Overview
As she progresses through a terminal illness, an extraordinary couple offer secular wisdom for the end of life and those in mourning
Walk the “grief and loss” section of a bookstore, and you’re waist deep in woo. “Find comfort in knowing your loved one is in a place of no tears and no pain.” “Deepen your relationship with God as you mourn.”
As a person who once grieved religiously, I’ve learned this emphasis on faith is a diversionary tactic away from authentic emotion. If you’re rejoicing in a resurrection, you’re repressing the reality of your beloved’s absence from the here and now. If this life is all we’ve got, death is a permanent separation. To grieve fully as finite humans, this demands acknowledgment.
Brushing away webs of wishful thinking is A Matter of Death and Life, a frank yet poignant end-of-life memoir cowritten by Irvin and Marilyn Yalom. Secularists who have lived with gusto, they accept their 87 years and counting—65 married together—as their one crack at existence, with no hereafter.
Each is well-regarded in their respective field. Irvin is one of the leading American psychotherapists of the late 20th century, scribing a seminal text on group therapy. (It was required reading in my psychiatry residency.) Marilyn is a cultural historian and pioneer in women’s studies.
Marilyn proposes their joint project after her diagnosis with multiple myeloma, a cancer of the bone marrow. She rightly figures a book about “two old people in the final dance of life” could help those in similar situations.
Marilyn emerges as such a warm, insightful figure…though I knew she would not survive these pages, her absence partway through was keenly felt.
As they pen alternating chapters, Marilyn comes through as the clear-eyed partner. As therapies fail or have intolerable side effects, she knows her end will soon arrive. She is ready to close her eyes for good, but recognizes her husband isn’t prepared to let go. As fatigue, chemo brain, and nausea evaporate her pleasures, she writes, “I have come to the understanding that one stays alive not only for oneself, but also for others.”
Irvin is not afraid of his own mortality, but he’s petrified of facing his remaining years without his best friend, creative spark, and co-parent of four kids. He has his own serious infirmities: a pacemaker, dependence on a walker, and possibly the beginnings of dementia. Nonetheless, he willingly embraces the role of caretaker.
Across several months of narrative, A Matter of Death and Life escorts us through many steps common to the end of life in a developed country. Retirement, surrendering car keys, contemplation of assisted living, the loss of bowel and bladder continence, hospice care, farewells to loved ones.
Refreshingly nonclinical, we observe Marilyn’s consideration of physician-assisted suicide: her lucid request for an evaluation, examinations by doctors to ensure she’s not harboring untreated mental illness. Interestingly, even on the Left Coast, one hospice doc is reluctant to help in this process, another far more supportive.
Marilyn emerges as such a warm, insightful figure, that I see why so many younger professors looked to her as a mentor. Though I knew she would not survive these pages, her absence partway through was keenly felt.
Previously, I knew Irvin only through his dense yet readable academic texts. (I highly recommend Existential Psychotherapy whether you’re a clinician or layperson. Its analysis of four struggles inherent to this life—death anxiety, responsibility in the face of terrifying freedom, connection beyond isolation, and creating meaning—was invaluable for this newly minted humanist.) By contrast, A Matter of Death and Life is brisk and straightforward in style.
Despite his overwhelming grief, Irvin’s solo handling of the back end of the book is masterful. Its brief chapters explore numbness and unreality in the immediate aftermath of Marilyn’s passing. He struggles with the reminders of her absence everywhere. Christmas is cancelled. He writes to survive. He contemplates then spurns suicide, explaining its rejection.
Although my own recent loss is different from his, it’s comforting to discover an older sage wrestling with the same feelings and cognitions. A crucial part of consolation is company in your grief, whether in person, online, or through the written page.
Like Irvin, I am no longer “smug and cozy.” We’ve both been surprised by peace in the notion of joining our loved one in nonexistence, when our turn on this planet ends, despite knowing we will not be conscious for this reunion.
Lest all of this sounds unremittingly grim, the Yaloms’ book is suffused with love: decades of love for each other, affection for their children, generous relationships with friends and colleagues. Grief is not a chipper subject by any means, but maturity and acceptance are exemplified here in a manner that should appeal to most readers.
Though Marilyn and Irvin were heavy-duty academics, they wear their scholarship lightly. Quotations from Nietzsche, Nabokov, and their own works are sprinkled throughout in a clarifying fashion.
In that spirit, I’ll end with two quotes. One was found by Marilyn on a gravestone, while researching a book on American burial practices: “To live in hearts we leave behind is not to die.”
The second is not cited here, but comes from Erik Erikson, another leading psychoanalyst of the previous century: “Healthy children will not fear life if their elders have integrity enough not to fear death.”
Many thanks to the Yaloms for a rich, woo-free book that will help adults, no matter their age, to live with less fear and more integrity.