Larry H. Pastor, MD

Et in Arcadia Ego by Nicolas Poussin

Sober Anticipation of Death (SAD): psychiatrist George Vaillant identified “anticipation” as a key defense mechanism of high-functioning individuals.[1]  SAD, short for “sober anticipation of death”, is a means of beginning the inevitable grieving process in advance of the loss, and thus preventing the full force of shock and trauma from delivering a hammer blow as compared to when the possibility of loss has never been contemplated.  Grief and the pain and longing of grief – how to deal with the loss of a loved one – is probably the greatest challenge we will ever face in our lives; the resiliency strength of SAD is key to surviving the loss of a loved one.[2]  SAD also motivates a person to live life more fully and consciously and draws from psychiatrist Robert Lifton’s concept of “the death imprint.”  The “death imprint” is a higher level of consciousness and more intense appreciation of life that results from an experience that results in a felt awareness of the reality of death.[3] 

SAD is not a recent discovery of modern psychology; on the contrary, the ancient Stoic philosophers advised making a practice of ‘negative visualization’, i.e., imagining the loss of those things one holds dear, in order to both better appreciate what one has, and to prepare for the possibility of their actual loss.[4]  Moreover, the phrase “memento mori”, loosely translated as “all things are mortal” or even “nothing lasts forever” became a running theme in classical literature and art, an admonition to fully appreciate the here and now because, well, indeed, nothing lasts forever.  Sometimes we hear the echo of this ancient admonition in the contemporary phrase, “There are no guarantees in life.” 

Knowing that life is not a straight line upward and onward, but an arc whose trajectory returns us to the mortal earth, dust unto dust, empowers us with the resilient resolve to live our lives more fully and appreciate those around us.  At different times and places death is a nearer or more distant presence but never entirely absent.  When I was an army doctor in a combat support hospital a few miles east of Fallujah, Iraq, death was never very far away.  Mortar rounds landing within the base perimeter, small arms fire, Apache helicopters in operation, dust and grayness all around, the crushed spirits of EPWs off-loaded from Bradley Fighting Vehicles, and the steady influx of disfigured and dismembered bodies of war’s victims were all part of the daily routine.  But how quickly and mercifully we lose that perspective when returned to the comforts of life in suburban America, a contemporary equivalent of Arcadia, the mythical land of classical antiquity where all is youthful, rustic, and serene.  In such faraway lands and halcyon states of mind is where the real danger lies:  we shouldn’t be caught slumbering our way through life.  As the ancients noted, “Et in Arcadia Ego” – “I (Death) am here too, even in Arcadia (in the midst of life).”[5]  Thus noted, SAD – awareness of sorrow, decay, and mortality – is a cause not for panic but for awe, not for retreat into denial but for moving forward into the embrace of the rhythm of life; for grief is but a continuation of love when the loved one has departed this mortal realm. 

Insurance agent Keith Wagner recalled being told by his doctor, at age 33, that he had a terminal illness with six months to live: “I decided I was going to really live what little life I had left.  My relationship with people started to change.  I began to tell people what I really thought.  I held my children and my wife in a way that I had not done before.  I wanted to live each day as if it were my last.” After a month, however, he received another call from his doctor: the initial tests were wrong, and, amazingly, he was actually in perfect health!  He wrote: “I was thrilled to get this news but soon realized that my life had changed forever.  Despite my terminal diagnosis I was having too much fun … Now, ten years later, my days are consumed with living … I am living.  I have an amazing sense of freedom.  I am loving life.”[6]  SAD is the best wake-up call anyone could give us.  An alternative acronym for this resiliency strength, an acronym that conveys the gravitas of life’s evanescence, might be DAMN (Deep Awareness of Mortality and Non-existence).  As in “DAMN! let us appreciate life while it is ours to appreciate!”

July 3, 2023

[1] George E. Vaillant, Adaptation to Life, Harvard University Press, 1998.

[2] For what it’s worth, my 30+ years as a psychiatrist lead me to believe that the two other major challenges of human life are (1) figuring out how to live a life of purpose, and (2) achieving and maintaining the “self skills” including self-esteem and self-acceptance (see the section on the resiliency strength of SABIO).

[3] Robert J. Lifton, The Broken Connection: On Death and the Continuity of Life, APPI Press, 1983.

[4] William B. Irvine, A Guide to the Good Life: the Ancient Art of Stoic Joy, Oxford University Press, 2009.

[5] Alain de Botton & John Armstrong, Art as Therapy, p.145, Phaidon, 2013.

[6] Keith Wagner, “Living and Loving Life”, pp. 153-155, in Dan Gediman, Editor, This I believe: On Fatherhood, Jossey-Bass, 2011.