In this episode, Gabe talks with PsychCentral.com editor-in-chief Dr. John Grohol about the importance of planning for the end of life. We all know that everybody dies, but at the same time, no one wants to think about their own inevitable death. Do you know how you would like the end of your life to go? What if you needed to make that decision for a loved one? Do you know what they want? Would they want to be resuscitated? Do they want to die at home or in a hospital? Do you even know what kinds of decisions need to be made, or what the options are?
Listen in as Dr. John explains that there is a degree of wisdom in realizing that everything must pass, and your time will come. When death is approaching, you don’t have to welcome it, but you also don’t have to fight it. Learn how planning for your own (or a loved one’s) death doesn’t have to be an existential crisis, but can instead provide a degree of safety and comfort.
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Guest information for ‘Planning for Death’ Podcast Episode
John M. Grohol, Psy.D. is a pioneer in online mental health and psychology. Recognizing the educational and social potential of the Internet in 1995, Dr. Grohol has transformed the way people could access mental health and psychology resources online. Pre-dating the National Institute for Mental Health and mental health advocacy organizations, Dr. Grohol was the first to publish the diagnostic criteria for common mental disorders, such as depression, bipolar disorder and schizophrenia. His leadership has helped to break down the barriers of stigma often associated with mental health concerns, bringing trusted resources and support communities to the Internet.
He has worked tirelessly as a patient advocate to improve the quality of information available for mental health patients, highlighting quality mental health resources, and building safe, private support communities and social networks in numerous health topics.
Computer Generated Transcript for ‘Planning for Death’ Episode
Editor’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.
Announcer: Welcome to the Psych Central Podcast, where each episode features guest experts discussing psychology and mental health in everyday plain language. Here’s your host, Gabe Howard.
Gabe Howard: Hello, everyone, and welcome to this week’s episode of the Psych Central Podcast. Today, we’ll be talking with the founder and editor in chief of PsychCentral.com who hosts this podcast. John, welcome again to the show. We always love having you.
Dr. John Grohol: I always love being here, Gabe.
Gabe Howard: Well, that is fantastic. So today we’re going to talk about one of those subjects that is kind of like mental illness. Everybody has heard of mental illness, but everybody has the wrong idea about it. We’re going to talk about, you know, death and the things surrounding death, grief and misunderstandings and family dynamics. And do people just discuss death openly?
Dr. John Grohol: Look, it’s a really uncomfortable conversation that most people are not comfortable having. They get anxious. They get nervous about talking it. People look at it as though it were a negative thing because we’re talking about the end of a person’s life. And I get that. It’s not. It’s a normal feeling to feel, like, I don’t want to talk about this weird and existential conversation, this topic where I’m either talking about my own end of life or I’m talking about a loved one’s end of life. These are not easy conversations, but they are necessary conversations.
Gabe Howard: The language that you just used is… these are necessary conversations. Nobody wants to die and nobody wants the people that they love to die. So why on earth would it be necessary to discuss this?
Dr. John Grohol: I think it comes down to a little bit of denial about the fact that we’re only on this earth for a given amount of time. And by talking about it, you make it more real and you start thinking about the fact that you are only on this earth for 80 or 90 or 100 years. And after that, your life is gone or your loved one’s life is is over. I think most people prefer not to think about such thoughts. They’re very uncomfortable for most people. They’re very anxiety provoking. These kinds of thoughts don’t make it easy for you to continue in your daily life and think that maybe what you’re doing has a lot of meaning. It can really bring in some deep existential questions about the meaning of life. But I think these are all very good things for a person to think about. These are not topics that one should shun or be in denial about, because I think far too many people put off these thoughts, put off these conversations until it’s actually happening to either themselves or a loved one. And I think at that point, it’s too late to really be thinking and considering all the options available to you — but too late. I simply mean that a lot of times you’re going to be under pressure to make difficult decisions in a shorter amount of time versus if you start having these conversations now. You hopefully will not have to have any kinds of decisions made in a week or a day’s time. You have months, you have years to think about these things.
Gabe Howard: It sort of sounds like what you’re saying is, it’s better to have a fire plan before the fire breaks out. This is why we have fire drills in school, because we want to know what to do in the event the bad thing happens.
Dr. John Grohol: Absolutely. This isn’t a piece of property. This isn’t even something that you very much love in your life. This is another human being. This may be yourself. And certainly something as important as that deserves some time, some attention and some considered thought.
