customs are arguably part of the problem. The notion of the body’s being eaten by earthworms isn’t an attractive one, even for those who believe that the Self won’t be around to experience the process, either because it will not then exist or because it will be elsewhere. (As Socrates says in the Phaedo, “Bury me? However you like. But you’ll have to catch me first.”) In one of the great monologues in Rosencrantz and Guildenstern are Dead, Ros — or is it Guil? — goes on at length about the horrors of the grave, and in particular how difficult it is to remember that you’re going to be dead in a box rather than being alive in a box.

Would cremation as a custom make a difference? Does it, where it is practiced? Does it, for those in Christian countries who choose it? Obviously, the causal links are hard to trace here; the image of the worms eating the body might help infect a whole culture with a horror of death, at such a depth that planning to have your own body cremated wouldn’t do much good. Still, just because the scientific work is hard doesn’t mean that it isn’t worth doing.

So on reducing the fear of death I’m left with questions, but no answers of much plausible utility. Yes, it seems to be possible not to fear death, but no set of activities I can imagine actually taking place would be likely to make that possibility real for any large number of people. I take it that fear of torment in an afterlife constitutes an important human problem, but at this point I doubt that there’s much of anything to do about it.

Now, how about happiness? Again, the analysis of my case presented above is a little bit discouraging, since it suggests that my new-found happiness might be quite hard to generalize. (Not everyone can be on vacation and the recipient of extraordinary displays of affection all the time.) But maybe we could do better than we’re currently doing; the inquiry seems worth making.

Relatively recently, a small group of economists (Scitovksy, Robert Frank) and psychologists (Kahnemann, Parducci) has begun to study happiness and unhappiness empirically, after decades in which those concepts were treated as purely subjective and not subject to investigation. (Xenophon turns out to have guessed some of the important findings; compare the opening of the Hiero with Scitovsky’s Joyless Economy. Benjamin Franklin’s long essay on pleasure and pain, written when he was in his twenties, also turns out to be prescient.)

Some of the results are fascinating:

*Controlling for everything else measurable, self-reported happiness predicts health outcomes over the coming year.

* It varies with objectively measurable personal characteristics such as social status and family situation, but a huge amount of the variance is unexplained by such variables and therefore has to be attributed to personal constitutional factors.

* Happiness correlates fairly well with position within a national income distribution (yes, the rich tend to be happier, in part because they have fewer spousal quarrels over money) but not above levels of GDP per capita well below those of the contemporary US, with the average wealth of the country or the period. (On average, Americans aren’t happier than the Irish, though the U.S. has about twice their national income per capita. Moreover, Americans today don’t report themselves as happier than their grandparents did in 1948, when the inflation-adjusted national income per capita was less than half what it is now. The median family income then would be at just about the poverty line now, but for purposes of happiness those average Americans weren’t “poor.”)

* Looking now at evaluations of particular experiences rather than overall happiness, when people rate things that happen to them in terms of their degree of pleasure or pain they tend to ignore duration, as a result of which an experience that is subjectively registered as more painful than another at every moment can still be recorded and recalled as less painful overall.

Some of these results seem to cut very near the roots of microeconomic policy analysis, which concerns itself entirely with giving people as much as possible of what they (think they) want. But despite the great distinction of some of the pioneers of the new work, the convincing nature of some of the experimental findings, and the obvious importance of the topic, it remains, for now, marginal within its disciplines and almost entirely ignored in applied work.

If it’s really true for advanced economies that the average happiness of a population does not vary with national income per capita, that ought to say something very important about the right way to trade off growth against other objectives (say, environmental protection or economic and social equality). If (here following Robert Frank) some goods, such as leisure, contribute to long-term happiness while others simply make their users run faster on Scitovsky’s “hedonic treadmill,” then the long-discredited concept of a “merit good” might turn out to have some real punch. So also if some goods are more positional than others (i.e., if for some goods it’s one’s consumption relative to a social average that matters, where for others it’s the absolute level, independent of the consumption of others). If different people have vastly different capacities for converting objective conditions into subjective contentment, maybe we should learn how to develop those capacities; enabling people to be happier with what they have could be thought of as a competing technology with enabling them to have more of what they want in producing the end-product “happiness.”

Dealing with drug abuse as a policy topic, I’ve spent years thinking about things that people buy and use that don’t turn out to make them happy, so I’m less threatened by this set of intellectual developments than my colleagues who pursue more civilized topics. But even allowing for that, it burns me up that we keep teaching freshmen and first-year policy students the old preference-satisfaction doctrine, as if it weren’t leaking badly below the waterline.

