Reframing The Stigma Surrounding Death and End of Life Experiences: An Interview With BJ Miller, MD

Reframing The Stigma Surrounding Death and End of Life Experiences: An Interview With BJ Miller, MD

What follows is a transcript for the podcast Home Grown Humans - BJ Miller, MD - Death - Hosted by Jamie Wheal

Topics include the following:

  1. Understanding one of the greatest mysteries of human experience
  2. Letting go of the shame associated with fearing death
  3. Death defined at the intersection of knowledge and belief
  4. Is consciousness limited to physicality?
  5. Standing at the edge of the abyss
  6. Religion’s role in end of life rituals
  7. What happens physiologically at death
  8. Unpacking the grief associated with death

Understanding one of the greatest mysteries of human experience

Jamie Wheal: I want to welcome BJ Miller, MD, hospice, and palliative care specialist who has, I think you're definitely one of the clearer voices advancing the conversation around rethinking our relationship to death and your beginner's guide to the end, your TED talk that has had lots of views, and clearly has struck a chord. Welcome to HomeGrown Humans.

BJ Miller: Thank you Jamie.

Jamie Wheal: The first obvious question I had for you, which was after reading in your bio that you had borne witness to, and facilitated the transition in over a thousand deaths, what is your perspective? What is your experience on fundamentally one of the great mysteries of the human experience?

BJ Miller: So, as happens, maybe, as you get farther into a subject, I have felt this way towards tea, I have felt this way towards music, where the pattern as you get into it, as you learn more, as you experience more, blah, blah, blah, I find myself getting very particular and wanting things a certain way, and finding a way to love the subject by manipulating it and getting very-

Jamie Wheal: What do you mean by that? That's a fascinating phrase.

BJ Miller: Well, by sort of taking death on, if death is something that happens to each of us, it's this wonderful mix of universal and totally particular. And so, if I embrace the particular of it, and so I had my own relationship to it, it forced me to do things. It made me take time seriously. It made me let go of taking time seriously, it has this way of, compelling you and allowing you to forgive yourself at the end of the day, which I love. It's got both sides of just about every coin I can imagine. And wanting deaths for people that I work with, patients, families, to go a certain way, erring towards the peaceful, towards this sort of a closure, towards some nice... Find a bow to put on it somehow.

But the farther I go along, and I think this is a good thing, I think this is a healthy thing, and I have, like I said, some comparisons in the rest of my life that we can talk about. But I find myself now after many years of this work, letting go of all sorts of projections, expectations, personal sort of stake in this thing, because the personal stake in this thing is pretty ego-driven, it's self-driven, there's a story to it. I'm much more interested in what's underneath the story, the pre-verbal stuff, and surfing it, where it will take me. In a way submitting to it, rather than trying to make it bend to me, is another way of putting it. And I have found, so now, where I am is, death has arrived at this sort of mundane place that I think it deserves to be.

You could label it with them any just about any adjective, sacred, profound. Sure. It is those things too, because it's everything, but it's also daily and humdrum and to be expected and probably not the end. In fact, we know it's not the end in some important ways. So, as I come full circle, I'm much less particular about it. I'm much less shocked by it. And it's settled into a relationship like you might settle into an old friend or an old blanket or something that you know pretty well, even though you don't know a totally well, and that's compelling. Yeah. It's arrived at a sort of mundane place for me, having toured the planet, toured the cosmos, and toured the sacred. I am back to seeing, maybe there's no difference between the sacred and mundane. Maybe it's all just one and we keep trying to label it, tease it out, name it, engineer it.

And there's plenty to say about that, but for me personally, sorry, I'm going on here, Jamie. But to answer your question for me, where I have arrived is essentially, that it's just part of life. It's like a need for air or water, or any other need or compulsion that we have. It's on that sweet list of fundamental things that humans do. Now, so I don't mean to say it's boring. It's amazing subject. It's just, I guess I've come to a place of some familiarity with it and I'm less shocked by it. But even as I say that, I want to just, and we can open any of this stuff up brother, of course, but I do think as, even as I say this, make that statement, I am very much aware, there's a little asterisk next to it, which is still death of me as a person is still an abstraction.

As close as I've come to it in my own life, working with others in their death or my own brush with death, I'm very careful to remind myself that I don't ever really know the subject and I should not seduce myself into... While it may feel familiar to a point, it's just to a point. And so I leave a little reserve, when I'm actually standing at the edge of my horizon, and it's really actually my time when I'm not just imagining it? I may freak the hell out. Who knows what I'm going to do. So I like to say that out loud to myself and others and just make space for, I don't know, there's plenty I don't know, and we'll see. But that, even that has become a source of love and curiosity and sweetness. I guess it's also mapped, mirrors my own maturity in life. I don't feel the need to know everything on some level. I don't know if that's resignation or maturity or who knows what, but it feels pretty good to me.

Jamie Wheal: Yeah. I always notice, whether it's some fictional retelling or something more historical of Spartans, Vikings, Lakota warriors, basically warrior societies, or any community where death is a clear and present danger. It could be the mountaineering community, it could be big wave surfing. It almost feels, well for one, there's the Valhalla thing of, today's a good day to die. My question isn't can I avoid it. We know we live way too close to the sharp end to kid ourselves about that, the question is can I navigate that transition with honor? And that's the victory, not cheating death, not Botox and fillers and endless life support.

BJ Miller: Right on.

Jamie Wheal: Right. And there's a degree of relief and satisfaction and gratification that, "Oh, okay, my number came up and I did it with dignity." Which, it feels so weird, and so fundamentally different than our contemporary whistling past the graveyard kind of expiration.

