End-of-life anxiety and finding meaning in a collapsing climate

They call it the existential slap. It’s the shockwave that thunders through your psyche after your doctor tells you the electricity that’s been pulsing down your arm isn’t a pinched nerve. A shadowy ghost in the brain scan confirms there’s a tumour ballooning inside your head, and there’s nothing to be done to stop it.

In a stunned fog, you have to decide: poison your body with two or three rounds of brutal chemotherapy to buy a few more months; or forgo treatment and try to yield with equanimity to the inevitable. Either way, you have to begin wrapping up your affairs, and quickly.

An end-of-life counsellor recently told me that when most cancer patients break this kind of news to their loved ones, the response is usually a fiery defiance: you can’t give up, they’ll say, you have to keep fighting. There’s still hope. Try this diet or that operation.

Well-intended as this is, it only leaves the person feeling isolated and alienated. What someone needs in that moment, the counsellor said, is to be allowed to grieve. They need the space to simply unravel and experience the full spectrum of crushing emotions. It’s messy and ugly, it’s threatening to a helpless observer. But it’s a necessary part of accepting the shock of hearing that someone has a suddenly foreshortened life.

My existential slap arrived at about midnight in the middle of June this year. I’d spent the evening as part of a panel discussion that was trying to convince a small crowd of Capetonians that the record-breaking cyclones, heatwaves, floods and wildfires we’ve seen crowding out global news headlines in the past few years are a sign of just how unstable our climate has become. But, I kept urging the audience, there’s still a small window in which we can act before we fill up the atmospheric “landfill” with so much carbon pollution that we’ll tip the system into a new and unstable state that will wipe out our civilisation and most of life on Earth.

In the afterglow of the energising discussion, I found myself sitting cross-legged on my porch in the slumbering night with the meniscus of a quarter moon shimmering overhead. In that somnambulant stillness, something hit me with the force of a tectonic collision.

It’s actually too late.

Scientists had been sending reports from the Arctic earlier this year, documenting the rate of ice and permafrost thawing that they said was happening 70 years ahead of schedule. This wasn’t just an unnerving extreme weather event. This was a sign that we’re slipping across a tipping point into a new climate regime. It’s the point of no return. It’s game over.

The 1.5°C ceiling in global heating that the UN Intergovernmental Panel on Climate Change (UN IPCC) has been cajoling governments to aim for in their emissions reduction targets is a fantasy. We’ve already dumped so much carbon pollution into the atmosphere that we have a “baked in” temperature increase of 3°C, regardless of whether we shut off all emissions right now or not.

The actual emissions course we’re on, which is rising year on year, is accelerating us into what writer David Wallace Wells describes as an uninhabitable Earth. It’s just a matter of time before it hits us. Like the lag when you turn on the hot tap in a shower, even though the initial jet feels tepid, the scalding water is already in the pipe and it’s about to blast its way out.

This was the moment that vaporised any hope (that we can still fix the problem) and years of ongoing denial (that it’s not as bad as all that).

A few weeks earlier, I’d written a piece about how those at the frontline of climate science and activism are canaries in the coal mine as we run ourselves to exhaustion fighting society-wide inertia that ignores the evidence of the extent of carbon pollution and its impact on the climate system. After nearly two decades of writing about this topic, it seemed all that work had done little to disrupt the system and what had seemed like a remote threat to other people, yet to be born, might actually start to unfold within my lifetime. What, I pondered in that piece, was the point of keeping on with this work if no one was listening?

I still didn’t believe, though, that the battle was lost. But, at midnight in June, all that changed.

Like the delay between seeing a branch of lightning slamming into the ground, and the sound of the thunder eventually rolling through, it was only the next day, during a bog-standard telephone call, that the existential slap became a medical emergency.

Ten minutes into a conversation with a colleague, as we compared notes on a job, I unexpectedly dissolved into uncontrollable sobs.

Somehow, in the mess of it all, I managed to ring out a few soggy words.

“It doesn’t matter if I die now, or in 10 years; either way, it’s over. Our work isn’t going to stop this train smash. I don’t have any dependents. When you take a pebble out of a stream, the water quickly fills its space. In the bigger scheme of things, life will go on. It doesn’t matter if I’m here or not.”

“Leonie,” my friend said, “you know how dangerous this thought track is.”

I did. But it was like having brain concussion: part of me knew I should get medical treatment, but I was too dazed to figure out how to do that. Where are my car keys? Which emergency room do I drive to? What do I tell the admitting nurse when I get there; that I’m having a climate-angst induced breakdown?

Thanks to my friend, who has survived a mental collapse herself, within an hour I was in medical care, cowering in the corner of a therapist’s couch where I shivered like a storm-soaked mutt as we tried to figure out the best treatment route. How do you bring down the fever of someone who can’t escape the environment that’s causing the fever? You can’t step out of the sauna conditions of a collapsing climate.

