In my view, the Twilight stories remind us that all we have is the here-and-now. Without love life is pretty meaningless, even if you are a vampire and can live forever.

The following is an excerpt from my chapter, Transcendence and Twilight: The Faith in Love, in the recently published The Psychology of Twilight, Smart Pop Books/Benbella (2011).

The Twilight Saga appeals to different readers and viewers for a variety of reasons; adolescents love the way they can identify with the main character’s burgeoning sexuality and its subsequent awkwardness, young people raised by less-than-attentive parents can connect with feelings of being left on one’s own, and adults are often captivated by the creative storylines and seemingly endless plot turns and surprises. But what I’d argue makes Twilight an international phenomenon is the way we can all psychologically relate to Bella and her desire for immortality.

Her love for Edward, though genuine, also serves as an escape from all of the trappings of normal human existence. Through him, she hopes to be saved from the limits of mortality, to find refuge from feeling tortured regarding her bodily and psychological shortcomings, and to be able to live forever, in the comfort of the one she loves. Bella’s love for Edward and her desire for transformation shields her from death anxiety.

The way Twilight represents love—as a vehicle for transcending death—is nearly religious, which might explain the way Twilight gets under our skin and stays with us. Both religion and Twilight offer a way of transcending mortal death and achieving immortality, and when we compare the two in this way, we end up with a completely different way of understanding the supernatural beings in both. The salient aspects of both religion and the vampire story are not dogma or fangs, but the power of love. Through this lens, vampires don’t damn the soul to hell, but rather facilitate entrance to immortal life.

Bella is the foundation of Twilight. It is her brooding yet compelling voice and point of view that frame our perspective. There is a lot to like about Bella. She is attractive, but self-effacing. She starts out the saga as the underdog at a new school, but quickly makes friends. She is overly guilty and self-conscious about her influence on others. And like a lot of us, she is looking for an escape from the dreary yet anxiety-ridden trappings of life.

As she says in the first book, Twilight, regarding her new home in Forks, “You could never see the sky here; it was like a cage.” Clearly Bella feels trapped and is looking for a way out. Such feelings are common in adolescents, who want to escape limits imposed by parental authority and the subsequent confinement of their families. We all revisit this feeling from time to time in adulthood, as well, when the routine and unexciting aspects of daily life harbor questionable meaning— wouldn’t be wonderful if we could find someone to “save” us?

Enter the attractive and mysterious Edward. He possesses unearthly good looks, is wealthy, and is seemingly as brooding, irritable, and disappointed in his existence. He is Bella’s soul mate. Bella’s eventual realization that Edward is a vampire, although initially excitingly terrifying, leads to the desirable possibility of transformation and everlasting life at his side.

This romance is one of the most exciting aspects of the Twilight story; the burgeoning passion between Bella and Edward captures the urgent and fervent desire of young love. The couple reminds many of us of the feelings we had when we initially fell in love: the feeling seems so unique and special that it’s hard to imagine that anyone else has ever felt this way, and the unique chemistry between Edward and Bella allows us to feel that mystical, exuberant thrill once again. And most importantly, as with all (especially young) couples in love, it seems that these feelings can last forever. It is as if love itself can ward off death.

Death anxiety is a basic human fear. Since we all experience ourselves as alive, with a sense of our bodies and our consciousness as we know it, many of us can’t imagine what death is like. Death anxiety, in the most basic sense, relates to this idea; we don’t actually know what death is or entails. Although we may have religious ideas (or not) about what death and the afterlife involves, we don’t really know for sure. So in the absence of factual data about what happens after death (and especially in the absence of religious ideas), we have the philosophy of psychology and psychoanalysis, which helps those of us who experience fears regarding death to understand and come to terms with the finality of life.