Gabe Howard: You’ve talked a lot about, you know, just not wanting to face it, the existential crisis, you’ve just really used a lot of language that makes it sound like, hey, look, everybody is going to die. This is something that you have to think about. But the reality is, is that we don’t have to think about it because death is going to come for us anyways. So you get into this risk-benefit analysis, the benefit of discussing it is, you know, what happens after you die. Like in the case of having a will where your property goes. And I think a lot of people can understand that. Are there other benefits or is this literally just about estate planning?
Dr. John Grohol: Well, let’s not negate the importance of estate planning. Even if you think you don’t have anything to pass along. Most people don’t actually have wills. So that in itself is kind of a disturbing thing and something to take into account. But moving beyond the question of finances and estate planning, it’s a question of how you want to die, because most of us, for better or for worse, are not going to die in an instantaneous car accident or some other accident where one minute we’re alive, then one minute we’re dead. That does happen. It’s a traumatic event all unto itself and very disturbing. But most of us will die because of disease or just of old age. And those kinds of deaths have a lot more planning associated with them. Because the medical establishment in hospitals and nursing homes all come into the equation. And most people are simply not ready to understand how all of that works until they have to start doing it for a loved one. I would argue that, by that point you’re trying to learn on the job, and it just makes it so much more difficult because you already have so many emotions tied up in the fact that your loved one is dealing with a terminal illness or something of that nature.
Gabe Howard: Let’s switch gears slightly a little bit and talk about how not making the decision for yourself doesn’t solve the problem — it just sort of puts the problem on to somebody else. About a year ago, my father-in-law died unexpectedly, but he died unexpectedly over the course of three days. One moment we thought everything was fine. He was a relatively young man. He was 64 years old. He had a heart attack and he never regained consciousness. The family stayed by his bedside, and we were forced to make this decision of what would he want? Would he want to stay on life support? Would he want surgery? You know, we were just given all of these options, and we didn’t know. And we were all sitting there trying to make the right decision for a person who could not participate. And of course, we’re faced with the reality that somebody who we care very deeply for and love very much is in trouble, is dying.
Dr. John Grohol: Absolutely, we think we’re going to live forever. And so we put off having conversations with our loved ones about what happens if we become incapacitated and can’t communicate with a family member or a loved one to let them know what our wishes are. So it becomes really, really difficult situations such as you’ve described where you’re trying to guess basically what the person wants, or you think you know what they want. But in all honesty, you’re probably coloring what they want with your own expectations and beliefs about if it were you lying there in bed. And family members can often disagree at a traumatic time like that. And that just adds so much more complication to something that’s already very emotional and complicated. And you’re looking at making life and death decisions, basically, for a loved one and not knowing what their choice would be.
Gabe Howard: I’m really glad that you brought up that, you know, family can disagree at a time like this because our family did disagree. Now the disagreement was really, really minor. I want to make sure to disclose that there’s no hurt feelings. By the time it came time to make the decision, everybody was, in fact, on the same page. But as the in-law, you know, I’m married and this was my father in law, remember? I’m watching his children and his wife go through this. And all I could think of is, can you imagine if one sibling wanted to fight and the other sibling wanted to pull the plug and they never came to that agreement? And then we go to my mother-in-law who has to decide. That could very much be seen as siding with one child over the other and creating a rift that never heals. And then, of course, that’s a position that she herself, who is still alive, doesn’t want to be in all because there’s not this this living will or this discussion that could happen around it. You don’t want your legacy to be I died and my family was ripped apart because of a medical decision that needed to be made.
Dr. John Grohol: Absolutely no one wants their own death or accident to result in a family disagreement that goes beyond that person’s death. And that is the tragedy that happens every day in the United States, where people have not given this any thought or had any discussion with their family. And then something tragic happens and they’re in the hospital. They can’t communicate. They may be unconscious. They might be in a coma. And no one in the family knows what to do. And the doctors are asking for your decision. They can’t sort of keep them in a state of limbo indefinitely, especially if it’s an accident or traumatic accident where they need to make decisions about, well, how, you know, did they have a “do not resuscitate” order? I mean, is that something that they have a living will? Do they know what exactly do they want in terms of the medical procedures? And these are things some people have already thought about, so they have a living will. And if the family doesn’t know about it, though, it’s useless. No one wants a contentious argument in a hospital room while your loved one is lying there in bed dying. This is not the best way to handle that kind of situation. It’s much, much better to have these conversations about the quality of life at the end of our lives before we get to a hospital, before doctors become involved.
