Photo Credit: Filter Magazine

Photo credit: cogitz

Not long ago, SevenPonds explored a fascinating part of Madagascar’s Malagasy culture: the tradition of second burial or “Famadihana.” The tradition is rooted in the belief that the body of the deceased needs time to decompose to properly pass into the next world. To aid this process, a Malagasy family will unearth the body from its burial site after seven years to commence “the turning over of the bones,” and bury it once more after an elaborate ceremony.

Famadihana is a costly and elaborate tradition, and often a family will have to wait longer than seven years to preform the ritual. But when the time comes, the body of the deceased is wrapped in a fresh white shroud and often buried in a new (and ideally upgraded) crypt. And before the family says goodbye to the deceased yet again, they gather to raise the newly enshrouded body high, and celebrate the life of the deceased loved one with the aid of song and dance.

Photo Credit: thirdgoal.org

Because Famadihana can be an expensive ceremony, often extended families will preform the turning of the bones for several bodies simultaneously. The result is a large ceremony bustling with the energy of countless family and friends. Famadihana is well known for being such a community-driven, and hence, deeply personal ritual.

But it also creates the space for a pretty great party.

And why not commemorate the occasion with an air of festivity? For the Malagasy people, the ceremony is an opportunity to remember the life of a loved one with joy in lieu of a stagnating, somber attitude. Grief is a necessary part of the end-of-life process and should be embraced, and it’s likely the air of Famadihana ceremony is bittersweet. But there is still a pervading air of merriment and remembrance that sets the ceremony apart from much graver, and more dispiriting burial ceremonies typical of Western cultures. The ceremony has become so internationally renowned that even popular tourist travel sites like Lonely Planet have highlighted the ceremony as a must-see. “Far from gloomy,” the site says, “[Famadihana] is really a great party, more like a wedding than a funeral” that has “much dancing to accordion music and drinking of gasoline-like rum.” One visitor to Madagascar says that “people kept offering me shots of rum, bumming cigarettes, and inviting me to dance.” Nearby, he says that “the immediate relatives of the dead huddled over the remains of their beloved, tenderly stroking their shrouds, singing songs, laughing and crying at the same time, and pouring rum on the decomposing bones in thanks for all the blessings.”

Photo Credit: ranouraii

The entire community comes together through Famadihana to celebrate the life of the deceased, with family members and friends traveling across continents to attend the event. Elders impart knowledge to the children at the ceremony while food is prepared and shared alongside meaningful and lively conversations about the deceased in a way that de-stigmatizes the role death can play in our everyday life.

And why not commemorate the occasion with an air of festivity? For the Malagasy people, the ceremony is an opportunity to remember the life of a loved one with joy in lieu of a stagnating, somber attitude.

SevenPonds connected with Jacques Randrianary, a filmmaker native of Madagascar whose documentary “Famadihana (Second Burial: Surviving Guilt and Grief) is soon to be released. “[I’ve] created a documentary on the ceremony [and] brought some originality [to it] in terms of the family story,” he tells us. The documentary is sure to show Famadihana in an insightful, original light, as it explores the many complexities associated with making the ceremony a reality. Check out the trailer below:

Famadihana: Surviving Guilt and Grief (Trailer) from Jacques Randrianary on Vimeo.

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Percent of Deaths Occuring in Hospital, 2010. Photo Credit: Dartmouthatlas.org

A recent article from Health Leaders Media discusses a Dartmouth Atlas report which finds that even though the cost of intensive hospice/hospital care is on the rise, that “aggressive end-of-life care” is in decline. And it is the rapidity of this transition that has stunned doctors most. “Patients dying in 2010,” states the report, “were less likely to spend a portion of their last days in a hospital, and were less likely to die in one than in 2007.” The report states that the Hershey Medical Center in Hershey, PA saw a “26% reduction rate in ICU days over a three year period and an 18% reduction in physician visits.”

“This [reduction] does not happen by accident,” explains the co-principal investigator of the Dartmouth Atlas Project, David Goodman, MD.

David Goodman, MD. Photo Credit: Dartmouth Medical

Meanwhile, the average spending for a terminally ill Medicare patient increased 15.2% in the last two years of life, “from $60,694 in 2007 to $69,947 in 2010.” While the costs were “not adjusted for inflation,” Goodman states that the rise was far higher than the consumer price index of 5.2%.