BJ Miller: Right on. And from where I sit, I don't know how you feel about that statement, but to me it's not just different. What you just described, I think, is a maturation. I think it's one of the ways you can tell that the U.S. As a country, per se, not skipping past the native history in this country, but the U.S. of A kind of last 200 and however many years. I think it's a tell how we treat aging and dying that we try to whistle past the graveyard to use your good phrase. That if I put on my critical hat, I think that is an incomplete, problematic take on death that doesn't do the subject justice, and doesn't do yourself justice and sets you up for our spectacular fall when death finally does come calling, and there's no more whistling.

So, in so many ways, if so much of a lesson points us back to, "Well, if I can't control this, then it becomes about how I handle it." Just like you were saying. And that's where so much of the action is of course, whether it's death or other things that happen to us that we didn't choose or couldn't control. And I see that, like I say, to me, that's a maturation to land where you just describe. And I do hold out hope that our country, our nation, our society, that we're having a moment around death, and that this could catalyze, be part of a new way of looking at ourselves in the world, a new way of appreciating life, a new way of appreciating nature. I think death has it in it to teach us a lot about all of those things.

Letting go of the shame associated with fearing death

Jamie Wheal: Well, and not intending this one to be a rabbit hole, because there's a main thread I absolutely want to stay on, but what's your take on like the Methuselah Project, Aubrey de Gray's life extension stuff, you and I were speaking at a Singularity U event in Africa, and he came on stage, and I just remember feeling just sort of torn between, on the one hand, this is super inspirational and really exciting, on the other hand, almost ghoulish juxtaposed against the amount of absolutely material visceral here and now suffering for people in these lives, and take your pick, whether it's the suicide epidemic and more people choosing to step off the mortal coil because they can't handle it than wars and natural disasters combined. You're like, "Whoa, that's a gut punch. We have to reckon with that," to the potential overpopulation, why would we be looking to extend and expand versus live long, die fast, clear the lane? Those kinds of experiences. So do you have a thought or a perspective on the kind of Silicon Valley techno-utopian project, cheat death?

BJ Miller: Yeah. Yeah, I don't know if you're good listeners, I feel like I'm smirking and that's a little on purpose. I do hold out a little, it's not contempt, just like a wink. "Okay, we'll watch you play that out, we'll see where you go, and hey, I don't know everything," but let's just take some of that, what you just said, Jamie. Let's open that up a little bit.

So, a moment ago I said as familiar as I've become with the subject to a point. I do hold out that I may lose my shit, as they say, when I'm getting close to my end. That's not, wouldn't be a failure in my book. In fact, one of the things I love about death is you can't fail it. You will succeed at dying. That is one of the most comforting thoughts that I have, because we're so performative. We're so trying to lever ourselves, wrench more and more out of ourselves, and we set ourselves up for the success-failure dynamic. We reify it at each other all the time, and there's something to it. I do it all the time. I hedge, I lever myself to get more out of my life, and that's okay. That's lovely. I'm all for it. But the idea of what death keeps doing is it says, every time you think you kind of have something, it's clear, death kind of reminds you what, you don't know, what you don't have.

It has a way of, in this way if you pursue it, it expands you, it expands your capacity to sit with maybe me freaking out at my own deathbed. That's just maybe what I need to do, and so I'm not going to hate myself for that. My preparation is not so much to not freak out, it's to not freak out at freaking out. It's like the secondary, sometimes people have to deal with depression. Then they have to feel ashamed to be depressed on top of it. Or some people like myself as a disabled person. I not only have to deal with disability and the pain and whatever goes with it, I have to be embarrassed too? That's ridiculous. And that's the stuff I'm trying to shave off. So it's more like it takes us to a sort of a meta level, you might say where you can watch yourself have all these reactions.

And the enemy here for me would be hating myself for having natural responses, or hating myself for being afraid. So death pulls us into this place where you have to make space for all of it. It really challenges the either-or thing. These dyads we keep setting up for ourselves. So back to your question, all this sort of rush for immortality, or at least life extension. I can watch that, even participate, and of course I'm not against life extension. I worry that it plays into the shame we already experience and foist on each other as we age and die. So if we hold out that you could succeed at living longer, well, we're also setting ourselves up for yet another thing to fail at.

And that seems to undermine the power of death on some level. And I'm very leery of that. But if I can hang out on my perch, I can applaud Aubrey. All the work that you're doing to, many people are doing to optimize our time on this planet and maybe even extend it, beautiful. That doesn't have to be pitted against death. It doesn't have to play into life versus death. I don't buy that. I think it's really important that death is part of life. And if I live a little longer, I'm all for that. Live a little better, great. That doesn't mean I have to hate death in order to lever myself that way. So, does that make sense a little bit, Jamie, what I'm saying as a response?

Jamie Wheal: Yeah, yeah, absolutely. And, you said something in your initial response where you said, "And we now know that death isn't the end," something to that effect. What did you mean by that? What is it that we now know?

BJ Miller: Well, we've known it for a while, it's just more that we so conflate life with my life. Then I further conflate my life with my ego or my identity. So we know we don't have a long time, that a body dies, put a body in the ground. It will decompose. That matter becomes other things. The energy transforms. There is no death of my atoms. There's no death of my molecules in this way. My body goes on to produce other forms of life. That's immortality. That sort of knocks on this idea of death being so final. So even just tracing the body, we know it does these things, it keeps going in these other ways. Or take the emotional plane, like being two humans who affect each other or with animals, or the emotional residue we leave. After you and I are done talking to Jamie, I'll still be thinking of you, hours and days and weeks and months from now, I'll be thinking about our conversation. It will live on in me, even though the conversation per se may have stopped.

