Mortally Wounded

Approaching death is perhaps the ultimate psychological testing ground. Although, remembering James Hillman’s maxim on mythology (“it doesn’t ground, it opens”), this doesn’t mean that we find here—if we are courageous enough—some kind of foundation or bedrock. The test is in having this kind of notion pulled out from under your feet, and finding out whether you panic at the overwhelming unknowing and infinity, or find some release in it.

The wonderful strength of Michael Kearney’s important book is that it brings brutally honest, heart-rending stories of his work with terminally ill cancer patients together with the anti-heroic, psyche-respecting work of James Hillman. Hillman is notable for his lack of case studies and personal stories in his work; he tends toward the idea that the earthy concreteness of “actual events” would falsely limit and distort the liminal, airy, Hadean perspectives of his archetypal psychology.

Kearney is well aware of this danger. The main disclosure of “technique” here is his discovery of the possibilities presented by imagework with those approaching death. However, he persistently qualifies and undermines any tendency we might have in reading his stories to see a simple pattern of imagework manifesting as a wondrous new magic bullet that automatically brings consolation in our final days. The importance of his imagework, and all the models and mythical analogies for his patients’ experiences, is resolutely subsumed beneath the primacy of lived reality. There are stories of broken, fear-stricken people in denial released into humbling, numinous peace before their deaths. There is also, for example, the story of Anne, a young mother with recurring breast cancer. After some successes with imagework, she awoke on what was to be her final day “confused and agitated”.

When I went into her room, a nurse was sitting beside a distraught-looking Anne attempting to reassure her. Meanwhile Anne, wide-eyed and kneeling on her bed, was calling out and rummaging through the sheets “looking for my baby.” I pulled a chair over so that I was facing Anne, took her hand, and said “Anne, it’s okay. We are with you. It’s okay. It’s going to be all right.” At that she stopped her searching for a moment, with the annoyance of one talking to another who, despite repeated attempts, cannot be made to understand, said, “It’s not all right.”

I would say that Kearney’s approach is true to Hillman’s theories; but what’s made amply clear by these stories is that both are simply true to the psyche, as it wends its labyrinthine, mysterious way through the mortal world. There are miracles, and there are “painful separations and unfinished business”. In the end, “Death cannot be tamed.”

The medical elements of palliative care of the dying are, of course, not denied. Painkillers are usually necessary—but, as some stories here testify with horrific clarity, they aren’t always sufficient. Some patients experience pain that even high doses of strong drugs can’t numb. Imagework, in giving fear a chance at another form than the blunt physical pain it’s found itself squeezed into, sometimes dissolves the pains that material medicine can’t deal with. The fighting spirit and the will to live are of course invaluable weapons, up to a point. Past that point, they seem to become tools of denial, making things much, much worse.

One interesting aspect of reading this book for me was how it subtly but importantly changed my thinking about euthanasia. Since watching with horror the news reports of Diane Pretty‘s experiences, I’ve been a firm believer in euthanasia being legal for certain situations. However, while it doesn’t seem that Kearney is arguing specifically against this view, his accounts of people becoming suicidal with suffering in their final days—and coming through the other side into some kind of peace with themselves before death—complexifies the field somewhat. For people with, say, motor neurone disease, who know with some degree of certainty that they will suffer total incapacitation for a time before actual death, there will always be a case for allowing them the option of assisted suicide. But Kearney’s accounts made clear to me what I thought before reading them, but not with as much power: the many situations in which death is approached via greyer areas of suffering are very complex, and cannot be reduced to a simple argument for or against euthanasia.

My charitable view of the religious dogma against suicide, believing it not to be our right to take what is only God’s to take, is that it’s an attempt to honour our basic ignorance of what ups and downs we might be drawn through in the future—even if that future is probably very short. This acknowledgement of the importance of affirming life, warts and all, up to the very end, however bitter, is of course an ideal, and situations will arise where the ideal cannot be met. I still think that the situation of those like Diane Pretty, where this ideal is impractical, or even of those who just don’t meet the ideal, should be accepted and affirmed as one of life’s warts. Typically, orthodox religion has hardened a noble ideal into a doctrine that causes suffering and subverts the very basis of the ideal that inspired it.

For anyone working with the terminally ill, Kearney’s psychological and mythical models—of emphasizing the importance of “depth”, and a descent into it, seen via the story of the “wounded healer” Chiron—should enrich their work. For myself, and anyone else keenly interested in psychology from a “lay” position, Kearney’s compassionate and humble accounts of his work will greatly enrich their appreciation of theories that seek to counter the destructive assumptions of the heroic ego with careful attention to the movements of the soul.