|
Evolution
has equipped us with an instinct to live that fuels a most intense fear of
D&D. In our culture, this fear is still managed mostly by avoidance,
denial, faith or media white-wash. (Whom would you rather have lunch with: a
minister, an undertaker, or a forensic pathologist?) Most of us would prefer
to avoid anything that vividly confronts us with our own mortality, hopefully
assuming that we will die painlessly in our sleep or that others will make us
comfortable as we leave life. This approach avoids the anxiety and confusion
about D&D that can accompany planning for these events. I think that the decision to not
think about D&D is OK. You may be a person for whom the cost in anxiety
or depression is not worth the possible benefits of reducing your suffering
or that of those you care about in the last stages of life. I would feel even
more comfortable with your decision if you would consider revisiting the
topic from time to time, just to see if your reaction is different, or if
there have been developments in the area which might make a difference to
you. |
1.1
|
People
differ in the way they react to emotionally-charged problems such as those
presented by D&D. At one
end of the scale are problem repressors who try to avoid or deny
problems and to suppress the emotions that go along with them. The repressor
benefits from not worrying about things until he must. At the
other extreme are the problem vigilantes who are always on the lookout
for something that might go wrong. Anxiety accompanies both this vigilance
and the problem-solving attempts that follow. When a vigilante, resolves
a problem, there can be a sense of accomplishment as well as relief from
anxiety. But, there will soon be another problem on the horizon ... |
1.2
|
People
differ in how readily they respond to problems with anxiety or with moodiness-depression.
Note that these describe a person who is especially prone
to react, rather than a person who is always feeling one of these
ways. So, when things are going well, a person with a high potential to react
might not be anxious or depressed, but would be to an unusual degree when
things are going badly. |
1.4
|
Impulsivity is the tendency to skip planning
and consideration of consequences before taking action. The impulsive person
might feel an internal pressure to do something right away, or he may not
know how to plan. |
1.5
|
Risk-taking
is different from impulsivity in that it assumes some awareness that a risk
is being taken. Most our lives are not filled with risk, but you can probably
think of a few times when you may have risked a job, or a relationship, or
when you decided that the thrill of a dangerous activity was worth the
possibility of harm. The opposite of a risk-taker would be a person who seeks
safety or security, even at the cost of boredom: |
|
Changes in the above
characteristics
could make a difference in your reactions to D&D, as follows: ·
Reducing
anxiety or moodiness can decrease the desire to leave life. ·
Toning
down impulsivity, repression, anxiety and moodiness can make you more
comfortable with thinking about and planning for D&D. ·
A
willingness to take risks could translate into a willingness to take your
chances with an unknown afterlife. ·
The problem
repressor's ability to not worry about a problem like D&D could be
quite useful. He might be more willing to work on something unpleasant if he
knows he can stop thinking about it when he wants to. Your
place on the vigilante-repressor scale and your readiness to respond with
anxiety or moodiness can also affect your reactions to the rest of the LLQ.
If you are a highly anxious or moody problem vigilante, you may be upset by
the questions and have a more difficult time forgetting about the thoughts and
images the questions evoke. If you
are an anxious or moody problem vigilante you may want to check section 12:Moving
away from D&D: Returning to life as usual to see whether the
suggestions there would work for you. If you are not good at putting problems
aside when you want to, maybe you'd be better off not thinking about D&D,
as discussed in Choosing
to deny or avoid D&D. Keep in mind, though, that the questions
proceed from least- to most anxiety provoking, and you can stop at any point. |
|
In figuring out what to do during
the next
hour, day, week or stage of our lives, most of us use some variation of the
Western scientific approach to decision-making: 1) First, we make enough observations
to predict the results of different courses of action. 2) Then, we look over our
observations, and figure out the costs and benefits of each alternative. We can
explain our decision by talking about cause and effect in a logical way.
Others can understand what we are saying and evaluate our conclusions using
the widely held rules for observation and analysis. There
are other channels people use to tune into different realities, and other
ways to process whatever data that reality provides. Instead of reason, some
people base their choice of what to do next on instinct, habit or addiction.
