Psychological assistance to the seriously ill and dying. “High-quality assistance to a dying person is the prevention of peace in society

The Book of Life and the Practice of Dying
Chapter XI
HEART ADVICE ON HOW TO HELP THE DYING

Sogyal Rinpoche

In one hospice I know, Emily, a woman in her seventies, was dying of breast cancer. Her daughter visited her daily and their relationship seemed to be very good. But when her daughter left, Emily almost always retired and cried. After a while, it became clear that the reason for this was her daughter's complete refusal to accept the inevitability of her death: she constantly encouraged her mother to "think positively", hoping that this would cure her cancer. All she did was that Emily had to keep her thoughts, deep fears, panic and grief to herself, and there was no one to help her explore them, to help her understand her life, no one to help her find healing meaning. in her death.

The most essential thing in life is to establish fearless, sincere fellowship with others, but for the dying, as Emily has shown, this is the most important.

Often, when you first visit a dying person, they become withdrawn, unsafe, and unsure of your intentions. So don't expect anything out of the ordinary to happen, just be natural and relaxed, be yourself. Dying people often do not say what they would like to say or express, and their loved ones do not know what to say or do. It is difficult to find out what they would like to say, or even what they are hiding. Sometimes they don't even know it themselves. Therefore, the first, essential thing is to relieve any tension, in any way that comes to mind most easily and naturally.

Once trust and confidence is established, the atmosphere will be relaxed, and this will allow the dying person to mention what he really wants to say. Warmly encourage him to express as freely as possible thoughts, fears and emotions related to dying and death. This honest and direct exposure of emotion is at the center of any transformation - coming to terms with life or dying a good death - and you must allow this person complete freedom of expression and allow him to say whatever he wants.

When the dying person finally confides his most personal feelings to you, do not interrupt him, do not deny or downplay what he is saying. A terminally ill or dying person is in the most vulnerable position of their entire life, and it will take all your skill and reserves of sensitivity, warmth, and loving compassion to allow him to open up. Learn to listen and learn to silently perceive: learn to open, calm silence, which will show the other person that he is accepted. Be most relaxed, unstressed: sit with your dying friend or relative as if you had no more important or pleasant thing to do.

I have found that in all serious life situations, two things are most helpful: a common sense approach and a sense of humor. Humor miraculously lightens the situation, helping to look at the process of dying in its true and universal perspective, destroying the excessive seriousness and tension of this situation. Therefore, use humor as skillfully and gently as possible.

I have also found, in my own experience, that it is essential not to take anything too personally. The dying may, at the moment you least expect it, make you the target of their anger and blame. As Elisabeth Kübler-Ross says, anger and guilt can be "displaced in any direction and projected onto their environment, sometimes almost randomly." Do not assume that this rage is really directed at you: knowing what fear and grief it comes from will allow you not to react to it in a way that could damage your relationship with the dying person.

At times you may be tempted to preach to the dying, or teach them the spiritual teachings that you yourself believe in. Never give in to this temptation, especially when you suspect that this is not what the dying person wants! Nobody wants to be "saved" by someone else's beliefs. Remember that your task is not to turn anyone into something, but to help this person in front of you get in touch with his own strength, confidence, faith and spirituality, whatever they may be. Of course, if this person is really open about spiritual matters and really wants to know what you think about them, don't refrain from discussing them.

Don't expect too much of yourself, don't expect your help to produce miraculous results or "save" the dying person. You will only be disappointed. People will die the way they lived, the same as they are. To establish true fellowship, you must make a deliberate effort to see this person as inseparable from his life, character, environment, and history, and accept him unconditionally. Also, do not be discouraged if it seems to you that your help is not very effective, and the dying person does not respond to it. We fail to know the deepest effects of our love and care.

How to show unconditional love

The dying person most needs expressions of unconditional love, free from any demands. Don't think that you have to exercise any special knowledge. Be natural, be yourself, be a true friend, and the dying person will be encouraged that you are really with him and interact with him simply as an equal, as one person with another.

I said, "show the dying unconditional love," but in some situations it's not so easy. We may have a long history of suffering associated with this person, we may feel guilty about what we have done to this person in the past, or we may feel anger and resentment about what this person has done to us.

So let me suggest two very simple ways with which you can release the love that is within you to this dying person. Both myself and my students who have worked with the dying have found that both of these methods are very powerful. The first is to look at a dying person and think that he is exactly the same as yourself, with the same needs, with the same basic desire to be happy and avoid suffering, with the same loneliness, the same fear of the unknown, the same secret sorrows, the same half-conscious feeling of helplessness. You will find that if you really do this, then your heart will open towards this person and love will be between you.

The second, and, as I have found, even more powerful way, is to place yourself, directly and directly, in the place of the dying person. Imagine that you yourself are lying on this bed in front of you, that it is you who are dying. Imagine that you are here, in pain and alone. Then really ask yourself: What do you most need? What do you need most right now? What do you really want from the friend in front of you?

If you do these two practices, I think you will find that what the dying person needs is the same thing that you would most like: to be truly loved and accepted.

I also often saw that the seriously ill longed to be touched, longed to be treated as if they were human beings and not as incarnations of the disease. A very great comfort can be given to the seriously ill simply by touching their hands, looking into their eyes, giving them a light massage or embracing them, or breathing softly in the same rhythm with them. The body has its own love language; apply it fearlessly, and you will find yourself bringing comfort and peace to the dying.

We often forget that a dying person loses his whole world: his home, his job, his relationships, his body and his mind - he loses everything. All the losses that one can experience in life merge into one overwhelming loss when we die, so how can a dying person not feel sometimes sadness, sometimes panic, and sometimes anger? Elisabeth Kübler-Ross believes that the process of coming to terms with dying goes through five stages: denial, anger, argument, depression, and acceptance. Of course, not everyone goes through all of these stages, and not necessarily in that order; for some people, the path to acceptance may be extremely long and thorny, while others may not reach it at all. Our culture does not give people very much a true perspective in which to view their thoughts, emotions and experiences, and many who face death and its ultimate challenge feel deceived by their own ignorance and experience a sense of terrible failure and anger, especially because no one seems to want to understand them, and what they most need. As Cecily Saunders, the great pioneer of the UK hospice movement, writes: “I once asked a man who knew he was dying what he most needed from those who cared for him. He said, "For someone to show they're trying to understand me." Truly, it is impossible to fully understand another person, but I will never forget that he did not hope for success, but only that someone would be interested enough in him to try to do it.

It is essential that we are sufficiently motivated to try and reassure the dying person that, whatever their feelings of failure and anger may be, this is normal. Dying releases many repressed emotions: sadness or numbness or anger or even jealousy for those who are still healthy. Help him not to suppress these emotions when they arise. Be with him as the waves of pain and grief rise; if there is acceptance, time and patient understanding, then these emotions will slowly subside, and the dying person will return to that basis of peace, tranquility and sound mind, which is most deeply and truly embedded in him.

Don't try to be too wise: don't waste time saying something profound. You do not need to do or say anything to improve the situation. Just be here as fully as you can. And if you feel severe anxiety and fear and do not know what to do, directly admit this to the dying person and ask him for help. This kind of honesty will bring you and the dying person closer and lead to more free communication. Sometimes the dying know better than we do how to help them, and we need to know how to use their wisdom and let them pass on what they know. Cecily Saunders asks us to remember that when we are with the dying, we are not the only ones to give. “Sooner or later, but everyone who works with the dying realizes that they receive more than they give, meeting endurance, courage and often humor. It needs to be said…” The confirmation that we recognize courage in them can often inspire the dying.

I have also found that it helps me to remember that this dying person, always, somewhere inside, is good in himself. Whatever emotions and rage arise, no matter how shocking or terrifying their manifestation at the moment, focusing on this - on the fact that he is internally good - will give you the control over yourself and the perspective necessary to give him all the help that you just can. Just like in a fight with a good friend, you don't forget about best sides this person, do the same for the dying person. Don't judge them by the emotions that come up, whatever they are. This kind of acceptance on your part will free the dying person, allowing him not to suppress himself as much as he needs to. Treat the dying person as if they were still the way they sometimes were: open, loving, and generous.

On a deeper, spiritual level, it helps me a lot to understand that the dying person has the true nature of a buddha, whether he himself realizes it or not, and potential opportunity full enlightenment. As the dying person approaches death, this possibility increases in many ways. Therefore, they deserve even more loving care and respect.

To tell the truth

I am often asked: “Should I tell people that they are dying?” And I always answer: "Yes, with the greatest calmness, kindness, sensitivity, and as skillfully as possible." Based on my years of experience visiting the sick and dying, I agree with Elisabeth Kübler-Ross, who saw that “most, if not all, of these patients know this anyway. They feel it in the change in attention given to them, in the new, different approach with which others begin to treat them, in the lowering of their voices or the fact that they are especially trying not to make a noise, in the tear-stained face of a relative or an ominous shadow on the gloomy face of a relative. who can't hide his feelings."

I have often found that people know instinctively that they are dying, but rely on others - their doctor or loved ones - to confirm it. If they do not, then the dying person may feel that his family is not able to cope with such news. And then the dying person, all the more, he himself will not be able to master it. Such reticence, lack of honesty will only make him feel even more isolated and unsettled. I believe that it is essential to tell the dying man the truth: at least he deserves it. If the dying are not told the truth, how can they prepare for death? How can they bring the relationships of their lives to their true conclusion? How can they take care of the many practical cases that they have to decide? How can they help those who remain to live on?

From my point of view, as a spiritual practitioner, I believe that dying provides people with the greatest opportunity to come to terms with their entire lives; and I have seen many people use this opportunity in the most inspiring way to transform themselves and get closer to their own deepest truth. So when we, with kindness and sensitivity, tell people as early as possible that they are dying, we are actually giving them the opportunity to prepare, to show their own forces and the meaning of your life.

Let me tell you a story that Sister Brigid, a Catholic nurse at the Irish Hospice, told me. Mr. Murphy was in his sixties and the doctor told him and his wife that he didn't have long to live. The next day, Mrs. Murphy came to her husband's hospice, and they talked and cried all day. Sister Brigid watched this old couple talking and crying every now and then, and when it went on for three days, she wondered if she should intervene. But the next day, the Murphys suddenly looked very at ease and calm, they sat holding hands and showing great tenderness to each other.

Sister Brigid stopped Mrs. Murphy in the corridor and asked what had happened between her and her husband to bring about such a great change in their behaviour. Mrs. Murphy told her that when they learned that her husband was dying, they together remembered all the years spent together, and many memories returned to them. They had been married for almost forty years, and it was natural that they were extremely sad to think and talk about all the things that they could never do together again. Mr. Murphy then wrote his will and farewell letters to their adult children. It was all terribly sad, because it was very difficult to leave everything, but they endured it all, because Mr. Murphy wanted to end his life well.

Sister Brigid told me that for the next three weeks that Mr. Murphy lived, the couple radiated peace and a simple, wonderful feeling of love. Even after her husband's death, Mrs. Murphy continued to visit hospice patients and was an inspiration to all of them.

This story shows how important it is to tell people that they are dying prematurely, and also how great an advantage it is to be able to face the pain of loss. The Murphys knew they were losing a lot, but by standing up to these losses and mourning together, they found what they could not lose - a deep love between them that survived the death of Mr. Murphy.

Fear of death

I am sure that Mrs. Murphy's ability to face her own fear of death, hidden in herself, helped her to support her husband. You cannot help a dying person until you admit to yourself how much their fear of death bothers you and triggers your own most disturbing fears. Working with the dying is like holding a relentlessly accurate mirror in front of you that reflects your own reality. You see in it the distinct face of your own panic and your own horror of pain. If you don't look into it and accept that face of panic and fear in you, how can you bear it in the person in front of you? When you come to a dying person to try to help him, you need to examine your every reaction, as all of them will be reflected in the reactions of the dying person, and can greatly help or hinder them.

Being honest with your own fears will also help you in your own journey towards maturity. Sometimes I think there's hardly more efficient way forcing our growth as human beings than working with the dying. Caring for the dying is in itself a deep contemplation and reflection on our own death. It's a way to face it and work with it. When you work with the dying, you may come to some resolution, a clear understanding of what is most important in life. To learn to really help the dying means to start becoming fearless and responsible for your own dying, and to find in yourself such beginnings of boundless compassion that we could never suspect.

Being aware of your own fears of death will immeasurably help you be aware of the fears of the dying person. Just really imagine what it could be: fear of ever-increasing, uncontrollable pain, fear of suffering, fear of loss of self-worth, fear of being dependent, fear that the life lived was meaningless, fear of being separated from everything we love, fear loss of control, fear of losing the respect of others; and perhaps the greatest of all our fears is the fear of fear itself, growing more and more the more we avoid it.

Usually, when you feel fear, you feel isolated, alone. But when someone is with you and talks about their own fears, then you realize that fear is universal, and then its sharpness, your personal pain, leaves it. Your fears return to the universal and universal environment. Then you are able to understand, feel more compassion, and deal with your own fears in a much more positive and empowering way.

As you face and accept your own fears, you become more sensitive to the fears of the person in front of you and find that you develop the skill and insight you need to help that person bring them out. fears out, manifest them, cope with them and skillfully begin to dispel them. You will find that when you face your fears, it will not only make you more compassionate, brave, and intelligent; it will also make you more skillful, and this skill will open up to you all sorts of ways to help the dying understand themselves and face themselves.

One of the most easily dissipated fears is the anxiety we all feel about the painful process of death. I would like to think that everyone in the world now knows that this is not necessary at all in our time. A study at St. Christopher's Hospice in London, which is well known to me and where my students died, showed that with proper care, 98 percent of patients can die a peaceful death. The hospice movement has developed a variety of ways to conquer pain through various combinations drugs, and not necessarily just drugs. Buddhist masters speak of the need to die in consciousness, with the most clear, unclouded and calm mental control. Controlling the pain without clouding the consciousness of the dying is paramount, and now this can be done. Every person has the right to such simple help at this most difficult moment of his departure.

unfinished business

Another concern of the dying person is often unfinished business. The masters tell us that we should die in peace, "without clinging, desire or attachment." It cannot be complete if the unfinished business in this life is not completed as far as possible. Sometimes you will find that people cling to life and are afraid to let it go and die because they have not come to terms with what they were and what they did. And when a person dies with guilt or bad feelings towards someone, those who remain alive suffer even more grief.