Dr. John Grohol: Because once doctors get involved and once the medical system starts to become part of the equation, you can really have things taken out of your control very quickly. Doctors have a very focused mind about keeping you alive no matter what. And that sounds really good when you’re 30 or 40 or 20 or 50 even. But when you’re 80 or 90, any kind of surgery, any kind of procedure — no matter how much the doctor says this is a minor procedure — it isn’t any kind of surgery, even microsurgery, even the stuff that they say is minimally invasive has additional risks. As I pointed out in an article I wrote in May: Once you install a pacemaker, for instance, guess what? Cardiologists don’t ever want to turn that off. They can turn off with a very simple device that takes 10 seconds, basically, to turn it off at the end of your life. You may want to turn it off because you don’t want the pacemaker to be doing the heavy lifting when the rest of your systems are failing. But doctors are very reluctant to shut down that device. They put it in your chest. It’s a weird thing where doctors want you to live, even when it’s clear that your time on this earth is coming to an end.
Gabe Howard: We’ll be right back after this message from our sponsor.
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Gabe Howard: We’re back talking about end-of-life decisions with Dr. John Grohol. Let’s talk about how to have these conversations. Do you have any advice? Like you said, everybody’s uncomfortable. If you don’t have a spouse, that probably means you’re going to raise this with siblings or parents or grandparents. And they obviously don’t want to think about them outliving you. So what advice do you have to get this on the table and get it hashed out?
Dr. John Grohol: It’s not an easy conversation to have. Let’s just acknowledge that up front, and you can actually use that as an “in” for having that conversation like, “Hey, mom, I want to talk about something that I know is gonna be uncomfortable for us to talk about.” But I think it’s really important because it’s about what kind of quality-of-life you want to have at the end of your life. And I think it’s important that we have this conversation, because although you think we may know your wishes, we don’t. So I want to talk to you about the different choices we have and to make sure that you’re on the record for how much, you know, medical intervention you want at the end of your life. What are your concerns? Well, how do you want your final weeks or months on this earth to be? Like, do you want to be in a hospital room or do you want to be at home comfortable in your own bed? These are things that you take for granted, like, why wouldn’t I want to be in a hospital? If all hospitals are very hectic, not peaceful places, they are not a good place to die, quite frankly. They’re not a good place to get a good night’s sleep. So if you can avoid dying in a hospital, if it’s not medically necessary for you to be there, I think most people would prefer to die in the comfort and solitude and familiar surroundings of their own home.
Gabe Howard: One of the things that sort of stumped me while you were talking is, you’re right, I never considered you would have to have the answers before you discussed it with your family member. How does one go about making those decisions? I mean, I’m sitting here kind of thinking about it now and I’m like, oh, my God, what do I want? I’ve gotten to the point where I know that I would like to be cremated rather than buried. As far as how I would like to die, how do I find out what my options are? So far, we’ve got hospital or home, but as you know, it’s much more complicated than that.
Dr. John Grohol: So I think everyone would benefit from going to their local library or going to Amazon.com and picking up a book by Atul Gawande called Being Mortal: Medicine and What Matters in the End. And he talks about basically all of the choices that you have available, how to have these conversations with loved ones and how to think about your end of life in a way that I don’t think most people have ever given much thought to. If not for yourself, especially if you have a family, there are people that are depending upon you in one way or another. You really need to think about what happens if I were no longer on this earth tomorrow. Are they taken care of? Do they know if I get into an accident and I’m unconscious? Do they know what my wishes are? And if you don’t know what your wishes are, do some research online. Because most of us just think that there is one road when we have a terminal illness. My father, for instance, died last year of Parkinson’s and the end of his life was good. But it probably could have been better had we had more information and knowledge about the choices that he would have preferred. And we didn’t have that conversation with him in any kind of in-depth way. And so his wife and myself and my two brothers, we had conversations and we basically all agreed on the course of action. But at some point, kind of second guess yourself and you have to wonder, like, is this really what he wants or what he would have wanted? Because there came a time where he couldn’t communicate. So it wasn’t at all clear that that those were the right choices for him. If you don’t have that kind of conversation with the person, then you’ll never know.
Gabe Howard: And obviously, that can potentially be a heavy burden to carry depending on the makeup of yourself or your family or the dynamics, etc., and this could all be avoided by having meaningful conversations surrounding end-of-life decisions.
Dr. John Grohol: Sure, and when I talk about meaningful conversation, it’s not Hey, we’re watching TV and let’s just have a kind of shallow short talker about it. That’s not going to be very meaningful or very in-depth. I know how hard it is to talk about — just to even connect with people authentically. One of the first things a person will say is, I don’t want to talk about this. My mom for the longest time said that to me and my brothers. I respected that. You don’t need to keep pushing the topic if they’re not comfortable with speaking about it, but just bringing it up plants the nugget in their mind where you try again a week or a month from then and you keep trying until she finally or he finally relents and says, OK, I get your point. There might be some benefit to having a living will. There might be some benefit to updating my regular will and thinking about these things on a deeper level than just, hey, I don’t want to die and I’m never going to die. So I don’t want to think about it. I don’t want to talk about.
