Showing posts with label Ehrenreich. Show all posts
Showing posts with label Ehrenreich. Show all posts

2023/07/05

** B Ehrenreich, NATURAL CAUSES, Ch 5 The Madness of Mindfulness [72-90]

 ** B Ehrenreich, NATURAL CAUSES,  Ch 5 The Madness of Mindfulness [72-90]

Barbara Ehrenreich 





CONTENTS

INTRODUCTION Ix

Chapter One: Midlife Revolt 1

Chapter Two: Rituals of Humiliation 14

Chapter Three: The Veneer of Science 32

Chapter Four: Crushing the Body 51

Chapter Five: The Madness of Mindfulness 71

Chapter Six: Death in Social Context 91

Chapter Seven: The War Between Conflict and Harmony 112

Chapter Eight: Cellular Treason 137

Chapter Nine: Tiny Minds 151

Chapter Ten: "Successful Aging" 162

Chapter Eleven: The Invention of the Self 181

Chapter Twelve: Killing the Self, Rejoicing in a Living World 197

NOTES 213

ABOUT THE AUTHOR 235

=====================

CHAPTER FIVE The Madness of Mindfulness [72-90]

In the struggle between mind and body, perpetually reenacted by fitness-seekers, the mind is almost univer­sally conceived as the "good guy"—the moral overdog that must by all rights prevail. Contemporary fitness culture concedes a certain advisory status to the body: We should "listen" to it, since, after all, the body is capable of doing a great many important things on its own, from healing wounds to incubating fetuses, with no discernible instruc­tions from the conscious mind. So if your hamstrings are squealing with pain, it may be time to recalibrate the leg lifts and squats. All-purpose guru Deepak Chopra advises:

Be open to your body. It's always speaking. Be willing to listen. Trust your body. Every cell is on your side, which means you have hundreds of billions of allies!

It's up to you, of course, to tune in to the body or ignore it. As a health columnist puts it: [72  73]

Your body pays attention to you. It thinks you're impor­tant! If you've spent a whole lot of time ignoring how you feel, just bulldozing along—your body has probably de­cided you're not interested in listening to these lines of communication. It hits the mute button. That's OK, you can turn your volume back on.2

The superiority of mind over body, or, more majestically, spirit over matter, is inscribed in every post-pagan religion and philosophical system. In the Manichean religion of third-century-CE Mesopotamia—which drew on Chris­tian Gnosticism as well as Buddhism—all of cosmology is a "struggle between a good, spiritual world of light, and an evil, material world of darkness, "3 a theme that came to full, dark flower in the medieval Catholic Church, with its celebration of self-mortification—saints, for example, who dined on little more than the dust they found in their monastic cells. 

To achieve spiritual salvation, the Spirit had to be freed from the body and all its vile inclinations, in­cluding its tendency toward disease and corruption. Today's Christianity, Islam, and Judaism, while far more permissive, often require adherence to some dietary rules and physical acts of obeisance like kneeling and prostration in prayer or wearing restrictive clothing. At the very least, the mind or spirit is expected to keep a tight rein on the body's sloth­ful, gluttonous, and lustful impulses. A twentieth-century anorectic associated her wasted body with "absolute purity, hyperintellectuality and transcendence of the flesh," adding that "my soul seemed to grow as my body waned.

But can the mind be trusted? Surveying today's fitness culture, a -mid-twentieth-century psychiatrist would no doubt find reasons to suspect a variety of mental disorders—masochism, narcissism, obsessive-compulsive disorder, and homoerotic tendencies (which were viewed as pathological until the 1970s)—any of which could in­dicate the need for professional intervention. Even the untrained eye can detect the occasional skeletal anorectic in the gym, sweating through hours of cardiovascular train­ing, and start to question the assumed intellectual superi­ority of the mind. We have come, hesitantly, to respect the "wisdom of the body," but can we be sure of the wisdom of the mind?

Just within the last decade, a new reason for alarm has arisen. Not only may the mind be twisted by the traditional emotional disorders like depression, but its fundamental cognitive powers appear to be dwindling. Teachers, parents, and psychologists have noted a steep decline in the ability to pay attention, among both children and adults. A 2015 study found that the average adult attention span had shrunk from twelve seconds a dozen years ago to eight sec­onds, which is shorter than the attention span of a gold-fish.5 Something seems to be going very wrong with the human mind, not in its emotional responses to the world, which have always been a bit unreliable, but in its ability to perceive and understand that world. 

Among the many diag­noses being bandied about are autism, which now occupies an entire "spectrum" of symptoms, 

Asperger's syndrome, 
attention deficit disorder (ADD), and 
attention deficit hy­peractivity disorder (ADHD)
—all of which overlap in symptomatology and can markedly affect academic performance. Any parent whose child was performing less than brilliantly in school would be remiss not to seek medical help.74  75

ADD and ADHD are now the most common pediatric diagnoses after asthma, partly for reasons that have nothing to do with any actual epidemiology. 

In the first decade of the twenty-first century, drug companies started marketing stimulants like Adderall and Ritalin as treatments for ADD/ADHD, often targeting parents and even children directly. One such ad showed a mother hugging a little boy who has gotten a B+ on a test, captioned with "Finally, schoolwork which matches his intelligence, "6 Another showed a kid in a monster costume removing his monster-head-covering to reveal a smiling blond boy. "There's a great kid in there," reads the text. "Now there's a new way to help him out. "7 Whether the drugs worked or not to boost grades, affluent parents were discovering that a diagnosis of ADD/ADHD could warrant giving their child additional time to complete in-class tests—a small but possibly deci­sive advantage in the competition to get into a good high school or college.

It did not take years of laboratory research to get to the likely source of this new "epidemic." Parents could see what was happening to their own children, who were being drawn to electronic devices—cell phones, computers, and iPads—as if to opium-infused cupcakes. They stare at the small screens for hours a day, often switching moment by moment between games, videos, and texting their friends.

 They have trouble focusing on homework or anything else in "the real world" even when their devices are forcibly removed. Neuroscientists confirmed that electronic addic­tion was "rewiring" the human brain, depleting attention span  and degrading the quality of sleep.9 In fact, as they withdrew from the physical world into their texts and their tweets, adults could see the same things happening to themselves. The term "distracted parenting" was invented to describe the parent who could barely focus on his or her children anymore, certainly not to the degree required to enforce a few hours of abstinence from devices a day. And what good could a parent do when the schools themselves increasingly use laptops and iPads as instruments of learn­ing? The small screens seemed to have swallowed the world.

The Technological Fix

The perpetrator was easy enough to locate—in Silicon Valley or, more generally, the high-tech industry that created the tempting devices and social networks that consume so much of our time. Silicon Valley is not just the source of the prob­lem; it also seemed to be ground zero of the inattentiveness epidemic. A 2001 article in Wired sounded an early alarm: Diagnoses of autism and Asperger's syndrome were skyrock­eting in Santa Clara County, home of Silicon Valley? Among the adult population of the Valley, surely something was wrong with Steve Jobs, who alternated between obses­sive attention to details and complete withdrawal into him­self, between a spiritual aloofness and uncontrolled temper tantrums. Some observers thought they detected a hint of autism in the unblinking, almost affect-free Bill Gates, and the characters in HBO's Silicon Valley are portrayed as well "within the spectrum?"[76  77] There is even a "Silicon Valley syn­drome," defined, incoherently, by the crowdsourced Urban Dictionary as "a collection of personality traits and physical characteristics specific to individuals residing around the San Francisco Bay Area. The effects of SVS are often confused for autism or Helen Keller [sic]."11 Put that together with Apple's slogan "Think different," and you might conclude that Silicon Valley has a problem not only with grammar, but with thinking itself.

Rising concerns about shrinking attention spans should—if anyone had been paying attention—have cre­ated a sense of crisis in Silicon Valley. Suppose the com­pany manufacturing a nutritional supplement advertised as "miraculous" was confronted with claims that its product actually enfeebles its users—which was roughly the situa­tion the tech industry found itself in. Not only did Silicon Valley's corporate culture encourage a "syndrome" of inat­tentiveness and self-involvement, but its products seem to spread the same derangement to everyone else. The devices that were supposed to make us smarter and more con­nected to other humans were actually messing with our minds, causing "Net brain" and "monkey mind," as well as physical disorders associated with long hours of sitting. As we click between Twitter and Facebook, text and hyper­text, one link and another, synapses are being formed and then broken with febrile inconstancy—or so the neuro­scientists warn us—leaving the neuronal scaffolding too fragile to house large thoughts. Hence the emergence of "digital detox camps" where grown-ups pay to live without electronic devices—as well as alcohol, sex, and gluten—in order to "reconnect" with the real world.12

A less arrogant industry might have settled for warning labels on its phones and pads—"Do not use while driving or attempting to hold a conversation," for example. But Silicon Valley "has an arrogance problem," tech columnist Farhad Manjoo announced in the Wall Street Journal in 2013, in response to a tech titan's plea for greater indepen­dence from regulation:

For Silicon Valley's own sake, the triumphalist tone needs to be kept in check. Everyone knows that Silicon Valley aims to take over the world. But if they want to succeed, the Valley's inhabitants would be wise to at least pretend to be more humble in their approach. 13