Sometimes people ask me: “Isn't it too late to make amends for the pain of the past? Isn't there too much suffering between me and my

dying friend or relative so that forgiveness may be possible?” I believe, and proved it to myself by experience, that it is never too late; even after great pain or abuse, people can find a way to forgive each other. There is a grandeur, seriousness, and finality in the moment of death that can make people reconsider all their relationships, become more open and ready to forgive, although before they might not have been able to bear it. Even at the very end of life, you can correct the mistakes of this life.

There is one way to help complete unfinished business that I and my students who work with the dying have found very helpful. It was developed from the Buddhist practice of equalizing and exchanging one's personality with others, and from the method of Gestalt psychology developed by Christina Longaker, one of my earliest students to address the realm of death and dying after her husband's death from leukemia. Usually, unfinished business is the result of blocked communication: when we are hurt, we usually defend ourselves by always speaking from the perspective of who is right and blindly refusing to see the other person's point of view. Not only does this not help anything, but it also blocks any possibility of a real exchange of opinions. So when you do this exercise, start with a strong urge to call out all your negative thoughts and feelings in order to try to understand them, work with them and resolve them, and finally let them go.

Then imagine in front of you the person with whom you have a problem. Visualize this person in front of your inner eye, exactly as you have always seen him.

Now imagine that he has really changed, so that he is now much more open and receptive to what you can tell him, much more than before, willing to frankly discuss and resolve the problem between you. Vividly visualize this person in this new state of openness. It will also make you feel more open to him yourself. Then really, in the depths of your heart, feel that you need to tell this person. Tell him where you see this problem, tell this person everything about your feelings, your difficulties, how unpleasant it is for you, how sorry you are about it. Say anything you thought was risky or embarrassing enough to say to this person before.

Now take a piece of paper and write down everything you would say to him. After that, immediately start writing what this person could say to you in response. Don't dwell on remembering what this person used to say: remember that now, as you visualized, he really heard you and is much more open. So just write what you see that comes spontaneously and let that person in your mind fully express his view of the problem.

Search within yourself and find what else you need to say to this person - any other hurt feelings or regrets from the past that you have kept inside or never mentioned before. Again, after each time you express your feelings, write the other person's response in the way that comes to mind. Continue this dialogue until you really feel that there is nothing more to hide in yourself or that nothing more needs to be said.

To test if you are really ready to end this dialogue, ask deep within yourself if you can now wholeheartedly let go of the past, are you satisfied with the insight and healing that this written dialogue has brought you, and are you able to truly forgive this person, or whether you feel that this person would forgive you. If you feel like you've made it, be sure to express any last feeling of love or approval you might be holding back and say goodbye to it. Now visualize this person turning and walking away; and even though you must let him go, remember that you can always keep in your heart his love and fond memories of the best parts of your relationship.

To come to an even clearer reconciliation with the past, have a friend read this recorded dialogue aloud to you, or read it aloud to yourself at home. As soon as you read this dialogue aloud, you will be amazed at the change that will happen to you, as if you really communicated with this other person, and really cleared up all these problems of yours with him. Subsequently, it will be much easier for you to relieve tension and speak directly with this person about your difficulties. And when you truly let go of the tension, there will be a subtle shift in the unspoken relationship between you and that other person, and often the tension in your relationship that has lasted for so long will dissolve. It's amazing, but sometimes you can even become best friends. Never forget that, as the famous Tibetan master Tsongkhapa once said, "a friend can turn into an enemy, and therefore an enemy can turn into a friend."

How to say goodbye

You need to learn to let go not only of tension, but also of the dying person. If you are attached to a dying person and cling to him, you can cause him a lot of unnecessary mental anguish and make it very difficult for him to let go of his own tensions and die peacefully.

Sometimes a dying person can live many months and weeks longer than doctors expected, while experiencing great physical suffering. As Christina Longacker discovered, in order for such a person to

let go of tension and die peacefully, he needs to get two precise assurances from those he loves. Firstly, they must give the person permission to die, and secondly, they must reassure him that they will be fine after he is gone and he does not need to worry about them.

When people ask me how best to give someone permission to die, I tell them to imagine themselves standing at the bedside of their loved one and saying to him with the deepest and most sincere tenderness: “I am here with you and I love you. You are dying and it is perfectly natural; it happens to everyone. I would like you to stay here with me, but I don't want you to suffer any more. The time we spent together was enough and I will always cherish it. Please don't cling to life anymore. Let go. I give you my full permission to die from the bottom of my heart. You are not alone now, and you never will be alone. All my love is with you."

One of my hospice students told me about an elderly Scottish woman, Maggie, whom she visited after her dying husband had already collapsed into unconsciousness. Maggie was inconsolable because she had not spoken to her husband about her love for him, and did not say goodbye to him, and now she felt that it was too late. The hospice worker encouraged her and told her that although he seemed unresponsive, he might still be able to hear her. She read that many of those who appear to be completely unconscious can actually perceive what is happening around them. She advised her wife to stay with her husband, telling him everything she wanted to say. Maggie wouldn't have thought of it herself, but she jumped at the idea and started telling him about all the good times they shared, how she would miss him, and how much she loved him. And in the end, saying goodbye to him, she said:

“It will be difficult for me without you, but I don’t want to see you suffer anymore, so it’s okay, you can let go.” As soon as she finished speaking, her husband let out a long sigh and died peacefully.

Not only the one who is dying, but their entire family needs to learn to let go. Keep in mind that each family member may have their own degree of acceptance. One of the greatest accomplishments of the hospice movement has been the realization of the importance of helping the entire family face their grief and uncertainty about the future. Some families resist letting go of a loved one, seeing it as a betrayal and a sign that they don't love them enough. Christina Longaker tells the members of such families to imagine themselves in the place of the dying. “Imagine that you are standing on the deck of an ocean liner ready to leave. You look at the shore and see that all your family and friends are seeing you off, waving their hands. You don't have the option to make a choice and decide not to leave, and the ship is already leaving. How would you like those you love to say goodbye to you? What would help you better on your journey?

Even an exercise as simple as this can go a long way in allowing each family member to deal with the sadness of goodbye in their own way.

Sometimes people ask me: “What should I tell my child about the death of a relative?” I say to be careful, but tell the truth. Don't let your child think that death is alien or terrifying. Let him touch the life of the dying person as fully as possible and answer honestly any questions the child may ask. The directness and innocence of a child can actually bring gentleness, enlightenment, sometimes even humor, into the pain of dying. Encourage the child to pray for the dying, and thereby feel that he is really doing something to help him. And after death has taken place, be sure to give the child special attention and affection.

To a peaceful death

When I look back at Tibet and the deaths I witnessed there, I am struck by the peaceful and harmonious environment in which many of them took place. Alas, such an environment often does not exist in the West, but my experience over the past twenty years has shown me that it can be created if you approach it with imagination. I believe that whenever possible, people should die at home, because most people feel most comfortable at home. And the peaceful death recommended by the Buddhist masters is most easily achieved in a familiar environment. But if someone has to die in a hospital, then you, those whom this person loves, can do a lot to make this death as easy and inspirational as possible. Bring houseplants, flowers, paintings, photographs of his loved ones, drawings of his children and grandchildren, or a cassette recorder of his favorite music, or food from home if possible. You can even get permission to bring the children to visit him or to stay overnight with his beloved relatives.

If the dying person belongs to the Buddhist or any other faith, then friends can build a small altar in his chamber with inspiring images. I remember my student named Reiner, who was dying in a private room in a Munich hospital. An altar was made for him with images of his masters. I was very touched by this and realized how deeply Reiner was helped by the atmosphere it created. Buddhist teachings tell us to build an altar with offerings when someone dies. Seeing Reiner's devotion and peace of mind made me realize how powerful it can be and how it can help inspire a person to turn their dying into a sacred act.

When a person is very close to death, I advise you to ask the hospital staff not to disturb him so often and stop taking tests from him, etc. I am often asked how I feel about death in the ward intensive care. We have to say that being there makes it very difficult to die peacefully, and hardly allows any spiritual practice at the time of death. There is no privacy for the dying: they are connected to monitors, and if they stop breathing or their heart stops, attempts will be made to revive them. There will be no way to leave the body after death alone for a while, as the masters advise.

If possible, you should arrange with the doctor to tell you when there is no longer a chance for the patient to survive, and then, if the dying person so wishes, arrange for him to be transferred to a separate room, without connecting monitors. Make sure hospital staff are aware of and respectful of the dying person's wishes, especially if they don't want to be revived, and make sure staff also know to leave the body undisturbed for as long as possible. Of course, in modern hospital it is not possible to leave the body alone for three days, as was customary in Tibet, but all the support that peace and quiet gives must be given to the dead to help them begin their journey after death.

Also try to arrange that at the time when the dying person is in fact already in the last stages of dying, he will not be given any injections or any procedures related to the invasion of the body. They can cause anger, irritation and pain in him, and it is essential, as I will explain in detail below, that the mind of the dying person be as calm as possible in the moments before death.

Most people die unconscious. From near-death experiences, we have learned the fact that dying and comatose patients may be much more aware of their surroundings than we think. Many accounts of near-death experiences report out-of-body perceptions, on the basis of which these people are able to describe with amazing accuracy and detail their surroundings, and sometimes even other rooms in the same hospital. This clearly shows how important it is to speak often and kindly to someone who is dying or in a coma. Conscious, vigilant, and actively loving care for the dying must continue until the very last moments of his life and, as I will show below, even after.

One of my hopes for this book is that physicians around the world will take very seriously the need to allow the dying person to die in peace and quiet. I want to appeal to the goodwill of medical professionals and hope to inspire them to find ways to make this very difficult transition into death as easy, painless and peaceful as possible. In fact, a peaceful death is an essential human right, perhaps more essential than even the right to vote or the right to justice; this is the right from which, as everyone tells us religious teachings, a lot depends on ensuring the well-being and spiritual future of a dying person.

You cannot do a greater good to a man than to help him die well.

Sangye Khadro

Many people do not want to hear, talk or even think about death. Why is this happening? Whether we like it or not, sooner or later each of us will certainly leave this world. And even before we face our own death, we will most likely have to experience the death of other people: relatives, friends, colleagues, etc. Death is a reality, a fact of life, and therefore is it not better to accept its inevitability and approach it with openness than with fear and denial?

Perhaps thinking about death makes us uncomfortable because we think that death will be a terrible, painful, and depressing experience for us. However, it doesn't have to be exactly like that. Passing away can be a moment of learning and growth; the time when we can feel love more deeply, we realize that in our life it has the greatest value, we become stronger in faith and devotion to religion and spiritual practices. Death may even give us insight into our true nature and the nature of all things, and this insight will enable us to be freed from all suffering.

Let's take the example of Inta McKim, director of a Buddhist center in Brisbane, Australia.

Inta died of lung cancer in August 1997. Two months before her death, she wrote in a letter to her spiritual master Lama Zopa Rinpoche: “Although I am dying, this best time in my life! … For so long, life seemed so hard, so difficult. But when you really realize death, it turns out to be a great happiness. I would not want your death to go unnoticed for you, so that you miss the great happiness that is born from the awareness of impermanence and death. These experiences are surprising and unexpected and are accompanied by great joy. This greatest time my life, the most exciting adventure, the best party!”

Inta spent the last few months of her life devoting herself to spiritual practice. At the time of death, her mind was calm, she was surrounded by relatives and friends who prayed for her. There are many similar stories about lamas, monks, nuns and spiritual practitioners who managed to meet death calmly, with dignity, and some of them even remained in meditation during and after death. With proper training and preparation, each of us can meet death with a positive and peaceful attitude.

It is very important to examine your thoughts, feelings and attitudes about death and dying to determine how realistic and constructive they are. How do you feel when you read or hear about the sudden and unforeseen death of a large number of people? How do you feel when you hear about the death of a relative or friend, or that they have been diagnosed with cancer? What do you feel when you see a hearse or drive past a cemetery? What does the verb "die" mean to you? Do you believe that there is something beyond this life, on the other side of death?

There are two unhealthy approaches to death. The first is fear, the thought that death is a terrible, painful experience, or complete disappearance. This fear leads to denial and a desire to avoid thinking or talking about death. But is it right, considering that one day we will have to go through this? Wouldn't it be better to accept the reality of death, learn to overcome your fears and prepare for the inevitable?

Another unhealthy attitude is careless and frivolous, leading us to say, “I am not afraid of death. I know that one day I will have to die, but everything will be fine, I can handle it. When I was young, I had the same attitude, but one day I was in an earthquake zone and for a few moments I was completely sure that I was on the verge of death. And then I realized how wrong I was: I was terribly scared and absolutely not ready to die! In The Tibetan Book of the Living and the Dead, Sogyal Rinpoche quotes a Tibetan teacher: “People often make the mistake of having a frivolous attitude towards death and thinking, “Death happens to everyone. It’s not a big deal, it’s a natural process, so I can handle it.” A wonderful theory, but it is true exactly until death approaches.

If you find yourself in one of these approaches, then perhaps you should continue your research on the topic of death. Increasing knowledge about death and dying will help us reduce the fear of death (because we have a tendency to be afraid of what we do not know, or what we cannot understand), and people with a frivolous attitude towards death will realize the importance of preparing for it.

First of all, let's look at the concept of death in the Buddhist tradition.

Death sometimes seems to people as a punishment for the atrocities they have committed, a collapse, a mistake, but none of these views is true. Death is a natural part of life. The sun rises and sets, the seasons come and go, beautiful flowers wither and lose color, people are born, live for a while, and then die.

One of the key truths that the Buddha revealed and taught us is the truth of impermanence: everything changes and ends. There are two levels of impermanence: gross and subtle. Gross impermanence boils down to the fact that everything generated and produced (be it people or other living beings, all natural phenomena and everything created by human hands) cannot be eternal and will end its existence at some point in time. As the Buddha himself said:

What was born will die
What has been collected will be dispersed,
What has been accumulated will be depleted,
What was built will fall
And what was high will become low.