“I feel like a cancer patient who has to decide between chemo or no chemo. Either way, the next few years are going to be painful, and brutal, and lonely. Whatever I choose, it’s a path I’m going to have to walk alone,” I said.

“So, this is about how you die alone,” my therapist reflected back.

I guess that’s it. How do you continue to live meaningfully when you realise that you have a suddenly foreshortened life, which may be filled with hardship?

Humanity is in an end-of-life crisis

I don’t use the cancer metaphor glibly. Many thinkers in the climate collapse community have used the hospice scenario as an analogy for the state of humanity at this unprecedented time of environmental breakdown.

Some in the psychotherapy community are getting wind of this. The International Journal of Applied Psychoanalytic Studies recently published a special edition on the mental health community’s need to respond to climate collapse.

“Living in a progressively more hostile and uncertain environment where governmental leaders do not give credence to the reality of the changes afoot may be experienced as a cumulative trauma, in which large groups may feel ‘gaslighted’ and terribly unprotected by their elected leaders,” the journal authors explain.

“The necessity for members of our field to apply psychoanalytic thinking to address this most pressing issue facing our species is not up for debate.”

The UN IPCC’s next big assessment of the state-of-climate science, due out in 2022, will give unprecedented attention to the mental health fallout from the acute stress of surviving extreme weather events, or the chronic distress of facing the existential threat of our own extinction.

The American Psychological Association has written extensively on this. The UK Council for Psychotherapy recently held a workshop on the role of their profession as society heads into climate collapse and mass extinction. The workshop asked how we move “from dread to resilience, from catastrophe to transformation, from helplessness to action, from fear to hope”.

Eco-psychology is a budding new movement.

There’s also an explosion of groups pulling together various spiritual approaches to deal with climate anxiety, which often draw on the work of environmental activist, author, Buddhist scholar and deep ecologist Joana Macy. Over the past four decades, Macy has designed processes aimed at building resilience for those working in environmentalism and her “work that reconnects” is regarded as the gold standard for processing ecological grief. There are many such groups emerging here in South Africa.

The books that rocked the boat

Three seismic publications may be part of the reason for the spreading social fever of climate anxiety.

First came the work of Professor Jem Bendell, from the University of Cumbria’s Institute for Leadership and Sustainability, who broke scientific protocol in 2018 by self-publishing a 34-page research paper after it was turned away by the Sustainability Accounting, Management and Policy Journal because the editors were worried about its potential emotional impact. In his hard-hitting and extensively referenced paper Deep Adaptation: A Map for Navigating Climate Tragedy, Bendell outlines why he believes the scientific data shows that near-term “climate-induced collapse is inevitable”. This is a reality which is often edited out of climate communications as a subtle form of the Overton Window – the range of ideas that are tolerated within public discourse – pressures scientists to tone down their messaging, in spite of the evidence.

Bendell’s paper went viral, and in the process birthed the “Deep Adaptation” movement, a conceptual map for how we can absorb the economic, political, social or environmental shocks coming our way.

Next came David Wallace Well’s Uninhabitable Earth: Life After Warming in early 2019, which paints an equally bleak picture.

In lockstep with that came Dahr Jamail’s The End of Ice: Bearing Witness and Finding Meaning in the Path of Climate Disruption, in which the former war correspondent “stitches together personal introspection and gut-wrenching interviews with leading climate experts”.

But there is also the possibility of recovery on the other side of this shattering awakening. Since publishing his paper, Bendell has been instrumental in setting up the Extinction Rebellion movement, cutting back his own work hours to pour more time into climate activism. He is also reaching out to the psychotherapy community in the UK to see how it can bring its expertise into the maelstrom.

“Good psychotherapy is not available to many people,” he said during an address to the UK Council for Psychotherapy recently. “And even if it is, then not regularly unless you are rich. It is also something that most people don’t look for. People who do not seek emotional support may be suppressing difficult emotions of sadness and fear, in ways that lead to the secondary emotions of anger, blame and hatred, as a means of escaping from their pain. That will make matters (in climate collapse) worse.

“Consequently, to help reduce harm from disruptions to our societies, there is a need for psychotherapeutic support to be provided, without request, across the whole of society.”

Jamail has also followed up his previous book with a new publication How Then Shall We Live? co-authored with Barbara Cecil, in which they speak about how each of us can find what it is we need to do “to really serve this planet”, even when we know it’s too late.

“Now is that time … don’t run around and panic. Don’t light your hair on fire. Don’t go out and see what other 10 more things you can do, or how many articles you can forward … just stop and get really, really quiet and touch down into the Earth and really listen and see what comes up into your heart.”

Jamail speaks about his own emotional coping efforts in this powerful interview, in which he reflects on losing a friend to cancer and how he’s applying the lessons from that experience to how he is living his life now, in the knowledge that so much life on Earth will be foreshortened because of climate collapse.

Pushing back against the Cassandra effect

I shared my own distress about the graveness of our “baked in” heating trajectory during a closed workshop recently, but the facilitator slapped me down for being too catastrophic. We’re not beyond hope, she insisted.