But humility was not in Silicon Valley's repertoire. Had they not, in just a couple of decades, transformed—or to use their current favorite verb, "disrupted"—the worlds of enter­tainment, communications, business, shopping, dating, and just about everything else? In the process, at least fourteen billionaires had emerged in the Valley itself, which is cer­tainly an undercount of tech billionaires nationwide. Wall Street and Hollywood could generate centi-millionaires; only in Silicon Valley could a young man (and it is almost always a man) without a college degree rather suddenly ac­quire an eight-figure fortune. Silicon Valley, whether in the Bay Area, Austin, Cambridge, or New York's Silicon Alley, is a setting that breeds megalomania or, as tech critic Evgeny Morozov terms it, "solutionism': an intellectual pathology that recognizes problems as problems based on just one criterion: whether they are 'solvable' with a nice and clean technological solution at our disposal. "14  [78  79]

Anything is possible, any problem solvable, with a simple "hack Space travel PayPal cofounder Elon Musk now heads up SpaceX, the first private space travel company. Health? Silicon Valley generates the personal monitoring devices that can continually reveal your inner workings far better than a doctor's office could. Who needs a doctor any­way? Picking up on the evidence-based critiques of med­ical practice, Vinod Khosla, "one of Silicon Valley's most revered venture capitalists," publicly announced that "healthcare is like witchcraft and just based on tradition" rather than being driven by data.'5

Far better to pick up a little biochemistry and proceed to "biohack" your own body. Dave Asprey describes himself as "a young, brand-new multimillionaire entrepreneur" when he confronted his own obesity and attempted, unsuccess­fully, to cure it by dieting and doing a ninety-minute work­out per day. Then he realized that our bodies and the Internet are not all that different. They are both complex systems with big pieces of data that are missing, misunderstood or hidden. When I looked at my body that way, I realized that I could learn to hack my bi­ology using the same techniques I used to hack computer systems and the Internet. 16

Asprey's lifesaving hack turned out to be "Bulletproof Coffee"—expensive mold-free coffee containing a generous portion of melted butter—which he now markets online and through his cafés. Exercise turned out to be just too time-consuming.

For obsessive biohacking no one tops Ray Kurzweil, the futurist, inventor, and bestselling author of a book on the coming "singularity," when artificial intelligence will be­come self-improving and overtake the human mind. Like Asprey, Kurzweil sees the body as a machine—in fact a computer—that can be continually upgraded. "I have a per­sonal program to combat each of the degenerative disease and aging processes," he writes. "My view is that I am re­programming my biochemistry in the same way I reprogram the computers in my life. "17 The only exercise he undertakes is walking, and his nutritional routine would seem not to leave time for workouts in a gym. Every day he takes "about 250" pills containing nutritional supplements, on top of which he spends a day a week at a clinic where supplements are delivered right into his bloodstream. "Every few months," he relates, "I test dozens of levels of nutrients (such as vitamins, minerals, and fats), hormones and meta­bolic by-products in my blood.""'

The goal here is not something as mundane as health. Silicon Valley's towering hubris demands nothing less than immortality. The reason why Kurzweil has transformed himself into a walking chemistry lab is to prolong his life just long enough for the next set of biomedical break­throughs to come along, say in 2040, after which we'll be able to load our bodies with millions of nanobots pro­grammed to fight disease. One way or another, other tech titans aim to achieve the same thing. As Newsweek reports:

Peter Thiel, the billionaire co-founder of PayPal, plans to live to be 120. Compared with some other tech billion­aires, he doesn't seem particularly ambitious. Dmitry It-skov, the "godfather" of the Russian Internet, says his goal is to live to 10000 Larry Ellison co-founder of Oracle finds the notion of accepting mortality "incomprehensi­ble," and Sergey Brin, co-founder of Google, hopes to someday "cure death."19  [80  81]

There is, to say the least, a profound sense of entitlement here. Oracle's Larry Ellison is reportedly "used to getting his way, and he doesn't see why that should ever stop. 'Death makes me very angry,' he has said, explaining why he has spent hundreds of millions to fund antiaging re­search. "20 If you are one of the richest men in the world, and presumably, since this is Silicon Valley, one of the smartest, why should you ever die?

======

Controlling Your Mind

With immortality on the agenda, surely the little matter of mass inattentiveness had a solution, and I mean a "so­lution" in the "solutionist" sense—something convenient, marketable, and preferably available on existing devices. But the solution, when it made its way to Silicon Valley, came from a realm apparently unrelated to digital tech­nology, and that is religion—in this case, Buddhism. 

Jon Kabat-Zinn, a Zen-trained psychologist in Cambridge, Massachusetts, had already extracted what he took as the secularized core of Buddhism and termed it "mindfulness," which he extolled in two bestsellers in the late 1990s. 

I first heard the word in 1998 from a wealthy landlady in Berkeley, who advised me to be "mindful" of the suffocating Martha Stewart—ish decor of the apartment I was renting from her, which of course I was doing everything possible to unsee. The probable connection to Buddhism emerged when I had to turn to a tenants' rights group to collect my security deposit. People like me—renters?—she responded in an angry letter, were oppressing Tibetans and disre­spected the Dalai Lama.

During the same stint in the Bay Area, I learned that rich locals liked to unwind at Buddhist monasteries in the hills where, for a few thousand dollars, they could spend a weekend doing manual labor for the monks. Buddhism, or some adaptation thereof, was becoming a class signifier, among Caucasians anyway, and nowhere was it more os­tentatious than Silicon Valley, where star player Steve Jobs had been a Buddhist or perhaps a Hindu—he seems not to have made a distinction—even before it was fashionable for CEOs to claim a spiritual life. Guided by an in-house Buddhist, Google started offering its "Search Inside Your­self" trainings, promoting attention and self-knowledge, in 2007.

Mindfulness went public as a kind of "movement" only in the second decade of the twenty-first century, though, when Soren Gordhamer, a former teacher of meditation to at-risk youth and at one point an aide to Hollywood's chief Buddhist, Richard Gere, found himself broke, divorced, and in the grip of a terrible Twitter addiction. Something had to be done to counter the addiction to devices, and it had to be something that in no way threatened the billion­aires who had lured us into it. As Mindful magazine later pointed out:

The lords and leaders of high tech aren't about to dismiss new technology as the beginning of the end of humankind—not only because they don't want to work against their own economic interests, but because they be­lieve in the innovative, interactive world fostered by new technologies... .Yet they also know that technology can be distracting, not only from where we are in any given mo­ment but from where we ought to be going.2'  [82  83]

In a stroke of genius, Gordhamer found a way to raise the issue while actually flattering the tech titans. He claims to have discovered that, while the rest of us struggle with in­tractable distraction, leaders from Google, Linkedln, Twit­ter, and other major tech companies seem to be "tapped into an inner dimension that guides their work. ­122 He called it "wisdom" and started a series of annual conferences called Wisdom 2.0, based originally in San Francisco, in which corporate leaders, accompanied by celebrity gurus, could share the source of their remarkable serenity, which was soon known as mindfulness.

At the same time, in London, a former Buddhist monk with a degree in Circus Arts, Andy Puddicombe, was trying to figure out how to spread Buddhist meditation techniques within the generally religion-averse business class. He and a partner created a company called Headspace, which at first staged events where large groups of people paid to partici­pate in guided meditation sessions. When the customers de­manded more convenient ways of packaging the experience, Headspace started marketing CDs, podcasts, and eventually a cell-phone-accessible app, distributed by Apple and An­droid. Politically and monetarily, this was another stroke of genius. It catapulted Puddicombe from near destitution to a net worth of f,25 million, 23 while, through efforts like Wis­dom 2.0, simultaneously transforming the tech titans from being the villains in the inattentiveness epidemic to the pu­tative saviors. There was an "irony," Fast Company noted, "in using technology to deliver mindfulness coaching to a population that's more and more tech-frazzled. "24 Bestsell­ing psychologist Daniel Goleman observed, more bluntly, "What a clever way to make money: Create a problem you can then solve. ­25

Mass-market mindfulness began to roll out of the Bay Area like a brand-new app. Very much like an app, in fact, or a whole swarm of apps. 

There are over five hundred mindfulness apps available, bearing names like "Simply Being" and "Buddhify." 

Previous self-improvement trends were transmitted via books, inspirational speakers, and CDs; mindfulness can be carried around on a smart-phone. 

Most of these apps feature timed stretches of meditation, some as brief as one minute, accompanied by soothing voices, soporific music, and cloying images of forests and waterfalls.

This is Buddhism sliced up, commodified, and drained of all reference to the transcendent. In case the connection to the tech industry is unclear, a Silicon Valley venture cap‑italist blurbed a seminal mindfulness manual by calling it "the instruction manual that should come with our iPhones and Blackberries."26 You might think that the actual Bud­dha had devoted his time sitting under the Bodhi tree to product testing; the word 'enlightenment" never arises in the mindfulness lexicon.[84  85]

Today mindfulness, in its sleek and secular form, has spread far beyond Silicon Valley and its signature industry, becoming just another numbingly ubiquitous feature of the verbal landscape, as "positive thinking" once was. While an earlier, more arduous version of Buddhism attracted few celebrities other than Richard Gere, mindfulness boasts a host of prominent practitioners—Arianna Hulfington, Gwyneth Paltrow, and Anderson Cooper among them. 