So that keeps on playing out in some way. Our legacies are things that we leave behind, the people we touch, et cetera, all those things keep going. So, I'm not saying death-

Jamie Wheal: [crosstalk 00:18:39] Even epigenetic memory, like ancestral.

BJ Miller:

Absolutely, absolutely. Exactly. So on all these planes, this thing that feels so concrete, so foreign, isn't so concrete and isn't so foreign. We die all sorts of ways across our lives. We lose things. We lose parts of the body parts, images, relationships, et cetera. We have little deaths all the time. So-

Jamie Wheal: Now what about continuity? So because, and I'm going to bungle the research, but I seem to remember reading something in the last couple of years where it was basically just sort of, at least, hypothesizing slash somewhat proving some continuity or still coherence of consciousness and being post technical clinical flatlines. And on the one hand, that's neat, super interesting, fascinating, and on the other hand, I was like, oh shit, what about organ donation? Are you actually getting cut to pieces while there's a part of you that could still be in coherence? So help me with that. What do you do on your driver's license? Because of course you're like, "Hey man, if my number gets punched, of course I want to be supporting other people with organ transplants, with whatever." And on the other hand, no, I don't want to still be there, almost like a lock-in, getting dismembered by accident.

BJ Miller: Right, and I don't... Sorry, I don't know why I'm laughing. That's not funny, but... It would be a little awkward. I think it's definitely awkward.

Jamie Wheal: I'm not dead yet.

The Intersection of Knowledge and Belief

BJ Miller: Yeah. Right. They're good, Monty Python helped us with this too. So, right on. And this is where knowledge and beliefs, there's an interface here where we're tripping, there's limits to what we actually know, and then our beliefs might take over. And then from there it may be an embrace of not knowing your mystery and that's sort of our panoply. And so what you're pointing to is somewhere in that space between knowledge and belief. So we're left with, and this is part of the mundane thing of death at the end of the day, like "Right, I'm one guy, just one life of a gazillion. I'll do what I can, you know, we'll see. I'll pursue what, I'll know what I know, I'll try to know more, I'll try to be honest about what I don't know, and do my best." And my sense is it's the same way on this point.

Having witnessed deaths, having been at the deathbed, having been there after the death, having talked to people who've had near death experiences having come close to it myself when I was 19, all of those experiences, or should I say, none of those experiences suggest that there's some, when we're buggering the body after we're done dying, whether it's for organ donation or whatever, putting formaldehyde in it or whatever we do to our poor bodies when we're done with them, I've seen no evidence of distress or suggestion that we're actually quietly, secretly accidentally torturing each other or ourselves in that way after the death. That if consciousness exists as an intact thing, I would struggle to believe that it's limited in the ways that our bodily physiology is limited.

Maybe it is part of our physiology, but if it is, it's in ways that we don't yet understand, and I have to believe there's something independent of our consciousness from our bodies, my own gut sense and all my experience suggests that. Is that wishful thinking? Because God, I'd sure hate to think in all those deaths I've been around that I've actually been torturing people. So maybe it's my own bias, but I just don't believe that, I think consciousness is bigger than our bodies.

Is Consciousness Limited to Physicality?

Jamie Wheal: So what's your sense, then, if you were tentatively advancing the hypothesis, "I don't think that consciousness and presumably whatever our mediated selfhood is is actually limited to physicality." What's your take on where does it live?

BJ Miller: I don't think we have words or constructs for that yet, so we're going to keep bumping up against our human limits, our language limits to try to grope our way forward. We'll see where all that goes. We'll see where it lands us. I think we're onto something here.

And another thing reifying my statement there is my own experiences when I was in the hospital where I was pretty darn close to death, and there was a feeling of... and it was a feeling. I'm sure it had some thoughts too, but it was a sense, right? It was a sense that, "Maybe I'll die. Maybe I won't."

It wasn't a fatalism. It was just a deep acceptance, a deep knowing that my body had this, that what was playing out here, potentially, was a natural act that we are wired for on some level, and I just had to get out of its way. And with all the pain going on, it wasn't hard to get out of its way.

I felt to give it any word is limiting, but it's closest thing, I would say, would be peace, nonplussed, "I could go left. I could go right. Great." Either way, this is where I think of end of life. We use this phrase, "end of life, end of my life, end of your life, end of a life," but life keeps on churning, and I think that's a really important distinction, again, trying to get away from... not away from, but to put the ego in its place.

And the last, another sort of example, where I just experienced something of what we're talking about, I think, is in my own use of psychedelics, my own playing with these chemicals. And it is playing. I don't mean in a recreational, ha ha ha way, but there's a playfulness to it that feels right where you're breaking down and you're reconstituting a million different ways. You kind of watch yourself fall apart and come together, fall apart, come together.

And recently, I had an experience with DMT that put me in that place where I, BJ, wasn't really there. I was, and I wasn't. Like I say, I will trip over the words. There aren't words for it. But what was so stunning was you could see what exists underneath your ego. You can see what's underneath your identity. You could feel part of some rippling fabric that was churning in a way that was so massive, so hard to understand that we weren't going to get there with our brains alone as a feeling.

And it was like [inaudible 00:28:38] I realized how self-reflective we are. I'm constantly looking back on myself to tell myself what I should or shouldn't do. I'm constantly in this self-other engagement internally. I'm constantly stepping out of myself to look back at myself.

And when I took myself, BJ, out of that picture, there was this huge, vast, churning, creative life thing underneath this. And that was beautiful, and it was reassuring, and it just put my brain and its words and its thoughts in its place in a sweet way.

