How When Breath Becomes Air Is Helping Create Conversations About Mortality

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In the epilogue of her late husband’s book, When Breath Becomes Air, Dr. Lucy Kalanithi gives the story its ending: She describes the circumstances of Dr. Paul Kalanithi’s death, something he had been courageous enough to face straight-on, both on the page and in the last years of his life. She writes that his “decision not to avert his eyes from death epitomizes a fortitude we don’t celebrate enough in our death-avoidant culture.”

And this was, and is, certainly true of Americans. Just last spring, Sheldon Solomon — the psychologist credited with pioneering the study of terror-management theory (that is, fear of death) — told The Atlantic’s Julie Beck, “Americans are arguably the best in the world at burying existential anxieties under a mound of French fries and a trip to Walmart to save a nickel on a lemon and a flamethrower.” But an interesting thing is happening, at least to the best-seller lists in 2016. Mortality — death, life, and the meaning of both — has become an unlikely hot topic, with When Breath Becomes Air currently at the top of the New York Times’ combined nonfiction and e-book list. Not far behind it sits Being Mortal, Atul Gawande’s 2014 examination of end-of-life care, inspired by his father’s death.

Also in 2014, there was Roz Chast’s Can’t We Talk About Something More Pleasant?, about the author’s loss of her elderly parents; it was a critical and popular success. Last fall, there was Gratitude, a collection of Oliver Sacks’s musings on his impending death. And coming up later this year is Katie Roiphe’s Violet Hour: Great Writers at the End, about the deaths of writers such as John Updike and Maurice Sendak.

Research in psychology has suggested for many years that ours is indeed a “death-avoidant culture,” as Dr. Lucy Kalanithi phrases it. In one creative study, Stanford researcher Jeanne Tsai found that Americans are so insistent on focusing on the bright side — and avoiding the dark — that this bias even shows up in the sympathy cards they choose. For her study, Tsai and her co-author, Birgit Koopmann-Holm, compared American and German sympathy cards, and found that the American ones tended to focus on positivity while pushing away the sadness. American cards were more likely to be literally brighter — as in, more colorful — and they tended to be filled with phrases like “Love lives on” or “Memories will bring comfort”; German cards, on the other hand, were more likely to be black-and-white, with messages like “In deep sadness” or “Words will not lighten a heavy heart.”

To Tsai, this is a telling finding, suggesting that “the emotions that people want or don’t want to feel are just as important in everyday life,” she said in a statement. And it’s exactly this — the emotions people don’t want — that can cause some real consequences, other research has found. In one recent study published in the Journal of Consumer Psychology, a pair of researchers argued that this is at least part of the reason that too many Americans fail to save adequately for retirement.

Americans can at least agree on this: Talking about this stuff, though undeniably uncomfortable, is crucial. A recent survey from the Conversation Project, a group that has been encouraging this type of thing since 2010, found that 90 percent of those surveyed agree that discussing end-of-life wishes is important — and yet just 27 percent of this group had actually had the guts to do it. And yet that may likely be changing soon, for the simple, practical reason that it’s now going to get a lot easier to have those conversations, at least with your physician. As The Wall Street Journal recently reported, starting this year, the federal government will now reimburse Medicare recipients for consultations with their doctors about end-of-life-care logistics. That’s one less hurdle to clear, anyway.

Harriet Warshaw, director of the Conversation Project, recently told WSJ that she credits Gawande’s book for giving “everybody permission to look at this issue.” She added later, “We plan for everything else but we don’t plan for this because it’s too hard a thing to even contemplate.” Bringing these subjects out into the open is no easy task. But reading about them? It’s a start.