Being Mortal

“The problem with medicine and the institutions it has spawned for the care of the sick and old is not that they have had an incorrect view of what makes life significant. The problem is that they have had almost no view at all. Medicine’s focus is narrow.—concentrating on repair of health, not sustenance of soul. For more than half a century now, we have treated the trials of sickness, aging, and mortality as medical concerns, putting our fates in the hands of people valued more for their technical prowess than for their understanding of human needs.”

“In 2008, the national Coping with Cancer project published a study showing that terminally ill cancer patients who were put on a mechanical ventilator, giving electrical defibrillation or chest compressions, or admitted, near death, to intensive care had a substantially worse quality of life in their last weeks than those who received no such interventions. . . . We’re caught in a transitional phase. However miserable the old system has been, we are all experts at it. You agree to become a patient, and I, the clinician, agree to try to fix you, whatever the improbability, the misery, the damage, or the cost. With this new way, in which we together try to figure out how to face mortality and preserve a meaningful life, we are plodding novices.”

“There are two assertions that extend the concept of mindfulness into the realm of active self-leadership. The first is that this Self does not need to be cultivated or developed. Beneath the surface of the protective parts of trauma survivors there exists an undamaged essence, a Self that is confident, curious, and calm, a Self that has been sheltered from destruction by the various protectors that have emerged in their efforts to ensure survival. The second is that, rather than being a passive observer, this mindful Self can help reorganize the inner system and communicate with the parts in a way that help those parts trust that there is someone inside who can handle things. Internal family systems therapy (IFS) focuses on cultivating an inner relationship between the Self and the various protective parts.”