I love my brain. I love myself. I just need to not confuse it with everything else. There's a sort of proportionality that I'm looking for.

Does that make sense?

Jamie Wheal: Well, I'm super curious as to what was the plot of that experience in hyper [crosstalk 00:29:32].

BJ Miller: Well that's much the point. There really wasn't a plot. A plot is a narrative, is a story, is words, has these constructs, right? So there really wasn't a plot. It was a sensation. It was a feeling.

Every time I tried to write something or put into words, I am back in that reflective place where I'm out of it, looking at it. That's different than being in it. And so I was just in it. Whatever plots... there were some giddiness coming in and out of the experience and some stories I told myself as I watched my ego come back online. I could see my stories for what they were. I can love my stories. I love illusions. Let's just call them illusions. The problem is you conflate all these things, right?

So there really wasn't much of a plot. I played around in my integration moment trying to kind of assert one, but they all fell apart. Nothing lasted. Nothing stuck.

Jamie Wheal: I think it's either Heraclitus or it's William Blake, but it's as re-quoted by McKenna, but it's, "Nothing lasts, nothing lasts, nothing lasts) and nothing is lost."

BJ Miller: Amen. Right on. That sounds right onto me.

Jamie Wheal: For me, those experiences... I always get this kind of gut churning, queasy feeling that the game is afoot, the stakes are high, there's seven... there's an infinite, multidimensional chess match going on, and I've just been forgetting for a moment that all the extra layers of it, and I'm needed at full strength, and I'm required to be psyching the fuck up, and whatever I'm diddling around with down here in 3D is just the wrapper on a much more consequential thing.

It's almost like going out surfing and just feeling the pressure wave of 100-foot creatures swim by underneath you, and you're like, "Whoa."

BJ Miller: I get that rush on my motorcycle.

Jamie Wheal: You strike me... I mean, as you describe the formative experience of your accident in college, and in some respects, you are shamanically marked as Charon paddling the River Styx, right? I mean, you are an emissary between worlds.

BJ Miller: Feels that way. It does.

Standing At The Edge of The Abyss

Jamie Wheal: So I'm curious. I mean, you've had more laps than most people ever experience. Is there anything in your fact pattern of just the experiences you've had that leave you pondering? Do you have some hypotheses that most of us would not get the chance to see?

BJ Miller: I certainly wonder. I certainly love pulling my chair up to the abyss and staring into it. I love staring into the night sky. But part because there's no hypothesis there. I just love the feeling. I just love being at my own limits at the edge of where I merge with the universe or the cosmic soup as you put it. No, I don't know that I... like I say, sorry, I'm really checking my brain on your question. Do I have a hypothesis? I don't know that I do.

I don't know if that's reassuring or problematic, but I think that's my answer.

Jamie Wheal: I mean, to me, this is personal and this is true for me across a broad range of non-ordinary experiences, but I sort of find myself subscribing to a sort of agnostic gnosticism.

You're like, there's definitely real immersive experience that is effing the ineffable, it's the piece to the past with all understandings, whatever it is. But what to make sense of it, to extrapolate, or to codify seems like a fool's errand.

BJ Miller: Right on.

Jamie Wheal: And curiosity and attentiveness and openness seems just a more generative spot to stand.

BJ Miller: Completely. Right on, brother. Well, I mean, you just... and Quakers would say, "You speak my mind." I feel I would sign up for that religion that you just laid out. Sign me up. That's... yeah.

Religion's Role in End of Life Rituals

Jamie Wheal: What was... so speaking of that, right, I mean, obviously, various scholars would make the case in Ernest Becker's Denial of Death and that whole deep rich tradition would make the case that religion simply was, somehow, a construct for us to try and wrestle with the inevitability of death.

And then interestingly, I don't know if this goes hand in hand with that original requirement and obviously, we track civilization. We track some form of culture as death rights, the even extending of consciousness to Neanderthals because it looks like they did actually orient their bodies East, West or did some death preparation. They must have been thinking that this is a meaningful thing. Therefore, we're not going to confer to them what we used to keep for homosapien sapiens, right?

And I think it's fairly well established that in many vibrant experiential religious traditions around the world from indigenous shamanism through the Eleusinian Mysteries through quite a lot of rites of passage and initiations around the world, right, in themselves have created this psycho-social technology of death practices. 

And so what's your sense? Our buddy Brian Muraresku, he recently wrote a book called the Immortality Key which was basically about... it's a fascinating story. I mean, it's very much like a real world DaVinci Code. He's trained as a lawyer, but he then went to the Vatican, went into their Catacombs, studied for 10 years, ancient texts, the whole bit, but basically, a pagan continuity hypothesis that the Eleusinian... the psychedelic, psychoactive, death-rebirth, initiatory rituals of the Eleusinian Mysteries persisted into gnostic, first century Christianity, and lots of painstaking analysis, archaeo-chemistry, looking at pots and earthenware, the whole bit, right? And really just quoting time after time after time, different leaders, thinkers, artists, theologians, et cetera, commenting on, hinting, pointing on, "Hey, it's the Plato. The mysteries don't just teach us how to die a better death. They teach us how to live a better life," all these things.

So what's your sense, if you have one, on that sort of ubiquity and pervasiveness of practicing resurrection of death-rebirth rituals as seed bed or source of a shit pile of culture?

BJ Miller: I think part of that practicing resurrection is decentralizing your sense of self and living through others and being part of something outside of yourself that includes yourself, et cetera.