A psychoanalytic view on the fear of death connects it to the fear of losing a loved one: fear of death can be seen as equal to the fear of losing those we love. Jerry Piven, in his article, “Birth, Death, Dread, and Religion” in Psychoanalysis and Contemporary Thought (2003), notes that because we as young children are terrified of losing our caretakers, we come to “experience love and being loved as the boundary between life and death.” As children, we are dependent on others, and losing our caretakers makes us vulnerable to death in both a symbolic and a real way.

The reality of death is the single most troubling and confusing aspect of human existence. As human beings we attach deeply (more so than other animals) and it is the attachments we have with other people and the meaning we give them that makes the reality of the human condition an even bigger blow. The awareness of death makes our attachments to others all the more complicated. From birth, we are aware of the terror of separation from those we need and love, because separation not only means the loss of those we long for, but also reminds us that we are ultimately alone in death.

In a way, Twilight eases our worries about death. The bite of the vampire does not damn the soul to hell, but rather can provide everlasting life with a loved one. It is moving and transcendent.

Campos describes that professional boomers had a very different experience than younger people of today. He cites the high cost of education and more ominously, the difficulty procuring employment for younger professionals who are saddled with large amounts of debt. And in the most pointed piece of criticism he says, “A lot of boomers have become insufferably smug and complacent.”

Ouch. It was easier for boomers to become successful professionals.

On the other hand, boomers are not all fat cats sitting around counting their money. Even middle-class older professionals are anxious, terrified, even about the rising costs of healthcare. In another thoughtful opinion piece in The New York Times, Jane Gross points out all of the things Medicare does not pay for, such as actual medical care in the form of nursing homes, home health aides, etc.

Gross implies that the Medicare system is designed to help some people live large. Pharmaceutical companies don’t seem to be suffering too much. Yet a lot of boomers and seniors have filed bankruptcy because of their medical bills.

If boomers are anxious about healthcare finances, maybe younger people are panicked. It is hard to function everyday with such an uncertain future. Though boomers and the young may see the world differently, perhaps we could all find common ground by acknowledging that we are in real trouble. Some sympathy for each other wouldn’t hurt either.

The author of that article, Keith Ablow, has been in the news lately and not in a good way. You may remember that he did more than simply raise eyebrows when he made insensitive and inappropriate comments regarding “Dancing With The Stars” contestant Chaz Bono. Before I go on, let me be clear. I do not support Dr. Ablow’s comments about this topic and found them offensive and just plain wrong on every conceivable level. See this article by my colleague Diane Ehrensaft, who refutes Ablow’s comments.

In the spirit of not throwing the baby out with the bath water, however, Ablow’s article, Why Denying Death Means Denying Life, points out the ways that the fear of death keeps us from actually living. He says:

“I think we should do everything we can to defeat the denial of death, because it is only when we feel how exquisitely mortal we really are that we can hope to live as fully as we might.

I was partly stripped of my denial by going to medical school. I saw lots of very young people get very ominous diagnoses, completely out of the blue. I saw people brought to the ER, who had seemed to be in perfectly good health, who collapsed and died playing a game of football, or jogging or shopping for groceries. And I often wondered whether they had done anything at all in the last month that they would have wanted to do, for sure, if they had known it would be their last month.”

He goes on to talk about telling people you love them and why. He promotes apologies and giving to charity. Basically he says, if you knew that you had a few weeks to live, what would you want to do to feel like you gave the most to your relationships and take care of the people and causes that you love?

I can’t argue with that. And as I have said before, for better or worse, physicians have a unique window into the randomness of life and death and what this means for all of us.

It was a hard decision to further publicize Ablow given what he said about Chaz Bono. Ironically, though, the decision to mention his article illustrates what he implies in his piece about death and living more mindfully. Just because someone does something hurtful or says something we don’t agree with does not make them inherently bad. People are complicated. I personally don’t know anyone who has the exact same views as myself. This is how it should be. Different ideas make life interesting. If there were not discrepant views, most of us writers would not have anything to say! Additionally, relationships would be pretty boring if it seemed others had the exact same mindset. I would be uninterested if my husband or my friends felt the same way I do about issues that matter to me.