Our existence is as fleeting as autumn clouds.
Watching the death and birth of beings is like watching the movements in a dance.
Life is like a flash of lightning in the sky
She is like a stormy stream, swiftly rushing down a steep mountain.

Subtle impermanence is those changes that occur every moment in all living beings and inanimate objects. The Buddha said that objects and phenomena do not remain the same from one moment to the next, but are constantly changing. These words have been confirmed in modern physics, as Gary Zukav points out in The Dancing Masters of Wu Li:

“Each interaction of intraatomic particles consists in the complete annihilation of the original particles and the creation of new intraatomic particles. The intraatomic world is a continuous dance of creation and destruction, when matter passes into energy, and energy into matter. Transient forms flare up and go out, forming a never ending and always newly created reality.

The Buddha skillfully conveyed his teaching on the inevitability of death to one of his disciples, Kiza Gotami. Kiza Gotami was married and had a child very dear to her heart. When the child was about a year old, he fell ill and died. Overwhelmed with grief, unable to accept the death of a child, Kiza Gotami took him in her arms and went in search of someone who could bring him back to life. Finally, she met the Buddha and begged him to help her. The Buddha agreed, but asked for mustard seeds to be brought to him, from a house where no one had ever died.

Kiza Gotami walked through the village from house to house, and although everyone was ready to give her a handful of mustard seeds, it was impossible to find a house that would not be touched by death. Gradually she realized that death happens to everyone, returned to the Buddha, buried the child and became one of the followers of the Enlightened One. Following him, she reached Nirvana, complete freedom from the endless cycle of rebirth and death.

People sometimes fear that if they accept the reality of death and think about it, they will become mentally ill or lose the ability to enjoy the pleasures that life offers them. But, as it is not surprising, everything happens exactly the opposite. Denying death makes us tense, and accepting this given brings peace. With an eye on death, it is easier for us to realize what is really important for us in life. For example, be kind and love others, be honest and unselfish. Realizing this, we direct our energy to precisely such actions and avoid actions that would make us feel regret and fear in the face of death.

In the Great Nirvana Sutra, the Buddha says:

Of all plowing, the most important is autumn.
Of all the footprints, the largest are elephant footprints.
Of all the realizations, the most important is the remembrance of death.

The awareness and remembrance of death is very important in Buddhism for two main reasons:

1) Awareness of the transience of being is likely to push us to spend time wisely, doing positive, good, virtuous actions, abstaining from negative, non-virtuous ones. As a result, we will be able to die without regret, and in the next life we ​​will receive a favorable rebirth.

2) The remembrance of death creates an urgent need to prepare for death. There are various methods (e.g. prayer, meditation, mindwork) to overcome fear, attachment, and other emotions that may arise at the time of death and cause worries, worries, and even negative states of mind. Preparing for death gives us the opportunity to die peacefully, with a clear and positive state of mind.

The benefits of death awareness can be confirmed by the results of near-death experiences. Near-death experiences people experience when they are literally on the verge of death, on the operating table or in a car accident. Later, when they come back to life, they are able to describe their experiences. As Songyal Rinpoche writes in The Tibetan Book of the Living and the Dead (p. 29):

“Perhaps one of the most striking discoveries is how it (near-death experience) transforms the lives of those who have gone through it. The researchers noticed surprising consequences and changes: a person becomes less afraid, more aware of the inevitability of death, he wants to care more about others, he understands better important role love, loses interest in the material side of life and is filled with faith in the spiritual dimension and the spiritual meaning of life, and, of course, it is much easier for him to agree that everything does not end with death.

Each of us is made up of a body and a mind. The body is formed by the constituents of material nature: skin, bones, internal organs and so on, and the mind - thoughts, perceptions, emotions, etc. The mind is an endless, ever-changing stream of experiences. It has no beginning and no end. When we die, our mind separates from the body and moves on to a new life. If we are able to agree with this idea and continue to build on it, then this will help us overcome the fear of death and weaken the attachment to this life. In the Tibetan tradition, it is advised to look at life through the eyes of a traveler who has stayed in a hotel for a couple of days: he likes the room, likes the hotel, but does not become attached to them excessively, because he knows that all this does not belong to him, and he will soon leave.

Our next rebirth and the experiences that are prepared for us are determined by how we live our current life. Positive, wholesome, ethical actions will lead to a good rebirth and an experience of happiness, while negative, harmful actions will lead to an unwholesome rebirth and joyless experiences.

Another key factor in determining what our next birth will be like is the state of mind at the time of death. We must make it our goal to die in a positive, peaceful state of mind if we are to secure a good rebirth. Dying in anger, with attachment, or in any other negative state of mind can lead us to be reborn in adverse circumstances. This is another reason why it is important to prepare for death. If we want to maintain a positive mindset at the time of death, then we need to learn now to keep our mind from negative states and accustom ourselves to positive ones with all our might.

Death and rebirth are two symptoms of an ordinary, cyclic existence (samsara) in which we are constantly faced with problems, dissatisfaction and lack of freedom.

We are in this position because of the defilements that are present in our mind (the main ones are attachment, anger and ignorance), as well as because of the imprints of actions (karma) committed by us under the influence of these defilements.

Once the Buddha was just like us, a prisoner of samsara, but he found the path to liberation and achieved complete perfect Enlightenment. He did this not only for his own salvation, but also for the benefit of all other sentient beings, because he realized that all sentient beings have the potential to achieve Enlightenment. This potential is also called "Buddha nature" and it is in it that the true, pure nature of our mind lies.

The Buddha is filled with the most perfect, pure compassion and love for all of us sentient beings. He gave teachings on how to free ourselves from suffering and achieve Enlightenment. That is what his Teaching, Dharma, is about. The Dharma shows us how to free our mind from defilements and karma - the causes of death, rebirth and all other samsaric problems - and thus become free from samsara and achieve final Enlightenment. The mindfulness of death is one of the most powerful sources of the energy that we need in order to practice the Buddha's Teaching and achieve bliss with its help.

Now let's look at some methods that will help us start preparing for death.

Christine Longaker, an American with 20 years of experience working with the dying, has formulated four tips to help us prepare for death while making our lives full and meaningful at the same time. Here are the recommendations:

1) Recognize and transform suffering

We must accept that various problems, difficulties and painful experiences are an integral part of our lives and learn how to deal with them. If we learn to overcome the small sufferings that we face along the way, we will be better able to cope with the great sufferings that we will face at the time of death.

It makes sense to ask yourself the following questions: How do I react when faced with physical or mental problems? Do I consider my reaction healthy, is it satisfying, or can it be improved? How can I learn to better deal with problems?

In this case, in the Tibetan tradition there are practices of developing patience, thinking about karma, cultivating compassion and tonglen (“giving and receiving”). An explanation of these practices can be found in Transforming Problems into Joy by Lama Zopa Rinpoche (Wisdom Publications, Boston, 1993).

2) Establish a heart connection with others, make relationships with them healthier, try to resolve old problems

This advice concerns our relationships with others, particularly family members and friends. The main points here are: to learn to be honest and compassionate in our interactions with others, to get rid of selfishness and try to resolve any long-standing problems that we have in relationships with others.

Reflect on your relationships with family, friends, co-workers, etc. Are there any unresolved issues in your relationship with them? What can be done to resolve them?

Tip: meditate on forgiveness, try to resolve problems.

3) Prepare for death with spiritual practices

Christine writes: “In any religious tradition, it is emphasized that in order to spiritually prepare for death, it is necessary to begin daily spiritual practice right now. It must enter so deeply into your consciousness in order to become your flesh and blood, a reflex reaction to any life situation, including the experience of suffering. The list of recommended spiritual practices of the Buddhist tradition is given below.

Try to imagine yourself at the moment of death: what thoughts and feelings are born in your mind? Do you know of any spiritual ideas or practices that would give you inner confidence and peace at the time of death? Have you studied them, have you started to apply them?

4) Try to determine what is the meaning of your life

Many of us go through life without a clear idea of ​​the purpose and meaning of our existence. This lack of clarity can become a problem for us as we age, as we gradually lose strength and become more dependent on others.

Therefore, it is very important to try to answer the following questions:

What is the purpose of my life? Why am I here? What is important and what is not important?

The painful or frightening experiences we experience at and after death are the result of negative actions or karma. To prevent these experiences, you need to refrain from negative actions and do as many positive actions as possible. For example, we can try our best to avoid the ten non-virtuous actions (killing, stealing, sexual behavior, rude speech, lying, slander, gossip, greed, malice and wrong view) and practice the ten virtuous deeds (consciously abstaining from killing, etc., and doing the opposite of the ten non-virtuous deeds). It is also good to take vows or commitments and perform cleansing practices on a daily basis.

Another aspect of Buddhist ethics is working with your mind to reduce the true causes of negative actions: defilements, or defilement emotions such as anger, greed, pride, etc., as well as the awareness of death, which is one of the most effective antidotes for defilements. .

To illustrate this point, I will give an example. I was told a story about a woman who had an argument with her son just before he went fishing with his father. During that trip, the son died. You can imagine the pain that the mother felt: she did not just lose her son - the last words she said to him were filled with anger.

It is impossible to predict when death will overtake us or someone else. Every time we part ways with someone a short time, there is no certainty whether we will meet again. Realizing this can help us stop clinging to our negative emotions and resolve problems in relationships with others as quickly as possible. This will ensure that we leave life with a light heart and save ourselves from painful regrets in the event that the person with whom we had a quarrel dies before we have time to apologize to him and fix the problems.

Also, as you approach death, it is helpful to start gifting others your property, or at least making a will. This will help ease attachment and anxiety -What will happen to my possessions? Who will get what? - at the time of death.

Learning spiritual practices, such as those taught by the Buddha, will help us overcome defilements and negative behaviors and become more wise and compassionate. In addition, the deeper we comprehend reality, or Truth (the nature of our life, the universe, karma, our ability to develop spiritually and the methods for awakening this ability), the less we will be afraid of death.

At the time of death, we may experience physical discomfort or pain. In addition to this, we may be plagued by disturbing thoughts and emotions, such as regrets about the past, fears about the future, sadness from parting with loved ones and loss of property, anger because of the failures that haunt us. As mentioned above, it is very important to keep your mind away from such negative thoughts and instead focus on the positive at the time of death. Examples of positive thoughts:

Focus on the objects of faith: Buddha or God;

Calmly accept your death and its attendant problems;

Maintain non-attachment to your loved ones and property;

Be positive about how we have lived our lives, remembering the good things we have done;

To feel love, kindness and compassion towards others.

In order to be able to awaken such thoughts and feelings in yourself at the time of death, you need to accustom yourself to them. The degree of habituation to positive states of mind depends on how much time and how much effort we have devoted to spiritual practice during our lifetime. And it is best to start it now, because we cannot know when the hour of our death will come.

1) Going for Refuge

In Buddhism, going for refuge is believing in and relying on the Three Jewels: Buddha, Dharma, and Sangha, combined with a sincere attempt to study and practice the Buddhist teachings. Buddhist teachings say that going for Refuge at the time of death will ensure a good rebirth and help avoid an unfavorable rebirth in the next life. Faith in one's spiritual guides, in one or another Buddha or Bodhisattva, such as Amitabha or Kwan-Yin, will bring the same result and at the time of death will give a feeling of deep peace.

2) Practices aimed at achieving rebirth in the Pure Lands

A popular practice, particularly in the Mahayana tradition, is to pray for rebirth in a Pure Land, such as the Pure Blessed Land (Sukhavati) of Buddha Amitabha. Pure lands are manifested by the Buddhas in order to help those who wish to continue their spiritual practice in the next life, free themselves from all distractions, difficulties and interferences inherent in ordinary world.

Bokar Rinpoche mentions four basic conditions that must be met in order to be reborn in Amitabha's Pure Land:

1. Remember the image of the Pure Land and meditate on it;

2. Sincerely desire to be reborn there and constantly pray for such a rebirth;

3. Purify from negative actions and accumulate positive ones, as well as dedicate the merits from this practice to rebirth in the Pure Land;

4. In your desire to be reborn in the Pure Land, be guided by Bodhichitta - strong desire achieve Enlightenment (Buddhahood) to be able to help all beings.

3) Mindfulness

Mindfulness is a meditative practice that involves being aware of everything that is happening to our body and mind; it is accompanied by an equanimity, free from attachment to what is pleasant and aversion to what is unpleasant. A deep familiarity with this practice makes it possible to cope with pain and discomfort, keep the mind from disturbing emotions and remain calm during death.

4) Love and kindness

This practice includes the development of caring, participation and kindness towards others. When we face difficulties or pain, our strong attachment to the self increases our suffering. If we focus less on ourselves and more on others, we will reduce our suffering. At the time of death, thinking about other living beings and wishing them happiness and liberation from suffering will bring peace to our mind. Lama Zopa Rinpoche says that these are the thoughts and feelings that are best experienced before and during death. They not only help us die in peace, but also purify our negative potential and increase our positive potential, our merit, which guarantees a good rebirth in the next life.

For more information on how to cultivate love and kindness, see Sharon Salzburg Loving-kindness - The Revolutionary Art of Happiness.

People are afraid of death because they don't know what will happen to them. The Tibetan Buddhist tradition offers a clear and detailed explanation of the process of dying, which includes eight stages. Eight stages correspond to gradual dissolution various factors, such as the four elements: earth, water, fire and air. When passing through the eight stages, various internal and external signs appear.

In the first four stages, the dissolution of the four elements occurs. In the first stage, the earth element dissolves. On external level this is manifested in the fact that the body becomes thinner and weaker, and internally - in the fact that a person sees mirages. In the second stage, the elements of water dissolve, on the external level this manifests itself in the fact that the fluids of the body dry up, and on the internal level, in the fact that a person sees smoke. In the third stage, the element of fire dissolves. On the external level, this is manifested in the fact that the body temperature drops, and with it the ability to digest food, and on the internal level, in the fact that a person sees sparks. In the fourth stage, the air element dissolves. On the external level, this is manifested in the fact that breathing stops, and on the internal level, in the fact that a person sees flames ready to break out. This is the moment when clinical death is usually declared. The gross physical elements have dissolved, breathing has stopped, and there is no more movement in either the brain or the circulatory system. However, according to Buddhism, death has not yet occurred because the mind or consciousness is still present in the body.

