Our present moment seems as good a candidate as any for the title of “the age of anxiety.” In the US, 32% of people suffer from an anxiety disorder during their lifetime (Kessler et al. Reference Kessler, Chiu and Demler2005). The COVID-19 pandemic has, of course, worsened our anxiety (Hwang et al. Reference Hwang, Rabheru and Peisah2020; Leland Reference Leland2022; Porter et al. Reference Porter, Favara and Hittmeyer2021). But it has also, at least in the western world, increased our awareness of death (Aguiar et al. Reference Aguiar, Pinto and Duarte2022; Rose Reference Rose2021). In 2021, Jacqueline Rose, of The Guardian, wrote that the western cultural “inability to countenance death … has been revealed for the delusion it always is” (Rose Reference Rose2021). It has forced us to ask, in the words of Rose, “What on earth … does the future consist of once the awareness of death passes a certain threshold and breaks into our waking dreams?”

As challenging as these circumstances are, they are not fundamentally new. In the dying moments of World War II, W.H. Auden, the great English poet, was 37 years old, living in Manhattan, and working on The Age of Anxiety, an extraordinary book-length, Pulitzer Prize-winning poem that would diagnose the “cultural condition” of his era (Auden Reference Auden and Mendelson1991). Decades after the poem’s publication, his friend Oliver Sacks would write of the poet’s “intuitive penetrating, almost clairvoyant sense of what was going on in people,” and Auden applies this psychological acuity in his attempt to reckon with an age not only of anxiety but also of death. And not only his age – The Age of Anxiety remains a diagnostic and therapeutic aid for our own cultural moment, and in the remainder of this essay, I will explore its themes of anxiety, loneliness, and solidarity, in order to help palliative care clinicians imagine a loving, humanistic response to the widespread loneliness and anxiety in our culture today.

The Age of Anxiety begins with four strangers in a bar in New York City. The characters are Malin, a medical intelligence officer; Rosetta, a successful buyer for a “big department store”; Emble, an anxious young naval recruit; and Quant, a clerk in a Manhattan shipping office. Though the poem takes place during World War II, we do not know the year, only the day: “It was the night of All Souls.”

All Souls’ Day takes place on November 2nd of each year; a day, for Christians, of prayer and contemplation on behalf of “the faithful departed.” The tradition enacts a form of solidarity across history, between the living and the dead, but in this poem, Auden’s characters begin the evening completely separate from one another. Quant stares at his reflection in the glass and wonders: “How well and witty when you wake up,/How glad and good when you go to bed,/Do you feel, my friend?” Malin ruminates about self-knowledge: “Man has no mean; his mirrors distort; …” Rosetta longs for an imagined innocent landscape: “Undulant land/Rose layer by layer till at last the sea/Far away flashed; …” Emble envisions dissatisfied, isolated men like himself: “Each calls across a colder water,/Tense, optative, interrogating/Some sighing several who sadly fades.”

The characters speak not a word to each other until a radio breaks in with news of the war, “compelling them to pay attention to a common world of great slaughter and much sorrow.” And so, “without their knowledge,” the suffering around them begins “to draw these four strangers closer to each other” until “they could no longer keep these thoughts to themselves, but turning towards each other on high wooden stools, became acquainted.” Malin leads the four in a long discussion of human life – individual and collective, intellectual and emotional, from infancy until “[the] end comes” – and the others voice their preoccupations in highly complex and alliterative verse modeled on the Old English of Beowulf.

What is the object of their union? Presumably, the characters hope for mutual connection, a sense of protection against the anxieties of the outside world, against the death that surrounds them, and by that measure, the quest is a rapid success. Early in the poem, the characters have already attained “a rapport in which communication of thoughts and feelings is so accurate and instantaneous” that the four of them “appear to function as a single organism.” But they soon sense that this connection is no final answer to their shared anxieties, and they are led, now, by Rosetta, on a dream-quest through diverse and imposing terrains, a journey for which “The sole essential is a sad unrest/Which no life can lack. …”

The setting shifts from the bar to a sightless unknown location. The characters begin this journey alone, in the dark, united only by “a restless urge to find water”; even their perceptions are scattered and disconnected. “Groping through fog,” Quant says, “I begin to hear/A salt lake lapping.” Rosetta sees a “tacit tarn” – a small mountain lake. Malin speaks of “Ducks and drakes at a pond”; Emble notes “[the] earth looks woeful and wet… .” As literary critic Alan Jacobs writes: “One by one they describe what confronts them, and it is often difficult to know whether they are experiencing the same thing…” (Jacobs Reference Jacobs2011). Accordingly, this journey ends much like the previous one, with a worldly ambivalence toward human community. Rosetta declaims that “Violent winds/Tear us apart” and the characters wake to find that they have been dreaming. They have gone nowhere. They are still in the bar on Third Avenue.

Nonetheless, the characters agree to continue with the evening, and they travel to Rosetta’s apartment to stage a highly contrived wedding banquet for her and Emble. But the festivities are short-lived. Quant and Malin leave, Emble falls asleep, and Rosetta, left alone, enters into a long, mesmerizing monologue, contrasting her deep Jewish heritage with the transience of modern relationships. Heading homeward, Malin sits on the train and wonders whether this shared quest has created any lasting change. “We belong to our kind,” he thinks, we are “judged as we judge,” implicated in a society filled with persistent anxiety and “apophatic loneliness,” in the words of another Pulitzer Prize-winning author, Marilynne Robinson (Lee Reference Lee2020).

Apophatic – that which evades speech. Lambent in Malin’s verses is the implicit need to move beyond theories about isolation and anxiety in the face of death and loneliness and into deeper connection. To stop talking about symbols and theories of connection, and to start connecting. For Auden, words are a timeless vehicle for communication, but they are also, at times, a method “to get out of knowing our neighbor.” After World War II, the poet focused increasingly on interpersonal responsibility not as a cure, but as a proper response to the isolation and dread of his age. Once, after hearing that an older woman was suffering from night terrors, he took a blanket and slept in her hallway until she felt safe again (Mendelson Reference Mendelson2014). And so, just as Rosetta is steadied amidst the chaos by her Jewish tradition, Malin, at the poem’s end, imagines a God “minding our meanings, our least matter dear to Him,” especially in the places “where we are wounded.” Though rooted in a particular spiritual tradition, this language acknowledges our dependence on one another in the broadest sense: whether that “other” is a loved one, a caregiver, or a religious faith.

We recognize this dependence by paying attention to loneliness, anxiety, and crisis, both around and within us, especially in moments like the COVID-19 pandemic, in which mortality inescapably reminds us that we are, all of us, limited and contingent beings. This recognition wounds our desire for objective security, our Freudian defense mechanisms against the imminence of death. But it also allows us to respond to those wounds through solidarity: a way of relating to the world in which your flourishing is my flourishing, your pain is my pain, and in which, therefore, I strive to be present even (or especially) in your loneliness, your pain, at the end of your life.

For the palliative care clinician, solidarity means proximity to the isolated and the anxious, whether they be a man in hospice care struggling with existential anxiety or an older woman living in a nursing home and isolated by her chronic pain. It could mean spending an extra hour minutes with such a person at the end of a long day, or training young clinicians to attend to these people and their problems. It may simply mean caring for the lonely, anxious, mortal people in one’s own life. “Knowing our neighbor” requires that we strive to understand and act upon the needs and concerns of the people around us, whether they be patients, colleagues, or family members.

Our age is perhaps no more anxious than Auden’s, but it feels more urgent than ever that palliative care clinicians help all of us in medicine to move beyond words about loneliness and anxiety, and into action that comforts the anxious and the lonely.