So I like to... I think it's really important in this that the thing that's not being resurrected... is the thing being resurrected or is not necessarily this limited version of ourselves, this narrow concrete. I am BJ. You are Jamie. I think the resurrection practice in daily life has a lot to do with yielding to how connected we are, how much I live through you and you through me and et cetera.

So, anyway, there's much to say about that, but I definitely think that that language that we're all pointing to a very similar thing here, that dying...

... very similar thing here. That dying, I don't know another way to put it there, why wait until death to die? It's not just a practice in the abstract. If I read any of those texts correctly, these deaths are happening not as an exercise, but part of what you got to key into is you're dying all the time. You're sloughing cells, the waste you make is death, little pieces of death. Like I was saying earlier, our sense of self. Yesterday is dead to us. It's in the past. This way where you're future oriented as we turn into our future, the past becomes something of a death. And I don't mean this just metaphorically. I mean just let yourself actually bake in that process that is happening. Whether you see it or not, it's happening all the time. And I think the joy is making that conscious. Of playing with that, rolling with that, delighting in that, feeling all the feelings that go with that. That, to me, is the practice.

So yes, I don't think we should practice our deaths in the abstract. I think we should look at how we're dying each moment and yet, and yet, and yet living each moment. And those two things are entwined. So even if you're just pursuing life, you will have to come to death. You will have to realize death as part of your pursuit of life, I think. And I think that's what Wendell Berry and others are trying to help us realize.

Jamie Wheal: And to your point about your own potential death, you say you might freak out, right? I think it's poetic to say practice resurrection. And it's poetic to say, hey, let go of our pain, our pleasure, our preferences. I was like, yeah, yeah. Right on, right on. Amen. Got it. Right?

BJ Miller: Right.

Jamie Wheal: But the reality is, is every single death, we absolutely white knuckle that shit. We absolutely don't want it to have to happen. There is a reflexive raging against the dying of the light. We're like, no, no, no, fuck it. I want this thing to work. I want to be seen or to win or to succeed or to be validated. And to have that stuff ripped out of our hands is always deeply uncomfortable, and I don't think we ever get over that. I constantly catch myself in that. I'm like, oh no, I've signed up for this. I'm totally down. And then it's like [inaudible 00:48:32] But not this time, not this wedding. So it feels like a perpetual tearing.

Yes. Yes. And this way, life in the mortal coil weight is. The first fucking thing we do when we come into this life is we wail. There's a violence to birth. There's a violence to death. These words, they have different meanings, but yeah, the tearing thing. That's why my sense, that's why I keep pointing us back to this meta level where peace is not being calm, peace is not hating yourself for not being calm, or something like that. There's something that a more durable peace allows for anything, in a way. It just doesn't grasp at it. It doesn't grasp at grasping.

So yeah, I feel that all the time. And I have started to equate those... One of the ways I know I'm alive often enough is that tension you're describing is actual pain. That's one of the things that tells me I'm actually still here, that I'm still going, is that I'm struggling. That's a sign of life on some level. So right on. We don't need to... Speaking of cosmic orphans, part of the cue for me in what you wrote about cosmic orphans, and even the concept, is don't orphan yourself. Don't leave part of yourself out of the equation. Positivism and trying to buffer ourselves against the negative, et cetera. Fuck that. To me, it seems like such a shocking waste of time, and what a boring life it would be to have no neuroses, no problems, no suffering, no pain, et cetera. No relevancy.

So anyway, yeah. I think like we were saying earlier, your opening question to me about what I've learned from death. Earlier on, like I was saying, our conversation is mirroring my own evolution on it, which is, I used to think the goal was comfort, the goal was peace. To keep the negative stuff out of the room, to keep the pain out of the room, all that stuff. No, no. That's like keeping life out of the room. No, no, no. I think it's much better. Yes, let's turn down the noise with morphine to some degree so that we can maybe be a little more present. Sure, I'm all for symptom management to a point. But that's step one, that's not the goal.

DH Lawrence's Poem The Ship of Death

Jamie Wheal: Now, I've only just come across this, so I'll be amazing and impressed if you've already tracked this. But have you come across DH Lawrence's poem The Ship of Death?

BJ Miller: Mm-mm (negative).

Jamie Wheal: So I backdoored into this. This was actually a friend of mine who's a Harvard psychologist who kept talking about Jungian psychology saying that the entire purpose of life is to build your ship of death. And I was like, oh, that's such a powerful, spooky, evocative phrase. Where did it come from? And then it turns out it comes from DH Lawrence. And he writes, it's got multiple verses, but he says, "Build, then, the ship of death. For you must take the longest journey to oblivion and die the death, the long and painful death, that lies between the old self and the new."

And then apparently, Jungians took that and then rolled it into this entire project or just body of reference that it is our goal to effectively make it from the idealistic, fundamentally adolescent, prejudging relationship through the tragedy into the post tragic. And the post tragic is... And in fact, I think in Tolkien, the elves are always talking about when they get to hop on those boats and fuck off and sail west, right? They're literally like, "Peace out, humans. Middle earth is overrated." And so that sense that the project of life is to build our ships of death feels... I haven't even, I'm delightfully not... I haven't wrapped my head around it yet, but it's just sitting here as something really neat to consider.

BJ Miller: Amen. Well, it's evocative as hell. It's a beautiful image. And yet another moment where I think he's telling us that death, oblivion, that's part of the deal. That's not some failing or some place to avoid, that's a place to go to. And it's almost, I think of skiing. I don't know if you're a skier, Jamie. When you learn, shit, I want to fly down this mountain going a zillion miles an hour, and it sounds scary and I don't know how to control that. And one of the first things, if you're going to get any good at skiing at all, you eventually have to learn that you actually lean downhill. You actually roll with it, you don't fight it. You move with it. I would imagine surfing's much the same. And that goes against some immediate reflexes. But once you're over that-

Jamie Wheal: And rock climbing too, right? You have to overcome the death instinct. If you cling to the rock, you lose your traction on your shoes.

