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The Stages of Grief & the Great Dying

by Zhiwa Woodbury

Planetary Hospice, part 2 of 2

This brilliant & beautifully researched paper by Zhiwa Woodbury frames our work in a way that can release fresh understandings and energy.
- Joanna Macy

Piero_di_Cosimo_prometeo.jpg
Mythological narrative of Prometheus by Piero di Cosimo (1515)

The Planetary Hospice Model
While the mental health profession has a crucial role to play in the Great Dying, it is largely ill-equipped to do so, due to its historical exclusion of our larger environment from the accredited model of psychological health. Ecopsychology, on the other hand, is reinventing psychology by including “the psychological processes that tie us to the world or separate us from it” in a more holistic vision of the human psyche that views humans and the world we inhabit as inextricably bound together. So from an ecopsychological viewpoint, the question now becomes: what is the role of mental health professionals in preparing society for the end of life as we know it?

We can look to the model of hospice here, and apply its principles at a societal level, with the idea that the coming “catastrophe” does not necessarily have to be met with widespread panic, dread, fear and hostility. However, given the prevalence of guns and survivalist mentalities, if the mental health profession does not actively advocate for a more sane response to the stages of dying, then the grieving process will continue to be repressed and will most assuredly surface in exactly this kind of pathological behavioral reactivity.


Industrial civilization has elevated the medical model of a Cartesian world to the level of technological madness, and transformed dying from a natural process that took place in the home to a nightmare scenario that played out in the hospital room. More recently, the advent of hospice and palliative care has empowered individuals to find meaning in death, creating an intentional space for the natural goodness and tenderness of the dying and their extended families to surface and to define the passage into the unknown themselves. If we are able to apply the same principles at a societal scale, then ecopsychologists and planetary thanatologists can become the kinds of spiritual midwives that will be needed to transform the planetary death/rebirth process from a painful dislocation rife with suffering and regret into a healing process for both the human race and the Earth itself -- even into a Great Awakening.

1. Denial
The starting point for planetary hospice is to consider what the societal mental health profile looks like in relation to the stages of grief that ensue from the time of rendering a terminal diagnosis. We have been in the grips of the first stage of grieving - denial - for some time now, and in fact even for those who now acknowledge the reality of global climate change, there is still quite a bit of denial concerning the seriousness of our situation and the pace of it. One of the inspirations for ecopsychology, Theodore Roszak, coined the term “ecological unconscious” to denote our deep connection to the planet that sustains us - our mother, Earth. Just as the special bond between a mother and her child gives rise to an intuitive sense of dis-ease when one or the other is imperiled, it is safe to say that our ecological unconscious has been troubled for some time now by the disconnection between our race and our planet - going at least as far back as Rachel Carson’s “Silent Spring,” which happened to coincide with the uneasy knowledge that the human race was poised on the brink of nuclear annihilation.

So while the 1960s marked the first time that collective human consciousness was faced with the prospect that we had the power to wipe out life on the planet, today we face the prospect that we are, in fact, in the process of doing so, one species at a time. The effects of this kind of knowledge on mental health can simply not be over-emphasized, especially immediately in the wake of the Holocaust. In the face of such a devastating external threat, and with the need to carry on with life as we know it, it only makes sense that, collectively, humans will suppress or repress such knowledge, and that it’s shadow will then surface in the form of mental illness in the most sensitive members of the population.

In 1962, 12 million Americans (6.5%) had been diagnosed with anxiety disorders, while another 4 million (2.2%) were labeled depressed. Certainly, a collective anxiety would seem to be an appropriate response to both the risk of nuclear war and the discovery that birds were disappearing at a vast scale due to the widespread use of pesticides. By 1975 - when the risk of nuclear war had been greatly diminished by improved relations among the superpowers, while awareness of our impacts on the environment had greatly increased - the number of Americans treated with anxiety was trending down as a percentage of population, while diagnoses for depression saw a four-fold increase from just 13 years earlier (to 8.3%).  By 2000, one out of every ten Americans was taking anti-depressants, and the incidence of people experiencing major depressive episodes had also increased dramatically from a decade earlier, from 3.33% to 7.06%.

