​​You mention that  this kind of work is for the professional. Why not the public?

I made CD specifically for professionals involved in some type of caregiving capacity such as healthcare, hospice, mental health, clergy, death doula, etc. The reason for this is because these are the people closest to that line that divides life from death. As a result, we should be as intimate with our fears on dying so that we can help clients around midlife, aging clients who are beginning to sense an end point to life, chronic and terminally-ill patients who are wrestling with existential factors.

​​​What is the reason behind the caution?

Like some spiritual (i.e. meditation, Chakra work , Kundalini, yoga, etc.) and psychotherapy (i.e. EMDR, Prolonged Exposure Therapy, various grief methods, etc.) approaches, CD can awaken (not create) mild and temporary levels of anxiety and sadness. Existential work includes attention on our upcoming phases of decline--aging, a terminal illness, and death. These topics naturally stir unease no matter if done therapeutically or talking about it while in line at the grocery store. Thus, the ability to regulate emotions is important, which for some diagnoses (treated or untreated) could prove challenging.

Fortunately, some research exists around simulated death work. Two articles to read are "To Die or Not to Die: A Review on Simulated Death" by Marcia A. Corvetto, MD and Jeffrey M. Taekman, MD, and "Use of High Fidelity Simulation to Teach End-of-Life Care to Pharmacy Students in an Interdisciplinary Course" by Irene Gilliland, PHD. 

Currently, no research has been done on CD. This isn't to say that I haven't asked. I do take surveys, though, during and after workshops. In general, the majority who have attended report a moderate level of one or more emotions: sadness, anxiety, joy, and peace. A fair number who responded to a week follow-up reported moving more into a reflective state and/or conversation with family about end-of-life care, which confirms the transient nature of feelings.

You refer to Conversing with Death as spiritual. Why?

I often refer to CD as existential, which could sound as if the work is purely psychological. However, CD is primarily spiritual work. The reason for this is that certain movements need to take place for the work to progress. First, there needs to be an understanding of the illusions we personally use to create a feeling of longevity and why. This involves themes of attachment and aversion. Second, there needs to be a deep curiosity and meaning-making intention around our own existential makeup that supersede sole logical inquiry.

What has been your observation while facilitating Conversing with Death?

In my years of facilitating CD, many reported feelings of sadness, mild anxiety, and joy. No one reported a threatened level of anxiety. Upon a one week follow up, those who responded stated that their initial feelings during the workshop dissipated and was replaced by fruitful reflections with self and conversations with one or more family members.

​What's the benefit of Conversing with Death?

CD practice has a number of existential benefits that can't often be attained by other methods. By courageously tuning into reflections around our last breath, we can: (1) think ahead enough to possibly reduce elements of surprise. Many unwanted surprises occur around end of life, in spite of one's wishes. Last breath reflections can soften this even a little; (2) befriend those feelings and mental states that come during end of life. There is a difference between how we feel when we are vibrant and how we feel during phases of decline. CD encourages a mindful approach that seems to best address internal experiences; (3) open dialogues with family early on. All too often families wait as long as they can before "bringing up the subject." Sometimes it is too late. Last breath awareness encourages discussions early on so that when the time does come family members are all on the same page and conflict remains at a minimum; and (4) create a more intentional, gratuitous life NOW. We often do take things for granted, thinking we have many tomorrows. Knowing that we don't have long can generate a greater moment-to-moment appreciation for living.

On another light, and one that has sobering implications, reflecting on impermanence can bring out reactions as the Terror Management Theory proposes (see Ernest Becker Foundation Website and the documentary Flight from Death). These reactions, which spring from the unconscious where temporary existence or impermanence is felt the strongest, aim to regain a sense of longevity that appears eternal and a power over what the Buddha called "the three heavenly messengers"--aging, illness, and death. Sometimes these reactions could be aggressive as the Terror Management Theory proposes.

Relevant Resources on Death & Healthcare Professionals

What exactly is Conversing with Death?

​Conversing with Death (CD) is a carefully constructed method that examines and attends to our current levels of existential awareness. CD aligns with courageous minds that believe we all have an innate awareness that we will become extinct, and sooner than later, in spite of our wish for some magical longevity. Though repressed by inner and cultural mechanisms, this deep awareness seeps often in disguising fashion into all aspects of life. CD promotes a felt-sense process to help caregiving professionals connect with and heighten their existential awareness.

Do I have to be in the dying stages to apply this exercise?

No. Many methods surrounding death are applied when someone is in their dying stages. CD encourages us to cultivate a relationship with our last breath way before the time does come. Why? By addressing all our fears and worries now we stand greater chance to design a more peaceful transition later.



Ernest Becker Foundation

​Articles & Books

  •  Advice on Dying: And Living a Better Life by His Holiness the Dalai Lama
  • "An Exploratory Study of Death Anxiety and Trainees' Choice of Theoretical Orientation" (Omega Westport, 2013-2014; 68(2): 143-159)
  • "Death Anxiety among Nurses and Healthcare Professionals"  (International Journal of Community Based Nursing Midwifery, 2016 Jan. 4(1): 2-10)
  • "I, Too, Will Die" by Kevin Quiles (In the Ernest Becker Foundation)
  • Last Breath Awareness: A New & Bold Approach on Death for the West by Kevin Quiles
  • "Psychological Research on Death Attitudes: An Overview and Evaluation" (Death Studies, 2004, 28:309-340)
  • ​The Denial of Death by Ernest Becker

Dying is an art, like everything else. I do it exceptionally well. I do it so it feels like hell. I do it so it feels real. I guess you can say I've a call. --Sylvia Path

Is this common?

Many cultures and spiritual traditions embrace this last phase of life and go on to incorporate it into daily life. The Buddha, for instance, encouraged his disciples--young and old--to meditate on the three heavenly messengers: aging, illness, and death. Western culture is currently infatuated with conquering the declining phases of life so as to sustain eternal youth.

Can anyone do this sort of work?

No. There are some that I would discourage from participating, and some I would not advise until certain factors have been adequately treated. Major Depressive Disorder, severe anxiety disorders, Personality disorders, and trauma are a few examples.