The Unspoken Terror: Mortality Awareness in Clinical Settings for Chronic and Degenerative Disease

Abstract This paper examines the paradoxical avoidance of mortality discussions in clinical settings, particularly with patients facing chronic disease and degenerative neurological conditions. Drawing on theological frameworks of divine presence manifesting through absence as articulated in the author's previous works, this analysis proposes that clinicians' systematic avoidance of death-related dialogue creates an "elephant in the therapeutic room" that undermines effective care. The concept of divine hiddenness (hester panim), as explored through the perspectives of Rebbe Nachman of Breslov and Rav Shagar, provides a hermeneutical framework for understanding how death's deliberate omission from clinical discourse paradoxically amplifies its influence on the therapeutic relationship. By integrating Simone Weil's concept of decreation and surrender with Rami Shapiro's notion of "falling through" suffering, this paper offers a theoretical foundation for transforming clinical approaches to mortality discussions. The analysis suggests that confronting rather than circumventing mortality awareness may facilitate a more authentic healing environment that addresses the existential dimensions of suffering inherent in progressive illness.