More importantly, however, is the value of forgiveness. People hurt us intentionally and unintentionally. While we need to correct people who have views that can be divisive and ill informed, it does not mean we need to wipe them out of consciousness. Relationships don’t last long if we kill off those who have hurt us. Since relationships are what make life meaningful, we benefit most when we tolerate the idea that people we love are capable of both good and bad.

The answer may be yes.

A study reported in Scientific American offers hope about the control we have when it comes to fighting heart disease.

The authors of the study report that those who had a genetic marker for heart disease had a lower risk of illness when they consumed fruits, raw vegetables and nuts.

Indeed, others have speculated that what we do behaviorally can impact whether or not our genetic predispositions lead to illness. Regarding diet and other illnesses, another recent study  found that breast cancer cells were less likely to grow in the presence of resveratrol, one of the substances found in red wine. Keep in mind this latter study involved breast cancer cells in a petri dish and not actual people.

Nevertheless, there is evidence that we can help our bodies prevent disease by eating healthy and nutritious foods. Maybe, the old saying, we are what we eat has some truth.

We have to be careful in over-interpreting these studies, however, particularly when they are dealing with cells and not human beings. Remember how broccoli was thought to be the magic vegetable to prevent cancer? There is likely no one food, consumed in isolation, which can prevent disease. Rather, a healthy lifestyle, in which a number of nutritious foods are a daily part of one’s diet, may be the key.

Wellness is not all in the body, however. The human mind does matter. Particularly in heart disease, a number of psychological factors influence illness, as strongly as other environmental factors do. Recent research suggests that severe anxiety and depression influence many illnesses, but especially heart disease, making the need for psychological interventions more important than ever for those struggling with illness. 

That said, take control where you can. Eat fruits, vegetables and nuts, and if you can stand it, reduce your meat intake for good measure. Enjoy some red wine with your food as well, just not too much.

Though this is alarming news, it is not necessarily surprising. Doctors have been quietly ceasing to accept Medicare for some time now, in large part due to the threat of cuts to the nationwide program for people over sixty-five.

Medicare rates have already been reduced, though it is unclear how much so per specialty.  In my own field, Medicare reimbursement rates have dropped almost 20% since I entered the field in the 1990’s.

Though the cuts that have already taken place ruffle the feathers of some medical clinicians, what seems to worry doctors more are the threat of annual and ominous SGR (sustainable growth rate) cuts which threaten to take a good chunk of change from the pockets of doctors. We have been able to stave off SGR cuts since the early 2000’s, but it is not clear that this year will be one in which doctors emerge unscathed. Currently, some physicians face an almost 30% reduction in pay if the government does not do what it has previously done, stall changes in Medicare reimbursement.

As we all know, Boomers are aging and understandably expect what was promised to them—healthcare when they turn sixty-five. I am not naïve to the realities of our national debt and the costs of health care. But reducing the reimbursement rates of physicians and psychologists has a number of serious consequences. Simply put, we need people who accept Medicare. Even now, I have trouble finding physicians or psychologists who accept this insurance when I am trying to refer someone. And the irony is, Medicare is not that hard to deal with. They are much less oppressive than other insurance organizations that require endless paperwork for treatment.

But the fears of SGR cuts, which have been going on for almost a decade now, have made clinicians fearful. Why become a Medicare provider if all you do is worry about a major cut to your livelihood?

Let me be clear, I do not think that physicians who are anxious about the impending SGR cuts are greedy. In fact, I believe the opposite. Student loans for physicians average in the 150,000.00 range. People in psychology doctorate programs also have significant debt. And since primary care physicians and psychologists are already receiving relatively low reimbursements compared to other specialties, the idea of cuts to salary might just be too daunting for those who do want to accept Medicare.