This backlash is predictable, probably because some still need hope, a form of denial, as a survival mechanism. A pendulum swing between denial and acceptance is apparently quite common for people who receive a terminal diagnosis.

According to the end-of-life counsellor, the facilitator’s reaction was typical of how people respond when a cancer patient tells their loved ones they’re going to die: you can’t give up hope, you just have to try harder to heal yourself.

If you’re not coping emotionally, the facilitator said, you just need to pray more, meditate harder, or get out into the mountains more often. Or just take a holiday.

What she doesn’t know is that’s exactly what I’ve been doing. On top of seeing a psychiatrist and a psychologist and taking meds. When you’ve already thrown all the big guns at your illness, and it’s still not enough, what do you do then?

While local author Helen Brain was penning her fictional Fiery Spiral trilogy for young adults, set in Cape Town in the year 2055, the post-apocalyptic world she was plotting out in her storylines were starting to look “uncannily” like the newspaper headlines she was reading each day. In the five years during which she wrote the three-part series, Donald Trump got into the White House and began turning back critical environmental legislation (this month, he begins the US’s formal withdrawal from the Paris Agreement); news of the planet-wide extreme weather events tipping me towards the edge were doing the same for her; and Cape Town’s Day Zero drama unfolded.

“How do you disentangle your professional catastrophising from reality?” she asked in a recent blog. “How do you cope with despair about the future and our continuing damage to the planet? If you’ve raised your kids and you’re reaching 60, why carry on living when the world is overpopulated and resources are running out?”

For some, the loss of their future is happening right now. Last week, Dr Mamphela Ramphele’s opening address at the Club of Rome’s global summit outside Stellenbosch (the speech was delivered on her behalf by her Club of Rome co-president Sandrine Dixson-Decleve) told the story of a community leader in the Amazon, fighting for his community to stay on ancestral land as corporate logging and big farming interests threaten to push them off.

“You talk about 2050, climate neutrality, and the Paris Agreement. But what does that mean to our community? Must we commit collective suicide in order to stay in our ancestral home?”

That Amazonian leader – and author Helen Brain and I – are not alone in our distress. Weekly, I have conversations with colleagues and strangers who privately raise similar concerns as they tentatively pull the curtain back on their darkest thoughts.

A therapist friend and I sometimes talk about how people plan their future when they’re knowingly living in “the departure lounge”: someone may have terminal cancer; another may have decided they’re done with the endless battle with treatment-resistant depression; someone else may be at the end of their natural life and want to take charge of their death with an intentional departure. More and more conversations are happening in private, in circles that overlap in the environmental world, with people whose retirement plan is an intentional departure. Some even have possible dates pencilled in their diaries.

This isn’t something they’d ever talk about at a dinner party, though.

The recovery curve: Denial, awakening, collapse, recovery

Woody Allen once quipped: “I’m not afraid of dying, I just don’t want to be there when it happens.”

We all know we’ll die eventually. But, as more of us wake up to the reality of climate collapse, we will have to go through an arc of personal collapse and recovery as we accept we are all living in the blast radius of a detonating planetary life-support system.

There is a clear story arc in my personal journey through the past gruelling year, one which seems to track what I’m seeing in others’ reflections, including from colleagues, what the American Psychological Association and the UK Council for Psychotherapy are saying, and the writings of people like Dahr Jamail and others: years of denial (“it’s not that bad, we still have hope”); shattering awakening (“it’s way, way worse than we realised”); emotional collapse (I spent 10 days in bed last month for no other reason than I just had to sleep off the accumulated fatigue of a year of being overwhelmed); to recovery (“how do I live a meaningful life, in spite of knowing the battle is lost”).

Since that day in June, when my therapist helped plot out an emergency treatment plan, I think I’m now on the right side of the recovery curve. But conventional psychotherapy may have its limitations.

As this blog points out, psychotherapy’s role is to repair something. How does it respond to people living in an unrepairable situation? Therapy’s function is to heal the individual. How does it respond when the illness is society-wide? It focuses on healing what has happened in the past. What do we do when today’s illness is because of what will unfold in our personal and collective future?

It’s this final phase of acceptance that’s important for the recovery, and where the skills of the hospice and palliative health community come in. It also brings to mind the work of American surgeon Dr Atul Gawande, whose book Being Mortal: Medicine and What Matters in the End reflects on what people need as they approach the end of their lives: not necessarily to have their time extended, but to find the richest and most meaningful way to live out their final weeks, days, and hours.

A large part of my own recovery is to keep on doing meaningful work: writing stories that try to convey the urgency of our ecological overshoot; working with others to plot ways to bring about political and economic disruption to the system that is plundering of the atmospheric space; and exploring innovative ways to help individuals and communities deal with the maelstrom of what is to come.

We may not be able to avert disaster but we can still support each other in it. And that’s why we need to keep on keeping on. Not because we can change the outcome, but because doing this work every day is the right thing to do. Right up until the end, whenever that may be. DM