There are different levels of consciousness: gross, subtle and subtle. The gross mind or consciousness includes six kinds of consciousness associated with the senses (consciousness associated with sight, hearing, smell, taste, touch, and mental consciousness) and eighty instinctive concepts. The six sense-consciousnesses dissolve in the first four stages of dying, and the eighty concepts in the fifth stage, after which the white vision appears. In the sixth stage, the white vision dissolves and the red vision appears. In the seventh stage, the red vision dissolves and the vision of darkness appears. White, red and black vision constitute the subtle level of consciousness.

Finally, in the eighth stage, the black vision dissolves and the stage of the most subtle mind of clear light enters. This is the most subtle and purest level of our mind or consciousness. Experienced meditators are able to engage the clear light mind in meditation, achieve the realization of absolute Truth, and even gain Enlightenment. That is why contemplatives are not afraid of death and even look forward to it, as if a holiday is approaching!

This is a brief explanation of the eight stages. More detailed explanations can be found in several books, such as The Tibetan Book of the Dead, translated by Robert Thurman.

Since we are understandably afraid of the unknown, becoming familiar with the stages of dying will help us overcome our fear of death to some extent. And if we begin to perform the meditation associated with the mental passage of the process of dying and the awakening of clear light, which is described in the Tibetan Vajrayana tradition, then it is quite possible that we will be able to achieve realizations at the time of death.

Here are just a few recommended spiritual practices that you can learn and practice on your own throughout your life and that will help you prepare for death. However, there are many other methods for people with different inclinations. When it comes to choosing the method that suits us best, we can rely on our own intuition and wisdom, or we can consult trustworthy spiritual teachers with whom we have a spiritual connection.

The Buddhist teaching says that helping another person to die in a peaceful, calm state of mind is one of the greatest virtuous deeds. This is because the moment of death is key to determining the next rebirth, which, in turn, will affect subsequent rebirths.

However, helping the dying is not an easy task. When people die, they go through many hardships and changes that naturally causes a restless state of mind as well as painful emotions. The dying have physical needs: they need to be relieved of pain and discomfort, they need help with the simplest activities, such as quenching their thirst, eating, defecation, bathing, etc. They also have emotional needs: they need to be treated with respect, kindness and love, to be listened to, to talk to them, and sometimes they want to be left alone and allowed to be in silence. They also have spiritual needs: they strive to find the meaning of life, to understand the cause of suffering, death; they want to find hope that after death there is some kind of continuation; to feel that they will be taken care of and beyond the threshold of death they will be guided by something wiser, more powerful than themselves.

Thus, one of the most important skills in helping a dying person is to learn to understand his needs and try to fulfill them as much as possible. The best thing to do when visiting a dying person is to put our own needs and desires aside and set our minds on the fact that we are completely dedicated to this person and are ready to do everything to make him feel more comfortable, happy and calm.

There are so many excellent books out there on how to care for a dying person, taking into account their physical and emotional needs. In this book, we will focus on spiritual needs and how to try to meet them.

When people feel they are dying, they sometimes experience disturbing emotions such as fear, regret, sadness; they cling to people and things related to this life, and even become angry. It can be difficult for them to cope with their emotions that overwhelm them, and at times it may seem to them that they are literally drowning in their emotions. What can help them at this moment? One must be near them, listen to them with sympathy and find words of consolation in order to bring their minds into an even state.

But to cope with this task, you need to know how to deal with your own emotions. Being close to a dying person can cause exactly the same disturbing emotions in our mind: fear, sadness, attachment, feelings of helplessness, etc. Some of these emotions we may not have experienced before and, having found them in our mind, we We may be surprised and even confused. Therefore, we need to learn how to deal with our emotions if we want to provide real help to another person.

One of the most better ways coping with your emotions is a mindfulness meditation (see above). Another way is to remind ourselves of impermanence, that we ourselves, other people, our bodies and our minds, and everything around us is constantly changing from one moment to the next, never remaining the same. Awareness and acceptance of impermanence are the most powerful antidotes to clinging, attachment, and fear, which is often resistance to change. It is also extremely helpful to develop firm faith in the Three Jewels of Refuge (Buddha, Dharma and Sangha). It gives us the strength and courage we need when we are going through violent emotions.

If the dying person is a family member or friend, then it will be especially difficult for us to cope with the attachments and expectations associated with him. Although it is difficult, it is still best to mentally “let go” of the person. Attachment to him is unrealistic and will only create more suffering for both of you. Again, most effective medicine from attachment, mindfulness of impermanence.

Sogyal Rinpoche in The Tibetan Book of the Living and the Dead (pp. 212-213) says that when helping a dying person, it is very important to give him hope and receive forgiveness. When people die, many of them experience guilt, regret, depression, or feelings of helplessness. You can help them by letting them have their say, by listening with compassion and without judgment. But try to lead them to remember the good things they did while they were alive and feel positive about the way they lived their lives. Focus on their successes and merit, not on their mistakes and misdeeds. If they are open to such information, then remind them that by nature they are pure and kind (in Buddhism we call this “Buddha nature”), and their transgressions and mistakes are transient and removable, like dirt on glass.

Some people are worried that their wrongdoings are so numerous and great that they will never find forgiveness. If they believe in God or Buddha, reassure them that the nature of God or Buddha is pure, their nature is unconditional love and compassion, so they will always forgive any mistake we make. If you have an unbeliever in front of you, then he needs to forgive himself. You can help him do this by encouraging him to be genuinely remorseful for his mistakes and willing to ask for forgiveness for what he has done. That is all that is required of him. Remind him that no matter what he did, he is in the past, and nothing can be changed, so it would be better not to cling to the past. However, you can start changing right now. If a person really feels regret about his mistakes and a desire to change, then he can always be forgiven. If there are people whom he has harmed before and they are still alive, then help him speak words of repentance and ask for forgiveness.

Sogyal Rinpoche writes (p. 213):

“All religions emphasize the power of forgiveness, and this power is especially needed and especially deeply experienced precisely at the moment of death. By forgiving and receiving forgiveness, we cleanse ourselves of the darkness of our transgressions and thoroughly prepare ourselves for the journey through death.”

If the dying person is a Buddhist, ask questions to find out how deep their knowledge and level of insight is. His answers will help you understand how to give him spiritual support. For example, if the dying person has a strong faith in Kwan-Yin (Tib. Chenrezig, Sanskrit Avalokiteshvara), then you should strengthen him in faith and advise him to pray to Avalokiteshvara as often as possible. Or, if he has been practicing mindfulness meditation, advise him to do this practice as often as possible. So, whatever doctrine or practice the dying person is familiar with, remind him of them and do everything to strengthen him in faith and inspire him to perform these practices. If he finds it difficult to do the practice on his own, because of pain, fatigue, or a confused state of mind, then do it with him.

If possible, place pictures of Buddha, Kuan Yin, Amitabha, and other deities where the dying person can see them. If he has spiritual mentors, put up their portraits as well. In addition, it is beneficial to recite the names of the Buddhas to the dying person, because the Buddhas promised to help living beings avoid bad rebirths.

Tell the dying person about impermanence and other Buddhist teachings, or read appropriate excerpts from books, but do this only if he is interested, do not be intrusive. Also be careful that your teachings do not cause confusion or anxiety in the mind of the dying person (for example, if the subject is too difficult to understand or if it is a new and unfamiliar teaching). Remember that the most important thing is to help the person achieve a calm and positive state of mind before and after death.

It may also happen that the dying person does not know how to meditate or pray. In this case, you can meditate, pray, or do other practices in his presence, dedicating merit to a calm state of mind at the time of death and a good rebirth of the dying person. You can also teach him to pray by saying Buddhist prayers or in your own words, from the heart. For example, he might pray to the Buddha, Kwan Yin, or other Buddhas he knows, asking them not to leave him in difficult times, to help him find the strength and courage to cope with his suffering, keep his mind calm, and find the path to good things. rebirth.

Here is a simple meditation you can teach a dying person: ask them to visualize in front of them whatever Buddha they believe in, imagining that they embody all positive, pure qualities such as compassion, love, kindness, forgiveness, and wisdom. Light descends from the body of the Buddha, filling the body and mind of the dying person, cleansing him of all negative deeds and thoughts and blessing him to gain pure, positive thoughts. The mind of the dying person merges with the mind of the Buddha, which has perfect purity and goodness. If the dying person is unable to do this meditation (for example, they are very ill or unconscious), then you can do it for them by imagining the Buddha above the dying person's head.

In addition, help the dying person to release worry and anxiety, ask him not to worry about loved ones and possessions, assure that everything will be taken care of, and convince him not to be afraid of what lies ahead, but still believe in the Three Jewels. Try, to the best of your ability, to help him develop positive states of mind: faith, compassion, love, and kindness, and to avoid negative thoughts: anger and attachment.

If the dying person belongs to another religious denomination, try to understand their beliefs and beliefs and speak to them in that language. For example, if they believe in God and paradise, help them strengthen their faith, turn their prayers to God, and be filled with confidence that after death they will be in paradise with God. You must treat the dying person with due respect, his faith and spiritual practice. Remember that the most important thing is to help him tune in to positive thoughts that lie in the context of his religion and practice. No need to impose your own beliefs on him or convert him to your religion. This will be a manifestation of disrespect for the dying and a violation of ethical standards. Such behavior on our part can cause anxiety and anxiety in the dying person.

If the dying person is a non-believer, do not use religious terminology when talking to him. In simple words, help him get rid of negative thoughts such as anger and attachment and develop positive thoughts and a calm state of mind. If he shows interest in what you believe, then you can tell him about it, but be careful that your story does not turn into a sermon. It may be more effective to have a conversation in which you openly share your views with each other. For example, if a dying person asks you to talk about what happens after death, then instead of immediately jumping into a discussion about rebirth, it is better to say: “I'm not quite sure. And what do you think?" , and start the conversation from that point.

If the dying person really wants to learn about the Buddhist religion and practices, then of course one can start telling them about them. You can talk about the life of the Buddha and his Teachings, about the Four Noble Truths, about impermanence, about love and kindness, about compassion, etc. Be attentive and sensitive to the reaction of the dying person: do not push, otherwise he may fall into a negative state of mind.

Remember that the main goal is to help him get rid of any negative thoughts and be in a positive, calm state of mind.

If the dying person is not a Buddhist, he will be uncomfortable if you read Buddhist prayers or perform Buddhist practices in front of him, then you can do them silently, so that he does not know about it. For example, you can sit nearby and meditate on love and kindness, sending the energy of goodness born in your heart to the dying person to help him find peace. Or you can visualize a dying Buddha or Kuan Yin above your head and recite prayers or mantras silently while visualizing a stream of light pouring from the Buddha image onto the dying person. Mentally imagine that this light purifies him and helps his mind to find peace and purity. It is likely that a person will feel the power of these practices, even if he does not know that someone performed them on his behalf!

You can continue to meditate or recite prayers, mantras, the names of the Buddhas in the process of dying a person, as well as for as long as possible after breathing has stopped. Remember that, according to Buddhist teachings, the cessation of breathing is not considered the moment of cessation of life. This is only the fourth of the eight stages of the dying process, and death actually occurs at the moment when consciousness leaves the body, that is, at the end of the eighth stage.

How long does it take to get to the eighth stage after stopping breathing? This cannot be said for certain. It all depends on various factors, such as the cause of death (for example, if a person's body was badly damaged in a car accident, then his consciousness can leave the body faster than in the case of natural death) and the state of mind (experienced meditators can remain in the eighth stage, stage clear light, longer than someone who meditated little or no experience of meditation).

How can we know that a person is really dead? According to the Tibetan tradition, there are several signs that indicate that the consciousness has left the body: the temperature at the level of the heart center decreases, the body begins to smell, and a small amount of fluid is secreted from the nostrils or genitals. Until these signs appear, it is best to leave the body alone. Before they appear after stopping breathing, it can take from several hours to several days. You can do this if a person died at home, but it is difficult if he died in a hospital, because hospitals have rules governing the length of time the body is in the ward or in any hospital room. You can ask the hospital staff to move the body to another room and leave it there for a few more hours while the necessary prayers and mantras are recited.

It is better not to touch the body from the moment the breath stops until the moment when consciousness leaves it. However, if it becomes necessary to move the body, first pull out a few hairs from the top of the head (or touch the top of the head if there is no hair). This stimulates the person's consciousness to leave the body through the crown, which is the exit point for a favorable rebirth, for example, in the Pure Lands. After that, you can touch other parts of the body.

In Buddhist tradition, it is recommended not to cry in the presence of a dying person. It is not advised to cry even after he has stopped breathing. It is also better not to talk about a person's property and how it will be distributed. Such talk can disturb a person's mind. Family members and friends may go to another room to cry or discuss practical matters. For a person who has died, it will be more favorable to hear the sounds of prayers, mantras and spiritual instructions.

Among the practices that Lama Zopa Rinpoche recommends doing for the deceased are Medicine Buddha, Amitabha, Chenrezig, Giving Breath to the Unfortunate, and Prayer King. Copies of the texts of these and other practices for the dying and dead can be obtained by writing to: [email protected] If there is a lama or an ordained monk in your area who knows how to do the Phowa (mind transference) practice, then you can invite him. If there is no such person, then do those practices and recite those prayers that you yourself know, with all the faith, sincerity and compassion that your heart is capable of.

After a person has died, we can continue to help him accumulate merit by doing virtuous deeds: recite prayers (you can turn to monks or nuns for help), make offerings, free animals that are being led to the slaughter, and meditate, etc. All the merits from these actions can be dedicated to the good rebirth of the deceased, his speedy Liberation from samsara and the achievement of Enlightenment. It is recommended to dedicate merit regardless of whether the deceased was a Buddhist or a non-Buddhist.

