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OBSERVATIONS: Tessa Richards A better way to die BMJ 2007; 334: 830 [Full text]

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A familiar topic to us in the East

Mahesh Rajasuriya   (14 May 2007)

Need to be mindful about death and dying?

Ravimal Galappaththi   (22 July 2007)

A familiar topic to us in the East 14 May 2007
Mahesh Rajasuriya, Senior Registrar in Psychiatry - Mid West Crisis Assessment and Treatment Team Harvester Clinic, 4A Devonshire Road, Sunshine, VIC 3020, AUSTRALIA Send response to journal: Re: A familiar topic to us in the East	Reading this timely article on dying prompted me to send you the following comments. The author asks the question that if we are really prepared for dying and death. I have asked a similar but different question, under different circumstances: 10 years ago, back in Sri Lanka, from my then mentor. The question was how well we are prepared for loss of status/ employment/ right to practise medical profession. And his response indicated not only he had thought about that but also about loss of an anatomical structure or a physiological function of our body, like a limb or sight, or life itself. He appeared well prepared for all of these losses. Potential loss and change and how to cope are topics for discussion in many of the personal and professional circles that I was part of in Sri Lanka. The ancient and vast information bank related to death and beyond, and compatible attitudes and behaviours of the individual and of the community, probably make it possible, and also, useful. Yes, today the world has become "more hedonistic and youth oriented". we have so much to do, so much to consume, so much to use, but so little time to do all that. I sometimes wonder if this is a complex defence against the severe anxiety caused by the imminence of death. Currently it is something that cannot be avoided by any means. Mahesh.Rajasuriya@mh.org.au Competing interests: None declared
Need to be mindful about death and dying? 22 July 2007
Ravimal Galappaththi, Staff Grade Psychiatrist, Crisis Assessment HomeTreatment Service & Early Intervention in Psycosis Dept Psychiatry, Grantham & Pilgrim Hospitals, Lincolnshire, UK, PE21 9 QU Send response to journal: Re: Need to be mindful about death and dying?	Reading this article led me to contemplate on a number of areas that we see in west that could have contributed to despair about death and dying. Professionaly we are much inclined to perceive and assess the more objective and biological affairs of patients, on a daily basis. In most occasions we see no relevance of spiritual and cultural belief systems and rituals, that may bring about important coping strategies during the process of death and dying. Cognitive thinking and learning in west is so called “scientific” that we would never have acquired and consolidated spiritual and cultural beliefs that may lead to less fearful and anxious feelings during the process of death and dying, both individually and at a community level. Indeed the practice of medicine and other sciences “conferred familiarity not understanding.” We became analytical, recognized patterns, seeked evidence and applied the same. How many of us step back and became mindful about the state of affairs in and around our micro universe? So without this, we wouldn't have built up the capacity to empathize and become compassionate about the issues around death and dying. Without this insight, motivation of individual and the community to seek understanding, develop compatible social attitudes would not have been a possibility. However it is likely that some of this understanding and attitudes might flourish in a connected social network which is certainly lacking in the west. It is worth noting how “primitive societies” in eastern and african cultures deal with dying and death related isses. Undisputedly dying and death needs to be rehabilitated back to a more central position in society. However, this may not be a success unless compatible attitudes, cognitions and behaviours are aquired. Maybe careful research into this area in different cultures may help formulate a practical and cost effective rehabilitation process. References 1. On Death and Dying Elizabeth Kubler-Ross M.D. 2. Invited commentary on: Death and dying in literature, Andrew Sims, Advan. Psychiatr. Treat., May 2003; 9: 217 - 219 3. Autobiographical narrative and psychiatry, Femi Oyebode, Advan. Psychiatr. Treat., Jul 2003; 9: 265 - 270. 4. Psychotherapy of the dying patient, A Stedeford, Br. J. Psychiatry, Jul 1979 Competing interests: None declared