They may depend on intuition, which can be described as listening to feelings
or to your inner self. You
can also let others define your reality for you. For example, you can live in
a reality suggested by a religious authority, guru or other charismatic
leader or teacher. There
are also different ways to process the same set of observations. Liberal
politicians, fundamentalist preachers, academic pundits and hormonal
teenagers will come to different conclusions about the same set of
circumstances, and will act very differently. In the
case of D&D, it seems that information vitally important in deciding what
to do in the last stage of our lives is missing: We do not know what the
consequences of acting a certain way while alive will be for what happens
afterwards. There are numerous – some would say infinite – possibilities. You
can imagine that some after-life scenarios would lead us to cling to life
until the last possible moment, while others would reduce or eliminate fear
of leaving. So,
the question becomes: What do we do when our usual method of decision-making
cannot be used because there is no way to get information on the consequences
of different courses of action? |
|
Your experience of the D&D of
others is
another influence on your feelings and ideas about these events, as are the
personality characteristics and the experiences you had as you were growing
up that you thought about in the preceding section. The
questions that follow are a bit more likely to make you uncomfortable because
they will bring to mind images of actual D&D. So, before we begin... |
|
If you
are not going to continue, I’d invite you to visit 12:Moving
away from D&D: Getting back to life as usual. If you have comments or
suggestions for improving the LLQ, please go to Your
reactions to the LLQ. |
|
What’s ahead in Sections 3-9: In Section 3 (this section)
there are questions about what you have thought or done about your own
involuntary or voluntary exit. You are asked whether have taken ordinary
steps such as making a will, and about any times in the past when you considered
leaving voluntarily. Sections
4-8 cover factors that could affect the decision to leave: your reaction to
Very Old Age, your quality of life, your value to your family and society,
and the possibility that leaving might be more accessible and socially
acceptable in the future. Section
9 offers you the chance to review all the factors that might go into a
person's choosing whether or not to leave. If you
are not going to continue, I’d invite you to visit 12:Moving
away from D&D: Getting back to life as usual. If you have comments or
suggestions for improving the LLQ, please go to Your
reactions to the LLQ. |
|
Some people say that they have
considered voluntarily leaving life; many will admit that the thought has passed through
their minds. If you
are one of the former, this experience will certainly affect how you think of
leaving life as a way to deal with the problems of Very Old Age or of
meaningless, interminable suffering.
|
|
Because so many people are living
so much longer than previously, it is probably time to talk about a new life stage, called
“Very Old Age”. But first, let’s back up. There is Middle Age which
has now been pushed to later in life to encompass the active years late in
one’s career or early in retirement. Next is Old Age, when dying brain
cells and the wearing out of the physical body result in some changes in the
type and level of activity. In Very
Old Age, your mobility and
functioning are restricted to the point that many of the activities that gave
you pleasure or a sense of accomplishment are no longer possible. In
addition, you must spend a lot more energy and money on body maintenance.
There may be things you must do each day to deal with chronic health
conditions or with physical and emotional pain. Your life expectancy may be
less than five years; it may be zero or less. Of course the conditions of Very
Old Age can be brought on by an accident or by serious illness, as well
as by advancing years. As with other life stages, Very Old Age
presents both positive possibilities and some new challenges. There
are several personality characteristics that can make a difference in the way
you react to Very Old Age: |
|
People
differ in their response to adversity, such as that which is presented
by being Very Old. Some people are fighters. They rise to a challenge and are
energized by struggle. If there is nothing to fight, they will look around
for something to attack and overcome. Others seek security and a life that proceeds
at an even, predictable pace. They avoid challenges or try to find the way
around them that takes the least energy. For
the fighters, Very Old Age is just another problem that they will meet as
they have done in the past: head-on and with confidence. Some security
seekers may find solace in leading a restricted life. Others might want to
escape by leaving life. |
|
People
differ in their capacity for pleasure. A high capacity here means the
ability to enjoy a great many things and to enjoy them a lot. Its basic level
depends both on brain chemistry and on heredity. Its level can vary depending
on general health, sleep, nutrition, and exercise, and level of stress. A low
capacity can be increased by antidepressant medication. People
with a high capacity for pleasure will be better able to enjoy activities
with low levels of stimulation such as those allowed by the restrictions of
Very Old Age. |
|
People
also have a physical pain threshold that may be independent of their
pleasure threshold. This threshold may increase or decrease with age, and is
of course affected by medication. New medications are constantly being
developed, and aggressive treatment for pain is becoming the norm. Pain is
also affected by environmental and psychological factors. Trying
to predict your response to the increasing pains of aging is difficult
because you may become less or more sensitive as you get older. It appears
that some people can adapt to almost anything, so you may be able to get used
to a lot more than you think. Also, pain is a complicated response that is
affected by psychological and social, as well as physiological, factors.
