The Regrets of the Dying

I was impressed by a recent article in the Guardian, 'The Five regrets of the Dying'. Palliative care nurse, Bronnie Ware, has written about the regrets of the dying. She lists five 'top' regrets [ I paraphrase them, Google her name to get the full version]:

• I wish I'd been true to myself.
• I wish I'd not worked so hard.
• I wish I'd had the courage to express my feelings.
• I wish I'd stayed in touch with my friends.
• I wish I'd let myself be happier.

They offer an agenda of issues that we should be address long before we die. A couple of these regrets are counter intuitive [at least in our culture]: 'I wish I'd not worked so hard' and 'I wish I'd let myself be happier' and deserve a closer look.

'I wish I'd not worked so hard'

What does work do that is so bad for you? The answer would seem to be that work, particularly for men,  takes up so much of their time that they miss out on their kids growing up, spending time with their partner, cultivating friendships, pursuing interests and so on. Obvious really. If you work too hard, the life you should have lived remans unlived.

It is interesting to see this in the current political climate. The political messages that are sent down to us from above  imply that we Britons don't work hard enough. A propos this I noted  a news item about the Centre for Economic and Business Research which suggests that banning Bank Holidays would save the country billions of pounds. I translate that as suggesting work and money should take precedence over happiness. So when we arrive at our deathbeds we can reflect on the fact that we missed even more of our lives by working on Bank Holidays as well as all the other days. That does not sound healthy to me.

Of course much depends on the kind of work you do. Working long hours in a factory or in a office is a different kettle of fish to work that involves meeting varied and interesting people. The latter is life enhancing unlike the former. I haven't read Bronnie's book yet but I presume that it will make this important distinction.

I wish I'd let myself be happier.

This is an interesting point. We usually regard happiness  as something we are constantly trying to maximise but this suggests that happiness is actually something we suppress. The Guardian article indicates that this has got much to do with staying within the comfort zones of familiar habits and not allowing yourself to explore new experiences and have fun. This is fascinating. Something I don't really understand fully. I'm going to go away and think about it.

By the way if you do go to the Guardian website to read the article don't spend too much time on the readers' comments section. Many of the contributions are fatuous, asinine or flippant and avoid the issues that the article presents which suggests to me an underlying anxiety about death on the part of the writers.

The article is a modern memento mori, a  reminder that we all die. Religious and philisophical writings have always presented the same message and suggested it should inspire us to put our lives in order. There are many quotes that I could put offer. Here's just one that gets to the point vividly:

'Death is a wise adviser that we have...one has to ask death's advice and drop the cursed pettiness that belongs to men [sic]that live their lives as if death will never tap them. If you do not think of death all your life will be personal chaos.'

Carlos Castenada.

I like the phrase 'cursed pettiness'.  'Cursed pettiness ' is the bane of our lives is it not?

Therapies that work with thoughts.

Rational Emotive Behaviour Therapy,  REBT, is similar to Cognitive Behavioral Therapy, CBT in that it looks at the thinking processes behind our emotions. In particular it explores at the beliefs that underlie our thinking; the premises from which we start. The founder of this school of therapy, Albert Ellis, suggested that three beliefs form the basis of emotional disturbance [I paraphrase here, Ellis was inclined to be verbose]:

• I must be perfect. If I am not, I'm a failure and deserve to suffer.
• People must be nice to me and if they are not they ought to be punished.
• My life must be enjoyable at all times. If not it's not worth living.

Holding these beliefs can lead to depression, anxiety, vindictive behaviour and all sorts of other kinds of human misery. We need to examine* these beliefs carefully and replace them with these more realistic beliefs:

• Human beings aren't perfect. Being imperfect does not mean failing.
• People aren't always nice to each other. I can't expect everyone to be nice to me all the time.
• Suffering and discomfort need to be accepted as part of life.

Beliefs affect the way we reason about what happens. So if we believe in the necessity of perfection, every time we slip up we regard this as a disaster. We awfulize it, to use Ellis's expression.Thus we might lose our car keys, catch a cold, have an argument with our partner and tell friends we have had the most dreadful day and rant on about it to such an extent that we start to feel seriously depressed. You wouldn't believe what an absolutely terrible day I've had. I deserve better than this! And so on and so forth. You can write your own script here if you like. It's a useful exercise.