We have had an epidemic of anxiety and depression in America over the last fifty years, along with an apparent progression from anxiety to depression. Collectively, would this not be a sane response to a progression in collective awareness from a suspicion that something was wrong in our relationship to our environment to a growing conviction that we are responsible for widespread extinction that may ultimately include our own progeny? From an ecopsychological viewpoint, this would hardly be unexpected. Psychotherapist Linda Buzzell points out:

During this global environmental crisis, it is crucial for mental health clinicians to begin to understand the connection between the epidemics of mental distress in modern industrial societies and the devastating impact of the destruction of our own habitat... Most therapy clients don’t realize that much of the grief, shame, emptiness, and fear they struggle with may be a natural response to the unnatural way we live. The loss and death of so many living beings, guilt over our individual and collective complicity in these deaths, and the ongoing distress of Earth, air, and ocean life all around us and in our very bodies are all sources of stress.

This unnatural pathology plays itself out by repressing our dysfunctional relationship to the natural world as we immerse ourselves in modern, urbanized lifestyles, refusing to acknowledge consciously the violence implicit in them - only to have the collective shadow of our destructive choices surface as mental dis-ease. From the 1960s to the 1980s, environmental problems were local. Beginning with discovery of ozone depletion in the 1980s, and escalating in the 1990s with the advent of global climate change, environmental problems have suddenly became pervasive on an unimaginable scale, raising the specter for the first time in human history that life as we know it was at risk.

From the ecopsychological view of our collective shadow, it makes perfect sense that we would see depression grow enormously in this same, relatively short time period in human history. Even for those with relatively stable psyches, it can be rather depressing to think about all this! Of course, if you choose not to think about it, to suppress your anxiety over our future prospects, then you are placing yourself at much higher risk of succumbing to debilitating depression at some point, no longer able to get out of bed to face the world. Unfortunately, over this same time period, mental health professionals were not asking all the right questions when their clients presented themselves with symptoms of depression. They would surely ask about family dynamics, problems at work, or even explore social dynamics, but rarely would they ask the most obvious questions: “How do you see the future of the planet? Does it concern you that so many species are disappearing?” So from an ecopsychological perspective, symptoms are addressed and a prescription is issued. But the systemic, underlying causes of dis-ease are left untreated, so the rates of depression continue to climb.

2. Anger
If this analysis is justified, then we can conclude that we have collectively been in a state of denial about the mortality of our species (and the effect we are having on creation itself) for some time now, and that this denial is associated with increasing prevalence of anxiety and depression in the population as a whole. After all, most of the increases came during a time of growing economic prosperity when the quality of life for most Americans was improving. What other explanations might account for such an epidemic in these particular pathologies? And for most of this time, thanks to irresponsible reporting in mainstream media and a political system corrupted by money, it has been quite feasible to maintain this state of denial, such as by pretending that the science was equivocal. In just the past few years, however, scientists have become much more politically engaged themselves, and the evidence has become irrefutable. In other words, relating this back to stages of grief, we can say that we are likely (slowly) emerging from the first stage of denial.

Arguably, had psychologists placed the human psyche in its natural world container years ago, and more fully assessed cases of anxiety and depression by casting light on the shadow of denial over the impacts humans are having on the planet, much suffering could have been avoided, or at least ameliorated.
The immediate prospects for the next  50 years are not pretty. It is therefore incumbent on mental health professionals to adopt a more proactive, ecopsychological view of the pathologies they witness playing out in their clients’ psyches.This raises a very important question. If we are now seeing a progression in our collective psyche from the stage of denial to the second stage of grief - anger - what might the mental health impacts of that be on the more sensitive members of the population? This is an especially poignant question in relation to the younger generations, as they are the first ones to have to deal with inheriting a planet that is no longer functioning naturally, and as they will be likely to witness things no other generations of humans have ever had to witness. How will they be likely to act out? How are they acting out now?