BJ Miller: Right on. And I would say, you tell me, but the way to overcome death anxiety would be to go into it. I don't think you step around it. Because once you're in it, then you realize you have some agency, you have lines of sight. You're not as afraid because it's not this impending thing, it's in you, it's there, you're there.

So in so many ways, I think DH Lawrence is... One of the ways I'm reading what your quote there is, it's something like leaning downhill, find a way. This oblivion thing is part of the deal, so find a way to go to it, work with it, create towards it. Building a ship. That's a creative, beautiful, creative, functional, practical act too, right? You are creating something that wasn't there to help you wrap your head around and embrace a fuller truth, and the fuller truth includes death, the fuller truth includes oblivion. So I think all these guys are telling us to lean into this place. Go there. That's where the life is. Maybe that's ironic. It's probably only ironic because our language suggests so. But yeah, I don't think it's fundamentally ironic at all.

Jamie Wheal: It's counter-intuitive from reactive survival patterning. Right?

BJ Miller: Right, right.

Jamie Wheal: But once you override that, you realize it's actually the thing that keeps me alive. Doing the counter-intuitive, falling down the mountain. Attacking the hill, even though I'm afraid of the hill. Leaning away from the rock, even though I'm terrified of falling off the rock. All these things have the paradoxical benefit of actually alleviating your fears. It's the classic shit with attachment theory. I withdraw and I defend myself and I deny me and you mutuality and true love. Therefore, I'm far more likely to get kicked to the curb and be left alone, reinforcing my semantic imprint of scarcity. All that shit.

What Happens Physiologically at Death

Jamie Wheal: So we've been philosophical and somewhat humanistic in our conversations so far. But you got a MD at the end of your name. And I'd love to also just tack over to, so you said, hey, let's lean into this. Probably one of the things I'm most curious about, excited about, just look forward to exploring in dialogues like this with more friends, peers, and colleagues, is what I found myself stumbling on in the research for Recapture the Rapture was effectively what felt like the neurophysiological protocols for death rebirth practice.

I hadn't come across, maybe you have, but I hadn't come across prior anybody assembling them and making the correlation to the existing ethnographic literature, like what have we done as humans throughout history around this thing. But it for sure felt like there was correlations with, just again and again, different studies, different research, different modalities, things that offer a deep brainstem stimulative global systemic reset that often have a correlation with super low EEG delta wave states that quite often do something. Something with vagal nerve tone, just as one of our group mechanisms, may potentially, and I don't... This one, to me it's super important, but I don't know the interactivity. But something to do with our endocannabinoid system, in the sense of singling mechanisms and homeostatic metronomic function.

And then something to do with energy in the form of sound, light, vibration, AC current, DC current, pain, orgasm. Something stimulation, mass stimulation, of intensity to the nervous system. And then potentially a respiratory element, up to and including static apnea, seems to precipitate some form of lived and felt dying. And typically includes highly information rich, super salient interior experience therein. It's not I'm just cross-eyed and drooling, it's not I blanked out and had amnesia. It's like, oh my God.

I don't know if you know Karl Deisseroth's work at Stanford. He's the godfather optogenetics. And he just did a study, they published it in Nature, in the fall where they did it with epileptic patients and genetically modified mice with ketamine. Created a dissociative state, had this positive antidepressive effect. Then realized it was three hertz in certain brain regions, and went back in and electrically stimulated in the humans and optogenetically stimulated in the mice. The three hertz repeated and replicated the dissociative state, minus the compound, the pharmacology.

I just saw a radar plot study of 5-MeO-DMT that in peak 5-MeO-DMT, it was literally panhemispheric. Just the entire brain lit up in delta, lit up. MIT kinesiologists doing comparable studies with nitrous oxide and double amplitude delta wave activity, with obviously William James, Winston Churchill, all the folks who have ever testified that there's a fucking thing there, and it's super, super salient, high information.

So back to the, where do you think consciousness comes from? And here we appear to have, if you punch these buttons, and take your pick. You don't need all of them exactly right. Mix and match. But let's say, take two out of three and choose your own adventure. You're going to have a wild ride, Mr. Sonoran Desert Toad's wild ride. You're going to have an epiphanic experience, and potentially a neurophysiological discharge, reboot, global system reset, and recheck their homeostasis. So A, how does that track for you? And B, what the fuck? Because I think that's the cheap codes to the mysteries.

BJ Miller: Right on. Well, yes, that does make sense to me. That does smell right to me. That does smell like my own experience. So what is that? What's going on there physiologically? I think you might find... And I know there are words for this. You're more a student of this subject than I am, in a way. I don't read about it so much as I just go hang out in it. So I will fumble for the words, brother. But I do think what you are pointing to, first of all, yes, I believe there's something there. And I think it gets back to the damage we do with our adjectives of things being either good or bad.

You might describe all of the panoply of stimulation you just described, those are forms of stress, a coordinated stress to the system. And you get the feeling like cars want to be driven. You're not protecting a car by not driving it. In the same way, we have this massive, crazy physiological system that's intricate and profound and stunning, and it wants to be driven. It wants to ride. It wants to do its thing. So I think one of the things we're learning, we know, is there's such a thing as good stress, if we must give it an adjective.

Jamie Wheal: [crosstalk 01:02:01].