Gabe Howard: And to be fair, I really don’t think that anybody is out there saying I’m never going to die. We all just think we have more time.
Dr. John Grohol: I think for some people, it is one of those irrational thoughts that comes through their head in the sense that I’m never going to die. Well, I’m never going to die in the near future. And for most people, the near future is every day. Every day they wake up with that same thought. Even when they’re 80 or 90, like an 80- or 90-year-old will wake up and they’re just like, sure, I… They’re like, I’m not dying today and I’m not dying next week. So they have… Sometimes they can be just as stubborn and just as irrational about whether they’re any closer to dying or not.
Gabe Howard: I think most of us get hit with this like a ton of bricks. We think that we’re invincible one day, and then we realize that we’re going to die the next. And we have a lot more to process than if we would have really considered this throughout the span of our lifetime. They start thinking about their end-of-life decisions at 25 and then, you know, they’re still thinking about them at 45, or 55, or 65 or whatever. And they really have this concept of it. They sort of have that to fall back on.
Dr. John Grohol: Yeah. I don’t think you need to have a lot of thought about it when you’re a 25 year old, but you should have some thought about it. And if not for yourself, then for a loved one, for a parent who is getting older, who is dealing with a chronic disease or has been diagnosed with even stage 2 cancer. It’s not something that you necessarily have to spend hours and hours on every year of your life. But it helps to stop thinking in that sort of irrational way that we’re all going to live forever, that your parents are going to live forever, that your partner is going to live forever. They’re not. And it’s a hard thing to come to an acceptance about. But the sooner you do, the more you will be in a position in order to help them make decisions about their end of life. So it doesn’t become this huge problem and meetings full of confusion and disagreement about what the person wants. Think about that. We plan for every other major event in our life to endless amounts of time and resources. You get married. The wedding planning can take a year. It could take two years for some people. You prepare for the arrival of a new baby. This is another big life event that it makes a lot of sense to prepare for. And I know it might be the most difficult thing to prepare for, but it will make it so much more easier, not only for yourself, but for your loved ones. And if you want to ease the emotional pain and suffering that comes with death, there is no better way to do that than to have some planning and prepare for it.
Gabe Howard: John, as always, it’s great to have you here. Do you have any final thoughts before we wrap up?
Dr. John Grohol: Look, there’s a lot of authors who’ve written about death and dying and how we deal with it in modern society. And I think in the United States it’s especially difficult because our modern society really puts a lot of emphasis on medical care in hospitals and technology and that we can save even the most people that have the worst conditions. And so there’s a lot of talk at the end of life about the things that a doctor can do to help prolong life. And it becomes a conversation about longevity. And you’re having this conversation with either the family or the person themselves of someone who’s 80 or 90 years old. And you’re talking about another three months extra, six months, an extra year. Really? I mean, is it really about longevity or is it? Also shouldn’t that conversation be about quality? Because quality of life goes downhill very quickly when a hospital becomes involved in your life. And that’s not a dig against hospital care. It’s a dig about the fact that your body is not as resilient physically as it was when it was 20, 40 or even in your 50s. And your body can’t recover from things that a 40-year-old or a 20-year-old body can recover from much more easily. So you really have to think about quality-of-life and quality of what you want the final months or even final year or two of your life to be. Do some research about living wills.
Dr. John Grohol: There’s plenty of examples online that you can review. Every state might be a little bit different in terms of their laws, but a living will will walk you through all the dozens of decisions that you or your loved ones would have to make. And rather than having them make it without your input, why not just sit down with that document today and go through it and say, hey, yes, I want a life support if I’m expected to live, I want these kinds of measures, if I’m expected to live. But if they know that these measures are just adding days to my unconsciousness, maybe that’s something you don’t want and everybody’s different. And it’s really, really important to understand that whatever your wishes are might not be the wishes of a loved one. So, to walk through a document like that… We actually walked through that document with my mom. It wasn’t pleasant. I won’t say this is a great conversation to have or a great meeting to have. And it took some time. It took over an hour, but it was necessary. And in the end, she understood why we were talking about it and why we were doing it. I hope she lives another 20 years or longer. I mean, I don’t wish her any ill will. It’s just that it’s just like we would plan for a baby or a wedding. We should plan for a person’s good death.
Gabe Howard: John, thank you so much, we appreciate having you. And thank you, everyone, for tuning in. And remember, you can get one week of free, convenient, affordable, private online counseling anytime, anywhere, simply by visiting BetterHelp.com/PsychCentral. We will see everybody next week.
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