It is very good to use the personal funds of the deceased for the accumulation of merit, for example, direct them to charitable purposes. It is important to know that the merits accumulated by family members (direct relatives of the deceased) are more powerful and effective. Performing virtuous deeds and dedicating merit to the deceased can help a person in the bardo (an intermediate state between death and the next life, which lasts up to 49 days). However, if the deceased finds the next rebirth quickly enough, then the merit that we dedicate to him, thinking that he is in the bardo, may not help him in this new birth, but may help him in subsequent rebirths, for example, shortening his life. being in an unfavorable birth.

I hope that the ideas in this booklet will help you come to terms with the inevitability of death and relieve your own and others' fears. There is a huge amount of material gleaned from ancient religious and spiritual traditions, as well as modern areas knowledge, such as psychology, sociology and palliative care, that helps you build your life so that you meet death with peace, calm and courage. And when people we love pass away, we can give them comfort, clarity of mind and hope. Let this little work inspire you in your own research on this important topic. And may all living beings be freed from the suffering associated with the termination of life, and achieve supreme peace and happiness beyond the cycle of birth and death.

IN Lately themes of dying and death are covered in numerous books, scientific papers magazines, radio and television broadcasts. So in the documentary "16 More Days ..." tells about one of the five London clinics for the dying, St. Christopher's Hospice. Since its opening in 1967, 1600 patients have died in this clinic. The people who are brought here have only 16 days to live - hence the title of the film. These are patients who can no longer receive medical care. Doctors, sisters, clerics and voluntary assistants cooperating in the clinic strive to help the dying: make it easier for them to die, free them from the pain and fear of death. This difficult task requires great sacrifice, patience and love. The viewers of the film experience the peaceful death of a seriously ill person - not dying alone, but, on the contrary, surrounded by his wife and children. Family members give the dying person the feeling that he is not left alone; they help him to survive in this life situation. The film shows that help in dying is the last help in life: people live their lives together, just as they must accompany the dying person to his death. The dying person should be able to express his feelings; he must know that he was not left alone. If his family members and caregivers refuse to help him, understand him and overcome his anxiety and fear together with him, then they can leave the patient in all alone. A dying person may notice with deep disappointment that he has been considered dead before he actually dies.
It is often not possible to help a dying person because even a person striving for this does not have the necessary prerequisites that would allow him to be near the dying person at this difficult stage of his life. Already at school and then in Christian communities, therefore, one should constantly strive to prepare people for the provision of such assistance. Important prerequisites for this are:
- the observation that the dying (other than those who die instantly) come to terms with the fact of their death at various stages of dying;
- the ability to penetrate into the world of feelings of the dying person and listen to him, as well as
- willingness to monitor their own behavior when communicating with the patient.
This chapter offers selected texts that provide guidance that may help in accompanying the dying.

Dying

An important contribution to the understanding of the dying person was made by the psychologist and physician E. Kübler-Ross with her book Interviews with the Dying. Based on her many years of experience with the dying in a Chicago clinic, she describes how the dying, at various stages of dying, come to terms with the fact of their imminent death. E. Kübler-Ross distinguishes five stages of dying, which in different people can have different duration and intensity. "If we do not leave the dying alone, if we listen to their hopes, patients quickly go through all five stages ... Sometimes one of the stages can be skipped, sometimes the patient comes back" (Kübler-Ross 1971). Based on the experience of E. Kübler-Ross, W. Becker gives an impressive description of the long and difficult journey of the dying person and his companions through the various stages of dying.
1. Unwillingness of the patient and his relatives to recognize the proximity of death When the terminally ill learns about his diagnosis or gradually realizes the truth about his situation, he goes through a stage of shock, which is characterized by unwillingness to accept reality. He reacts to the hard reality with the illusion of health and well-being: "No, no, this does not concern me! This is not happening to me, this cannot happen to me." Such a reaction helps the patient to dull the shock caused by the news of the impending end, and gradually get used to the current situation. For more late stage refusal to recognize reality is replaced by "isolation" of feelings. At this stage, the patient talks about his health and illness, about his death and immortality, as if emotionally it does not affect him at all.
The shock is experienced not only by the dying, but also by his relatives. They realize that their words mean little, their expectations are unrealistic, and that they themselves tend to close their eyes in the face of death. They are also involved in the patient's unwillingness to acknowledge reality, and this reinforces their need for detachment from reality. It often happens that the patient's relatives still cling to the denial of reality, while the patient himself is already beginning to prepare for it. The dying understand these needs of their loved ones and often pretend that they do not recognize reality, although in fact they are already beginning to consciously come to terms with it. Some are only able to endure meeting a dying person on the condition that they withdraw completely from him.
These observations show how important it is that anyone who wants to help a dying person clearly understands his own attitude towards dying and death.
2. Emotions, protest The stage of refusal to recognize reality is followed by the stage of emotions. The dying man is seized by a stormy stream of feelings. He comes into a state of anger and rage: "Why did this have to happen to me?" Anger can turn to loved one, a doctor, a nurse, a priest, and even God. It flares up on the most insignificant occasions and is often not provoked by those against whom it is directed. Often the dying person is not even able to express his anger, as he is hindered by the habit of external and internal control. External control is carried out by the persons accompanying the dying person, since they do not allow negative emotions, preferring to deal with friendly and obedient patients. Many also have strong inner control against negative emotions because they consider them unworthy of a Christian and hesitate to express their anger. At this stage, it is especially difficult for those accompanying people who perceive the outbursts of anger of the dying person too personally. If you are unable to accept the question "Why did this have to happen to me?" as an expression of the anguish and fear of the patient, you have to look for another answer that explains everything, and you cannot find it. The place of sympathetic perception of the patient is then replaced by numerous words that do not reach the patient in his suffering and prevent him from expressing his feelings. If, on the other hand, the accompanist is so deeply imbued with the feelings of the patient that he barely retains the ability to maintain a distance between him and himself, then the flow of the patient's feelings becomes even stronger until he drowns in it. At this stage, the dying need companions who are ready to listen to them and sometimes also endure their unreasonable anger, because they know that such an attitude helps the dying person in those moments when he cannot suppress his anger. If the caregiver understands the patient's feelings and his own, he can help the patient avoid depression.
3. Negotiations for the continuation of life After the stage of denial of reality and the subsequent stage of the explosion of emotions, the stage of negotiations follows. Just as a child, in response to a refusal to fulfill his request, first violently protests, and then tries to get around this refusal with the help of clever maneuvers, so the dying bargain for a delay - for example, with God. As payment, they may offer to give their lives to God, such as dedicating the remaining years of their lives to church service. In any case, such attempts at negotiations are very natural for a person and quite normal. Just as the negotiating stage can end in a spiritual and religious "sale" for a dying person, so many companions also feel their spiritual bankruptcy. The answers they give to the most important questions turn out to be unsuitable not only for the dying person, but also for themselves. If they participate in a trade initiated by a dying person, they are in danger of reinforcing the patient's illusions, while at the same time depriving him of an understanding listener. At the same time, the struggle with the hope of the dying person for some way out of the situation is useful to him only when it helps him to move on to the next stage.
4. Hope; negative and positive depression The negotiation phase rarely lasts long, as the progression of the disease and the nature of the treatment of the patient make it clear to him in what position he is. He may respond to this understanding with realistic hope or doubt. Hope in this case is associated not with the improvement or development of the existing situation, but with the process of dying and life after death. We are talking about such problems as the refusal to artificially prolong life at any cost, the hope of liberation from pain or the opportunity to feel a loved one next to you in your hour of death. If the dying person at the stage of negotiations realized that he was bankrupt in the field of spirit and faith, then the only reaction left to him is despair, which can manifest itself either as the bitterness of a stoic, or as a depressive state. There are two forms of depression. The first form of depression is the patient's reaction to the losses he endures, namely the changes that befell him as a result of the disease, the inability to correct the mistakes he made earlier, helplessness, the inability to continue to fulfill his duties, for example, in relation to the family. Another form of depression is associated with the threat of loss of life and loved ones. It serves as a preparation for the final acceptance by the sick of their fate and is part of the dying work of the dying. This, the second, form of depression, unlike the first, usually proceeds very calmly, if the patient has something to tell, what to discuss and put in order.
If the attendant manages to be with the patient at this stage of his spiritual development, then various possibilities open up for him in the fight against depression. At the same time, it is necessary that the accompanist control his own depressive manifestations. At this stage, the dying person openly seeks the human closeness of the escort to make sure that neither now nor in the future will he be left alone. The dying person now faces the most important questions about the past and the future. An escort can help him resolve family problems and settle economic and financial issues. He can think about the meaning of life and pray with the dying.
5. Acceptance and farewell At the last stage, the stage of agreement with one's fate, the dying person is extremely tired and weak. If he has managed to express his feelings and perform his dying work, then his need for peace and sleep increases. He has reached a certain degree of calm and composure, and the circle of his interests is narrowing. He can say with approval: "Yes, here comes my last hour". Intellectual penetration into death is combined with emotional readiness to accept death. If despair brought feelings of disappointment and helplessness to the dying person, then he welcomes his death as the end of despair and loneliness.

Support for the dying

When the death of a loved one enters a person's life, most people experience helplessness and despair. How can you help the dying? Is the help of a doctor and qualified nursing care enough? What role does faith play in this? How can a person who calls himself a Christian help another person to die with dignity? Information on these issues is contained in the book of Metropolitan Anthony of Surozh "Life, illness, death", M., 1995.

Help for the dying

One of the first forms of helping a dying person is to take good care of him. This means not only professional and technical side affairs.
Along with professionalism, we are talking about the human aspects of such care. We often hear from caregivers that they would like to devote more time and attention to this side of the matter, but they do not have enough time for this ... The human aspects of care are more often truly embodied when the patient is at home, although home care may not be as professional. The lack of professionalism in this case is compensated: as E. Kübler-Ross (1970) noted, "a couple of spoons of a well-known homemade soup can be more useful for a patient than an injection in a hospital ..."
- The second way to help a dying person is to overcome physical suffering and pain.
With the help of medicines, the doctor can overcome or significantly reduce almost any pain, and this is very important for the patient ...
- Even more excruciating than physical pain can be emotional suffering caused by the upcoming farewell and parting with loved ones. Therefore, a very important form of helping a dying person is an attempt to capture and take on these sufferings to the greatest extent possible, creating an atmosphere of friendliness and cordiality around the dying person. Less correct is this form of helping a dying person, when he is "protected", hiding from him the sad truth about his condition.
- The fourth form of assistance consists in the appointment of psychotropic (sedative or stimulant) drugs by the doctor. Their use allows in the future to move on to a really deep, internal overcoming of the emotional problems that the patient faces at the last stage of his life. It happens that helping a dying person requires giving up trying to prolong his life for some more time. In some cases, the process of dying lasts a very long time, so long that there is a danger that the patient will no longer be able to cope with such a situation due to the tedious process. In such a situation, it may turn out to be quite ethical (moral) to take responsibility and refuse to fight one of the periodically occurring deadly complications in the course of the disease, which will result in the approaching death of the patient. As we shall see, it may be permitted and even deemed necessary in the interest of the patient to allow the patient to die from one of these complications. The use of passive euthanasia (and we are talking about it) in certain cases can be considered one of the forms of assistance to the dying.

Psychological support for the dying as the best form of assistance is that:
1. talk to the patient about the fatal nature of his illness and the associated feelings of insecurity, fear, stubbornness, loneliness and grief;
2. such relationships are created with the patient, in which an honest, open conversation is conducted with him, thanks to which we are able to help the patient on a personal, especially emotional level, cope with his dying and die his own death;
Many are of the opinion that if the patient tries to get around the problem of his death, then his alienation and deep loneliness increase.
Such a view is developed in detail in Leo Tolstoy's Death of Ivan Ilyich. Patients often feel alienated from the family if the family does not tell them the truth - the truth that will give them courage. Physicians such as Weissman and Hackett of Harvard University believe that human closeness and warmth are the only cure for the dying, because dying is a solitary labor. By all this we do not at all want to say that the doctor must frankly declare to the patient that he is ill with a fatal, incurable disease and that he will be "liberated" within a month. Truth has many faces; each of them acts when it is needed. The truth under such circumstances should not deprive the patient of the last ray of hope. Hope for improvement never completely disappears, even when a cure is impossible ... Truth and hope are not mutually exclusive ... Weissman and Hackett believe that the patient, even without learning anything new, often notices that his family is insincere with him , as a result of which he has to spend a significant part of his energy protecting the feelings of his loved ones, instead of relying on their support. If the knowledge of death is completely removed from the patient, this deprives him of meaningful relationships with himself, with his family and other people who mean anything to him.
If the patient does not know the truth and does not share this knowledge with other people who visit him, he cannot develop a sense of community with them. Most of us have already experienced situations in which the dying patient did not know the truth about his condition and our relationship to him could only be superficial.
L. N. Tolstoy raised this problem in "The Death of Ivan Ilyich": "The main torment of Ivan Ilyich was a lie - ... that they did not want to admit that everyone knew and he knew, but they wanted to lie about him on the occasion of his terrible situation and he himself was forced to take part in this lie ... And he had to live like this on the edge of death alone, without one person who would understand and pity him.

Problem: The truth at the sick bed

H. Cr. Piper notes that the question of the truth at the bedside of the patient is not connected with the foundations and dogmas, but is a problem of communication, communication between the dying and those accompanying him. According to Piper, it is not about whether we have the right to say "this" to the patient, but about how we, together with him, can bear the burden of our fate (the fate of the dying person and our own associated with it). Such "communication" and such "solidarity" (closeness) with the sick doctor, nurse, confessor and relatives can also help him, according to M. K. Bowers, which is confirmed by the following example from his book. When a priest visited a seriously ill person, the following conversation took place: "Mr. priest, I know that I am seriously ill, but I must know how seriously. I cannot get any direct answer from anyone here. If I die, I must know about this. This fight with the shadows is just terrible. Would you lie to me, mister priest?"
The priest replied: "Yes, you are very seriously ill. But the question you have raised is a medical question that I am unable to answer. But I know how important it is for you to answer it. I will try to talk to Dr. V about it." ." The priest found a doctor in the hospital and told him about his conversation with the patient. The doctor thought for a while and said: "It will be better if we talk together with Mr. T. Let's go to him."
At the patient's bedside, Dr. V. openly referred to his conversation with the priest and to the patient's question. Then he said: “I did not talk to you in detail about the possible outcome of your illness because there are many things in your illness that are not clear to me. conventional means treatment. However, you have pretty good blood and your heart is very good at additional load. In such a situation, various unforeseen accidents can occur that will change the development of the disease in one direction or another. We are doing everything we can to solve these problems and fight infection in every way we know how. I have told you all I know and I promise to inform you immediately if there is any significant change in your condition. However, until then, you and your priest can also help us, we really need you. Always ask me anything you want and I will always give you as honest an answer as I can, okay? It's good that you addressed your question. I will visit you more often." After the doctor left, the patient said to the priest: "What a relief to know how things really are. It’s just terrible when you don’t know anything, but you just lie and think all the time. A person has a right to know what is happening to him, doesn't he?" Then the patient and the priest talked for some more time, after which the priest said a short prayer for the doctor and for the release of all healing powers sick. The patient fell asleep, and from that moment a gradual decrease in inflammation began. It is possible that this was facilitated by the release of the patient from fear after he learned the truth about his condition.