It debuted at Davos in 2013 to an overflow crowd, and Wis­dom 2.0 conferences have taken place in New York and Dublin as well as San Francisco, with attendees often fan­ning out to become missionaries for the new mind-set—starting their own coaching businesses or designing their own apps. A recent Wisdom 2.0 event in San Francisco ad­vertised speeches by corporate representatives of Starbucks and Eileen Fisher as well as familiar faces from Google and Facebook. Aetna health insurance offers its thirty-four thousand employees a twelve-week program and dreams of expanding to include all its customers, who will pre­sumably be made healthier by clearing their minds. Even General Mills, which dates back to the nineteenth century, has added meditation rooms to its buildings, finding that a seven-week course produces striking results:

[Eighty-three] per cent of participants said they were "tak­ing time each day to optimise my personal productivity"—up from 23 per cent before the course. Eighty-two per cent said they now make time to eliminate tasks with lim­ited productivity value—up from 32 per cent before the course. 27

It was Silicon Valley, though, that legitimized mindful­ness for the rest of the business world. If mindfulness had first taken root in General Mills, it would never have gained the status it's acquired from Google and Facebook; baking products just don't have the cachet of digital devices. Sil­icon Valley is, after all, the "innovation center of the uni­verse," according to its boosters, home of the "best and the brightest," along with the new "masters of the universe" who replaced the old ones after the financial crash that tem­porarily humbled Wall Street. Mindfulness may have roots in an ancient religion, but the Valley's imprimatur estab­lished that it was rational, scientific, and forward-looking.

To the tech industry, the great advantage of mindfulness is that it seemed to be based firmly on science; no "hippie bullshit" or other "woo-woo" was involved.

 Positive think­ing had never gained much traction in Silicon Valley, possi­bly because the tech titans needed no help in believing that they could do (or hack or disrupt) anything they set out to do. The other problem with positive thinking is that despite the efforts of PhD-level "positive psychologists," it had no clear scientific backing and in fact bore a strong resem­blance to "magical thinking"—"If I think it, it must be so." But advocates of mindfulness could always point to a 2004 study by a neuroscientist showing that Buddhist monks with about ten thousand hours of meditation under their belts had altered patterns of brain activity?

86 87



 Shorter bouts of meditation seemed to work at least temporary changes in novices The field of "contemplative neuroScience" was born, and Silicon Valley seized on it for a much-needed "neural hack." Through meditation, monastic or app guided, anyone could reach directly into their own moist brain tissue and "resculpt" it in a calmer, more attentive di­rection. Mindfulness, as its promoters put it, fosters—or as it is often put, even "induces"—"neuroplasticity'

"Neuroplasticity" is an impressively scientific-sounding term, but it is an innate property of neuronal tissue, which persists whether we make a conscious effort to rewire our brains or not. Everything we experience subjectively, every thought and emotion, produces at least transient physi­ological changes in the brain. Trauma and addiction can lead to longer-lasting changes; even fleeting events may leave the chemical traces in the brain that we experience as memory. In fact, "plasticity" is a pallid descriptor for the constant, ongoing transformation of brain tissue: Neurons reach out to each other through tiny membranous protru­sions called "spines," which can form or disappear within minutes or seconds. Spines appear to be involved in the formation of new synapses linking neurons, which in turn hold together the ever-changing structure of neural firing patterns. Synapses that fire frequently grow stronger, while the inactive ones wither. Well-connected neurons thrive while neglected ones die. There is even some evidence that neurons in mature animals can reproduce.

What there is no evidence for, however, is any particu­larly salubrious effect of meditation, especially in byte-sized doses. This was established through a mammoth federally sponsored "meta-analysis" of existing studies, published in 2014, which found that meditation programs can help treat stress-related symptoms, but that they are no more effective in doing so than other interventions, such as muscle relax­ation, medication, or psychotherapy. 2' 

There is no excuse for ignoring this study, which achieved worldwide atten­tion. So 

maybe meditation does have a calming, "centering" effect, 
but so does an hour of concentration on a math problem or a glass of wine with friends. 
I personally rec­ommend a few hours a day with small children or babies, 
who can easily charm anyone into entering their alternative universe. 
As for Silicon Valley's unique contribution, mind­fulness apps, a recent study concluded that there is an almost complete lack of evidence supporting the use­fulness of those applications. We found no randomized clinical trials evaluating the impact of these applications on mindfulness training or health indicators, and the po­tential for mobile mindfulness applications remains largely unexplored.30

For an industry based on empirical science and employing large numbers of engineers, Silicon Valley has been remark­ably incurious about the scientific basis of mindfulness—probably because the "neuroplasticity" concept is just too al­luring. The line of reasoning—or, I should say, analogizing—goes like this: If the brain can be rescuipted through con‑scious effort, then mindfulness is as imperative as physical exercise; the brain is a "muscle," and, like any muscle, in need of training. 

88 89

The metaphor of mind-as-muscle is almost ubiq­uitous in the mindfulness industry. For example, one popular and highly rated mindfulness app, c11ed "Get Some Headspace," advertises itself as a "gym membership for the mind:' Google's chief motivator, Chade-Meng Tan, whose of­ficial corporate title was "Jolly Good Fellow," installed the company's mindfulness training program, "Search Inside Yourself," in 2007, later telling the Guardian:

If you are a company leader who says employees should be encouraged to exercise, nobody looks at you funny... . The same thing is happening to meditation and mindfulness, because now that it's become scientific, it has been demys­tified. It's going to be seen as fitness for the mind.3'

So it's not "science" that legitimates mindfulness practice. The only thing that science contributed was the notion of neuroplasticity, which morphed into the mind-as-muscle metaphor, which in turn suggested the metaphor of mind­fulness as a form of fitness training. The mind can be con­trolled much as the body can—through disciplined exercise, possibly conducted in a special space, like a corporate medi­tation room, which, Tan suggests, should be seen as no more outré than the company gym.

Of course, there is a slight metaphysical mystery here: Who is in charge? In the physical fitness case, the duality lies only between the body, which was thought to be inert, and the mind, imagined as an immaterial essence—the site of "I" or "us." 

But if the mind has also been reduced to a substance, though fortunately a malleable one that can be molded and controlled, then where is the "I"? This is one of the paradoxes of the endeavor to use the mind, conceived as a conscious agent, to control itself. 

Ruby Wax, a high-profile British mindfulness teacher and promoter, seems to hint at the problem when she says:

The difficult thing is, your brain can't tell there's something wrong with your brain. If you have a rash on your leg, you can look down and see it. But you don't have a spare brain to make an assessment of your own brain. You're always the last to know—that's the bitch.32

But whichever prevails in the mind-body duality, the hope, the goal—the cherished assumption—is that by working together, the mind and the body can act as a per­fectly self-regulating machine. 

Certainly the body had seemed willing to cooperate ever since the 1932 publication of physiologist Walter B. Cannon's book The Wisdom of the Body, which laid out the delicate mechanisms of homeosta­sis, through which the body attempts to keep blood sugar level, acid/base balance, and body temperature at constant "normal" levels. 

Now add in the brain, with its ability to send the individual mind ranging out into the collective mind represented by books, experts, and the Internet—bringing back important new information: 

Eat more veg­etables (or turmeric, or whatever is fashionable at the mo­ment); 
exercise daily; 
take time to unwind. 
Combine mind plus body with freshly updated data, some of it perhaps col‑lected on your self-monitoring devices, and act quickly to generate fresh instructions to forestall any looming prob­lems. 

This, I imagine, is how Silicon Valley "immortalists" spend their time—scanning all the health-related informa­tion and instantly applying it—which may seem a small price to pay for eternal life.90 



214 ENDNOTES ENDNOTES 215

CHAPTER FIVE: THE MADNESS OF MINDFULNESS

1. Deepak Chopra, "How to Start Listening to Your Body," Oprah.com, www.oprah.com!spirit/How-to-Start-Listening-to-Your-Body.

2. Michael Taylor, "What Does 'Listen to Your Body' Actually Mean?," mindbodygreen, November 15, 2013, wwwmindbodygreen.com/0- 11660/what-does-listen-to-your-body-actually-mean.html.

3. "Manichaeism," Wikipedia, https://en.wikipedia.org/wiki/ Manichaeism.

4. Quoted in Susan Bordo, Unbearable Weight: Feminism, Western Culture, and the Body, 10th anniversary ed. (Berkeley: University of California Press, 2003), 148.

5. "New Microsoft Study Shows Rapid Decline in Attention Spans," Mrs. Mindfulness, http :!!rnrsmindfulness.com!new-microsoft-study-shows-rapid-decline-attention-spans!.

6. Alan Schwarz, "The Selling of Attention Deficit Disorder," New York Times, December 14, 2013, www.nytimes.com/2013/12/15! health/the-selling-of-attention-deflcit-disorder.html ?pagewanted =all&_r0.