Then again, I know some physicians and mental health clinicians with trust funds who don’t care how much they make. These doctors still take Medicare and will likely continue to do so. But for the majority of clinicians without family money and young children to raise, or even those who want a nice apartment in an urban area, they need to make a little bit of money as a reward for the ten-plus years they spent in school, not to mention all of the lost time in earned income that could have gone to a retirement account. Not all clinicians can afford to be generous. Many wish they could be.

Doctor’s work hard to get to where they are. They should be compensated reasonably. Isn’t it better for all of us if doctors feel that they are paid well for their time?

I have a friend who paid a medical doctor privately for specialty services until she was sixty-five and qualified for Medicare. She told me her doctor, who had always been so nice to her, cut short her visits by half the time once she started using her Medicare to pay. It is just not fair to doctors or patients when money becomes the primary emotional currency that determines our interactions in medical encounters.

We need doctors and they need us. It is not unreasonable that they are paid for their time and expertise. In our national budget, we may be able to cut a lot of things. Is it really fair or reasonable to cut the services of people who have spent a decade of their life to become doctors or psychologists? I hope the intellectual pursuits of those who want to help people still matter.

The article raises a number of concerns about the uses of medical technology employed to have a baby later in life. As I have written about here and elsewhere, medical technology can seduce us into believing that we do not have limits.

Although Miller’s piece raises a number of important controversies about having children later in life, I was reminded of an issue rarely discussed in the coverage of assisted reproductive technology and the media in general, that of women and men who decide they do not want children.

The hype about having babies often misses the fact that people are increasingly choosing not to have children.

The reasons why men and women are choosing not to have children are complex.  Though not always the case, men who do not want children often get a pass from judgment. Societally, men are not supposed to want kids as much as women do; however, this is a difficult thing to generalize. I have met many men who long for babies as much as women do. There are excellent examples of gay men raising children, which serve as powerful reminders that men have maternal instincts too. I have known many men (gay and straight) who are loving, attentive and thoughtful toward children.

Women who are conflicted about having children or are clear that they do not want to raise kids seem subject to more intense criticism. Some people think that women who do not want children are not “maternal enough,” which is often a euphemism for selfish. A number of blogs echo this sentiment, which can be found with a simple Google search.

Why do women who do not want children make people feel uncomfortable? This is particularly curious, especially when there is a good amount of data that having children can lead to strife. 

Wanting kids is supposed to be “natural.” But then again, some would say that marriage between a man and a woman is the only way people in love can be committed, as Miller also discusses. I don’t agree that marriage should be defined by anyone other than those who want to get married. I also don’t believe that hesitancy about having children is unnatural. Similarly, those who have kids and are conflicted or remorseful about their decision to procreate should be met with kindness and understanding. Having kids can be rewarding, but raising a child is also met with a number of challenges.

The idea of women as “maternal” has an important meaning for all of us psychologically. We all hoped our own mothers were maternal and up for the parenting task, but sometimes people have kids and then realize they are ill-equipped for the job. The children of these parents often find their way into therapy as adults.

Women and men currently of childbearing age are the first generation to consciously question if they want to have children. Such persons, in my mind, should be given credit; maybe people who do not want to have children want to focus on other ways to help the world. Or perhaps they just do not feel like they are equipped to be good parents.

A friend of mine who had a child last year commented on the bizarre way that she and her husband were treated like they knew how to handle their newborn. As a sensitive and thoughtful parent, she was scared about the vulnerable infant they were about to take home. She said, “Why do they care more about if we have an infant seat than if we know what we are doing with this kid!?”  I thought, because people believe that parenting is supposed to be natural. And maybe in an evolutionary sense it is, but does that mean all parents get it right? Sometimes things go terribly wrong in parenting.  Given this, why are we so critical of those who avoid having children and focus their energy on other creative pursuits?

If you are feeling confused, don’t worry. It’s complicated; but then so are the dynamics of denial. Consider this conflicting statement:  “The comparative data shows that the notion that Boomers feel seven years younger than their age has been consistent since 1993. What’s grown worse is their view of their own health, which can be expected given the 18 years. In 1963, 64 percent saw themselves as being in very good/excellent health. That declined to 58 percent in 2003.”