Death

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Fear of death. Psychological help for the dying

Introduction

psychoanalytic fear dying

The cause and roots of the fear of death are biologically and culturally determined. From the point of view of the preservation of the human race, the fear of death helps to reduce the incidence of unnecessary risk and premature death. According to J. Hinton (1872) - this is a part of the human constitution, necessary for the existence of the individual. On the one hand, the fear of death is a genetically determined instinct, and on the other hand, it is the fruit of a religious and cultural worldview.

The formation of the fear of death in the Greek philosopher Epicurus is indicative, the description of which we find in A. Menya (1992).

The son of a poor Athenian immigrant, Epicurus spent his childhood on the island of Samos, the birthplace of Pythagoras. His mother was a spellcaster of evil spirits. From childhood, Epicurus accompanied his mother when she went from house to house, fighting demons. Throughout his childhood, he was accompanied by horror from the constant proximity of something sinister and the fear of death. Subsequently, having become a famous philosopher, Epicurus wrote: “If we were not at all disturbed by suspicions about death, that it has something to do with us, as well as a misunderstanding of the boundaries of suffering and passions, then we would not have needed to study nature. ” (Letters and fragments. 4.11).

Epicurus lived a long life (341-271 BC) filled with illness and fear. He wrote that in order to find peace, a person should not think about death. “The most terrible of evils, death, has nothing to do with us, since while we exist, death is still absent; when it comes, we no longer exist.”

In order to heal the world of fears, Epicurus proposed a "quaternary medicine" - tetrapharmakon:

* Don't be afraid of the gods

*Don't be afraid of death

* You can endure suffering

* You can achieve happiness.

1. Fear of death in psychoanalytic theory, an existential direction of philosophy

The psychological aspects of the origins of the formation of both pathological and non-pathological fear of death have been studied by many psychiatrists, psychologists and psychotherapists. most interesting and have great importance for the therapy of the fear of death and dying the following concepts.

Z. Freud (in scientific papers until 1920) interpreted the fear of death as derived from separation anxiety or castration anxiety, which are associated with the preoedipal and oedipal stages of libido development.

Since 1920, he radically changed his views and presented them in the book "Essays in Psychoanalysis" (1938). In addition to the love instinct (Eros), Freud introduced the concept of the death instinct (Thanatos). In his opinion, the struggle between these forces lies at the heart of mental activity person. Freud adhered to this point of view until the end of his life. The problems of thanatology were extremely relevant for the scientist. From the memoirs of contemporaries, colleagues and biographers, it is known that he himself suffered from thanatophobia. The contemporary Indian philosopher Bhagawan Shri Rajnesh, in his Reflections on the Sayings of Jesus, writes: “...whenever anyone mentioned death, Freud began to tremble. Twice he even passed out and fell out of his chair just because someone was talking about mummies in Egypt. On another occasion, Jung was also talking about death and corpses, and suddenly Freud trembled, fell down and lost consciousness. If death is so terrible for Freud, then what to say about his students? And why does death cause such fear? In his works, he repeatedly returned to this theme. His reflections are reflected in the following works: “Totem and Taboo”, “We and Death”, “Beyond the Principle of Pleasure”, “I and It”, “Thoughts in Case of War and Death”, “Essay on Psychoanalysis” and others.

A follower of Freud, Otto Fenikel, based on data from psychoanalytic literature, denied the existence of the phenomenon of “normal fear of death” and argued that this fear hides other subconscious ideas: fear of loss of love or castration, fear of one’s own arousal (especially of sexual orgasm), fear of being punished for wishing death on another.

Carl Gustav Jung, one of the best students of Z. Freud, the universally recognized "crown prince of psychoanalysis", later became one of the famous apostates of psychoanalytic theory. In the psychological essay "On the Psychology of the Unconscious" he disagreed with Freud's concept of the existence of basic instincts - Eros and Thanatos. With an encyclopedic knowledge of mystical traditions, he attached great importance to the spiritual aspects of human existence. Together with his students, Jung carefully explored the psychological meaning and symbolic expression of death in different cultures. He came to the conclusion that the motives associated with death are powerfully represented in the subconscious, and the death instinct (like other instincts) are not biological, but symbolic in nature.

In the psychology of individuality developed by Jung, sexuality is considered as the dominant force in the first half of life, and the problem of approaching death in the second half. Jung considered it natural to think about death in the second half of life, while he regarded manifestations of increased concern about this topic in his youth as a psychopathological phenomenon.

The problem of the fear of death is central in the existential direction of philosophy, which is the basis of existential-humanistic psychotherapy, which originates in the philosophy of Soren Kierkegaard, Martin Heidegger and the phenomenology of Edmund Husserl. The worldview position of the existentialists is most fully reflected in the work of M. Heidegger “Being and Time” (1927). According to his concept, in every minute of human life there is an imperceptible awareness of one's own frailty and finiteness of being. Heidegger writes: "Life is being turned towards death." The awareness of mortality is interpreted by him as the basis of true existence, revealing the meaning of being and freeing from the illusions that accompany a person.

S. Kierkegaard, studying the problem of human fears, singled out two fundamentally different kind:

* Fear-fear - caused by a specific circumstance, object, person

* Fear-longing is an indefinite, diffuse metaphysical fear, the subject of which is “nothing”. It is generated by a person's awareness of his finiteness and defenselessness in the face of the fact of death.

According to M. Heidegger, through fear for a person, the last of the possibilities of his existence is revealed - death.

In the existential analysis of Viktor Frankl, logotherapy, the central place is occupied not by the problem of the finiteness of being, but by the problem of the meaning of life. The development of his theory was decisively influenced by his personal, tragic experience of being in a concentration camp. The main thesis of the concept postulates that a person strives to find meaning and feels an existential vacuum if this desire remains unfulfilled. For each person, the meaning is unique and inimitable and is based on life values.

V. Frankl distinguishes three groups of values:

* The value of creativity, the main way of realization of which is labor.

* The value of experience, the most significant of which is love.

* Attitude values, which Frankl divides into a triad: a meaningful attitude toward pain, guilt, and death. Emphasizing these values ​​is very important when working with dying patients and suicides.

In addition to various ideological approaches to the problem of death, for psychiatrists, a clinical phenomenon known as thanatophobia is very important - an obsessive fear of death, the age dynamics of the formation of which is described in E. Erickson's theory of psychosocial stages of development.

2. Attitude towards death depending on the stage of psychosocial development according to E. Erickson

At the first stage of psychosocial development (birth - 1 year), the first important psychological crisis is already possible, due to insufficient maternal care and rejection of the child. Maternal deprivation underlies “basal distrust”, which further potentiates the development of fear, suspicion, and affective disorders.

At the second stage of psychosocial development (1-3 years), the psychological crisis is accompanied by the appearance of a sense of shame and doubt, which further potentiates the formation of self-doubt, anxious suspiciousness, fears, and an obsessive-compulsive symptom complex.

At the third stage of psychosocial development (3-6 years), the psychological crisis is accompanied by the formation of feelings of guilt, abandonment and worthlessness, which subsequently can cause dependent behavior, impotence or frigidity, personality disorders.

The creator of the concept of birth trauma O. Rank (1952) said that anxiety accompanies a person from the moment of his birth and is due to the fear of death associated with the experience of separation of the fetus from the mother during birth. R. J. Kastenbaum (1981) noted that even very young children experience mental discomfort associated with death and often parents are not even aware of it. R. Furman (1964) held a different opinion, who insisted that only at the age of 2-3 years can the concept of death arise, since during this period elements of symbolic thinking and a primitive level of reality assessments appear.

M.H. Nagy (1948), having studied the writings and drawings of almost 4,000 children in Budapest, as well as conducting individual psychotherapeutic and diagnostic conversations with each of them, revealed that children under 5 years of age do not view death as an ending, but as a dream or departure. Life and death for these children were not mutually exclusive. In subsequent research, she revealed a feature that struck her: the children spoke of death as a separation, a kind of boundary. Research by M.S. McIntire (1972), carried out a quarter of a century later, confirmed the revealed feature: only 20% of 5-6 year old children think that their dead animals will come to life and only 30% of children of this age assume that dead animals have consciousness. Similar results were obtained by other researchers (J.E. Alexander, 1965; T.B. Hagglund, 1967; J. Hinton, 1967; S. Wolff, 1973).

B.M. Miller (1971) notes that for a child preschool age the concept of "death" is identified with the loss of the mother and this is often the cause of their unconscious fears and anxiety. Fear of parental death in mentally healthy preschoolers was observed in 53% of boys and 61% of girls. Fear of one's death was noted in 47% of boys and 70% of girls (A.I. Zakharov, 1988).

As a rule, memories of a serious illness that threatens to die at this age remain with the child for life and play a significant role in his future fate. So, one of the “great apostates” of the Vienna psychoanalytic school, psychiatrist, psychologist and psychotherapist Alfred Adler (1870 - 1937), the creator of individual psychology, wrote that at the age of 5 he almost died and in the future his decision to become a doctor, t .e. a person struggling with death was conditioned precisely by these memories. In addition, the experienced event was reflected in his scientific outlook. In the inability to control the timing of death or prevent it, he saw the deepest basis of an inferiority complex.

Children of school age, or stages 4 according to E. Erickson (6-12 years old) acquire knowledge and skills of interpersonal communication at school, which determine their personal significance and dignity. The crisis of this age period is accompanied by the appearance of a feeling of inferiority or incompetence, most often correlated with the child's academic performance. In the future, these children may lose self-confidence, the ability to work effectively and maintain human contacts.

Psychological studies have shown that children of this age are interested in the problem of death and are already sufficiently prepared to talk about it. The word “dead” was included in the dictionary text, and this word was adequately perceived by the vast majority of children. Only 2 out of 91 children deliberately bypassed it. However, if children of 5.5-7.5 years old considered death unlikely for themselves, then at the age of 7.5-8.5 years they recognize its possibility for themselves personally, although the age of its supposed onset varied from “through several years up to 300 years”.

G.P. Koocher (1971) examined the beliefs of unbelieving children aged 6-15 regarding their intended state after death. The spread of answers to the question “what will happen when you die?” was distributed as follows: 52% answered that they would be “buried”, 21% that they would “go to heaven”, “I will live even after death”, “I will be subjected to God's punishment”, 19% “arrange a funeral”, 7% thought that they would “fall asleep”, 4% - “reincarnate”, 3% - “cremate”. Belief in the personal or universal immortality of the soul after death was found in 65% of believing children aged 8-12 (M.C. McIntire, 1972).

In children of primary school age, the prevalence of the fear of death of parents sharply increases (in 98% of boys and 97% of mentally healthy girls of 9 years old), which is already observed in almost all 15-year-old boys and 12 summer girls. As for the fear of one's own death, at school age it occurs quite often (up to 50%), although less often in girls (D.N. Isaev, 1992).

Adolescence (12-18 years), or the fifth stage of psychosocial development, is traditionally considered the most vulnerable to stressful situations and for crises. E. Erickson singles out this age period as very important in psychosocial development and considers the development of an identity crisis or role shift, which manifests itself in three main areas of behavior, to be pathognomonic for it:

* the problem of choosing a career;

* selection of a reference group and membership in it (the reaction of grouping with peers according to A.E. Lichko);

* alcohol and drug use, which can temporarily weaken emotional stress and allows you to experience a sense of temporary overcoming of insufficient identity (E.N. Erikson, 1963).

The idea of ​​death in adolescents as a universal and inevitable end of human life approaches that of adults. J. Piaget wrote that it is from the moment of comprehending the idea of ​​death that the child becomes an agnostic, that is, he acquires a way of perceiving the world inherent in an adult. Although, while acknowledging “death for others” intellectually, they actually deny it to themselves on an emotional level. Adolescents are predominant romantic attitude to death. Often they interpret it as a different way of being.

Among 13-16 year olds, 20% believed in the preservation of consciousness after death, 60% believed in the existence of the soul, and only 20% believed in death as the cessation of physical and spiritual life.

A. Maurer (1966) conducted a survey of 700 high school students and the question "What comes to mind when you think about death?" revealed the following responses: awareness, rejection, curiosity, contempt and despair. As noted earlier, the vast majority of adolescents have a fear of their own death and the death of their parents.

In youth (or early maturity according to E. Erickson - 20-25 years old)

By passing adolescence, thoughts about death are less and less visited by young people, and they very rarely think about it. 90% of students said that they rarely think about their own death, in personal attitude it is of little significance to them (J. Hinton, 1972).

The thoughts of modern domestic youth about death turned out to be unexpected. According to S.B. Borisov (1995), who studied female students of the Pedagogical Institute of the Moscow Region, 70% of respondents in one form or another recognize the existence of the soul after physical death, of which 40% believe in reincarnation, i.e. transmigration of the soul into another body. Only 9% of interviewees unambiguously reject the existence of the soul after death.

Mature age

At this time of life, the frequency of depression, suicide, neuroses, and dependent forms of behavior increases. The death of peers prompts reflection on the finiteness of one's own life. According to various psychological and sociological studies, the topic of death is relevant for 30%-70% of people of this age. Unbelieving forty-year-olds understand death as the end of life, its finale, but even they consider themselves "a little more immortal than others." This period is also characterized by a sense of disappointment in professional career and family life.