2. Ibid.

3. Lizette Borreli, "Human Attention Span Shortens to 8 Second Due to Digital Technology: 3 Ways to Stay Focused," Medical

Daily, May 14, 2015, wwmedicaldaily.com!hunianattenti

on‑span-shortens-8-seconds-due-digital- technology- 3-ways-stay-focused-333474.

4. Ruth Buczynski, "Do Electronic Devices Affect Sleep?," National Institute for the Clinical Application of Behavioral Medicine, wwwnicabm.com/brain-electronics-the-brain-and-s1eep54892!

5. Steve Silberman, "The Geek Syndrome," Wired, December 1, 2012, http://archive.wired.com/wired/archive/9.12/aspergers _pr.html.

6. "Silicon Valley syndrome," Urban Dictionary, www.urban dictionary. com!deflne.php?term= Silicon +Valley+syndrome.

7. Rebecca Greenfield, "Digital Detox Camp Is So Easy to Hate," At­lantic, July 9, 2013, wwwxheatlantic.com/technology/archive/ 2013/07/digital-detox-camp-so-easy-hate/313498/.

8. Farhad Manjoo, "Silicon Valley Has an Arrogance Problem," Wall StreetJournal, November 3, 2013, www.wsj-com/artides/ SB10001424052702303661404579175712015473766.

9. Evgeny Morozov, "The Perils of Perfection," New York Times, March 2, 2013, www.nytimes.com/2013/03/03/opinion/sunday/ the-perils-of-perfection.html ?r=0.

10. Liat Clark, "Vinod Khosla: Machines Will Replace 80 Percent of Doctors," Wired, September 4, 2012, wwwired.co.uk/news/ archive/2012-09/04/doctors-replaced-with-machines.

5. Dave Asprey and J. J. Virgin, 7heBulletproofDiet: Lose Up to a Pound a Day, Reclaim Energy and Focus, Upgrade Your Life (New York: Rodale, 2014), ebook, location 125.

6. Ray Kurzweil and Terry Grossman, Fantastic Voyage: Live Long Enough to Live Forever (New York: Rodale, 2004), 141.

7. Ibid.

8. Betsy Isaacson, "Silicon Valley Is Trying to Make Humans Immortal—And Finding Some Success," Newsweek, March 5, 2015, www.newsweek.com!2015!03/13!silicon-valley-trying-make-humans-immortal-and-finding-some-success-3 11 402.html.

9. Jeff Bercovici, "How Peter Thiel Is Trying to Save the World," Inc., July/August 2015, www.inc.com/magazine/201 507/jeff-bercovici!can-peter-thiel-save-the-world.html.

10. Line Goguen-Hughes, "Mindfulness and Innovation," Mindful, November 9,2011, wwwmindful.org/mindfulness-and-innovation/.

222 ENDNOTES

22. Soren Gordhamer, Wisdom 2.0: Ihe New Movement Toward Pur­poseful Engagement in Business and in Life (New York: HarperOne, 2013), 4.

23. Katie Hing, "Monk Who Inspired Gwyneth Paltrow and Emma Watson Now Worth £25 Million," Mirror, July 4,2015, wwwmirror.co.uk/3am/celebrity-news/monk-who-inspired-gwyneth-paltrow-6003291.

24. Bill Barol, "The Monk and the Mad Man Making Mindfulness for the Masses," Fast Company, January 28, 2015, wwwfastcompany.com/3041402/body-week/the-monk-and-the-mad-man-making-mindfulness-for-the-masses.

25. Erin Anderssen, "Digital Overload: How We Are Seduced by Dis­traction," Globe and Mail, March 29, 2014, www.theglobeandmafl.com/life/relationships/digital-overload-how-we-are-seduced-by-distraction/article 1772 5778/?page= all.

26. HarperCollins New Zealand promotional page for Soren Gord-hamer, Wisdom 2. 0, www.harpercollins.co.nz/9780061899256/ wisdom-2-0.

27. David Gelles, "The Mind Business," Financial Times, August 24, 2012, wwwft.comuintl/cms/s/2/d9cb7940-ebea-1 1e1-985a-00144feab49a.html#axzz24gGdUpNS.

22. Marc Kaufman, "Meditation Gives Brain a Charge, Study Finds," Washington Post,January 3,2005, www.washingtonpost.com/ wp-dyn/articles/A43006-2005Jan2.html.

24. http://arcbinte.jamanetwork.com/article.aspx?articleid=1809754.

22. I. Plaza, M. M. Demarzo, P. Herrera-Mercadal, and J. GarcIa-Campayo, "Mindfulness-Based Mobile Applications: Literature Review and Analysis of Current Features,"JournalofMedical In-ternet Research mHealth uHealth 1, no.2 (November 1, 2013), wwwncbi.nlm.nih.gov/pubmed/25099314.

Jo Confino, "Google's Head of Mindfulness: 'Goodness Is Good for Business," Guardian, May 14, 2014, www.theguardian.com! sustainable-business/google-meditation-mindfulness-technology.

Emily McManus, "Why Aren't We Asking the Big Questions? A Q&A with Ruby Wax," TED Blog, October 10, 2012, http ://blog.ted.com/why-arent-we-asking-the-big-questions-a-qa-with-ruby-wax!.





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The Art of Dying Well by Katy Butler - Ebook | Scribd

The Art of Dying Well by Katy Butler - Ebook | Scribd



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The Art of Dying Well: A Practical Guide to a Good End of Life
By 
Katy Butler

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This “comforting…thoughtful” (The Washington Post) guide to maintaining a high quality of life—from resilient old age to the first inklings of a serious illness to the final breath—by the New York Times bestselling author of Knocking on Heaven’s Door is a “roadmap to the end that combines medical, practical, and spiritual guidance” (The Boston Globe).

“A common sense path to define what a ‘good’ death looks like” (USA TODAY), The Art of Dying Well is about living as well as possible for as long as possible and adapting successfully to change. Packed with extraordinarily helpful insights and inspiring true stories, award-winning journalist Katy Butler shows how to thrive in later life (even when coping with a chronic medical condition), how to get the best from our health system, and how to make your own “good death” more likely. Butler explains how to successfully age in place, why to pick a younger doctor and how to have an honest conversation with them, when not to call 911, and how to make your death a sacred rite of passage rather than a medical event. This handbook of preparations—practical, communal, physical, and spiritual—will help you make the most of your remaining time, be it decades, years, or months.

Based on Butler’s experience caring for aging parents, and hundreds of interviews with people who have successfully navigated our fragmented health system and helped their loved ones have good deaths, The Art of Dying Well also draws on the expertise of national leaders in family medicine, palliative care, geriatrics, oncology, and hospice. This “empowering guide clearly outlines the steps necessary to prepare for a beautiful death without fear” (Shelf Awareness).
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Scribner
Release date
Feb 19, 2019
ISBN
9781501135323

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The Art of Dying Well: A Practical Guide to a Good End of Life Hardcover – 1 April 2019
by Katy Butler (Author)
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A reassuring and thoroughly researched guide to maintaining a high quality of life—from resilient old age to the first inklings of a serious illness to the final breath—by the New York Times bestselling author of Knocking on Heaven’s Door.

The Art of Dying Well is about living as well as possible for as long as possible and adapting successfully to change. Packed with extraordinarily helpful insights and inspiring true stories, award-winning journalist and prominent end-of-life speaker Katy Butler shows how to thrive in later life (even when coping with a chronic medical condition), how to get the best from our health system, and how to make your own “good death” more likely. This handbook of step by step preparations—practical, communal, physical, and sometimes spiritual—will help you make the most of your remaining time, be it decades, years, or months.

Butler explains how to successfully age in place, why to pick a younger doctor and how to have an honest conversation with her, when not to call 911, and how to make your death a sacred rite of passage rather than a medical event.