But back to the patient in question. Cancer seems to have made him happier. Can he keep the happiness as he loses the cancer? Take, for the moment, the optimistic view. He’s had a near-death experience, and has become enlightened as a result. Enlightenment has made him happy.

Well, maybe. It’s certainly not the currently fashionable New Age enlightenment that treats all possible outcomes as equally good, or as necessarily intended for our good, and therefore not to be worried about. (This is the view of Spinoza, whose name for some reason is pronounced “Pangloss” in Latin, “Pollyanna” in English. That brave little girl is maligned in common parlance, where her determination to accept all events as good is confused with Micawber’s blind confidence that good events will somehow happen.) I seem to have come to the understanding that one possible outcome usually understood as awful wouldn’t be so bad, but that doesn’t keep me from considering some possible outcomes as very bad indeed, or from fearing them accordingly.

My sister Kelly generously suggests that my reaction to my situation exemplifies courage, and that the exercise of a virtue is naturally a source of happiness. That explanation has the twin advantages of linking the two phenomena under study and of not demanding a generalized enlightenment (which as far as I can tell hasn’t happened) to account for my good cheer. And it certainly makes sense that the discovery that I have a fortunate quality — lack of terror of death — should improve my mood. I expected to experience fear as death approached, and now I expect to experience less of it. That’s a gift, and I’ve always liked getting presents.

On the other hand, the word “courage” is only a partial fit for what’s going on, because the word has, I think, two distinct senses, only one of which fits the current facts. The overarching meaning of courage — acting as one would want to act in the face of threat, “grace under pressure,” seems to apply; I’m handling the threat of death with less-than-expected difficulty. But “courage” in its ordinary meaning implies behaving well while confronting or experiencing something feared or painful. (Perhaps we should call this “grit.”) I exercise courage in the second sense every time I go to the dentist; I know that it will be very unpleasant, and I go anyway. (My behavior once I’m in the dentist’s chair does not exemplify courage; my regular dentist just gave up and told me to go to the hospital, where the work can be done under a general anaesthetic.)

What’s happening now is quite different. I’m not handling my fear well; I’m just not afraid. What I’m benefiting from — exercising is somehow too active a verb — is courage in the Socratic sense: knowledge (felt and put into action, rather than merely intellectually apprehended) of what is, and is not, to be feared. It’s certainly a virtue — a quality that confers benefits — but it’s not an effortful virtue; it just sits there conferring away without needing to be tended.

The Platonic Socrates seems to say (but perhaps ironically) that anyone who really knows himself would know that nothing is to be feared except for acting wrongly, and would therefore always experience this effortless courage and always act rightly. Well, I doubt it. (This does not compromise my piety toward Socrates; doubt is one of the Platonic sacraments.) I’ve had bad things happen to me, and I didn’t like it, and I don’t want them to happen any more. I fear them. And at that point my deficiency in the effortful courage, in grit, gets to be expensive; I tense up when I get an injection, even though I “know” perfectly well cognitively that tensing up makes it hurt more. Ideally, I should produce some excess Socratic courage and sell it to finance the purchase of grit, but there seems to be some sort of market imperfection blocking this obviously sensible trade.

“Before enlightenment, draw water, chop wood. After enlightenment, chop wood, draw water.” Eventually, whatever gains I have made need to be consistent with pulling my weight in the boat, which I’m currently not doing. Long-term, consuming much and producing little doesn’t constitute a socially generalizable option. When the vacation is over and I’m (at least partly) cleaning up after myself, will there be any gain left, and if so, how can it be preserved?

My bonds to my friends should be stronger, unless I get myself tied up in retrospective embarrassment about how much I owe them. But as conditions return to normal, tact is likely to reassert itself. (I value tact, in myself and my friends.) Maybe we can keep saying what we actually mean to one another, at least a little more than has been the case in the past. That would be nice. We’ll see.

About work, I have my doubts. I work on things I want to work on, but work is mostly chores, and I hate chores. I’d rather go for a hike — well, not right now, but in general — or read a good book. The one chore I had to finish after dropping all the rest was grading papers from winter term. It wasn’t any less of a chore, and I didn’t do it any better or with any less emotional stress, than is usual for me. I can arrange not to do it in the future, but only by not giving my students something I think they need. There’s no obvious way to continue to do it without continuing to hate it. Most of their work is bad, by the only standard I have, and reading it makes me sad and angry, and pushes my failures as a teacher right in my face. [Memo to self: work harder for higher admissions standards; better students greatly reduce this problem.]