Two disturbing trends come immediately to mind. According to Attorney General Eric Holder, the overall incidence of mass shootings has at least tripled since 2008, with thirty taken place in 2013 alone.  These young boys are certainly acting out horrific anger, and yet when the circumstances of their lives are dissected by the press, there never really seems to be proportionality between the problems they’ve experienced in their short lives and the terrible consequences of their planned actions. Perhaps of even greater concern, we are now seeing the same kind of spike in suicide rates that we observed with rates of depression in the 1990s. The rates of suicide showed a steady decline during the 1990s, at the same time of dramatic increases in anti-depressant availability. However, since 2000, that trend has reversed, and there has been a steady increase in suicide rates, erasing all the gains in prevention seen during the 1990s. In 2009, the number of deaths from suicide surpassed the number of deaths from vehicular accidents in the United States. While suicide has traditionally been concentrated in the teenaged and the elderly segments of the population, in the first decade of the new millennium, the suicide rate among baby-boomers (age 35 to 64) surged by nearly 30 percent.  That happens to be the very generation that fueled the environmental movement from its inception, and is thus most keenly aware of exactly what is transpiring with rates of extinction and the peril to the planet, and how unsuccessful that movement has proven to be.

Numerous mental health experts have speculated on the reasons for this dramatic increase, and they all seem to agree that people kill themselves for economic reasons. This is perhaps the clearest evidence of just how pathologically disconnected we have become as a culture from nature. We are in the process of ending life as we know it on planet Earth, and when an epidemic of suicide breaks out during the same decade when this terrible realization has begun to dawn on us, mental health experts attribute it to a downturn in the economy!

Mental states that are considered to be indicators of suicide risk include an affective state of hopelessness, a sense that nothing will ever get better, along with anger, agitation, anxiety, fearfulness, and apprehension. These would certainly be understandable emotional responses to the current ecological crisis. Over the course of about fifty years, we have gone from being vaguely aware that something was terribly wrong in our relationship to our mother Earth to a phase of denial that, in fact, we are in the midst of a great extinction of species and a threat to continued life on the planet in the face of mounting evidence to that effect. Finally we have arrived at a time when nobody can credibly pretend anymore that we are not on a disastrous course - it is quite clear that life as we know it is coming to an end. During this same time frame, we have witnessed in the American populace dramatic progressive increases in the incidence of anxiety disorders, then widespread depression, and then of mass murder and suicide rates. The mass murders are increasingly associated with young adults and youths, and the spike in suicide rates is largely found among the baby boom generation that entered the world at the advent of nuclear brinksmanship and has watched helplessly as the environmental crisis has grown from a localized problem to the threat of ecological annihilation.

3. Bargaining
Because of the lag time associated with climate change, by the time humans fully appreciate the gravity of the situation, it will already be too late to avoid grievous consequences. However, it is inevitable that we will then do everything we should have been doing all along to reverse the process, especially given our unreasonable faith in technological fixes.  And because of the incomprehensibility of the prospects, again it seems inevitable that a large part of the population will progress to yet another type of denial and repression. What one might anticipate with this level of frantic bargaining going on at the societal level in the midst of unprecedented ecological breakdown is an increasing incidence of dissociative disorders in the general populace. Dissociation from one’s personal identity is thought to be a mechanism for coping through psychological disconnection from situations or experiences that are simply too traumatic to integrate into our sense of who we are. Depersonalization disorders (feelings of detachment from one's own experience, body, or self) and selective amnesia (characterized by memory loss of a specific category of information) might be two kinds of dissociation that are logical responses to the shock of realizing on some conscious level that the planet is becoming unlivable, especially as iconic species like polar bears, penguins, whales, elephants, songbirds and tigers blink out of existence.

4. Depression
In the personal terminal situation, the stage of depression is brought on by the realization that no amount of bargaining is going to avoid the inevitable onset of death, after the reality of the situation has had a chance to really sink in. At the societal level, when we are collectively confronting the final, unintended and fatal results of the course we have been on since the advent of the industrial revolution, we can anticipate disengagement at a massive scale, marked by widespread apathy and withdrawal. This will actually be the critical stage for mental health workers, as without extensive psychological triage,it can be expected to devolve from here into chaos, panic, and the survivalist mentality associated with apocalyptic delusions.