This down-to-earth manual for living, aging, and dying with meaning and even joy is based on Butler’s own experience caring for aging parents, as well as hundreds of interviews with people who have successfully navigated a fragmented health system and helped their loved ones have good deaths. It also draws on interviews with nationally recognized experts in family medicine, palliative care, geriatrics, oncology, hospice, and other medical specialties. Inspired by the medieval death manual Ars Moriendi, or the Art of Dying, The Art of Dying Well is the definitive update for our modern age, and illuminates the path to a better end of life.
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Review
“Butler’s factual, no-nonsense tone is surprisingly comforting, as are her stories of how ordinary folks confronted difficult medical decisions… Her thoughtful book belongs on the same shelf as Atul Gawande’s best-selling Being Mortal and Barbara Ehrenreich’s Natural Causes.”
—The Washington Post

“A better roadmap to the end… combines medical, practical, and spiritual guidance.”
—Kate Tuttle, The Boston Globe

"A commonsense path to define what a 'good' death looks like."
—USA Today

“An empowering guide that clearly outlines the steps necessary to avoid a chaotic end in an emergency room and to prepare for a beautiful death without fear.”
—Shelf Awareness

“Straightforward, well-organized, nondepressing… Free of platitudes, Butler’s voice makes the most intimidating of processes—that of dying—come across as approachable. Her reasonable, down-to-earth tone makes for an effective preparatory guide.” 
—Publishers Weekly

“This book is filled with deep knowledge and many interesting experiences. It is a guide for staying as healthy and happy as possible while aging, and also shows how important it is to be medically informed and know our rights in the communities where we live, in order to stay in charge of our lives and therefore less afraid of the future. Katy Butler has written a very honest book. I just wish I had read it ten years ago. You can do it now!”
—Margareta Magnusson, author of The Gentle Art of Swedish Death Cleaning

“The Art of Dying Well is a guide to just that: how to face the inevitable in an artful way. Katy Butler has clear eyes and speaks plainly about complicated decisions. This book is chock-full of good ideas.”
—Sallie Tisdale, author of Advice for Future Corpses

“In plain English and with plenty of true stories to illustrate her advice, Katy Butler provides a brilliant map for living well through old age and getting from the health system what you want and need, while avoiding what you don't. Armed with this superb book, you can take back control of how you live before you die.”
—Diane E. Meier, MD, Director, Center to Advance Palliative Care

“No, you won’t survive your death, but you can live until the very last moment without the pain and humiliation that inevitably accompany an over-medicalized dying process. Katy Butler shows how, and I am profoundly grateful to her for doing so.” 
—Barbara Ehrenreich, author of Natural Causes

“This is a book to devour, discuss, dog-ear, and then revisit as the years pass. Covering matters medical, practical, financial and spiritual – and, beautifully, their intersection – Katy Butler gives wise counsel for the final decades of our ‘wild and precious’ lives. A crucial addition to the bookshelves of those seeking agency, comfort and meaning, The Art of Dying Well is not only about dying. It’s about living intentionally and in community.”
—Lucy Kalanithi, MD, FACP, Clinical Assistant Professor of Medicine, Stanford School of Medicine

“The Art of Dying Well is the best guidebook I know of for navigating the later stages of life. Katy Butler’s counsel is simple and practical, but the impact of this book is profound. A remarkable feat.”
—Ira Byock, MD, author of Dying Well and The Best Care Possible, Active Emeritus Professor of Medicine, the Geisel School of Medicine at Dartmouth

Praise for Katy Butler and Knocking on Heaven's Door

“This is a book so honest, so insightful and so achingly beautiful that its poetic essence transcends even the anguished story that it tells. Katy Butler’s perceptive intellect has probed deeply, and seen into the many troubling aspects of our nation’s inability to deal with the reality of dying in the 21st century: emotional, spiritual, medical, financial, social, historical and even political. And yet, though such valuable insights are presented with a journalist’s clear eye, they are so skillfully woven into the narrative of her beloved parents’ deaths that every sentence seems to come from the very wellspring of the human spirit that is in her." -- Dr. Sherwin B. Nuland, author of How We Die: Reflections of Life’s Final Chapter

“Knocking on Heaven’s Door is a thoroughly researched and compelling mix of personal narrative and hard-nosed reporting that captures just how flawed care at the end of life has become." -- Abraham Verghese ― New York Times Book Review

“This is some of the most important material I have read in years, and so beautifully written. It is riveting, and even with parents long gone, I found it very hard to put down. ... I am deeply grateful for its truth, wisdom, and gorgeous stories—some heartbreaking, some life-giving, some both at the same time. Butler is an amazing and generous writer. This book will change you, and, I hope, our society." -- Anne Lamott ― author of Help, Thanks, Wow

"Shimmer[s] with grace, lucid intelligence, and solace." -- Lindsey Crittenden ― Spirituality and Health Magazine

"[A] deeply felt book...[Butler] is both thoughtful and passionate about the hard questions she raises — questions that most of us will at some point have to consider. Given our rapidly aging population, the timing of this tough and important book could not be better." -- Laurie Hertzel ― Minneapolis Star Tribune

"This braid of a book...examines the battle between death and the imperatives of modern medicine. Impeccably reported, Knocking on Heaven's Door grapples with how we need to protect our loved ones and ourselves." ― More Magazine

"A forthright memoir on illness and investigation of how to improve end-of-life scenarios. With candidness and reverence, Butler examines one of the most challenging questions a child may face: how to let a parent die with dignity and integrity. Honest and compassionate..." ― Kirkus Reviews

“Katy Butler’s science background and her gift for metaphor make her a wonderfully engaging storyteller, even as she depicts one of our saddest but most common experiences: that of a slow death in an American hospital. Knocking on Heaven’s Door is a terrible, beautiful book that offers the information we need to navigate the complicated world of procedure and technology-driven health care.” -- Mary Pipher ― author of Reviving Ophelia and Seeking Peace: Chronicles of the Worst Buddhist in the World

"Katy Butler's new book—brave, frank, poignant, and loving—will encourage the conversation we, as a society, desperately need to have about better ways of dying. From her own closely-examined personal experience, she fearlessly poses the difficult questions that sooner or later will face us all.” -- Adam Hochschild ― author of King Leopold’s Ghost and To End All Wars

"This is the most important book you and I can read. It is not just about dying, it is about life, our political and medical system, and how to face and address the profound ethical and personal issues that we encounter as we care for those facing dying and death. [This book's] tenderness, beauty, and heart-breaking honesty matches the stunning data on dying in the West. A splendid and compassionate endeavor." -- Joan Halifax, PhD, Founding Abbot, Upaya Institute/Zen Center and Director, Project on Being with Dying: Cultivating Compassion and Fearlessness in the Presence of Death

"This beautifully written and well researched book will take you deep into the unexplored heart of aging and medical care in America today. With courage, unrelenting honesty, and deepest compassion, ... Knocking on Heaven’s Door makes it clear that until care of the soul, families, and communities become central to our medical approaches, true quality of care for elders will not be achieved." -- Dennis McCullough ― author of My Mother, Your Mother: Embracing "Slow Medicine,'" the Compassionate Approach to Cari

"Butler’s advice is neither formulaic nor derived from pamphlets...[it] is useful, and her challenge of our culture of denial about death necessary...Knocking on Heaven’s Door [is] a book those caring for dying parents will want to read and reread. [It] will help those many of us who have tended or will tend dying parents to accept the beauty of our imperfect caregiving." -- Suzanne Koven ― Boston Globe

"Knocking on Heaven's Door is more than just a guide to dying, or a personal story of a difficult death: It is a lyrical meditation on death written with extraordinary beauty and sensitivity." ― San Francisco Chronicle

"[Knocking on Heaven's Door is] a triumph, distinguished by the beauty of Ms. Butler's prose and her saber-sharp indictment of certain medical habits. [Butler offers an] articulate challenge to the medical profession: to reconsider its reflexive postponement of death long after lifesaving acts cease to be anything but pure brutality." -- Abigail Zuger, MD ― New York Times
About the Author
Katy Butler’s articles have appeared in The New York Times Magazine, The Best American Science Writing, and The Best American Essays. A finalist for a National Magazine Award, she lives in Northern California. She is the author of Knocking on Heaven’s Door and The Art of Dying Well.
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Product details
Publisher ‏ : ‎ Scribner (1 April 2019)
Language ‏ : ‎ English
Hardcover ‏ : ‎ 288 pages
====
From other countries
SevenSevens
5.0 out of 5 stars A rare book and a must read for everyone
Reviewed in India 🇮🇳 on 20 February 2023
Verified Purchase
Not everyone is comfortable talking about death and the medical journeys that many of us or our loved ones go through. This book is insightful and comforting to have read if we are to ever feel challenged by life as we face death
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Hank Dunn
5.0 out of 5 stars Read it NOW and again and again.
Reviewed in the United States 🇺🇸 on 5 December 2019
Verified Purchase
“Dying peacefully in your own bed takes a lot of planning and preparation. Dying in an ICU, hooked up to machines, most often, is the accident.” I have said this repeatedly in my over 35 years as a nursing home, hospital and hospice chaplain. Katy Butler fleshes this out in "The Art of Dying Well: A Practical Guide to a Good End of Life."
A peaceful passing is not accomplished only by arranging for hospice and pain management in the last two or three days of life. Ms. Butler says the preparation starts years before. Of course, the obvious practical steps are important, like completing a “Living Will” and “Durable Power of Attorney for Healthcare.” I say “obvious,” but precious few people actually take the small number of minutes needed to complete these documents. So, perhaps, not so obvious, therefore, it needs to be said again, and again. Butler takes this preparation for dying well to a whole new level, way beyond pieces of paper.
The book is organized in seven chapters, each covering a phase from our healthy years to our final days. The chapters are: 1. “Resilience”; 2. “Slowing Down”; 3. “Adaptation”; 4. ”Awareness of Mortality”; 5. “House of Cards”; 6. “Preparing for a Good Death”; and 7. “Active Dying”. Each chapter starts by helping the reader identify whether he or she is in this phase… “You may find this chapter useful if…” and there is a list of signs marking that particular phase. For example, if “You can’t walk a half a mile unaided, unscrew a jar, or pick up a dining room chair” you may benefit with the information in chapter 5 “House of Cards.”
A recurring section in all but the last chapter is “Finding Allies in…”. These are healthcare professionals in every field from preventive medicine, physical therapy, house call programs, to hospice. Nurture your “tribe” too. While you are healthy, take care of your friends, neighbors (especially your younger ones), people in your faith community and family members—you may need to call on them someday.
Omitting “Finding Allies” from the “Active Dying” (the last hours or days of life) chapter says to me, if you haven’t been developing these relationships by your last days, it may be too late. Family and friends are really needed in this last phase. Could you ask your next-door neighbor to pick up some meds at the pharmacy if you have never met them? Build your tribe long before you need them.
If one waits until just a few days before dying to start preparations to have a peaceful death, it may be too late. A HUGE problem hospices face is last-minute admissions. It is a problem because it can take a several days to get all the necessary medical equipment into a patient’s home and find the best way to get pain under control. We are back to my “dying peacefully takes a lot of planning and preparation.”
Not to be overlooked in preparing for a peaceful end is the spiritual side of life. This may or may not be religious in nature. Butler points the reader toward many spiritual traditions with examples of prayers and rituals. Those who do not consider themselves to be religious will find resources here. The chaplain in me really appreciates this aspect being included in a book called “A Practical Guide”. Saying goodbye at the end of life IS a spiritual journey.
In the end, Butler turns to a healthcare system which makes dying well so much harder. The way our system works in the United States is doctors and hospitals are paid for doing stuff. The more aggressive the treatments… the more machines used… the more tests ordered and more needle sticks… the more providers are paid. We (through Congress and Medicare/Medicaid) have no problem spending $7,000 a day on a dying elderly patient in an ICU but cannot find the money for more physical therapy to help another old person live independently. A doctor can order pills for a frail patient that cost hundreds of dollars but can’t help them get food. Katy Butler, appropriately, encourages all of us to become activists in changing the way we care for, not just the dying, but those living with frail health throughout our declining years.
Get the book. Read it now. Read it again every time you find yourself moving from one of Butler’s phases to the next.

