Old Age, Sickness and Death

"Even though I was endowed with such fortune, such total refinement, the thought occurred to me: 'When an untaught, run-of-the-mill person, himself subject to dying, not beyond dying, sees another who is dying, he is horrified, humiliated, & disgusted, oblivious to himself that he too is subject to dying, not beyond dying. If I — who am subject to dying, not beyond dying — were to be horrified, humiliated, & disgusted on seeing another person who is dying, that would not be fitting for me. As I noticed this, the living person's intoxication with life entirely dropped away." The Buddha, Sukhamala Sutta, translation by Thannisaro Bhikku 

A recent phone call with my old friend Allan Davies, which left me reflecting on some basic Buddhist principles, prompts this post. Allan told me that he had been visiting a friend of his who is dying of brain cancer in a squalid north Devon nursing home. His friend, who is in his mid-sixties, is alone and destitute and apart from Allan and another friend, appears to have no one who shows any concern for him in his final days. Allan and his other friend provide emotional support to each other as they enter the drab, malodorous premises of the nursing home. For seeing their friend dying in such dismal surroundings leaves them both feeling helpless and dejected, especially as the dying man himself is barely able to acknowledge their presence. The overworked and no doubt underpaid workers in the nursing home barely find the time to feed and medicate their patients and can't begin to attend to the emotional needs of all the dying, feeble people who depend on them. The austerity measures which the government instituted five years ago and look to be increased after the recent election, may be partly to blame for the dreary conditions in which Allan's friend is dying. But though there is no excuse for the heartlessness of the government's policy, the underlying and inescapable certainties of old age, sickness and death, which Buddhism regards as signs of metaphysical significance, are surely the deeper sources of his suffering. Clearly, no one can be blamed for these intractable realities that are imposed on all of us by our conditional existence. Yet, how we act in the face of these conditions determines the moral and spiritual quality of the lives we lead. If we treat them as universals that encourage us to compassion, we benefit others and may also acquire precious wisdom for ourselves by doing so. But if we regard them merely as vague, distant eventualities that we can long postpone while pursuing our more selfish interests, we aggravate the suffering that comes from simply being alive. This may not be apparent to those whose good fortunes appear to grant them temporary immunity from the ravages of old age, sickness and death. But it becomes obvious to anyone who bothers to look. Indeed, bothering to look and learning to see is much of what the Buddhist path is all about and should certainly influence the practice of Buddhist psychotherapy. As always, the Buddha's example is the best place to begin reflecting on these truths.

Everyone knows the story of the Buddha's enlightenment which begins with his auspicious birth as the crown prince of a royal family and his coddled upbringing in palatial luxury. Lacking for nothing, Prince Siddhartha nevertheless intuited the inevitability of old age, sickness and death when, on successive journeys into a nearby city, he noticed an old man, a sick man and a dead man. Deeply shaken by what he had seen, it was upon later seeing a wandering holy man, the last of the Four Sights, which led him to begin his spiritual quest. In spite of its profundity, the story of the Buddha's awakening has the reassuring tone of a fairy tale that we know will end happily. A dose of realism is required for us to appreciate that these momentous encounters are actually common, everyday occurrences. Even so, they were momentous enough to stimulate his unusually deep and sensitive nature and move him to begin his spiritual quest. In fact, what he later realised upon becoming the Buddha was that old age, sickness and death stood on the ontological fault lines of suffering which affected every phenomenon that came into existence. As the Buddha, he developed these insights into principles that became known as the Three Marks of Existence--impermanence, not-self and suffering [anicca, anatman and dukha]--and became foundational to his teaching. But even if we accept that these truths are undeniable, most of us can't prevent ourselves from trying to evade them. And that is the point: accepting the Three Marks merely as metaphysical propositions does not really count for very much. It is only by seeing the pervasiveness and inevitability of suffering that we can reach a deeper understanding of the nature of reality and our precarious place within it.    

The suffering in the world is in fact limitless as most people recognise, at least intuitively. But rather than try to alleviate suffering when we see it in others, we may be more inclined to turn away from it, knowing that in the long run of things there is nothing we can really do. Small wonder then that many of us cling to our more selfish desires in the hope that by pursuing them we can at least find some satisfaction for ourselves. But an unfortunate illusion may occur if we commit ourselves to such a way of being. We see the world as the domain of our desires and interests and imagine that it exists in order to sustain us; sustain others, too, perhaps, but sustain us first. This is the logic of self interest that governs the world and we would be unwise to disregard it or discount its benefits, especially if it helps to make us more responsible for our actions. But when we are restricted by such logic, compassion comes as an afterthought, if it comes at all. Even so, most of us dread the possibility that we might not find compassion when we most desperately need it. For it is bad enough to die old and sick. How much worse will our suffering be if we have to die alone, as well? Unlike Prince Siddhartha, many of us prefer to ignore to this troubling question. But ignoring it does not make it go away.

Neither Allan nor his friend is a Buddhist, but then compassion isn't the sole property of Buddhism, either. Evolutionary psychologists assure us that a tendency towards compassion is part of our genetic inheritance, which may come as something of a consolation given our more selfish and violent tendencies. But I would argue that something deeper and more subtle is in action whenever people act with compassionate motives towards the suffering of others. Although compassion may well derive from an evolutionary development that values self sacrifice in the interest of group cooperation, its more immediate, personal benefit comes from widening our understanding of what it is to be human. It also counters the tendency to see our good fortune as destiny and the suffering of others as mere background noise to the music of the spheres. As Siddhartha realised, we too will be subject to much the same suffering that we are horrified to witness in others. Compassion, then, not only recognises the inescapable truth of suffering, it also puts us in a position to learn from it. But what we learn cannot be grasped by any abstract formula. We must learn it from the depths of our being, which is as much a matter of feeling as it is of thinking. 

There is, however, an unfortunate and mistaken idea that compassion is merely a sentimental virtue which takes flight on the wistful hope that all the suffering of the world can be washed away by a wave of human kindness. But as the First Noble Truth tells us, suffering is the most fundamental and obdurate fact of existence. It is both a proximate cause of compassion, as well as the abiding reality that will survive it. Allan's friend, for example, will not be recovering from cancer nor is he likely to die in more congenial surroundings. Whatever consolations he receives will come from his few remaining friends or others in the nursing home who may not know him at all. Though Buddhism tells us that compassion can be the gateway to higher wisdom, we may not always be able to see this. But we should all be able see that compassion evokes a sense of shared humanity when people need it most. That may not make us bodhisattvas, but it does make us better human beings.