“Whether we’re beating the cost of living index or lagging behind, the norm is what’s killing us,” he states, “[and] there’s strong evidence that lengthy end-of-life stays in hospitals and receiving uncomfortable procedures are not what patients want.” And after studying the progression of end-of-life care in hospitals in around 18 states, the report found that “practices to encourage more appropriate care for terminally ill patients has stagnated” overall.

The report itself is based in observations of “various healthcare services at the end of life such as time spent in a hospital, [the] number of physician visits, durable medical equipment, and whether the patient died during a hospital stay.”

Photo Credit: dartmouthatlas.org

Goodman states that some of the blame for the decline can be placed on doctors and clinicians who are simply “not very good at assessing patient preferences. [They] don’t receive the training to do it. Aggressive care [is] making good on a pledge to extend [a] life [by] a week or a month longer. Too often these discussions never occur.”

For a the full break-down, read the entire article here.

You may also be interested in:

• TIME’s Joe Klein Talks End-of-Life Care in His Article “The Long Goodbye”
• Vermont Passes Aid-in-Dying Legislation
• 10 Facts About Hospice Care You May Not Know

“Baby mine, don’t you cry.

Cover of Bette Midler

Baby mine, dry your eyes.Rest your head close to my heart,

never to part, baby of mine.

Little one, when you play,

pay no heed what they say.

Let your eyes sparkle and shine,

never to tear, baby of mine.”

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• “The Rose” by Bette Midler
• “Unforgettable” by Nat King Cole
  
• Beautiful Memorial Music: “I’ll Be Missing You” by Puff Daddy, Faith Evans and 112

Nancy’s father, Dave, after a day of hunting

When Nancy was a girl, she and her father often went fishing in Ann Arbor, Michigan. They wandered through the woods together — touched the petals of the plants and flowers they discovered there, chased live fish and tadpoles in the springs, picked up snakes and bugs with their bare hands.

Nancy and her father went camping every other year during the last decade of his life. On their last trip to Copper Harbor, he seemed unusually tired, but his mind was as sharp as ever. He reflected, at length, on the beauty of the waterfalls surrounding them; talked about what it was like to grow up in the Upper Peninsula.

The weekend that her father passed away, Nancy was supposed to visit her parents for Easter. She returned to her home after work and hit the play button on her answering machine to find that her mother had left her a message: “Your father is dead. Give me a call.”

Nancy’s breath caught in her throat. How could this be real? Yes, her father had suffered from heart problems for years, but there never seemed to be an imminent sense of peril. How could he have died? Just like that?

At his funeral, a staggering number of people approached Nancy to tell her what a good man her father was — how helpful, and how loving. Nancy already knew this to be true. Throughout her life, her dad had given her sound, practical advice. He always had an innate sense of how to fix things (from household plumbing, mechanical, and electrical issues to Nancy’s broken heart when her first high school boyfriend broke up with her in the 11th grade), and had taught her everything she knew in the way of self-reliance. Because of him, she knew how to fix a toilet, change a tire, catch a trout.

Her father was her rock-solid constant in a world of flux and uncertainty — an ever-available resource she could (and often did) consult whenever the need or desire struck. And suddenly, that resource was gone.

Her sense of stability was, for the first time, truly rocked.

Nancy and her father on a fishing trip

Who could she call when she needed guidance on financial investments or potential job switches? Who would know exactly what to say to reassure her when she felt nervous or uncertain? Suddenly, Nancy realized how much she needed her father — how much she depended on him to remind her that she was, in fact, independent.

The self-sufficient woman she’d believed herself to be suddenly felt like a child — a child who wanted her father.

In the months that followed his death, Nancy’s mind returned over and over to that last camping trip: Her father’s uncharacteristic physical fatigue… the fresh, self-caught trout and buffalo meat they’d cooked over an open flame… the deep belly laugh they’d shared when they tried to yank the cork out of a wine bottle (in the frenzy of her efforts, Nancy ended up flat on her bottom)… the way he’d begun to reflect on his life and even speak about his own death. “I’m ready to go when I go,” he’d told her. “I want you to remember that I had a good life.”

He’d said that he was proud of his children, that he was happy and comfortable. In fact, he said everything a daughter could hope for her parent to say — everything that “should,” theoretically, bring a one a sense of comfort and resolution following her father’s death. But she couldn’t deny the reality of her feelings: Although this may have soothed the ache of Nancy’s loss, it didn’t come close to erasing it.