Elderly people (stage late maturity according to E. Erickson). Studies of gerontologists have established that physical and mental aging depends on the personality characteristics of a person and how he lived his life. G. Ruffin (1967) conditionally distinguishes three types of old age: “happy”, “unhappy” and “psychopathological”. Yu.I. Polishchuk (1994) randomly examined 75 people aged 73 to 92 years. According to the results of the studies, this group was dominated by persons whose condition was qualified as "unhappy old age" - 71%; 21% were persons with so-called “psychopathological old age” and 8% experienced “happy old age”.

The fear of death includes several components: fear of the finiteness of life, fear of torment at the end of life, fear of everyday problems associated with death (for example, organizing a funeral).

The attitude of professional physicians to the problem of curation of dying patients changed dramatically in the 60s after the publication of Hermann Feifel's book The Meaning of Death (1957). In 1968, the Thanatology Foundation was established in New York, headed by Austin Kucher. In addition to physicians, this organization included writers, philosophers, priests and other specialists interested in issues of thanatology. In 1967 in England, Dr. Cecilia Sanders, who works with cancer patients at St. Christopher, founded the first modern type hospice. The main activity of the staff of this hospice was the desire to do everything so that the patient fully, without experiencing pain, lived the rest of his life, reconciled with his fate and was not alone and misunderstood. The word "hospice" means a hospice. These houses have existed at the monasteries for several centuries and served as a haven for sick pilgrims going to the Holy Land to worship (Saunders, 1990).

In 1981, the World Medical Association adopted the Patient's Rights Code, which established the patient's right to "die with dignity." In 1988, the English journalist Victor Zorza, author of the book “The Road to Death. Live to the end”, which became a kind of manifesto of the hospice movement, came to the USSR and organized the charitable society “Hospice”. The first hospice was organized in St. Petersburg. Analyzing data from 3 years of work experience chief physician this hospice A.V. Gnezdilov (1994) states that in addition to the methods of palliative medicine, focused mainly on the relief of pain, the psychological and spiritual support of patients is very important, since more than 60% of them have mental disorders.

3. Psychological help for the dying

Among the psychotherapeutic methods of working with dying patients, V. Frankl's logotherapy is the most adequate method. The main thesis of V. Frankl's teaching boils down to the following: a person's life cannot lose its meaning under any circumstances; the meaning of life can always be created by the revitalization of the three existentials of human existence - spirituality, freedom and responsibility - even with a fatal illness on the verge of death. Overcoming the existential vacuum and transforming the tragic triad “suffering-guilt-death” occurs through filling life with meaning.

The main activities of the psychiatrist and medical psychologist with dying patients should focus on the following issues:

1. Relief of psychopathological symptoms and behavioral disorders. Most often, these patients have reactive depression, neurosis-like states, possible intoxication psychoses and conditions accompanied by impaired consciousness, an organic psychosyndrome, as well as behavioral disorders in the form of auto-aggressive and aggressive tendencies. It is advisable to stop psychotic states with psychotropic drugs. If necessary, you can give the patient anxiolytics and antidepressants.

4. Psychological support and psychotherapeutic help

Most often, dying patients need psychotherapeutic help aimed at reducing the fear of dying and the so-called “death anxiety”, which often arise or become aggravated in the preterminal stage (more often among non-believers). Death anxiety is accompanied by pronounced vegetative manifestations and syndromes of alienation, annihilation and being in danger.

Alienation syndrome is characterized by a feeling of loneliness, isolation from the outside world and derealization. Despite the fact that patients communicate with others, they seem to be already in a different reality, ordinary conversations and problems are alien to them.

The annihilation syndrome is expressed in the fear of the onset of “nothing”, when the World will live and develop, and the dying person will disappear. Patients feel impersonal, do not show their individuality, their self-esteem decreases, they withdraw into themselves.

The syndrome of being in danger includes the experience of an ineradicable danger to life with a radical of aggression, which is due to the awareness of one's own vulnerability and finiteness, as well as the inability to change anything. Thanatologists classify this syndrome as destructive, as patients transfer responsibility for their feelings to others and often show irritability and malice towards staff and relatives, in whom they see enemies. According to psychodynamically oriented psychiatrists, a dying person is at the peak of destructiveness, practically losing the difference between the concept of “killing” and “being killed”.

5. Spiritual support of the patient

It should be carried out not only by medical personnel, but also, if the patient wishes, by representatives religious denominations. Christianity teaches that the meaning of life is to become better by the end than it was. The last disease can give a person this opportunity. Doctors dealing with seriously ill patients noted that a fatal illness often changes the patient's worldview, and sometimes his character. E. Kübler-Ross, together with her colleagues, published a collection of articles on this topic, which was called “Death - last stage growth." It published stories of the spiritual transformation of people on the verge of death. A person who understands that life is coming to an end has two options - to passively wait for death or to fully use the remaining time for personal growth. It is necessary to talk about this possibility with the patient, using both psychotherapeutic techniques and examples from the literature and the lives of remarkable people. Interestingly, Elisabeth Kübler-Ross herself, one of the classics of thanatology, writes that she would be happy to die of cancer, as she would like to experience the spiritual growth of the personality that the last illness brings with it.

6. Psychological support for the patient's relatives

First of all, it must be remembered that the relatives of the dying person also need information, advice and support. Often they have an urgent need to share their feelings and thoughts with someone. The doctor should help them understand the causes of discontent, irritability, anger and other negative reactions of the patient, which often cause suffering to relatives. In addition, it must be remembered that over 40% of relatives themselves fall ill after the death of a loved one, so preventive psychological measures to prevent the development of mental and behavioral disorders are also essential.

R. Konechny, M. Bowhal (1983) describe those psychological methods effects that are appropriate to apply in the clinic in relation to dying patients: “We seek to alleviate the patient's situation through symptomatic treatment, prescribe palliative and minor manipulations that can have a beneficial effect as a placebo. We adhere to the principle good care and try to reduce physical discomfort. We avoid interventions that are more unpleasant in themselves than the disease itself. We show understanding of the fears and fears of the patient, we strive to tactfully distract the patient's attention from them and switch it to more pleasant or interesting impressions and memories from his past. We will ensure more frequent contact with relatives, especially with the parents of a sick child. Relatives are warned not to disturb the patient in vain. We agree with the help of relatives when caring for the sick. We do everything to ensure that the patient does not have the feeling that he is “debited from the account.” At the end of the conversation and rounds, we must cheer him up with the words “goodbye tomorrow.” The position of the doctor can alleviate the fact, the authors note, that important life moments, certain social norms operate that will help overcome unpleasant and complex elements of contact (“silence is also an answer”, “public lie”). Doctors who are themselves afraid of death cope worse with this problem. There is a perception that doctors are more afraid of death than representatives of other professions.

It should also be noted that when a patient dies, it is necessary to take into account the impression it makes on other patients. In any case, the requirement to ensure the possibility of a dignified human death is valid for all patients without exception. Especially in such exceptional circumstances, it is important to prevent manifestations of professional deformation on the part of medical personnel.

According to P.I. Sidorova, A.V. Parnyakova (2000), "truthfulness at the bedside is a general trend of our time." This trend affects not only the doctors themselves, but also the relatives of patients, as well as all those involved in the care. At the same time, according to the authors, excessive frankness in these situations should be avoided - the doctor should not be verbose. Relations with the patient under any circumstances should be based on mutual trust. At the same time, one should take into account a certain specific dynamics of psychological reactions in terminal patients, described by Margaret Kübler-Ross, the features of a particular case, a particular situation. In the event that a patient has a pronounced denial reaction and he does not want to know about the mortality of his disease, then this topic should not be discussed. The patient should not be forced to think about death if he passionately wants to forget about it, unless, of course, such a "blind" attitude towards the disease does not interfere with the therapy.

R. Kociunas (1999) lists several important, from his point of view, principles that should be taken into account when providing psychological help dying people:

1) Very often people die alone. The well-known philosophical saying: “A person always dies alone” is often taken too literally and justifies their protective fencing from the dying. But the fear of death and pain become even stronger if a person is left alone. A dying person cannot be treated as already dead. You need to visit him and communicate with him.

2) One should carefully listen to the complaints of the dying person and carefully meet his needs.

3) For the benefit of the dying, the efforts of all the people around him should be directed. In dealing with him, one should avoid superficial optimism, which causes suspicion and distrust.

4) Dying people prefer to talk more than listen to visitors.

5) The speech of the dying is often symbolic. For a better understanding of it, it is necessary to decipher the meaning of the symbols used. Usually the patient's gestures, stories and memories that he shares are indicative.

6) A dying person should not be interpreted only as an object of concern and sympathy. It is not uncommon for those around you, with the best of intentions, to decide what is best for the dying person. However, excessive assumption of responsibility reduces the patient's range of autonomy. Instead, you should listen to him, let him participate in decisions about treatment, visitors, etc.

7) The most that a dying person can use is our personality. Of course, we are not the ideal means of assistance, but still the best way appropriate for this situation. Being with the dying requires simple human responsiveness, which we must show.

8) Psychologists and doctors should confess their doubts, feelings of guilt, hurt narcissism and thoughts about their own death.

The staff working with the dying and their loved ones also need psychological help. With them, first of all, one should talk about conscious resignation with feelings of guilt and powerlessness. It is important for physicians to overcome the humiliation of professional dignity. This feeling is quite common among physicians, for whom the death of a patient is, in a certain sense, an occupational disaster.

Conclusion

An important contribution to the understanding of the dying person was made by the psychologist and physician E. Kübler-Ross with her book Interviews with the Dying. Based on her many years of experience with the dying in a Chicago clinic, she describes how the dying, at various stages of dying, come to terms with the fact of their imminent death. E. Kubler-Ross distinguishes five stages of dying, which in different people can have different duration and intensity. “If we do not leave the dying alone, if we listen to their hopes, patients quickly go through all five stages ... Sometimes one of the stages can be skipped, sometimes the patient comes back” (Kübler-Ross 1971). Based on the experience of E. Kübler-Ross, W. Becker gives an impressive description of the long and difficult journey of the dying person and his companions through the various stages of dying.

1. The unwillingness of the patient and his relatives to recognize the proximity of death. When a terminally ill person learns of his diagnosis or gradually realizes the truth about his situation, he goes through a stage of shock, which is characterized by an unwillingness to accept reality. He reacts to the harsh reality with the illusion of health and well-being: “No, no, this does not concern me! This is not happening to me, this cannot happen to me.” Such a reaction helps the patient to dull the shock caused by the news of the impending end, and gradually get used to the current situation. At a later stage, the refusal to acknowledge reality is replaced by "isolation" of the senses. At this stage, the patient talks about his health and illness, about his death and immortality, as if emotionally it does not affect him at all.

The shock is experienced not only by the dying, but also by his relatives. They realize that their words mean little, their expectations are unrealistic, and that they themselves tend to close their eyes in the face of death. They are also involved in the patient's unwillingness to acknowledge reality, and this reinforces their need for detachment from reality. It often happens that the patient's relatives still cling to the denial of reality, while the patient himself is already beginning to prepare for it. The dying understand these needs of their loved ones and often pretend that they do not recognize reality, although in fact they are already beginning to consciously come to terms with it. Some are only able to endure meeting a dying person on the condition that they withdraw completely from him.

These observations show how important it is that anyone who wants to help a dying person clearly understands his own attitude towards dying and death.

2. Emotions, protest. The stage of refusal to accept reality is followed by the stage of emotions. The dying man is seized by a stormy stream of feelings. He gets into a state of anger and rage: “Why did this have to happen to me?” Anger can turn to a loved one, a doctor, a nurse, a priest, and even God. It flares up on the most insignificant occasions and is often not provoked by those against whom it is directed. Often the dying person is not even able to express his anger, as he is hindered by the habit of external and internal control. External control is carried out by the persons accompanying the dying person, since they do not allow negative emotions, preferring to deal with friendly and obedient patients. Many also have strong inner control against negative emotions because they consider them unworthy of a Christian and hesitate to express their anger.

At this stage, it is especially difficult for those accompanying people who perceive the outbursts of anger of the dying person too personally. If you are unable to accept the question “Why did this have to happen to me?” as an expression of the anguish and fear of the patient, you have to look for another answer that explains everything, and you cannot find it. The place of sympathetic perception of the patient is then replaced by numerous words that do not reach the patient in his suffering and prevent him from expressing his feelings. If, on the other hand, the accompanist is so deeply imbued with the feelings of the patient that he barely retains the ability to maintain a distance between him and himself, then the flow of the patient's feelings becomes even stronger until he drowns in it. At this stage, the dying need companions who are ready to listen to them and sometimes also endure their unreasonable anger, because they know that such an attitude helps the dying person in those moments when he cannot suppress his anger. If the caregiver understands the patient's feelings and his own, he can help the patient avoid depression.

3.Negotiations about the continuation of life. After the stage of denial of reality and the subsequent stage of an explosion of emotions, the stage of negotiations follows. Just as a child, in response to a refusal to fulfill his request, first violently protests, and then tries to get around this refusal with the help of clever maneuvers, so the dying bargain for a delay - for example, with God. As payment, they may offer to give their lives to God, such as dedicating the remaining years of their lives to church service. In any case, such attempts at negotiations are very natural for a person and quite normal.

Just as the negotiation phase can end in a spiritual and religious "sale" for the dying, so many companions also feel their spiritual bankruptcy. The answers they give to the most important questions turn out to be unsuitable not only for the dying person, but also for themselves. If they participate in a trade initiated by a dying person, they are in danger of reinforcing the patient's illusions, while at the same time depriving him of an understanding listener. At the same time, the struggle with the hope of the dying person for some way out of the situation is useful to him only when it helps him to move on to the next stage.