Ellis refers to this desire to have perfection  as an example of  musturbation. The musts in our lives are what is explored in REBT sessions: there are all sorts of 'musts' as well as the 'must be perfect' such as, 'must be good', 'must be clever', 'must be witty', 'must be good at sport'. Some of these may be very specific such as 'must eat  everything on my plate'. Beliefs such as these can underlie eating problems and are worth exploring if you have this kind of difficulty. We pick lots of 'musts' when we are children. Not all of them are bad ' must not kill people ' is one worth keeping, for example. What we must do, though, is look at them rationally.

As with all cognitive therapies much of what REBT offers is powerful ideas that have been around for centuries presented in a new format. It is one that I, personally don't like. I can't stand the way Ellis mangles the English language with his ugly neologisms like 'awfulization' and 'musturbation'. But I must emphasise that REBT can be a very useful toolkit examining what is happening  your life, one that you can use on your own -there are lots of self help resources that can be Googled- or one that can be used within the context of a counselling session.

If you prefer you can find the same philosophical approach  that underpins REBT in M. Scott Peck's book  The Road less Traveled  which starts with the sentence 'Life is difficult'.  Or in Buddhism: the Buddha's First Noble Truth, is Dukkha,  The Truth of Suffering  which observes that discomfort, suffering are part and parcel of life and should be accepted.

*I nearly used the expression 'challenged our beliefs' but managed to avoid it. It is on my list of phrases that have become meaningless cliches through bureaucratic abuse. One of my constant concerns is the way language can be drained of meaning by the way it is used by institutions.The counselling process requires words to do their work well by conveying strong unequivocal meanings, so it is important that the words we use, when discussing the subject of counselling, are carefully chosen.

Cognitive Behavioral Therapy

Cognitive Behavioural Therapy, CBT for short, is an effective method of dealing with certain kinds of problems.The idea behind CBT is simple: how we think affects how we feel and how we behave.

This is not a new idea. The Dhammapada - an ancient Buddhist text- emphasizes how important it is to look at the nature of our thinking if we want  to be happy. 'All that we are is a result of what we have thought.' The Stoics of the Classical world advised a similar approach. CBT dresses up this attitude to life  in the language of modern psychotherapy.

CBT can be done with a therapist or with the help of  books, for example, Mind Over Mood by Dennis Greenberger and Christine A. Padesky. This book summarises it's content on the front cover where it states: Change how you feel by changing the way you think. It contains useful tables that can help you explore how you think about what happens in your life.[Google 'Thought Record Sheet' if you want to see what one looks like.] You start with looking at a situation that upsets you and then proceed to identify the automatic thoughts that arise in connection with it. For example, you may feel nervous when talking to your boss, and notice that your automatic thoughts in this situation are 'I'm useless', 'I'm afraid he'll tell me off' or 'I'm not important enough for him to spend time with.'

Having identified the thoughts the next step is to look at the evidence for and against them rationally. Having done this you proceed to establish a more accurate view of your situation. This may be, in the above example,  that in fact you are demonstrably useful, and that you are valued and liked by your boss.

In practice it can be quite difficult to identify thoughts and feelings. In real life situations events happen fast and you end up feeling a bit puzzled how you got to feel the way you do. A mindful attention can help but that is something easy to recommend but difficult to put into practice. A therapist can help [not necessarily an 'official' CBT practitioner] by facilitating the reasoning process and by keeping you focused on the task in hand. It is very easy, when you are on your own, to meander away from  the problems you are trying to tackle and  for the obvious reason that they are distressing. A counsellor can provide a reassuring presence that can help you stay on track.

All therapies involve the reasoning processes  that are formalised in CBT. There are some close cousins to CBT such as Rational Emotive Behaviour Therapy, REBT for short. This works by looking at dysfunctional beliefs and thinking styles. More of this another time. I'm trying to keep my entries to a digestible size.