All her life, Nancy understood her sense of safety in the world through her father.

Now her father was a memory, and nothing in world could change that.

Marguerite Maneau-Rao, LCSW, ATR, is the CEO and founder of the Presence Care Project. Once a volunteer at Zen Hospice, she now focuses on mindfulness based techniques to reduce stress among those suffering from dementia and their caregivers. She is a licensed clinical social worker and registered art therapist with a mindfulness-based psychotherapy private practice in Palo Alto, CA.  She also facilitates the Stanford Parkinson’s Caregiver Support Groups. She shares her mindfulness practice in the Mind Deep blog and on Huffington Post. 

Katie: What is the Presence Care Project?

Marguerite: It’s a nonprofit and the goal is to disseminate mindfulness-based dementia care and training throughout the whole spectrum of organizations that have caregiving going on.

Katie: What is it mindfulness based care?

Marguerite: It’s using mindfulness as a practice to help care providers and those with neuro-cognitive conditions to help them reduce stress and provide the best care possible. Mindfulness as a practice has been proven in 120 research studies to have benefits in terms of stress reduction, improvement in telomeres and chromosomes and cellular aging — all positive, restorative effects caused by mindfulness.

As you probably know, caregiving for dementia and other high care conditions often causes high emotional and physical stress. Mindfulness helps the caregiver be present for the person regardless of what’s happening in that moment. We train caregivers to respond as opposed to react. We help heighten sensory awareness to understand the stimuli that the person is subjected to. You can change their environment so it doesn’t stress the that person so much. In the case of dementia and memory loss, it helps to be in the present moment and meet them in their reality. There are many, many reasons for why mindfulness helps with quality of care.

Katie: What is your role and how did you get involved with the Presence Care Project?

Marguerite: It started with my mom, who had a long journey with Alzheimer’s that started ten years ago. First, I became aware of her symptoms. I experienced a wide range of emotions, and bringing mindfulness to our relationship changed how she reacted to me. It was very positive and took me away from the despair, frustration and anger I was

Marguerite Manteau-Rao

feeling. I experienced a more hopeful and joyful way of being with her. In the course of my work with Zen Hospice, I saw the impact of training as a volunteer and the kind of relationship that could be had. I was comparing how a person would react differently to different treatment. I became influenced to combine stress reduction with my clinical training and also my group facilitator training.

I was wondering if there was something that existed to support caregivers, and there was no specific curriculum for them to address the challenges of dementia. So I decided to create my own. I partnered with OSHA, the center for preventative medicine. I have been consulting for several organizations and senior communities and kind of used these communities as my sandbox where I could experiment [in] different ways. I also give a lot of shorter trainings (one to two hours) in many communities. Now I’m looking at giving daylong intensive trainings in Modesto. I’m riding this new wave just starting in the field of dementia care and it’s very exciting. I can see how it works and what impact it has on people, and it has ripple effects. They bring it to their family members and other institutions and the benefits spread.

Katie: What kind of services do you provide?

Marguerite: There’s the training, [which] is eight weeks [and] that’s based on the mindfulness stress reduction model. It is tailored specifically to dementia care. Each week, it follows the same format, teaching traditional mindfulness practices, body scan, loving kindness and experimental approaches to dementia care. There is an element of group sharing where participants talk about what’s happening to them as professional caregivers or family. There is also some homework to practice between classes. When I give shorter trainings, I just simplify it so they can come away with one thing they will actually do. They usually come away with one thing that works and I’ve heard back from them about it. With institutions, I tailor it a little differently. The trainings at UCSF are two to three hours at a time. It depends, and I adapt it to every institution.

Katie: Is there anything else you’d like our readers to know?

Photo credit: revedavion.com

Marguerite: I do private coaching and I keep my private practice going, which is exclusively mindfulness based. I work with caregivers and those with cognitive disabilities from spinal or brain injuries to those who’ve had a stroke. I work directly with the person, with caregivers, or [with] both at once. I can work remotely via Skype or phone. And I enjoy sharing through my writing on different blogs and on twitter. I compose small tweets about the practice and invite people to join me. I also want to add that end-of-life definitely comes into the picture of mindfulness based training, which helps with stress reduction as a loved one is nearing the end-of-life experience.

Katie: Thanks, Marguerite!

Marguerite: Thank you.