Still you may have developed a sense of your responsiveness to pain that may
have some relationship to your potential for suffering from the changes of
aging. |
|
Your
response to emotional pain or your emotional fragility is another
characteristic which may predict how well you will cope with Very Old Age. A
history of emotional problems suggests that a person may not do well,
especially if treatment has been unsuccessful. On the other hand, sometimes
people get their first effective treatment during old age and are as happy,
or happier, than they have ever been. Very
Old Age may bring a dulling of the emotions that can protect the person from
emotional pain. The tendency of Very Old people to live in the present and in
the distant past can protect them from the frustration that comes from
comparing their lives to those who are younger. Still,
the transition from active Old or Middle Age to Very Old Age with its
disappointments and frustrations can hit hard ... |
|
Many Very Old people don’t seem
terribly upset with
their lives, at least on the surface. They don’t continually complain, or say
that they would rather not be living. |
|
Your Very Old Age may last a long
time, and
will last longer as medical science continues to extend our life expectancy.
Your quality of life during this extension may not be very good. The
questions that follow ask you to think about how you might react to the
changes that can occur during this stage of life. Remember that you may be
able to adapt much better than you imagine now, and that many of the problems
listed are partially preventable. If you
are Very Old, you may want to skip this question and those like it rather
than be reminded of losses to which you have already adjusted. Otherwise, you
can respond to the questions as if they were asking you about your current
thoughts and feelings. |
|
The
next two questions are similar to the one above. They ask about your
adjustment to possible losses of Very Old Age. |
|
Not everything about Very Old Age
is bad,
and some changes may be very welcome. For example, there is a continuation of
the reduction of job and family responsibilities that began in previous
stages. There is a lessening of the immediacy of the needs for sex and power
that can create such turmoil earlier in life. Also, there are ways a person
can reduce or compensate for the impact of the kinds of losses listed above.
For example, there are the “Four S’s of Very Old Age”: Socializing,
Spectating, Sitting, and Sleeping. And there can be many more ... |
|
How can you determine how your
well life is going now and how it will go in the future, so that you could decide
whether you want to consider leaving? Evaluating
QOL is not so difficult if your life is either just fine or simply terrible
most or all of the time. For example, for most people, if job, family and
health are acceptable than life is OK. On the other hand, if your life
is full of ups and downs or in the process of change, it can be difficult to
make an overall judgment or prediction. Furthermore,
it can be difficult to imagine the bad times when things are good and or the
good times when things are bad. This makes it difficult to make an overall
judgment of your life. Related
problems are those of “faking good” and “faking bad”. Faking good can be
motivated by the desire to look good to others, or to avoid admitting to
yourself that things aren’t going well. Faking bad or “catastrophizing” can
be used to elicit help or attention, or to provide justification for avoiding
responsibility. Your
responses to the questions may also be affected by the social conventions
that come into play when someone asks you how things are going. Asking this
question is usually a way for someone to give you a little stroke and then
move on to other things. He does not want you to respond with a recital of
your problems. If you do this too often, people will begin to avoid you.
Avoiding acknowledgment of problems is the easy way out for you, too. You
might ask yourself to what degree this social convention is operating when
you consider the questions which follow, many of which ask you in different
ways, “How are you doing?” A
question about QOL requires a comparison. Should you compare yourself to
others who are similar in some way? Should you compare how things are with
how you expected them to be or with how they used to be? Should you compare
yourself to people who seem to be much worse off because they are ill,
injured or handicapped, or because they are the victims of war, flooding, or
other catastrophes? Or should you anchor your judgment in your own internal
standard of acceptability which comes from your own physiological
responsiveness to different kinds of pleasure and pain? Once
you have settled on how things are going now, you must predict the way things
will be in the future. What things about yourself or outside yourself might
make things better or worse than they are now? Will time or your own
problem-solving lead to improvement? Are there new medications or other
treatments in the pipeline that might change your life for the better? Do you
have pre-Alzheimer symptoms or other indications that your health might
rapidly deteriorate? Deciding
whether to stay in situation or leave it is often a problem. Think about the
difficulties in deciding whether to change jobs, end a relationship, stop
playing a slot machine, or, as a proxy sufferer, to have a pet put to sleep. You
must try to: · Pick a time span to use in your
assessment of how well things are going, · Weight good and bad experiences or
observations according to criteria of importance or intensity, · Add or otherwise combine your good
and bad experiences into an overall rating, · Predict how things will be if you
do what you can to make things better, taking into account the possibility
that things beyond your control might improve or get worse. You
must also accept the fact that there is no way of knowing for sure what will
happen if you leave life. The
questions that follow below will help you to make the best assessments of QOL
and level of suffering that you can. In addition, you can try to be honest
and accurate in your ratings – to resist any tendencies to look good or bad.
