When I was 14, and sitting in a circle with my mom, my best friend, her mom, and her mom’s best friend, I came to a sudden understanding that has become the foundation of everything I write on this blog.

I believe the occasion was a cookie exchange, and it was something my friend did once a year. Her mom’s friend, who also worked at the hospital with my mom, was called Georgia*.

She was delightful in every possible way – warm, funny, sweet, without a sharp edge anywhere. She put up with wild shenanigans during sleepovers and let us dress like Madonna on Halloween and eat as much candy as we wanted. She always kept cinnamon Graham crackers in the house. She let us coax her onto a giant trampoline once, to bounce gingerly and scream in delighted terror. She loved her daughters openly, broadly, and unashamedly, and raised them to be as wonderful as she was.

Her husband had died suddenly of a heart attack a short time before. He, she, and their entire family were large people — tall, broad, and stocky. They were also, I thought, nice to look at, and comfortable to be around. From what I could tell, they ate and moved and lived their lives just like everyone else. I admired that.

After exchanging cookies, we gathered in the living room and drifted into chat. At some point, probably following some hospital gossip, Georgia recounted to my mom the story of a recent doctor’s visit.

The visit had not gone well. I believe Georgia went in for some reason related to her husband’s death, maybe to get help with stress or grief. The doctor — a slender, athletic woman in her 20s — had, after haranguing Georgia about her weight, asked how her husband died. Georgia answered that he had died of a heart attack, and the doctor snapped, “Well, no wonder he’s dead. He was obese and he was a smoker. What did you expect?”

The mothers in the circle fell into a stunned silence. I looked at Georgia’s face, and she seemed somehow apologetic.

How anyone could say something so cruel to a person I knew to be unfailingly kind and sweet, and whose husband’s death had recently devastated their entire family, was an utter shock to me for about two seconds. And then I knew something, and I didn’t know how I knew it, but I knew it with such angry certainty that it just came out.

“That doctor is scared of death,” I said loudly.

How else on earth could you explain a doctor expressing anger and blame at someone for accidentally dying? And to then vent that anger on his grieving wife? You couldn’t. There was no other explanation but the fear of death, utilizing the Just-world Hypothesis as its conduit.

The Just-world Hypothesis is the cognitive bias that causes people to blame other people for their misfortunes, even in cases where blame is not appropriate or not proven. Because we want to believe that we live in a fair world, and that people get what they deserve. If they do something wrong, bad things happen to them. But if they do everything right, and follow all the rules, nothing bad will ever happen to them.

It’s a mental shortcut we use, a theory that seems to have the power to predict what will happen — because to an animal, the power of prediction is essential to survival. It helps you to avoid the very worst bad thing that could ever happen, which is death.

If you die, the doctor was saying, clearly you did something to deserve it. When you deserve it, death is expected, which should somehow rob it of its terror. And because I, a doctor, am smart enough to avoid doing the wrong things, and actually dedicate my life to doing all the right things, I don’t deserve to die, and can therefore predict that it will not happen to me.

Last night, one of my group members quoted Anne Lamott —

I think perfectionism is based on the obsessive belief that if you run carefully enough, hitting each stepping-stone just right, you won’t have to die.

I tend to agree.

I have discovered, through questioning the lovely people I work with, that at the bottom of every fear of eating too much, or of gaining too much weight, resides the fear of death. In the final analysis, it always comes down to this — the awareness that we have to die, someday, and that anything we do might hasten the inevitable.

Some philosophers claim that entire fields of inquiry, entire cultures and civilizations, perhaps the social contract itself, are founded on the awareness and fear of death, and the simultaneous effort to deny it.

Ernest Becker, in The Denial of Death, calls these “immortality projects,” ways that we attempt to create something that might not only forestall death in the immediate sense, but that lives on after we do to achieve a sort of abstract immortality. Great books are written, tall towers constructed, fame and fortune sought, all in the faint hope that our name will live on, long after our body lies beneath the stone on which it is carved.

Even in the absence of dramatic efforts to achieve posthumous fame, our entire lives and all the decisions we make may be interpreted as coping mechanisms for managing, and suppressing, the fear of death. The cracks we step over on the sidewalk, the locks we check over and over (literally or figuratively), the black cats we avoid, the salt we throw over our left shoulder, the pleasure we systematically deny ourselves for the sake of seeming to purify our one immortal organ, the soul — and the trust we withhold from our body, that traitor, who can’t be counted on to keep any promise but the inevitable one.

Fear of physical pleasure, and fear of the seeming bottomlessness of our physical appetites, are disguises for the fear of death.

Responding to your body requires admitting, first of all, that you have a body, that you are a body, that your head does not float on a metaphysical balloon somewhere just north your body, untouchable. This admission requires you to acknowledge that bodies die, and that you will die too. The separation of mind and body, soul and body, spirit and body, is itself a coping mechanism, a sort of immortality project.

All of this would be well and good if it did not cause us to make such tragic decisions during our uncertain, finite, and invaluable lives. Decisions that cause us, effectively, to deny life itself. The fear of death, and the denial of the few concrete things we can touch and cling to as real and worthwhile, can lead to wasted lives. People wrung out and demoralized, lives spent and used up, running on a treadmill toward a mirage that never comes any closer.

How then shall we live?

Health can be redefined as the manner in which we live well despite our inescapable illnesses, disabilities, and trauma. -Jon Robison

My proposal is that we live in the way that best reflects how we most want to use our precious time, right here, right now. My proposal is that we live well despite our inescapable fear of death. Our time is valuable in more than one way, both in quantity and quality, and neither one should be sacrificed for the sake of the other.

We may instead try, as best we can, to strike a balance between the two, and not go to extremes in an attempt to escape what we all know is coming — but neither to hasten it purposely by squandering what little we do have in a blaze of reckless glory.

This means, then, that I would never suggest running out to smoke and drink yourself into oblivion. Or to gorge yourself on food that makes you feel like shit, even if it tastes like anything but. Or to avoid exercise at all costs, out of a stubborn refusal to (again) admit that you have a perishable body and that it requires a certain measure of care — and in doing so, to deny yourself your life.

Do the things you can reasonably do, without unduly burdening yourself, to be a good steward of the gift of life.

I equally would not suggest that you force yourself to eat food you hate, or eat too little of the things you enjoy and feel deprived, or slog away at life like you’re putting in your time at a dismal job, waiting for the blessed release of quitting time. That you mortify the body to purify the soul. That you sacrifice yourself, your invaluable time, doing things that you hate, hurting yourself mentally and physically, to prove yourself worthy of escaping death, somehow superior to the weak mortals living their pathetically finite lives around you. In short, to live a delusion — and in doing so, to deny yourself your life.

If you genuinely enjoy marathons, run them. If that would be torture to you, don’t. Find something else to enjoy. If you love salad, eat it. If salad is punishment, for God’s sake, there are a million other foods to take its place. Food that isn’t enjoyed isn’t worth a damn. Find something better. You deserve it.

If you feel unfit, if you feel tired and exhausted and find it difficult to move, be good to your body. Feed it good food, give it fresh air and light, and move it gently and compassionately until it is stronger. When it is strong enough, use it to do things that inspire, excite, and even scare you.

Do something that makes you scream in delighted terror.

This is a limited time offer — don’t deny it. Make it count.

*Not her real name.

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