Meaning of Death

A Psychiatrist’s Approach to Death

Orville S. Walters
Orville S. Walters

When successful integration of religion and psychiatry is achieved, it will not come first in the pages of a journal or a textbook. It starts inside the psychiatrist himself. Dr. Walters writes as a capable psychiatrist. After 1971 he held the titles of research professor emeritus of the University of Illinois, Urbana, and clinical professor of psychiatry at the University of Illinois, Peoria. Dr. Walters also writes as a convinced Christian. His article deals with death not as a phenomenon in life in general, but with the reality of his own death. It is his witness that Christ’s power released him from the fear of death – the ultimate problem of human existence. He demonstrates that the victory of grace must first be won in the experience of the psychiatrist before it can be worked out in his notebook. Dr. Orville Walters was highly respected and deeply loved by those who knew him. He died on February 18, 1975 shortly after putting this witness on paper.

A Psychiatrist’s Approach to Death

Men have tiptoed around the subject of death for centuries. They have avoided speaking the word death by using many euphemisms. But in recent years the taboo has been lessened by a great deal of writing that deals explicitly with death. Research papers, magazine articles and books have multiplied prodigiously. So much, in fact, has been written that the Journal of the American Medical Association recently carried an article titled “Dying is Worked to Death.”

One of the most widely read books is Death and Dying, written in 1969 by Elisabeth Kübler-Ross, a psychiatrist. Her book, together with her many appearances as a lecturer, have encouraged free discussion, and have helped to focus upon the needs of the dying. She has described several stages through which she believes most dying patients pass. She considers these “defense mechanisms” as ways of coping with approaching death.

The first phase, she believes, is denial of impending death, expressed by the attitude, “It cannot be true.” Denial, Kübler-Ross asserts, is followed by a period of anger, rage, envy and resentment, implying the question, “Why me?” Anger is followed by bargaining, with the patient seeking to barter some change of attitude on his part for prolongation of his life. According to Kübler-Ross’s observations, depression is the last phase before acceptance – the final stage in which the patient’s struggle is over, and he begins to restrict his interest in mundane affairs.

Death and the Living Christ

Death and Dying takes little notice of the resources of Christian faith for the dying. The Bible has a great deal to say about death. Anyone who has opened it often is familiar with the attention given by Jesus and Paul to death and future life. A biblical faith includes the theological concepts of a living Christ, man’s “eternal contemporary,” and of divine grace, administered to man’s need by the Holy Spirit. Jesus asserted sovereignty over death when he admonished his followers, “Let not your hearts be troubled…. My peace I give to you; not as the world gives do I give to you.” (John 14:27)

Paul established a relation “in Christ” that enabled him to write,
So we do not lose heart. Though our outer nature is wasting away, our inner nature is being renewed every day…. For we know that if the earthly tent we live in is destroyed, we have a building from God, a house not made with hands, eternal in the heavens. (2Cor. 4:16; 5:1)

It is difficult to imagine the writer of these words working through anxiety over approaching death in the troubled stages currently associated with dying. Since Paul, countless persons in every century have found comfort in these words and have found courage to face death without fear because they are “in Christ.”

There is a bumper sticker type of faith affirmation that seems simplistic, but which, nevertheless, lends itself to analysis with as much plausibility as some more sophisticated declarations: “My God is alive; I talked to him this morning.” This may seem grossly presumptuous or highly mystical. It is, in fact, the confident expression of underlying pre-suppositions that God is personal, that He is accessible through prayer, and that the reality of God’s nearness may be discerned by faith, even though it is beyond the grasp of science. Those who scorn these premises, which may not be asserted or even conceptualized, necessarily have a different set of assumptions. The credo of those who derive their beliefs from science is found upon analysis to be only an alternative philosophy, scientism. This system must compete in the marketplace of ideas with personal theism, “the old time religion,” on the basis of explanatory scope, durability under criticism, and the contribution that makes to human equanimity in facing the contingencies of existence. A cold, sterile and brash scientism, when stripped down to its inductive presuppositions, requires a greater leap of faith that belief in the God of revelation, who has been man’s dwelling place in all generations. Humanism, with its brave but shaky trust in man, requires an even greater exercise of faith.