It will be up to you to pick a period of time to use for your assessment. Try
to pick one that is long enough to predict the future. It
will also be up to you to choose a standard of comparison. The questions do
not restrict your choice. The reference point most people use is a minimum
level of pleasure/satisfaction/contentment that has developed over the years
and that is a combination of the factors mentioned above. The
hope is that you will come away from the sections on QOL and suffering with
the realization that assessment of these areas is not simple, and that a
decision as to whether to stay or leave should not be based on how you happen
to see things at a particular period of time. The hope is that responding to
the questions get you thinking about ways your QOL could be improved. The
best way to deal with the emotionally-laden complexities of any important
decision based on evaluation of QOL or suffering is to consult an expert,
such as a counselor or therapist. The questions he or she will ask will help
to make sure that your assessment of QOL is as accurate as possible. Of
course the main job of a counselor or therapist is to help you to improve
your QOL. There
are many different approaches to measuring QOL. Some examples are included in
the Measures
of QOL in Appendices
at the end of the LLQ. You can begin your consideration of your own QOL with
the questions below. If you want to go further, you can try some of the other
inventories. Unlike the questions which follow, some of these other
inventories will give you a score, and some will sample feelings over a
period of time. |
|
The
questions which follow ask you to rate areas of your life in terms of pleasure/discomfort
and feelings of accomplishment/failure. These often occur together
but are not the same thing. You can get a sense of accomplishment from
something that is unpleasant to do, and you can get pleasure from some
activity that accomplishes nothing except to recharge you so that you can
tackle a more worthwhile activity. You
are also asked to rate the importance of each area’s contribution to
your sense of well-being. Very low pleasure and accomplishment
ratings in very important areas identify problems that need
improvement. If they cannot be improved, they will be the ones that provide
the strongest pressure to leave. Because
this QOL assessment is supposed to help you to decide whether or to consider
leaving, you are also asked to predict the potential for positive or negative
change. So, low
or negative pleasure or accomplishment ratings in important
areas that have low potential for improvement will be most likely to create
the impulse to leave. |
5.1 Use
this scale to rate Pleasure and Sense of Accomplishment
BA
= Better than Acceptable
A = Acceptable
LA
= Less than Acceptable
Use this
scale to rate Importance
H
= High
M
= Moderate
L
= Low
Use this
scale to rate Potential for Positive or Negative Change:
+
= Positive change possible or expected
0
= None
-
= Negative change possible or expected
|
The
other side of QOL is suffering ... Some
people believe that suffering always has meaning or value: · Suffering ennobles the sufferer.
Anyone who suffers is a hero and, like the mountain climber or other extreme
adventurer, is an inspiring example of what human beings can endure. · Suffering leads to spiritual
growth by focusing a person’s attention on answering a series of important
questions beginning with “Why?”. · A person becomes closer to his God
by suffering -- in the case of the Christian religion, by suffering as Jesus
did – or by making a connection between his suffering and God or Allah’s purpose.
It is
also possible that suffering may have physiological or psychological
benefits. In some situations, certain kinds of suffering may stimulate
the release of the body’s natural opiates (endorphins). Suffering is
typically followed by a feeling of relief that is uniquely pleasurable.
Suffering can also relieve guilt and shame. A
significant number of people believe that pain of suffering in the last
stages of life is balanced by opportunities for spiritual growth and for
becoming closer to those you love. They believe you will discover an immense
peace and a sense of worth in finding meaning in your suffering and in
improving or resolving your relationships with significant people in your
life. Both you and your survivors will benefit in ways that you and they
couldn’t if you left life voluntarily. If you
do believe that suffering is an always a positive or meaningful experience,
the conclusions you draw from your responses to the questions that follow
will be different than those who find that suffering is often meaningless.
You will say, “Yes, I do (or will) suffer, but because suffering has benefits
or positive meaning for me, I do not consider it to be something to be
avoided". |
5.5 The
following question asks about your current levels of discomfort or suffering in
various areas.
Fill in degree
of suffering created by the situation using this rating scale:
H =
High
M =
Moderate
L = Low
There is
a space for you to put how long your suffering has lasted (the duration) in
days, weeks, months or years.
There is
another space for you to indicate the direction you expect any change
to take, using this scale:
+ =
Change for the better possible or expected
0 = No
change possible or expected
- =
Change for the worse possible or expected
|
A
version of this next question will be asked at several points later on, as
you consider other factors that affect your thoughts and feelings about
leaving life: |
|
Before you leave this section, you should realize we don’t
ordinarily spend much time looking backwards in order to make a serious
judgment about how well we are doing. Most of us simply forge ahead and
assume things will improve or we work hard to make things better. So, you
should realize that the sense of dismay from remembering bad experiences is
created partly by this scanning backwards and may well disappear when you
return to living more in the present and future. |