Though the idea that one can feel young and sick seems contradictory, one possibility is that people who are ill are coping exceptionally well with their disease. Another idea is that some Boomers are in denial about aging. This second hypothesis may have some traction.

For example, in the world of writing and publishing I have heard that books geared toward Baby Boomers about aging and illness don’t sell because, as several people put it, “Boomers are in denial about aging and death.” And in the clinical world, I have had many patients of very advanced ages talk with me about living another couple of decades, sometimes even when they have had severe life-threatening illnesses.

So how can some people report feeling young while still acknowledging the limitations of aging and illness?  Denial.

Many in the fields of psychology and psychiatry, but particularly in psychoanalysis, have emphasized the ways we can all hold two (or more) very different ideas about things. We can have different states of minds in which opposite beliefs exist.

Denial is not always a bad thing. Research in oncology has shown that short-term denial can be adaptive in the early phases of illness. Additionally, I remember when I was being trained in hospitals with medically ill patients and my supervisors told me that the goal of treatment should be to reduce denial in patients who were dying. As clinicians, I am not sure that we always need to have this as a goal (especially when it is our goal and not the patient’s!) People often don’t want to change their psychology at the end of their lives, and it is not my place to enforce the “right” way of thinking.

Long-term denial can have a price, however. Particularly for Boomers, I worry that some people expect their bodies to do more than they can. I have known several people who have ignored warnings about certain physical activities, only to find that they become injured when they decide to hike 6 miles or jet ski, or even make sure they are fully oriented and able to walk when they get up in the middle of the night.

There are also profound psychological implications of denial. When we ignore reality, a part of us knows. It is as if we are making a Faustian bargain with our mind. No matter what we tell ourselves, some aspect of our psyche is engaged with reality. Anxiety and depression can result when we become aware that the story we are telling ourselves is not an accurate biography.

If denial works, that is just fine with me. Aging and illness are hard to think about. Unfortunately, it often does not work to pretend that aging does not have negative consequences.

Aging and illness requires us to manage a number of hits to self-esteem. As we get older most of us have to deal with the narcissistic injury of having bodies that don’t work as well as we would like.

Narcissism can be viewed as a negative word in psychology and psychoanalytic theories. 9See this Psych Central page for a description of excessive narcissism.) However, narcissism not only has normal and developmental underpinnings, some level of narcissistic defenses (not when narcissism is a personality disorder) are crucial to our being able to manage a number of stresses and disappointments in life. Even Freud (1917) implied that there is normal and excessive narcissism. Kohut took this many steps further, however, and questioned whether narcissism is fundamentally pathological. Among the many things he said, one of the most important is that it may not be so unusual for us to want to be loved and admired.

Our relationships with our bodies are inherently narcissistic. We expect to control our bodies and expect them to work when we want them to. We need to feel competent—athletes know this idea quite well as they require a certain kind of performance from their bodies on a regular basis. Additionally, although excessive self-sufficiency can be problematic, many people take comfort in knowing that they can do most things for themselves.

Aging and illness can change the ways we relate to our bodies. In extreme examples, illness can require extreme dependency, such as when people need help using the bathroom or getting dressed in the morning. Many older adults who do not experience this level of dependency often complain about needing reading glasses or needing to write things down so they remember them. Such minor adjustments can be hard for people who experience themselves and their bodies as not needing assistance.

In order to age well, we have to come to terms with the fact that our bodies stop serving us as well as they used to. For many aging is a blow, but I worry that the culture of psychology and the negative understandings of narcissism make it hard for people to feel like they can have negative feelings about aging. The literature in popular culture may even make this worse. Much of what we see in the popular press has to do with a blatant denial of aging. Ideas that we can stop the aging process are all over the Internet these days. And if you can’t change internal aging, just change it externally by doing everything you can to look younger. It is as if changing the outside (our appearance) will alter the inside (our physical biology).