Maybe the students and I would both be better off if I restricted my teaching activities to those I do well and happily, since when I’m suffering I also make the students suffer. But I know damned well that if I don’t teach them to write they won’t learn, and that if they don’t learn to write their career options will be drastically limited. There’s no clean way out. (I could compromise by making the papers optional, extra-credit assignments.)

Well, how about on the research side? Writing is usually a chore, and, like many others, I have a habit of committing myself to projects with deadlines as a way of forcing the words onto the paper. It almost always works — I hate welshing even more than I hate the work of writing — but the usual result is weeks of anticipatory suffering and several bad days of actually writing under time pressure.

The current essay, by contrast, counts as my “work” for the moment, and I certainly want to get it out the door this week before I go back into the hospital, but since I haven’t promised it to anyone to whom it matters whether it’s produced or not there’s no anxiety about finishing it. That doesn’t seem to have reduced my productivity on the project.

If anything, the effect of not having to write is liberating, according to the great Tom Sawyer principle. (“Work consists in anything a body is obliged to do. Play consists in anything a body is not obliged to do.”) Not having to, I’d just as soon write as do anything else. Right now, it’s 3 am, but the words are flowing, so I’m not tempted by bed.

Maybe I should start saying no to requests to write papers and instead just write the papers and send them off. Might work.

Make boundaries between work and the rest of life? Start taking real vacations? Nice work if you can get it, but I doubt my patterns are so malleable. Why shouldn’t I do my catalog shopping from my desk and read papers at home in bed? It’s clear that thinking that way has gotten me into trouble, but somehow I doubt that I will be able to unthink that perfectly obvious thought.

Produce less? Not a bad option from a personal perspective — what I value are the ideas, not the published papers, and the flow of ideas isn’t likely to slow much — but my departmental colleagues have a stake in my measured productivity, so there’s a non-trivial ethical problem in slacking off now.

On the consumption side, I can’t report the reduced materialism that’s supposed to go with enlightenment. My attachment to my favorite possessions has, if anything grown, and so has my desire to get my house remodeled. (The more time I spend at home, the more the details matter. I’m moving art objects on my walls by matters of inches as staring at them convinces me they’re not quite right where they are.)

My other ambitions and concerns seem to be unchanged in identity and intensity. I want Democrats to win all elections; I want my department to be great; I want to get some sense and humanity back into drugs and crime policy; I want to revise Against Excess and write a book on the application of behavioral economics and game theory to crime control strategy.

So there doesn’t seem to be much of a general values reorientation, such as is reported to accompany profound spiritual experience. (I have gotten more sentimental — there are now stories I cannot recount without choking up — but that just continues a trend of the last several years. I expect to keep the sentimentality, whatever happens next.)

Perhaps it’s good news that I can become cheerful in the face of surface adversity without changing any of my desires, but there’s reason to question how much of what I’m now experiencing I’ll be able to keep when (if) I return to the real world. Maybe I’ll be able to recall my current mood as needed, even after the conditions that gave rise to it are changed.

That would be a valuable thing to be able to learn to do; one can always hope.

If you have never in your life done anything you’re ashamed of or could have done better, you’re welcome to reject any and all Democratic Presidential candidates for their personal flaws. But no one gets to her 50s (or even 40s, or 30s) without regrets—no one honest, anyway. So let’s try to judge these people based on their actions and words in the public arena—what they’ve done for others, and what they propose to do.

This is not a taste test; we’re not consumers, entitled to titillation or inspiration or glossy packaging before we purchase. We’re citizens looking for a sister- or fellow-citizen—as flawed as ourselves—who most closely approximates our public ideals, plans and goals. For some reason I think of Tennyson’s Ulysses:

Come my friends, tis not too late
To seek a newer world….
Tho’ much is taken, much abides; and tho
We are not now that strength which in old days
Moved heaven and earth, that which we are, we are;
One equal temper of heroic hearts,
Made weak by time and fate, but strong in will
To strive, to seek, to find, and not to yield.

Today someone expressed enthusiasm for a candidate by saying, “Who cares about votes?” I don’t understand that: every day that goes by, every terrible judicial appointment, every regulatory rollback, every white-supremacist speech or action, shows how critical it is to care about votes.

So let’s stop sipping and spitting and get down to the business of choosing an able candidate. Able to be elected, and able to do what matters as President when she is.