Dying within the lie


It is in our nature to lie.  Falsehood is one of the most creative things we do and the most remarkable of the human arts. We construct castles from ether and support their ephemeral walls on a foundation of accepted truths, which themselves are wisps of previous lies. The more we live within lies, the greater the challenge and more the harm. We pay a heavy price for fabrication.  What happens to us, when we lie about dying?

The denial of death is critical support for futile medical care, missed opportunity and needless suffering.  Never passes a day without attending a patient and family who, because they have not planned for the inevitable, are cursed with pain, loss, confusion and fear.  By lying to themselves and their families about the guaranteed future, the chance to live life at its end is lost and any possibility of “a good death’” vanishes like mist.

It is nearly universal in our society to deny my own death and that of those I love.  If I do not accept the need to plan for the end of my life, than I do not decide how I wish to spend that time.  If I do not plan, than the medical default of aggressive, complex care, colludes with the unexamined anxiety of my family and I when illness strikes and drives me to “do everything,” which includes doing too much, and thus obliterates my final days, filling them with pain.  Denial of death can be a costly lie.

This, then, is given.  Deny death and you may lose the chance to control a precious part of your life.

It occurs to me, that perhaps the problem is more than those final days when we are struck with disease.  What affect does the lie have upon each of us when we are healthy and the end is not near?

Perhaps, it is a good thing.  If for 74 out of 75 years I deny death and therefore live more fully, extra suffering at the end is simply the devil’s price.   Can you imagine living in a society where the sick are hidden in institutions, we mourn the loss of one but not many, grandma is just sleeping and children should not fret, the nightmares are fantasy, reality lasts forever?

However, if we look at life as a continuum, birth to death, and do not separate out “the end” as somehow special, than we must conclude that just as death deceit causes havoc in the throws of terminal disease, it also causes great damage through the rest of life. If denial can disrupt something so blatantly obvious as actually dying, how heavy must be the burden of the steady weight of the lie through the years of growth, learning, building, loving and daily life. The state of unreality that we work so hard to create, suppressing death at every age even as we rush inexorably toward it, affects us deeply, isolating each of us in silos of fear, and creating individual behaviors and societal disruptions that are complex and almost immeasurable in their scope and significance. Even the sunrise changes when we deny the sunset.

We live each day in denial.  We deny that now, may be our last.  The lie keeps eternity from creeping into each moment, but neglects the unknown.  It may be our most magnificent creation.  Nonetheless, by closing our eyes, we fail to see the monster that stalks our everyday.