Hank Dunn, author of "Hard Choices for Loving People: CPR, Feeding Tubes, Palliative Care, Comfort Measures, and the Patient with a Serious Illness"
29 people found this helpful
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M. R. Reynolds
4.0 out of 5 stars A very good read
Reviewed in the United States 🇺🇸 on 9 November 2022
Verified Purchase
I live in a Christian senior community where death is no surprise or shock to anyone. Each individual chapter in the book has a good summary of that chapter's key points. One of the most important points in the book is to accept your mortality and don't blindly accept riding on the carousel of repeated circular trips to the E.R. (the gun and knife club). The good end of life part is when you know you are about to cash out in life's check out lane (my words) seek to surround yourself, if you can, with peaceful surroundings and family, which you won't find in the E.R. or in most intensive care units. Near the end of the book the author delicately mentions details about some who seek to hasten their death. One star off my rating because the author, also near the end of the book, dwells on non-Christian traditions.
5 people found this helpful
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A CPA and CFP® professional
5.0 out of 5 stars I didn't choose to be born, and I don't choose to die
Reviewed in the United States 🇺🇸 on 30 September 2019
Verified Purchase
I've read a lot of books on end-of-life planning lately. I'm doing a unit with my clients on "Getting Your Affairs In Order" just as a sort of "yep, checked that box" sort of thing. No one is imminently dying, as far as I know. But that's the thing with being a planner: you don't actually KNOW when, so best to know this stuff ahead of time in case you need it.

Like most books I've read on this topic, Katy Butler's "Art of Dying Well: A practical Guide to a Good End of Life" is sort of mixed up between talking to caregivers and the person who will be doing the dying. Some messages are easier to read when you imagine yourself as the caregiver, of course, but anything you learn in the course of being a caregiver you can pivot to use for yourself when the need arises.

Talking about death starts out stilted and hard, but quickly becomes sacred. It's like imagining a childbirth, all gross with blood and feces and unattractive uses of sexual parts. When you're distant from the occasion it's unseemly to give TMI. But when it's YOU having a baby, or your spouse, well: we want to know ALL the tricks for avoiding tears on the perineum, how to roll the nipples, what sort of car seat you want to have installed in advance.

Reading about death is much the same. In fact, one quote that stuck with me was "I didn't choose to be born, and I don't choose to die." It's a contemplation of the limits of our powers. Sometimes we're just swept along with these great forces and control is an illusion. You can meditate on that for yourself if you wish, it leads to useful places.

This entire book leads to useful places, in my opinion. Knowing when to post a MOLST on the fridge, knowing when NOT to call 911 (and what to do instead): this is useful information for most of us. It gives you some language to help interpret what doctors are trying to tell you, which I found helpful. She does this at various stages. When they say you're ill, asking what the progression of the disease will look like is more helpful, in some ways, than their estimate of how long you'll live. (The doctors routinely over-estimate how long you'll live, by the way. They may be thinking 3 to 6 months and tell you 6 months because they want you to have hope. But it can screw up planning!)

I'm a financial planner and this book isn't a clear win for the financial piece of it. That's Harry Margolis' "Get Your Ducks In a Row". But I liked this book better than the trollishly named "Advice for Future Corpses". Recommended.
25 people found this helpful
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SassyFpT
5.0 out of 5 stars Very important read for everyone
Reviewed in the United States 🇺🇸 on 5 June 2021
Verified Purchase
This is a book anyone should read. There are important actions everyone needs to take in order to make sure that your wishes are being met. There is sudden illness and health crisis and emergency where you may not be able to tell doctors and family what you want or don't want to happen now. There are wishes for your death that on my you know and maybe you have not even given thought, but you should. Age is no deterrent for death. It can happen just like that to you at your age right now.

Being prepared is not only good for you, but will aid your loved ones and your doctors. You could be in an accident and there suddenly are questions and critical decisions that only you can make, but if you are unconscious or unable to think, who then will know what it is you want to happen? Don't leave these possibilities undecided or in strangers hands, or worse burden your loved ones with such life or death death decisions.

This book is great, will take you through the steps everyone should take while in good health.

I'm chronically ill and I have long planned my last days, weeks or months, but this book explained much I didn't know and realize that I still needed to do and understand. This book is on my Kindle right up front, I often go back to read some sections again to make sure I have taken all the actions needed so my death will be following my wishes. Death may not be pain free and peaceful, it may be a struggle, but I know that at least my wishes have been made clear and everyone that needs to know my wishes knows them.
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RLL
5.0 out of 5 stars Great "how to" book
Reviewed in the United States 🇺🇸 on 11 February 2023
Verified Purchase
Similar to Atul Gawande's "Being Mortal", this book is, indeed, practical. It not only tells you about end-of-life problems, it tells you what to do and how to do it. If you don't want to die in a hospital devoid of friends and family, I would first read "Being Mortal" and then read "The Art of Dying Well".
2 people found this helpful
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Beth
5.0 out of 5 stars You MUST READ this - practical, realistic, not morbid, accurate - see the other reviewers
Reviewed in the United States 🇺🇸 on 26 April 2019
Verified Purchase
As a married, no children, baby boomer, I THOUGHT I had done everything legally necessary to prepare for our aging in place in an urban area. I have had the privilege of being at the deaths of my mother (65) at my age of 34, my father (87) at my age of 56 - both are at home, one with hospice, one without but an understanding physician who gave us adequate sedation. I also attended the date of my mother-in-law(91) - I was 62 yrs old then, in a hospice home in LA, Calif, in lieu of my only-child husband who was recovering from a brain infection occurring at the same time she became seriously and terminally ill. I myself have had numerous serious illnesses beginning in my late 20s, survived and am still here having interacted frequently over the years with the medical system for myself and family members. Upon retiring, I served as a hospice volunteer for 2 years in urban Montgomery County MD near NIH. I disagree with the hospice chaplain's review of this book. We have all our legal documents, advanced medical directive, DNRs, but I learned yet again, we need other directives I had never heard about. I will buy this on audio so my husband can listen to this as we make our frequent drives to our second home in a rural tidewater area on the Chesapeake Bay. This is a practical, positive guidebook. You should also read Atul Gawande's "Being Mortal" at the same time.
15 people found this helpful
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K. Mundie
5.0 out of 5 stars A Thoughtful Guide for End of Life Planning
Reviewed in the United States 🇺🇸 on 20 April 2022
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I originally got this book out of the library but realized I needed to buy it because it would be a book I would return to again and again while dealing with eldercare issues for my parents and in-laws.
The book is an excellent and up to date guide for the various stages of growing older and what older adults can do to live as independently and comfortably for as long as possible. The book as realistic tips and advice yet also takes into account the emotional elements to growing older and moving from independent living to interdependent living and then acceptance and care for the very end of life.
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chriswy
5.0 out of 5 stars An invaluable guidebook
Reviewed in the United States 🇺🇸 on 19 February 2019
Verified Purchase
Several years ago I entered my eighth decade still vital and vibrant until a cancer diagnosis divided my life into before and after. Up until then I had lived with little thought I would grow old and a confident reliance on the best modern high-tech medicine had to offer. My diagnosis was a wakeup call to live a better life. My treatment, though effective, was a confrontation with the limitations of modern medicine in the face of an aging and increasingly fragile body.