4. Hope; negative and positive depression. The negotiation phase rarely lasts long, as the progression of the disease and the nature of the treatment of the patient make it clear to him in what position he is. He may respond to this understanding with realistic hope or doubt. Hope in this case is associated not with the improvement or development of the existing situation, but with the process of dying and life after death. We are talking about such problems as the refusal to artificially prolong life at any cost, the hope of liberation from pain or the opportunity to feel a loved one next to you in your hour of death. If the dying person at the stage of negotiations realized himself bankrupt in the field of spirit and faith, then the only reaction left to him is despair, which can manifest itself either as the bitterness of a stoic, or as a depressive state. There are two forms of depression. The first form of depression is the patient's reaction to the losses he endures, namely the changes that befell him as a result of the disease, the inability to correct the mistakes he made earlier, helplessness, the inability to continue to fulfill his duties, for example, in relation to the family. Another form of depression is associated with the threat of loss of life and loved ones. It serves as a preparation for the final acceptance by the sick of their fate and is part of the dying work of the dying. This, the second, form of depression, unlike the first, usually proceeds very calmly, if the patient has something to tell, what to discuss and put in order.

If the companion manages to be with the sick person at this stage of his spiritual development, then various possibilities open up for him in the fight against depression. At the same time, it is necessary that the accompanist control his own depressive manifestations. At this stage, the dying person openly seeks the human closeness of the escort to make sure that neither now nor in the future will he be left alone. The dying person now faces the most important questions about the past and the future. An escort can help him resolve family problems and settle economic and financial issues. He can think about the meaning of life and pray with the dying.

5. Acceptance and farewell. At the last stage, the stage of agreement with his fate, the dying person is extremely tired and weak. If he has managed to express his feelings and perform his dying work, then his need for peace and sleep increases. He has reached a certain degree of calm and composure, and the circle of his interests is narrowing. He can say with approval, "Yes, here is my last hour." Intellectual penetration into death is connected with emotional readiness to accept death. If despair has brought the dying man feelings of disappointment and helplessness, then he welcomes his death as the end of despair and loneliness.

List of used literature

1. Kübler-Ross E. About death and dying / E. Kübler-Ross. - M.: Sofia, 2001. - 110 p.

2. Solovieva S.L. Psychology of extreme conditions / S.L. Solovyov. - St. Petersburg: ELBI-SPb, 2003. - 128 p.

3. Yurieva L.N. Crisis states / L.N. Yuriev. - Dnepropetrovsk: Art-Press, 1998. - 155 p.

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The relevance and importance of the work of a psychologist in the hotbed of extreme situations and the provision of emergency psychological assistance. Acute emotional shock, psychophysiological demobilization, a significant deterioration in a person's well-being in an extreme situation.

A person's life path ends with his death. You need to be prepared for this, especially if there is a bed patient in the family. Signs before death will be different for each person. However, the practice of observations shows that it is still possible to identify a number of common symptoms that portend the imminence of death. What are these signs and what should be prepared for?

How does a dying person feel?

A bedridden patient before death, as a rule, experiences mental anguish. In sound consciousness there is an understanding of what is to be experienced. The body undergoes certain physical changes, this cannot be overlooked. On the other hand, the emotional background also changes: mood, mental and psychological balance.

Some lose interest in life, others completely close in on themselves, others may fall into a state of psychosis. Sooner or later, the condition worsens, the person feels that he is losing his own dignity, more often he thinks about a quick and easy death, asks for euthanasia. These changes are hard to observe, remaining indifferent. But you will have to come to terms with this or try to alleviate the situation with drugs.

With the approach of death, the patient sleeps more and more, showing apathy towards the outside world. In the last moments, a sharp improvement in the condition may occur, reaching the point that the patient who has been lying for a long time is eager to get out of bed. This phase is replaced by the subsequent relaxation of the body with an irreversible decrease in the activity of all body systems and the attenuation of its vital functions.

Bedridden patient: ten signs that death is near

At the end of the life cycle, an elderly person or a bedridden patient feels more and more weak and tired due to a lack of energy. As a result, he is increasingly in a state of sleep. It can be deep or drowsy, through which voices are heard and the surrounding reality is perceived.

A dying person can see, hear, feel and perceive things that do not actually exist, sounds. In order not to upset the patient, this should not be denied. It is also possible to lose orientation and the Patient is more and more immersed in himself and loses interest in the reality around him.

Urine due to kidney failure darkens to almost brown with a reddish tint. As a result, edema appears. The patient's breathing quickens, it becomes intermittent and unstable.

Under pale skin, as a result of a violation of blood circulation, dark “walking” venous spots appear, which change their location. They usually first appear on the feet. In the last moments, the limbs of a dying person become cold due to the fact that the blood, draining from them, is redirected to more important parts of the body.

Failure of life support systems

Distinguish primary signs appearing on initial stage in the body of a dying person, and secondary, indicating the development of irreversible processes. Symptoms may be external or hidden.

Disorders of the gastrointestinal tract

How does the bedridden patient react to this? Signs before death, associated with loss of appetite and a change in the nature and volume of food consumed, are manifested by problems with the stool. Most often, constipation develops against this background. A patient without a laxative or an enema finds it increasingly difficult to empty the bowels.

Patients spend the last days of their lives refusing food and water altogether. You shouldn't worry too much about this. It is believed that dehydration in the body increases the synthesis of endorphins and anesthetics, which to some extent improve overall well-being.

Functional disorders

How does the condition of patients change and how does the bed patient react to this? Signs before death, associated with the weakening of the sphincters, in the last few hours of a person's life are manifested by fecal and urinary incontinence. In such cases, it is necessary to be prepared to provide him hygiene conditions using absorbent underwear, diapers or diapers.

Even in the presence of appetite, there are situations when the patient loses the ability to swallow food, and soon water and saliva. This may lead to aspiration.

When severely exhausted eyeballs strongly sink, the patient is not able to completely close the eyelids. This has a depressing effect on those around you. If the eyes are constantly open, the conjunctiva must be moistened with special ointments or saline.

and thermoregulation

What are the symptoms of these changes if the patient is bedridden? Signs before death in a weakened person in an unconscious state are manifested by terminal tachypnea - against the background of frequent respiratory movements, death rattles are heard. This is due to the movement of the mucous secretion in the large bronchi, trachea and pharynx. This condition is quite normal for a dying person and does not cause him suffering. If it is possible to lay the patient on his side, wheezing will be less pronounced.

The beginning of the death of the part of the brain responsible for thermoregulation is manifested by jumps in the patient's body temperature in a critical range. He can feel hot flashes and sudden cold. The extremities are cold, the perspiring skin changes color.

Road to death

Most patients die quietly: gradually losing consciousness, in a dream, falling into a coma. Sometimes it is said about such situations that the patient died on the “usual road”. It is generally accepted that in this case, irreversible neurological processes occur without significant deviations.

Another picture is observed in agonal delirium. The movement of the patient to death in this case will take place along the “difficult road”. Signs before death in a bedridden patient who embarked on this path: psychosis with excessive excitement, anxiety, disorientation in space and time against the background of confusion. If at the same time there is a clear inversion of the wakefulness and sleep cycles, then for the patient's family and relatives such a condition can be extremely difficult.

Delirium with agitation is complicated by a feeling of anxiety, fear, often turning into a need to go somewhere, to run. Sometimes this is speech anxiety, manifested by an unconscious flow of words. The patient in this state can perform only simple actions, not fully understanding what he is doing, how and why. The ability to reason logically is impossible for him. These phenomena are reversible if the cause of such changes is identified in time and stopped by medical intervention.

Pain

Before death, what symptoms and signs in a bedridden patient indicate physical suffering?

As a rule, uncontrolled pain in the last hours of a dying person's life rarely increases. However, it is still possible. An unconscious patient will not be able to let you know about this. Nevertheless, it is believed that pain in such cases also causes excruciating suffering. A sign of this is usually a tense forehead and deep wrinkles appearing on it.

If, during examination of an unconscious patient, there are assumptions about the presence of a developing pain syndrome, the doctor usually prescribes opiates. You should be careful, as they can accumulate and, over time, aggravate already serious condition in connection with the development of excessive overexcitation and convulsions.

Giving help

A bedridden patient before death may experience significant suffering. Relief of symptoms of physiological pain can be achieved drug therapy. Mental suffering and psychological discomfort of the patient, as a rule, become a problem for relatives and close family members of the dying.

Experienced doctor at the evaluation stage general condition the patient can recognize in him the initial symptoms of irreversible pathological changes in cognitive processes. First of all, this is: absent-mindedness, perception and understanding of reality, the adequacy of thinking when making decisions. You can also notice violations of the affective function of consciousness: emotional and sensory perception, attitude to life, the relationship of the individual with society.

The choice of methods of alleviating suffering, the process of assessing the chances and possible outcomes in the presence of the patient in some cases, in itself can serve therapeutic agent. This approach gives the patient a chance to really realize that they sympathize with him, but they are perceived as a capable person with the right to vote and choose possible ways to solve the situation.

In some cases, a day or two before the expected death, it makes sense to stop taking certain medications: diuretics, antibiotics, vitamins, laxatives, hormonal and hypertensive drugs. They will only exacerbate suffering, cause inconvenience to the patient. Painkillers, anticonvulsants and antiemetics, tranquilizers should be left.

Communication with a dying person

How to behave relatives, in whose family there is a bed patient?

Signs of approaching death can be obvious or conditional. If there are the slightest prerequisites for a negative forecast, it is worth preparing in advance for the worst. Listening, asking, trying to understand the non-verbal language of the patient, you can determine the moment when changes in his emotional and physiological state indicate the imminent approach of death.

Whether the dying person will know about it is not so important. If he realizes and perceives, it alleviates the situation. False promises and vain hopes for his recovery should not be made. It must be made clear that his last will will be fulfilled.

The patient should not remain isolated from active affairs. It is bad if there is a feeling that something is being hidden from him. If a person wants to talk about last moments your life, it is better to do it calmly than to hush up the topic or blame stupid thoughts. A dying person wants to understand that he will not be alone, that he will be taken care of, that suffering will not touch him.

At the same time, relatives and friends need to be ready to show patience and provide all possible assistance. It is also important to listen, let them talk and say words of comfort.

Medical assessment

Is it necessary to tell the whole truth to relatives in whose family there is a bed patient before death? What are the signs of this condition?

There are situations when the family of a terminally ill patient, being in the dark about his condition, literally spends his last savings in the hope of changing the situation. But even the best and most optimistic treatment plan can fail. It will happen that the patient will never get back on his feet, will not return to active life. All efforts will be in vain, spending will be useless.

Relatives and friends of the patient, in order to provide care in the hope of a speedy recovery, quit their jobs and lose their source of income. In an attempt to alleviate suffering, they put the family in a difficult financial situation. Relationship problems arise, unresolved conflicts due to lack of funds, legal issues - all this only aggravates the situation.

Knowing the symptoms of imminent death, seeing irreversible signs of physiological changes, an experienced doctor is obliged to inform the patient's family about this. Informed, understanding the inevitability of the outcome, they will be able to focus on providing him with psychological and spiritual support.

Palliative care

Do relatives who have a bed patient need help before death? What symptoms and signs of the patient suggest that she should be treated?

Palliative care for the patient is not aimed at prolonging or shortening his life. Its principles affirm the concept of death as a natural and regular process of the life cycle of any person. However, for patients incurable disease, especially in its progressive stage, when all treatment options have been exhausted, the question of medical and social assistance is raised.

First of all, you need to apply for it when the patient no longer has the opportunity to lead an active lifestyle or the family does not have the conditions to ensure this. In this case, attention is paid to alleviating the suffering of the patient. At this stage, not only the medical component is important, but also social adaptation, psychological balance, peace of mind of the patient and his family.

A dying patient needs not only attention, care and normal living conditions. Psychological relief is also important for him, easing the experiences associated, on the one hand, with the inability to self-service, and on the other hand, with the realization of the fact of an imminent imminent death. Prepared nurses and know the intricacies of the art of alleviating such suffering and can provide significant assistance to terminally ill people.

Predictors of death according to scientists

What to expect for relatives who have a bed patient in the family?

Symptoms of the approaching death of a person "eaten" by a cancerous tumor were documented by the staff of palliative care clinics. According to observations, not all patients showed obvious changes in the physiological state. A third of them did not show symptoms or their recognition was conditional.

But in the majority of terminally ill patients, three days before death, a marked decrease in the response to verbal stimulation could be noted. They did not respond to simple gestures and did not recognize the facial expressions of the personnel communicating with them. The “smile line” in such patients was omitted, an unusual sounding of the voice (grunting of the ligaments) was observed.

Some patients also had hyperextension neck muscles(increased relaxation and mobility of the vertebrae), non-reactive pupils were observed, patients could not close their eyelids tightly. Of the obvious functional disorders, bleeding in the gastrointestinal tract (in the upper sections) was diagnosed.

According to scientists, the presence of half or more of these signs may most likely indicate an unfavorable prognosis for the patient and his sudden death.

Signs and folk beliefs

In the old days, our ancestors paid attention to the behavior of a dying person before death. Symptoms (signs) in a bedridden patient could predict not only death, but also the future prosperity of his family. So, if the dying person asked for food (milk, honey, butter) in the last moments and relatives gave it, then this could affect the future of the family. There was a belief that the deceased could take wealth and good luck with him.

I had to prepare for imminent death if the patient is without obvious reasons shuddered a lot. It was like looking into his eyes. Also a sign of close death was a cold and pointed nose. There was a belief that it was for him that death was holding the candidate in the last days before his death.

The ancestors were convinced that if a person turns away from the light and most of the time lies facing the wall, he is on the threshold of another world. If he suddenly felt relieved and asked to be transferred to his left side, then this is a sure sign of an imminent death. Such a person will die without pain if the windows and the door are opened in the room.

Bedridden patient: how to recognize the signs of impending death?

Relatives of a dying patient at home should be aware of what they may encounter in the last days, hours, moments of his life. It is impossible to accurately predict the moment of death and how everything will happen. Not all of the symptoms and symptoms described above may be present before the death of a bedridden patient.

The stages of dying, like the processes of the origin of life, are individual. No matter how hard it is for relatives, you need to remember that it is even more difficult for a dying person. Close people need to be patient and provide the dying person as much as possible. possible conditions, moral support and attention and care. Death is an inevitable outcome of the life cycle and it cannot be changed.