However, with proper spiritual guidance, this stage could be re-visioned as a kind of collective dark night of the soul, a fertile stage of turning inward and preparing for the death/rebirth phase that follows. In other words, it is only by lack of spiritual vision that this collective stage of grieving will be perceived as the end of the world, versus the end of life as we have known it. Given the appropriate spiritual container, it could easily become a time of coming together in our humanity, a collective turning inward instead of an isolated one, and a “Great Turning” (as Joanna Macy puts it) to a new world that awaits us on the other side of purgatory.

5. Acceptance
At the level of the individual, the existential crisis evoked by knowledge of a terminal illness may result in considerable suffering as patients examine their lives in light of illness and impending death. Patients confront losses on many levels, with altered life roles, lost aspirations, and awareness that their loved ones are also suffering... Some patients despair when confronted with their own mortality, which may manifest itself in feelings of fear and foreboding, injustice, anger and rage at their illness.

Multiply that by 7 billion, and it becomes quite obvious that the most critical issue from an ecopsychological perspective of planetary hospice care is facilitating a collective process of grieving that ferries society to the acceptance stage as fully and harmoniously as possible. When nothing more can be done to stop the progression of the disease, the prospect of dying is difficult to avoid. The person may feel helpless trying to combat natural forces that have gone awry, forces that seem bent on destroying the body... We may fight to the end with the attitude “I’ve always outwitted the percentages. Why not now?” Or we may take a different approach, coping with the end of life by making the most of the time we have left.

Unfortunately, it seems all too predictable that a freedom-loving, gun-toting, substance-abusing, individualist country like America will approach the end of life as we know it with a fair amount of antisocial pathology, transposing the breakdown of our life support system into a breakdown in the social order, with many responding to the existential threat with paranoia and hostility, deciding it’s “every man for himself” or, alternatively, seeking security in like-minded militias and religious cults. While there will definitely be pockets of this kind of resistance in any event (in fact, there already are), the whole point of advancing planetary hospice is to provide a ‘viable’ alternative to social chaos -- comfort in the face of helplessness, hope for those who despair, and, perhaps most of all, vehicles for finding meaning in the most tormenting circumstances faced by the human race since the Black Death of the 14th Century.

It would seem that the most critical aspect of acceptance may be promoting peace by re-defining hope - a common component of the hospice model. Spirituality is a key component of coping with the dying process, and involves fostering hope through spiritual meaning. If the human race itself were facing certain extinction, it would be difficult to reconcile that extinction with any harmonious religious world-view. Thus, it becomes imperative to hold out hope for the survival of our species. The end of life as we know it is not equivalent to humanity’s end, and that is a message that needs to be clear. It certainly should mean the end of the Industrial Age, and its relentless exploitation of nature and human spirit. It most definitely means the end of the population boom, which has more than doubled in the relatively short lifetime of baby-boomers. In fact, it is easy to attribute climate change to the simple idea of endless economic growth through exploitation of natural resources in combination with exponential population growth -- the unsustainability of this model has been clear for many decades now.

Beyond the necessary end of “endless” growth and expansion at the expense of nature, it becomes difficult to speculate just what the end of life as we know it might mean…The beginning, perhaps, of reconciliation, atonement, and sharing -- living once again according to natural laws, the ‘golden rule,’ and not arbitrary man-made laws driven by corporate agendas. True crisis has always tended to bring out the best in humanity, and there is no good reason to presume our worst crisis of all will not call forth our very highest potential.

This kind of holistic view of the Great Dying as a death/rebirth process is something that must be organically cultivated through facilitated dialogue and the interpersonal, society-wide exchange of ideas - while we still have the communication infrastructure in place to conduct such dialogue. It is difficult to imagine that people will look to government institutions for this kind of leadership - the very same institutions that have failed us so miserably. Instead, we can be expected to turn to religious and spiritual leaders, mental health experts, and social media, and this is why a planetary hospice movement is needed sooner rather than later.


◊ Zhiwa Woodbury is a longtime dharma practitioner, hospice provider & environmental attorney. The above is extracted from the full referenced version, available as a PDF here. Publ. here 6.5. 2014


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