Katy’s first book, Knocking on Heaven’s Door, along with her public persona in the Slow Medicine movement, opened my mind to a new way of thinking about living, dying and the changing role of modern healthcare in an evolving, more patient-oriented, landscape. The Art of Dying Well is a new and much-needed companion for those of us on the far side of our midyears. It is practical - a map, a handbook, an ally - as we explore paths to resilience, decline, adaptation, acceptance, preparation and peaceful passing in an increasingly impersonal and over-medicalized healthcare system. My brand new copy, already inked, dog-eared and tattered is now beside me as I navigate my own journey forward. An excellent resource.
215 people found this helpful
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Scott S.
5.0 out of 5 stars Read if you think you might die
Reviewed in the United States 🇺🇸 on 10 May 2022
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This book is chock full of practical and thoughtful ideas and advice. It’s written in clear terms and doesn’t shy away from the mechanics of death and dying. The stories shared are Illuminating and often moving. I came away feeling validated about my helping friends and family as they died. I’m also thinking about what I want for end of life care.
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=====

The surprising comfort of a new book about death

Review by Michael Dirda
March 20, 2019 at 12:15 p.m. EDT

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The woods decay, the woods decay, and fall,

The vapours weep their burthen to the ground,

Man comes and tills the field and lies beneath,

And after many a summer dies the swan.

So begins Tennyson’s haunting poem “Tithonus,” a meditation on death as part of the natural order of things. Natural, that is, for everyone except Tithonus, to whom the gods granted immortality but not eternal youth. Thus he grows older and older, ever more feeble with each passing day, yet can never die.

Today, “Tithonus” seems an uncanny prevision of much contemporary medicine. Drugs and radiation, chemotherapy, ventilators, feeding tubes, medical drips and monitors — all these may be worth enduring when a reasonable hope exists for a return to the world outside the intensive care unit. But, suggests Katy Butler in “The Art of Dying Well,” for more dire cases, when there is no cure for the cancer or one is already old and frail, alternative courses of action may be preferable. Some noninvasive treatments and gentler medications may allow a life with dignity, even if a shorter one, and avert the suffering and purgatory of a living death.


The author Katy Butler (Camille Rogine)
Butler isn’t a doctor, but she is a professional science writer and author of the widely admired “Knocking on Heaven’s Door,” a critique of our broken medical system told through case histories and an account of her father’s traumatic last years. Not surprisingly, then, this “practical guide to a good end of life” delivers on its subtitle, offering detailed advice on dealing with — in poet Philip Larkin’s phrase — “age, and then the only end of age.” Butler’s factual, no-
nonsense tone is surprisingly comforting, as are her stories of how ordinary folks confronted difficult medical decisions. In short, if you’re coming up on three score and 10 or have already passed that biblical term limit for earthly existence, you will want to read “The Art of Dying Well” and keep it handy, if only for its lists of what to do as one’s physical condition changes.


Overall, Butler’s advice can be summed up in the Boy Scouts’ motto: Be prepared. If you’re merely approaching the end zone, do all you can to preserve your well-being. Exercise. Keep your weight down. Eat lots of vegetables. Control your blood pressure, cholesterol and sugar, ideally without medications or with the smallest dosages possible. Stay mobile, but watch out for falls. Be sure, too, that your financial and medical records are organized, comprehensible and digitally accessible to the appropriate people in case you are incapacitated.

‘Old Age: A Beginner’s Guide’: What you really need to know about life’s later years

After all, accidents and unexpected diagnoses happen, and no one knows when or from where the blow will fall. While you can, think through possible medical futures, however unpleasant. Do you wish to be kept alive no matter what, at any cost? Are there procedures you want nothing to do with? Whatever you decide, make sure that your family, friends and medical advisers are aware of your desires — and that you and they have the proper documentation to implement them. These start with a durable power of attorney for health care, so that someone you trust can make decisions if you can’t. You should also set up a living will or advance directive as a guide to what you want and don’t want if you land in the emergency room. Better still, consider the somewhat similar POLST or MOLST — physician or medical orders for life-sustaining treatment — which is more scrupulously honored by hospital personnel because it is signed by your doctor.

In general, Butler tends to be wary of the medical establishment. Pharmaceutical companies, hospitals, physicians and nursing homes make money on drugs and high-tech procedures, often overprescribing the former and automatically recommending the latter. Butler suggests that palliative care, milder, less invasive protocols and physical therapy are often underutilized, work well or well enough, and avert the ravages and often devastating aftereffects of expensive Hail Mary treatments.


(Scribner)
Throughout “The Art of Dying Well,” Butler stresses the vital importance of having what she calls a “tribe.” A tribe can be one’s extended family but might also include the neighbors you socialize with, or your bridge club and fishing buddies, or members of your church — in short, the people you care about and who care about you. What matters is that a tribe’s members are mutually sustaining: They help each other out. Loners don’t do well in old age.

Ditch the quest for eternal life and just enjoy the days you have

The need for a support circle grows particularly important for those who hope to die at home. Hospice care is invaluable — and Butler recommends starting it sooner than most people do — but its visiting providers are overworked, underpaid and too few. So you will need friends, family or hired caregivers to give you painkillers and sips of chicken soup. Of course, a rational society would properly tax its obscenely super-rich if only to pay better, more appropriate wages to hospital and hospice nurses, physician assistants and the aides in dementia wards and long-term nursing facilities. When you need to have your soiled linen changed, you will bless the one who does it.


The actively dying, Butler reminds us, are frequently troubled by unfinished business: They have regrets, want forgiveness, fear being utterly forgotten. Above all, they yearn to know that their lives had meaning. Some solace may be found in having been part of an enterprise larger than oneself — a religious faith, the education of children, the advancement of some area of art, science or scholarship, civic activism, the care of the sick and dying. There will, nonetheless, always be regrets.

Butler’s “The Art of Dying Well” covers much I haven’t touched on, including aging in place, Medicare, assisted suicide and last rites. Her thoughtful book belongs on the same shelf as Atul Gawande’s best-selling “Being Mortal” and Barbara Ehrenreich’s “Natural Causes.”

Michael Dirda reviews books each Thursday in Style.

THE ART OF DYING WELL
By Katy Butler

Scribner. 274 pp. $26

In deleted racist tweet, author Barbara Ehrenreich attacks Marie Kondo

In deleted racist tweet, author Barbara Ehrenreich attacks Marie Kondo


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In since-deleted xenophobic tweet, author Barbara Ehrenreich attacks Marie Kondo
Sarah Day Owen Wiskirchen
USA TODAY

Author Barbara Ehrenreich is known for books such as USA TODAY best-sellers "Nickel and Dimed: On (Not) Getting By in America," "Bait and Switch: The (Futile) Pursuit of the American Dream," and most recently, "Natural Causes," released in 2018.

But in a since-deleted xenophobic tweet, Ehrenreich made a comment about fellow author Marie Kondo that quickly went viral.

Kondo is the author of "The Life-Changing Magic of Tidying Up" and "Spark Joy," both international bestselling books. Kondo, who is Japanese, is also the star of a new Netflix show, "Tidying Up with Marie Kondo," in which she used a translator to communicate with English-speaking clients.

'Tidying Up with Marie Kondo':How do you neatly fold and store gender biases?


"I will be convinced that America is not in decline only when our de-cluttering guru Marie Kondo learns to speak English." Ehrenreich tweeted at 11:05 a.m. Monday.

Twitter users were quick to point out the problematic post. One wrote:

"I assume Barbara Ehrenreich will delete this racist/xenophobic tweet but let’s not forget that even otherwise “progressive” white folks have a huge capacity for racism."




In her bio, Ehrenreich defines her career as including essays and opinions "mostly on themes related to social injustice and inequality" and activism for issues including "peace, women’s rights, and economic justice."


Ehrenreich's tweet drew comparisons to the milkshake duck meme, which describes something with broad appeal and popularity, accepted as good or delightful, then problematic.



Used in this context, by another author: "And lo, the great and mighty milkshake duck raised its massive, dripping head from the fell swamp and claimed in its beaked maw the once bright Barbara Ehrenreich."


Ehrenreich later walked back her deleted tweet in a subsequent tweet, saying "it's OK with me" that Kondo doesn't speak English to an American audience:

"I confess: I hate Marie Kondo because, aesthetically speaking, I’m on the side of clutter. As for her language: It’s OK with me that she doesn’t speak English to her huge American audience but it does suggest that America is in decline as a superpower."

Her non-apology tweet was not well received.

Brave New Medicine | Physician | Alternative Medicine

Brave New Medicine | Physician | Alternative Medicine



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Brave New Medicine: A Doctor's Unconventional Path to Healing Her Autoimmune Illness Kindle Edition
by Cynthia Li MD (Author), Arlie Russell Hochschild (Foreword) Format: Kindle Edition


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In this revelatory memoir, Doctor Cynthia Li shares the truth about her disabling autoimmune illness, the limitations of Western medicine, and her hard-won lessons on healing—mind, body, and spirit.

Li had it all: a successful career in medicine, a loving marriage, children on the horizon. But it all came crashing down when, after developing an autoimmune thyroid condition, mysterious symptoms began consuming her body. Test after test came back "within normal limits," baffling her doctors—and baffling herself. Housebound with two young children, Li began a solo odyssey from her living room couch to find a way to heal.