BJ Miller: Yes. Right on. Exactly. So holotropic breath work, it puts us in a little bit of what you're describing this vagal stimulation, this respiratory drive, some interaction with our neurochemicals in some way sets us into this state. What's that guy? Wim Hof and his breathing stuff and cold water. I think these are all pointing to whether... Or 5-MeO-DMT. They're different ways to do much the same thing, which is a coordinated stress to the system that lets our system do what it can do, what it wants to do. And in a way, you blow out the stick with the metaphor. My feelings, when I have those experiences, the sense is I'm blowing out my carburetors. And that's healthy, that's good. I feel lighter at the end of those stressful experiences. So there's something good in there, right? There's something alive in there.

How that works and all the myriad ways we might trip into it and make it more of our daily lives, rather than these esoteric experiences, that I'm very interested in. Because especially if you just follow the molecule DMT, if it's an all mammals, we make it all the time. These states that you're describing, these experiences that you're describing, if they are part of this natural makeup and they're among us all the time, it's just a matter of us accessing them. Well, I think over time, we can practice our access. We can notice it. I think we probably blow past a lot of these experiences just in the aesthetic. Just the feeling of being in the woods or a sunset, whatever lights you up.

But I think I'm very interested in the aesthetic domain. My sense is that we have access to ecstasy much of the time, but because of our distractions, our constructs or whatever, our agendas, this means to an endness, this strategic approach to life all the time, what we're doing now is for something later. I think that stuff gums us up and we're probably blowing paths. We probably have much more access to this zone that you're talking about than we realize. And we don't need to be in a yurt in the woods with the toad necessarily. That can help facilitate that pathway, open up that pathway, and in a way, familiarize ourselves with that place so that we're less likely to blow past it in our daily lives. But that's my sense, is these are very normal places in a way. I don't know. What do you think?

Jamie Wheal: I think I'm forever on the hunt for common sense cosmology. Fundamentally, it would be a 21st century Western Taoism or a transcendental existentialism. Just whatever the fuck is. People talk about relational formats. Is it lifelong monogamy, serial monogamy, polyamory, whatever, whatever, whatever. And you're like, let's just be what wants to be. And can we align our orienting generalizations so they are as close a match, versus us propping up the way things ought to be and we somehow decided? And then can we just work with what is?

And to your point about death, I loved your bit about you're going to succeed at it. So we should probably relax into that. And we should probably build, instead of what we're doing, which very much feels like King Canute, or the little Dutch boy with the fingers in the dike. We try to hold back a lot of reality. And the longer you hold it back... In fact, there's a book called Trickster Makes This World. It's a really neat treatise on exactly embracing the [inaudible 01:06:05]. He said if you try and deny, effectively, the unpredictable, the scary, the fickle, the whimsical of life, you invite chaos and cataclysm downstream. And I always think of the Glen Canyon Dam on the Colorado River in the Grand Canyon. You try and hold back nature and the rhythms of it, of flood and drought, how riverbanks and beaches and ecology and all of it are done. And all we do is we beckon to the equation cataclysm downstream.

BJ Miller: Amen. This is what I meant earlier about how we orphan ourselves. Internally, we orphan ourselves from nature, from our nature. And as you were talking to me, I'm right there with you. And I think what a disservice to their Western tradition that maybe we're... I don't know if we're coming to a close. Who knows. But the man versus nature bit. That was in all of our high school literature. It's certainly in the American experiment that nature's this thing to conquer or overcome, or somehow prop ourselves up against. What the fuck are we doing? What? Why? Of course we're alienating ourselves from reality, from nature. Explicitly, we are. And until we see ourselves, until we see human nature as part of nature writ large, I think we're going to continue to be at odds with ourselves around death and in so many other ways.

So right on. And I guess that was my feeling back in the hospital bed when I was near the end too. It's important to be overwhelmed at times, and I was overwhelmed. There was no choice. I had to submit to this idea of death being around the corner. It was the tonnage of pain, the tonnage of fear, of adrenaline coming at me. This was not an exercise. And in that, was it strength? I'm so glad I was overwhelmed. I actually don't mind being overwhelmed anymore. I actually look forward to it. It tells me a lot. It shows me a lot. 

Unpacking The Grief Associated With Death

Jamie Wheal: So something that I've just kind of glimpsed out of the corner of my eye, and I don't, I wouldn't in most situations even broach it, right? But as we see a move towards more... Basically increased grief, right, and a capacity to not be able to sort this out, and people are just fibrillating. And so whether it's the QAnon community, or anti-vaccine, magical thinking, conspiracy theories, millenarianism, like it's all coming undone, let's do something radical or drastic.

Most... Our conversation today has fundamentally been about, well, make peace with death, stop fighting, right? What I want to ask you is the exact opposite, because it seems to me that if conditions were to decohere, and you became somewhat convinced that the Mad Max hordes are coming for you, or the next Ebola, or whatever it would be, our number's up, and there's no way we're getting out of this. Or there is some happily ever after, and Heaven's Gate style, we want to actually accelerate our transition to get off this world of suffering, this mortal coil.

What is to prevent the rise of ecstatic death cults? And how would you make the case, which is not an opposition, I understand that it's a false paradox, but how would you make the case to say, "Actually, no. Don't slip out. Don't step out. Don't check out. Do rage against the dying of the light until the moment that it actually comes." How would... What case would you make, if you wanted to make one, to say, "Hey, this life is precious too." And we ought to put... You know, help us reconcile that paradox. Because I could see an awful lot more people, right, the diseases of despair there.