Jesus asserted sovereignty over death.

One of the finest traditions associated with the early Christian concerned their poise and confident faith in the face of death. The process of dying cannot be adequately understood by applying a rigid phenomenological framework that does not do justice to the resource of biblical faith and the contribution that faith makes to the acceptance of death. A great mass of Christian testimony to victory over the fear of death has accrued through the centuries. Should Freud’s deterministic premises be invoked to reject such historical evidence, it must be recognized that there is an increasing decline of faith in an irrational unconscious and a widespread return of trust in the validity of conscious reports.

Living with Death

When I had surgery over two years ago for cancer of the stomach, I was aware of the overall statistics for five year survival – one chance in ten. Even though there were encouraging aspects that favored complete removal of the tumor, I tried to take a realistic view of the odds. My surgeon, a mature and highly trained professor of surgery, was supportively optimistic, but candid. I was given a copy of the pathological report, which indicated extensive infiltration and rapid growth. When periodic examinations and tests were made later, I received copies of the reports. Since these were negative for two years, I maintained a guarded optimism, balanced by a sober realism based upon the statistical chances of survival. The appearance of symptoms at the end of two years led to exploratory surgery. I was barely out of the recovery room when my surgeon standing at the foot of the bed, confirmed recurrence and spread of the primary disease.

Two years of living with ambiguity concerning surgical cure of the cancer did not require any radical reorientation of life. I have been a committed Christian since age seventeen, and have tried to practice my faith across the years as a medical school teacher, president of church junior college, family physician, psychiatrist, and university medical administrator. The experience of God’s presence has been a consistently ongoing reality. I believe the vitality of that relationship made possible the acceptance of uncertainty concerning the end of my earthly life. I continued to work with troubled people, commending the resources of divine grace wherever I could do so effectively. With the self awareness t hat is required in the competent psychiatrist, I cannot identify in my own experience the stages commonly attributed to the dying patient.

I did find reason to be grateful for two years in which to enjoy nature to the fullest, to appreciate the simple beauty of life – deep blue sky and spreading trees, warm sunshiny days and the culture of growing things. I found enhancement of love for a devoted life-comrade, gratitude for two strong sons and a daughter who have established Christian homes and vocations, and grandchildren who are exploring Christian faith for themselves. I have kept up my hobbies – flower-growing and photography – trying to capture and perpetuate some of nature’s delicate loveliness. I have been thankful for the lingering movement of my illness. The time has brought articulation of renewed appreciation on the part of friends, deepening love of family, opportunity to complete unfinished business, and even the planning of my own final rites.

I cannot identify in my
Own experience the
Stages commonly
Attributed to the
Dying patient.

An Affirmation of Life

The statement that follows is in the hands of my doctors and will be entered into my clinical record if I become a hospital patient. The first two paragraphs are slightly modified from the Catholic Hospital Association’s “Christian Affirmation of Life,” and are followed by my own statement of faith.

I believe that God our Father has entrusted to me a shared dominion with him over my earthly existence so that I am bound to use ordinary means to preserve my life but I am free to refuse extraordinary means to prolong my life.

I request that, if possible, I be consulted concerning the medical procedures that might be used to prolong my life as death approaches. If I can no longer take part in decisions concerning my own future, and if there is no reasonable expectation of my recovery, I request that no extraordinary means be used to prolong my life.

I am ready to give up this life with awareness of my own defects and inadequacies, but with confidence in a loving personal God, who cares for individuals as well as worlds. I face death with faith in a living Christ who came to reconcile us to God; who, by his own atoning death on the cross enables us to become sons of God and joint heirs with himself. I approach death with a deep sense of gratitude for the abundant life that has been mine through grace ministered by the Holy Spirit and through the fellowship of God’s people. “Thanks be to God who giveth us the victory through our Lord Jesus Christ.”