Brave New Medicine details the physical and existential crisis that forces a young doctor to question her own medical training. She dives into the root causes of her illness, learning to unlock her body's innate intelligence and wholeness. Li relates her story with the insight of a scientist, and the humility and candor of a patient, exploring the emotional and spiritual shifts beyond the physical body.

Millions of people worldwide are affected by autoimmune disease. While complex conditions like chronic fatigue syndrome (ME/CFS) are gaining attention, patients struggling with these mysterious ailments remain largely dismissed by their doctors, families, and friends. This is the harsh reality that doctor-turned-"difficult patient" Li faced firsthand.

Drawing on cutting-edge science, ancient healing arts, and the power of intuition, this memoir offers support, validation, and a new perspective for doctors and patients alike. Through her story, you can find the wisdom and heart to start your own healing journey, too.
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“I love this book—a harrowing and somehow also charming account by a brilliant doctor of how 
she healed her body, mind, spirit, and soul from a debilitating autoimmune disease. After her doc- 
tors had given up on her, with a husband and two little children at home, she broke out of the 
constraints of Western medicine and found her way home to health, renewal, and her own true 
self. This beautifully written, prescriptive book is going to change—and even save—people’s 
lives.” 
—Anne Lamott, New York Times bestselling author of Bird by Bird and Almost Everything 
 
“Eat, Pray, Love meets Anatomy of an Illness meets a Deepak Chopra workshop in this engaging, 
exquisitely written doctor-as-patient memoir. Cynthia Li humbly, humorously, and honestly un- 
earths the roots of her debilitating illness, but the gifts don’t stop there. With 15 practical, ground- 
ed tips for how to heal, this book also serves as an unconventional, whole health prescription, 
sure to facilitate the healing journey of others. With raw transparency and the kind of courage we 
need among both doctors and patients, Brave New Medicine charts a new terrain, bridging conven- 
tional medicine with functional medicine, nutrition, environmental health, intuition, and spiri- 
tuality—all in a highly entertaining, hard-earned miracle story.” 
—Lissa Rankin, MD, New York Times bestselling author of Mind Over Medicine and The Daily 
Flame, and founder of the Whole Health Medicine Institute 
 
“In Cynthia Li’s spellbinding book, we encounter the moving story of a physician struggling with 
her own autoimmune illness. Li’s writing is so intimate—and so exacting—that it cuts like a knife. 
She raises fundamental questions about the future of medicine, her own future, and about being a 
doctor and a patient at the same time. The result is a beautiful book that will be read and remem- 
bered for years to come.” 
—Siddhartha Mukherjee, Pulitzer Prize-winning author of The Emperor of All Maladies 
 
“Each year brings a new stack of ‘how-to’ health manuals, but Cynthia Li’s book is different. It’s a 
moving, personal—and sometimes unsettling—investigation into the deepest questions sur- 
rounding chronic illness. What makes us sick? How do we live with the uncertainty of a myste- 
rious condition? How do we define health in an age when conventional medicine focuses almost 
exclusively on disease management? The answers Li arrives at in her exploration change her as a 
person, and the way she practices medicine. Her book is full of wisdom for both health care prac- 
titioners and those suffering from chronic illness.” 
—Chris Kresser, MS, LAc, New York Times bestselling author of Unconventional Medicine 
 
“It is a major concession to admit how much Li’s book inspired me, given how deeply skeptical I 
am about alternative medicine. When Li, a physician herself, develops a terrifying syndrome that 
regular medicine can’t even identify, she becomes her own doctor, charting her symptoms, doing 
experiments, and seeking help from whoever offers it. Emotionally, she rises from a crouch of de- 
feat to the confident stride of an explorer—and you will find yourself rising with her.” 
—Barbara Ehrenreich, author of Natural Causes, and founder of the Economic Hardship Re- 
porting Project 
 
“This is a memoir for our time. Cynthia Li is a superbly trained physician of internal medicine
====


Beyond Medicine: What Qigong Taught One Doctor About Healing


Cynthia Li

Almost 7 years ago, I met Master Gu for the first time. My former midwife-turned-friend and mentor, Yeshi Neumann, had invited me to his studio in Petaluma, CA, for a workshop. Innocent enough, I thought. Low risk. I was a doctor of internal medicine, trained to think critically and methodically, skeptical of anything that might fall into the realm of “miracles.” 

But I was also desperate. I had suffered for years with complex autoimmune conditions, including Hashimoto’s thyroiditis, chronic fatigue syndrome, fibromyalgia, and dysautonomia–the “shadow” conditions of Western medicine. 

Despite conventional treatments, my health continued to worsen. At one point, I was bed-bound for 6 months, housebound for 2 years. So when Master Gu encouraged us to practice every day, I figured I had nothing to lose. 

With my health brittle and my children young, I started with 15 minutes twice a day, doing sound healing practices. When I could stand erect to do movement forms, I began noticing, after years of chronic vertigo, that I could stand with my eyes closed. Gradually, I committed to practicing 45 minutes every morning. As I understood it then, mind-body practices were just another slice of the total pie of all the other health-promoting changes I’d already made by studying integrative and functional medicine: 
  • nutrient-dense diets, 
  • a rainbow of vitamins and minerals, 
  • a pocketful of herbs, 
  • sleep hygiene, 
  • gut healing, 
  • acupuncture, 
  • cranial osteopathy, 
you name it. 

My health was improving in numerous ways. No need to urinate throughout the night, an increase in appetite, stability in weight, and a lessening of vertigo, aches and fatigue. I was laboriously but gratefully moving toward 100 percent.

Then my health crashed. Again. Despite all I’d done, my entire stress system plummeted. I endured a 3-month period that felt like a prolonged near-death experience, terrifying not just because I was at the edge of life, but because many of my experiences fell into “mystical” or “energetic” realms, of which I wanted no part. 
Was I not already on the forefront of internal medicine, integrative and functional medicine, intuitive medicine? I realized what I knew was but a drop in the ocean. I didn’t need more information. I needed, in fact, a miracle. 

One of the primary things I did was to dive deep into qigong. I ramped my practice up to 2-2 1/2 hours a day, doing lachi and visualizations when I couldn’t get off the couch. I bought Master Gu’s textbook and Luke Chan’s 101 Miracles of Natural Healing, poring through and highlighting them as though medical textbooks. Master Gu and the 101 testimonials from the Medicineless Hospital in China reminded me that our bodies store the subconscious, complementing the theories I knew of epigenetics (how our thoughts and emotions and movement dictate the folding patterns of our DNA) and neuroplasticity (how the same factors change how our nervous system wires and rewires). In the framework of root-cause medicine, I realized I hadn’t gone deep enough. Down below the factors that cause disease and those that promote health, lay the mysterious qi energy. It wasn’t a slice of the health pie; it had the potential to be the whole pie itself. Qi surrounded and infused me, seen and unseen. But its potential depended upon two things: my capacity to tap into the qi field by my consciousness (the mind and heart), and my ability to activate its flow within my trillions of cells (the body). 

After a while, something shifted. I went from doing the practice as transactional (I practice in order to get better) to transformational (I practice because it connects me to the energetic source of healing, whereby the body heals as a side-effect). Healing the body as a side-effect! I’d done so much soul- and mind-centered work prior, but had somehow compartmentalized mind and spirit from the body. And as a doctor, my ultimate goal for myself and my patients was always to heal the body, too. 

Since the plunge into qigong, the trajectory of my health, for those who have witnessed it up close, would be categorized as a radical remission. It defies all medical explanation. I’ve also tapered completely off my levothyroxine, which I’ve taken for 14 years. My husband has been astonished, not fully grasping what’s going on, because on the outside, it seems I had always been doing everything “right.” Last week, my family took a river rafting trip in the desert canyons of eastern Oregon. For over a decade, this kind of trip was something I had to sit out. This time I went. And I paddled through rapids, hiked the shale hillsides, and slept under the twinkling of the Milky Way, feeling both like me, and not me, too. Perhaps this was a truer me than I’d ever known. All my husband could say was, “Whatever you’re doing, keep doing it.” 

Whatever I’m doing, I’m entering yet another paradigm shift. That is, learning that when we tap into Pure Consciousness, the complex prescriptions distill into golden simplicity. Food and air and water are sources of energy. So is qi. And in many ways, harnessing qi feels more important to me now than eating food. 

I hesitate to ever tout one practice as The Method, because like anything else in deep healing, it’s not one-size-fits-all. We’re unique beings with unique lineages and gifts and callings. Wisdom Healing Qigong connected me to my Chinese heritage in a way I’d never been before; it also transformed the trauma I experienced growing up in an evangelical community in Texas (the dualism of good and evil and the fear of being left behind) into one of the most powerful healing forces in my life now (God as pure consciousness, as the common origin of all, and Jesus as the embodied form of pure consciousness).

There’s so much I don’t know and can’t explain. It can only be experienced. But what I gather is this: nature’s laws are immutable. What we call miracles don’t defy these laws; they just access laws higher than we’ve previously encountered.

Published July 19, 2019