There was a story I heard that haunted me from a decade ago, which was the... Some members of the Yanomamo tribe down in the Amazon were so distraught with their loss of habitat, the encroaching of mining and logging, et cetera, that they were literally hanging themselves on jungle vines. Nothing abrupt or violent, just literally just collapsing, and literally giving up the ghost. Right? So how do we... How do we take a stand against that? Or acknowledge it and wait for it? Or what would you say? What would you offer to somebody who is in the despair of trying to solve the Gordian Knot, monkey puzzle of today? What case would you make for hanging around and seeing it through?

BJ Miller: Well, there's lots to say. Let's... You might have to remind me of some of the things you just said so nicely, but it's a little bit like... When you're actually in that place, when you're actually inhabiting this life-death interplay, not just thinking about it or worrying about it. I think for so many of us... Like as a kid, I hated, if I had an exam or a paper due two weeks hence, it was harder for me. I'd rather be taking the goddamn test than be worrying about the test. There's something better about actually being in the thing you're worrying about. It almost always is more interesting, less horrifying than we imagine it to be. So one key comment if I were advising anyone here would be, let's just, let's see. As this abstraction becomes more and more real, see how you feel. What do you have to lose, you know?

And this little bit reminds me of the feeling I had in the hospital bed, where it was really like, oh. And I have, this has stuck with me. I choose life again and again and again. I live near death, and some days I actually well might conceive of choosing it. My sister chose it, I've known many people who have. I... You know, no shame, if you're done, okay. And I'm not going to guilt you around that.

But in those moments, I keep finding, when I'm at that, what feels like a limit, I'm like, "Okay, well, I'm still here." You know, I guess oblivion's waiting for me either way. So if I'm still here, might as well keep going or keep trying, because the end's coming no matter what I do, why would I expedite the end? So in other words, I just kind of keep hanging in there, stay in the zone, keep choosing life. Most every day, I have to say, "Do I want to do this another day? Am I going to try to do this living thing?" Especially in front of this Gordian Knot you're describing of our times.

And it's always like a 51-49 for me. I'm always like, okay, on balance, 51% of me says, "Keep going, okay, I'll keep going." And in that sort of humdrum, very boring-ish kind of way, you just kind of keep choosing it until you can't. As long as you have a choice, you might as well keep choosing life, because who knows what's coming. Even as dire as it may feel, keep holding out the possibility of being surprised. That's why I love doting on the things that we don't know, the mystery, because in that, in the mystery, may be solutions we haven't grokked yet. So hanging in there another moment may avail you of some more information, or at least an enjoyable experience, or at least an overwhelming experience, something. So, in this very boring way, I'd say just, if you can, keep choosing it. You're going to die anyway. It's coming. Yeah, okay.

So that's one response. If you're really teasing out your fear of an impending doom from actually being in the doom, if you're really clear that death is part of life, and coming no matter what you do, those two things soften the edges a little bit, and have allowed me to keep, so far anyway, to keep choosing life. Another moment, another day. So does that... You feeling that? Because does that make sense to you, Jamie? As I was describing that, can you imagine that, do you have an analogy in your own life? Do you hang out at the 51-49 zone? Or do you need to make a more robust case for life to keep trying?

Jamie Wheal: Hmm. Well, I was just arrested by your mention of your sister. Did she voluntarily exit?

BJ Miller: Yeah. Yeah, yeah.

Jamie Wheal: Yeah. And just the way you hold that, that in itself was a shift for me. I'm like, "Whoa, whoa, whoa."

BJ Miller: Yeah.

Jamie Wheal: That felt tender and beautiful, and also fairly rare. Right? We collapse into the tragic stories, we collapse into something other than how you appear to be holding it.

BJ Miller: Yeah.

Jamie Wheal: So I was still there. I was... When you said that, I was just like, "Holy shit, wow."

BJ Miller: Yeah. Yeah. Yeah, that's been a real teacher for me, that this idea that death is no one wants to die, and... Bullshit. Plenty of people want to die. I want to die sometimes. I know a lot of people who have chosen it. So no, I think there's something important in there.

And just to kind of, I don't mean to cut you off, but just to say, yeah, it is a very tender place. Vulnerability, tenderness, those things now read to me as strengths. I used to play into those were weaknesses inherently. No, not at all. What's strong about something that's invulnerable? It can't help but be strong. That's not very strong. Something that can fall apart, and chooses to not, that to me is strong. Something that can fall apart and still be itself, that to me is strong.

So my sister Lisa is one of the great teachers for me there. When I realized when I get upset about her death, I can trace it back. And this is true of grief in general. I wonder how you feel about your mom's death on this one, as you mentioned earlier, but I've come to see grief as a very essential process, not this thing to run away from or avoid. Actually a very loving process.

Jamie Wheal: Yes.

BJ Miller: And so when I get upset about missing my sister, sometimes angry at her for leaving, leaving me, leaving. I remember that's me just missing her. That's me just wishing I had more. That's okay. I can wish I had more, but my choices weren't have Lisa indefinitely. My choices were don't have Lisa at all, or have her for the 29 years I had her. Those were really the options. I could have denied her existence while she was on the planet, or I could have delighted in her for the time I had. And if presented that way, well then I got a pretty good deal. I got 29 fucking years with her.

So I can, I'm aware of the... As suspicious I am of our constructs... I'm not suspicious of them, they're very useful, I love to play with them. I'm suspicious when we confuse our constructs with the whole of reality that we're trying to understand.

Jamie Wheal: Yeah. Well, B.J. my man, thank you. This has been a beautiful exploration, and I'm super grateful for, yeah, just basically your heart and your voice, what you bear witness to in your own life, and what... It's beautiful and needed.

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