So, at this point you might be thinking, what does a movie like this have to do with a thoughtful, New Age website about death and dying? Well, for one, (SPOILER ALERT) everyone in the movie dies. Going further than that, they all know they’re going to die ahead of time. When the characters realize the Apocalypse has indeed arrived, they go through all five stages of grief according to the Kübler-Ross model: denial, anger, bargaining, depression and acceptance. They come up with inventive ideas in an attempt to escape their inevitable ends. As funny as the choices and the scenarios end up being, I believe this idea of trying to escape death strikes a chord for many people watching. It isn’t a question of what we would do if faced with a scenario as unlikely as the Apocalypse; it’s a question of how we choose to handle our own mortality.

As the movie goes on, the events get stranger. They expertly parody classic horror films, some of which include The Exorcist and Rosemary’s Baby. Jonah Hill, for instance, becomes impregnated by Satan and later has to be exorcised. Pushing the envelope a little bit further, Danny McBride manages to survive the apocalyptic world by resorting to cannibalism and instating himself as a lord of cannibals. Craig Robinson sacrifices himself and is immediately beamed up to Heaven for his good deed. The other characters realize they can go to Heaven, too, as long as they prove to have good souls. In the end, they all prove themselves worthy of Heaven and upon arrival find themselves at the Hollywood party of a lifetime. While obviously poking fun at the L.A. scene and Christian ideas of the afterlife, the ending note is an overall positive one. Again, it’s open to interpretation, but I wouldn’t mind an afterlife that involves a reunion of the Backstreet Boys.

Apocalypse? (Photo credit: mikelehen)

In a number of ways, This Is the End points a stiff finger at the irrational fears and taboos surrounding death. Today’s culture has a difficult time talking about death, let alone laughing about it. With all of the distractions and coping mechanisms we use to deny our mortality, it isn’t that big of a stretch to believe there’s a funny movie about it. This Is the End might not be the most highbrow interpretation of our culture’s fear of death, but it certainly serves as an invitation to talk about it.

What do you think — do comedies about death lighten the mood or trivialize the end-of-life experience? 

Watch the Trailer Below:

Read more SevenPonds film reviews:

• Film Review: The Descendants
• Film Review: My Girl (1991)
• Film Review: That’s “Amour”

Photo credit: poetryfoundation.org

Irish writer and poet Oscar Wilde is beloved for his incomparable, grating wit. Even when the author was nearing death in Paris’s Hôtel d’Alsace (known simply as L’Hôtel today) he found the means to make one final, clever remark.

Some say Wilde died from syphilis, while others insist he fell victim to a severe ear-infection. Whatever the fatal ailment, his last words were directed towards the gaudy hotel wallpaper when he exclaimed the above lines.

Needless to say, the wallpaper won.

Photo credit: bestmastersincounseling.com

The infographic serves a very important purpose, as it informs the public on one of life’s most sensitive subjects within the larger discussion of end-of-life: suicide. Talking about suicide on an individual basis is already a very complicated, and emotionally exacting task. So an attempt to understand the changes in suicide rates in relation to race, age, sex, and culture is a very necessary and commendable endeavor.

Photo credit: bestmastersincounseling.com

Among the information presented by the infographic is the fact that there are over 1,000,000 suicides a year. And in a study of suicides per 100,000 people, we learn that Greenland is “the suicide capital of the world” followed by South Korea, Lithuania, Guyana, Kazakhstan, Belarus, China, Slovenia, Hungary, and finally Japan at number ten (the U.S. comes in at thirty-three).There also appears to be a significant disparity between men and women on the subject, with far more men committing suicide per 100,000 people across cultures. We also learn of the perspectives ancient cultures had on taking one’s own life. In the religious throes of the colonial era, suicide was not only interpreted as a sinful tragedy but was also considered a crime under the common law of England. Contrastingly, the ancient Egyptians and Greeks associated suicide with human autonomy, seeing it as a drastic but de-stigmatized act that could be committed by an individual.

Photo credit: bestmastersincounseling.com

Suicide is one of the most difficult topics to bring into the open, and for this reason it is crucial to discuss it and understand its countless motivations, as well as its relationship to current and past cultures. For in this way, we can better learn how to help others overcome the desire to commit suicide.

Read the entire infographic here. And if you or someone you know needs help, call the ever-available National Suicide Prevention Lifeline as 1-800-273-TALK (8255).

Photo credit: gwilmore