This strikes me as more than a bit sad. Aging is a reality and it causes us to feel bad. Even people who are lucky enough to age with minimal limitations still suffer some degree of loss. For those who are subject to illness, they have even more grieving to contend with. Part of dealing with the sadness associated with growing older is to realize that aging and illness are narcissistic blows. Our self-esteem can suffer as we age.

It hurts to grow older—emotionally and sometimes physically. Managing self-esteem as we age is more about accepting limitations and not pretending that they do not exist.

The research team led by Professor Christos Markopoulos noted that they “observed that radiotherapy was administered less frequently and administration of chemotherapy sharply decreased with increasing age. Thus, it is most likely that under-treatment of the elderly may explain the worse age-specific breast cancer outcome found in our study.”

Others have found similar results when looking at women being treated for breast cancer.

It’s hard to know exactly how to interpret these studies. Breast cancer is a complicated disease and a number of factors can impact prognosis. Additionally, age and co-existing medical conditions can make certain treatments more risky in the elderly. I certainly do not know as much as oncologists who make treatment decisions on a regular basis. On the other hand, I am aware that many cancer trials exclude elderly patients.

Additionally, in nearly twenty years of working with doctors and patients, I can’t say that I have not suspected age to be a factor in the medical decisions of many older patients I have treated.

Regarding other women’s health issues, we already know that overweight women are less likely to receive the same care as those who are thinner. Age-bias may be harder to detect than sex discrimination but some argue that it exists, albeit in a subtle fashion.

Bias in medicine is often unconscious and without malevolent intent. However, it seems to me that we need to urge physicians to become aware of bias (if and when it exists). Keep in mind that we don’t know how to explain the studies on women with breast cancer.

That said, patients should be fully informed about the risks and benefits of treatments. Older patients, it seems to me, should be given the same treatment options as younger patients. None of us want to be in the position of having someone else make decisions for us. And overall, we need to be thinking about how to include older men and women in cancer clinical trials, so we know best how to help them.

Friends and family are often terrified by severe illnesses, especially when they occur in younger adults, and though they might want to be helpful, they often don’t know what to say. When people feel helpless platitudes can be common. Who wants to hear friends say such things as, “Well it could be worse, right?” (Often the answer is, “Not really”), or “Illness is a gift; you can learn a lot from it.” (And the answer is, “Maybe, but it’s a gift I don’t want.”)

Sometimes people affected by illness don’t want to talk about it. That’s okay. People with illness, especially those undergoing difficult medical treatments, often relish the breaks they have when they do not feel like a sick person. They look for friends and family members who can treat them as “normal” people again. This does not mean that patients will necessarily act happy. In fact, it can be quite distressing to medical patients when they feel that people are trying to get them to feel or act in a good mood.

When we try to cheer people up who are ill, it can be more about managing our own anxiety than about really trying to help. People who are sick are often not happy and it is not our job to change that. When we try to cheer people up, it can communicate the message that we do not want to hear about what they are going through.

People struggling with illness need to think about what they want and need in a friend or support system, and find people who will listen in the ways that they need. Requirements for good listening are unique and individual, however. Some people want practical advice, some want to vent, and some need empathic, “what would a therapist say” kind of support.  Not everyone can manage talking about illness. If you are a patient, only take a risk in talking about your health with someone who you think is a safe bet. Consider the kinds of support your friends or family can offer. If you have a brother who is best at offering practical advice, it might not be best to call him when you have undefined anxiety and just want someone to listen. On the other hand, he might be the perfect person to call when you are thinking about finding a new doctor.

As friends and family, we are not on stage when trying to help someone who is ill. Extending the acting metaphor, we as loved ones are not the main characters. We are simply in supporting roles trying to help the person we care about. As supporting actors we can offer a lot; even when we feel helpless, we can communicate how much we care.