When does a person begin to die?

The Psychological Autopsy monogram was written by Avery Wiesema and Robert Kastenbaum. Both are remembered for their work in the beginnings of grief work. I heard both years ago at grief seminars. This was published in 1968 so we are going back a few years. I was three years into my experience as a full time hospital chaplain. I had already begun to train lay people as story listeners in the hospital. We were finding grief stories in some form as the theme in the majority of stories heard by the Befrienders. We started a grief resource group in January 1975 as a result to stody grief in its many aspects. Then in 1976 we started a grief recovery group which went through many different phases before I retired in 1992. Genesis Hospital has continued the grief recovery program. 

I came across Psychology Autopsy in 1971 on a Clinical Pastoral Education sabbatical at the Alcohol Treatment Unit, the University of Iowa, Iowa City, Iowa. This was a very helpful learning experience providing deep insights into the issue of both addiction in our current culture and idolatry in Scripture. Also how alcohol is used as a pain reliever in handling grief and losses of all kinds in the craving of being better, even perfect. 

The counselors at the Alcohol Treatment Unit talked about fractional suicide. Addictions take their toll on our life expectancy, lowering the years we will live. And with Alcohol Addiction, the terminal phase is either DT’s or Kidney failure. The terminal phase would be different for others. Smokers often have pulmonary obstructive lung disease or cancer. with the obese often have a diabetic condition with complications followed by loss of a foot.

Sometime after my reading of the Psychological Autopsy I had a situation in the hospital emergency room which was a classic example. A man working at the Rock Island Arsenal had a cardiac arrest. A young medical intern who was assigned to the Arsenal began procedures to resuscitate. He worked during the ambulance ride to the hospital and continued in the emergency room. The wife arrived and I spend some time hearing her side of the story. Her husband removed himself from relating to his family, even his wife, although they lived in the same house. Work was his only activity. 

I had a chance to visit with the doctor after the wife had left. I heard his lament about not being able to save this man’s life. I then shared with him the story I heard from the wife and the monogram on the psychological autopsy. The question was evident, when did this man begin to pull away from life and relationships. I do not have that story. What I have is the story of his dying process which began long before his cardiac arrest. Was his cardiac arrest part of a broken heart experience, loss of purpose and meaning, etc. We have questions without answers other than there is an in depth way of studying our dying process: the psychological autopsy.

I know about this first hand. When the family farm was lost in 1938 under questionable legal circumstances and my father’s inability to get an automatic calf feeder on the market he began to register a depression that became chronic and then became physically manifest as a heart attack leading to an early death. His unresolved grief could be called a broken heart. 

My grandfather who lived long, 86 years, was very active mentally in a home with several men his age. They played cards for enjoyment, sheepshead. When he fell and broke a hip and was required to go to the home that met regulation standards, no more card playing with his friends, he gave up and died within six months. My effort to revive his interest in life was rejected.

When does a person begin to die? is a valid question and the psychological autopsy is a way to examine the life.

Shalom,

Marlin Whitmer