  • Don't know why but I have never been afraid of dying. I felt the same when I lost my mother and my husband of 35 years, that was hard because it was a sudden accident giving me no time to prepare.I am only afraid of a painful dragged out end. I felt no different when facing my own cancer so maybe just me but since dying is inevitable I can't understand denial.
    • James Salwitz, MD
      Perhaps that is a valuable lesson. When we are exposed to loss and death at an early age, it may release us from the burden of the lie. jcs
  • Death is guaranteed ..life is a possibility. Death is neither bad or good...it can happen in bad or good ways. I am not living in denial. I make every attempt to be truthful. Sissela Bok, 'Lying"..great book from a course called 'Current Moral and Social issues" , Rutgers University, New Brunswick. Striving to maintain one's own personal integrity always seemed worthwhile to me. Rather than think selfishly and subjectively. Preventable death , medically, occurs every day. That is what concerns me. I do not think of death as a monster or as an angel...bit medieval ..the monsters are those who make life and death decisions because of selfish subjectivity.
    • James Salwitz, MD
      Nicely said. I think it is when we allow the monster which is our denial about death, to destroy life, that we lose much. jcs
      • I agree about the dangers of denial. and thank you! I remember a time when I never saw death even as a possibility. It was something that only happened to mostly the aged. Thank you again! I watched Van Helsing with Hugh Jackman last night. :) Very entertaining..a little silly but...
        • An afterthought, 'The Phantom of the Opera', 2004, with Girard Butler as the Phantom....more poignant. Not necessarily applicable to death..but to treatment and outcomes and the ravages of disease.
        • D Someya Reed
          I'm so glad you watched Van Helsing. Your description of it is perfect. Jodi (my wife) loved the Phantom of the Opera with Gerard Butler. I played some of the music from that film (exclusively) at her memorial service. I play three different songs each time I visit the niche at the columbarium on the DVD player we used when she was receiving chemotherapy. Jodi loved music. The staff there love it as well and tell me to "crank it up, we need more life around here."
  • D Someya Reed
    Your first line reminds me of an old Bill Cosby routine where his children, even the youngest and most innocent, lie to their mother that he “made them” eat chocolate cake for breakfast. I don’t believe that anyone truly is ever in denial of death. We all know that we are not immortal and one day will cease to exist in the bodies we now inhabit. Every clock stops ticking, every machine breaks down eventually. Nothing lasts forever…we can’t even grasp “forever” as a concept. What I do believe we deny and lie to ourselves about is futility, at all stages. When everything is futile, we grasp for that one thing that might work. Under futile circumstances, we lie to ourselves that somehow we can control the length of our lifespan or that of another even for one more day. Some even try a bit harder with cryonics. Sometimes, it appears we were successful and those successes propagate the belief that if it happened once, it can happen again. The success, when it happens, is fantastic. The likelihood encourages the lie. I “lied” to my wife every day during her illness that she asked me, “Am I going to die?” I always answered the same way, “Not on my watch!” We both smiled (hers being the one her dad still claims cost him a lot of money) and we both knew to be a lie. But it wasn’t the lie, it was the affirmation that I was still (and would be) there for her. It gave her cancer stricken, paralyzed body a reason to smile any day she wanted. Our family understood it but not others (and yes, I’m talking about hospice). They only heard us say it once and wrote it up as I was in “denial of death” and “pre-grieving my loss.” Did they ever ask me about it? Nope. So they set out on a path that was totally without foundation. When the facts didn’t fit, they “lied” in the medical reports. They never even mentioned her paralysis, quadriplegia in any reference. How do you miss that? Who was in denial? Although there are some things that you can and probably should do, I don’t believe that planning for your death will change anything about the pain and suffering you and/or your family will endure. Facing up to the truth of any situation is the hardest thing we ever have to do as a people and why we lie to ourselves so much. Do we want to return to the days when the old and dying were cast adrift or left under a tree as the tribe moved on? Or the time that we were embarrassed of our old and dying and institutionalized them? Do we want a future society that determines that no one over a certain age will receive medical care because the return on investment is just not there? I don’t think so. But yet we lie to ourselves when we speak in absolutes. Everything has an exception and sometimes those exceptions become new truths. Some of us will make the choice to embrace our mortality and do great things because of it. Others will hide from it and quietly slip away into oblivion. There are as many possibilities in-between as there are lies to justify them. The greatest lie is the truth we are not told. If we don’t know both the good and the bad, any decisions we make are based on lies (of omission). There truly is no such thing as a stupid question. Stupidity (and denial) is not to ask it.
    • Beautifully expressed. One of my major issues is with control freaks..authoritarian types. One can only make good decisions based on truth..sometimes people always lie to themselves and present to you as that...their lie....makes life very difficult.
  • amy challener
    thank you for a wonderful comment on fear of death is prevalent we cannot even use dieing, "he passed" everything is done to keep death from happening. that is why we do not have doctor assisted suicide, that is why dr. Kevorkian, my hero was reviled, instead of hailed. no acceptance soon that I can see, we can only hope that family's will not let their own suffer.
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  • Beautifully stated. Although denial works to some degree for lots of issues, the inevitability of death is indeed undeniable. Still we try.
  • Good blog post! And I'm glad to see a medical practitioner urging end-of-life planning for the general public. I'm not sure what it will take for folks to emerge from the fantasy world of death-denial. I'm one of those who doesn't fear death, although I'd like to live a good deal longer if possible! Having nearly drowned at age ten, every year I'm alive seems like a gift from the Universe. Once past my fifties, I told my children not to recommend any extreme medical measures unless there was a good chance I'd recover from an illness. That's in my living will, as well. Let's make it respectable - even ethically commendable - to die well.
    • James Salwitz, MD
      Remarkable how an early terrible experience lifted from you the burden of denial and perhaps allowed you to live a fuller life. Thanks for your comment. jcs

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