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Simon Critchley on the History of Death

Question: How do contemporary societies conceive of death?

Critchley:    Every culture has had rituals around death, all right.  It’s a constant feature of what it means to be human.  It’s human culture and what makes our culture unique is our inability to really face up to it, to death, and touch it, have appropriate rituals that surround it.  What interest me about, I mean, the book is about the philosophical ideal of death or, and that is something that you find emerges in the end of the, with the death of Socrates, the end of the 4th century B.C. and the idea there is that to philosophize is to learn how to die and the philosopher is the person who can die the good death and dying the good death is essential to the wisdom that constitutes what it might mean to live.  So, a good life means being able to face up to one’s mortality.  So, that idea of the philosophical death which really begins with Socrates, that’s what I’m tracing through in the book.  But there’s a wider concern which is about, I don’t know, the ritualization of death, our inability to face up to death.  You know, we live in a culture which is, where death is obscene.  It’s sort of hidden away.  I like to think of us as ways of anti-Victorians.  The Victorians could memorialize death and ritualize death in a very powerful way but couldn’t deal with sex.  We talk endlessly about sex but really we can’t deal with death.  So, we are in a strange situation of, you know, the one certainty of human life is the fact that it’s going to end and that’s what we find most difficult to deal with.  Our culture finds it more difficult to deal with and we run away by not thinking about it or by constructing beliefs in the afterlife. 

Question: How did the Greeks conceive of death?

Critchley:    Philosophy begins with Plato, with Plato’s transcriptions of these dialogues.  But then what these dialogues are for?  We don’t even know why they exist but there they are and this new thing called love of wisdom philosophy develops and it develops in a sense as a kind of personality cult around this figure of Socrates and what Socrates did was to wander around Athens, talking to people, asking what they meant by certain topics and interrogating them.  But really the key issue is really the fact that Socrates was condemned to death by the people of Athens for blasphemy, for impiety with regard to the gods of the city and for corrupting the young, and Plato then tells the story of Socrates’ trial and execution over 4 dialogues.  It’s a huge, hugely important thing and Socrates says in the last dialogue which called the Phaedo and, you know, the philosopher is already half-dead.  The philosopher is the person who professes death, who is already, as who have made himself into a resemblance of death.  You know, he’s, and what that means is the philosopher is the person who is contented, who can accept the mortality without the need to run off into beliefs in the afterlife, something like that.  You know, the great death is Epicurus’, not that... Epicurus dies in pain, surrounded by his disciples.  This is another common feature of death in Death of Philosophers in the Ancient World, but he didn’t die alone.  He died surrounded by their disciples and Epicurus dies in pain from kidney stones.  It is a painful death, the last 14 days of his life was spent suffering from this pain but he dies with this, in a state of tranquility.  This was a key thing in the ancient world, the cultivation of tranquility or calm in the face of death.

Simon Critchley's historiography of death.

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Image source: camillo jimenez/Unsplash
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  • 10-15% of people visiting emergency rooms eventually develop symptoms of long-lasting PTSD.
  • Early treatment is available but there's been no way to tell who needs it.
  • Using clinical data already being collected, machine learning can identify who's at risk.

The psychological scars a traumatic experience can leave behind may have a more profound effect on a person than the original traumatic experience. Long after an acute emergency is resolved, victims of post-traumatic stress disorder (PTSD) continue to suffer its consequences.

In the U.S. some 30 million patients are annually treated in emergency departments (EDs) for a range of traumatic injuries. Add to that urgent admissions to the ED with the onset of COVID-19 symptoms. Health experts predict that some 10 percent to 15 percent of these people will develop long-lasting PTSD within a year of the initial incident. While there are interventions that can help individuals avoid PTSD, there's been no reliable way to identify those most likely to need it.

That may now have changed. A multi-disciplinary team of researchers has developed a method for predicting who is most likely to develop PTSD after a traumatic emergency-room experience. Their study is published in the journal Nature Medicine.

70 data points and machine learning

nurse wrapping patient's arm

Image source: Creators Collective/Unsplash

Study lead author Katharina Schultebraucks of Columbia University's Department Vagelos College of Physicians and Surgeons says:

"For many trauma patients, the ED visit is often their sole contact with the health care system. The time immediately after a traumatic injury is a critical window for identifying people at risk for PTSD and arranging appropriate follow-up treatment. The earlier we can treat those at risk, the better the likely outcomes."

The new PTSD test uses machine learning and 70 clinical data points plus a clinical stress-level assessment to develop a PTSD score for an individual that identifies their risk of acquiring the condition.

Among the 70 data points are stress hormone levels, inflammatory signals, high blood pressure, and an anxiety-level assessment. Says Schultebraucks, "We selected measures that are routinely collected in the ED and logged in the electronic medical record, plus answers to a few short questions about the psychological stress response. The idea was to create a tool that would be universally available and would add little burden to ED personnel."

Researchers used data from adult trauma survivors in Atlanta, Georgia (377 individuals) and New York City (221 individuals) to test their system.

Of this cohort, 90 percent of those predicted to be at high risk developed long-lasting PTSD symptoms within a year of the initial traumatic event — just 5 percent of people who never developed PTSD symptoms had been erroneously identified as being at risk.

On the other side of the coin, 29 percent of individuals were 'false negatives," tagged by the algorithm as not being at risk of PTSD, but then developing symptoms.

Going forward

person leaning their head on another's shoulder

Image source: Külli Kittus/Unsplash

Schultebraucks looks forward to more testing as the researchers continue to refine their algorithm and to instill confidence in the approach among ED clinicians: "Because previous models for predicting PTSD risk have not been validated in independent samples like our model, they haven't been adopted in clinical practice." She expects that, "Testing and validation of our model in larger samples will be necessary for the algorithm to be ready-to-use in the general population."

"Currently only 7% of level-1 trauma centers routinely screen for PTSD," notes Schultebraucks. "We hope that the algorithm will provide ED clinicians with a rapid, automatic readout that they could use for discharge planning and the prevention of PTSD." She envisions the algorithm being implemented in the future as a feature of electronic medical records.

The researchers also plan to test their algorithm at predicting PTSD in people whose traumatic experiences come in the form of health events such as heart attacks and strokes, as opposed to visits to the emergency department.

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