Against the Natural Order: Notes from the Dementia Ward

It is 3:00 AM on a Tuesday in a Scottish psychiatric hospital, and the rain is hammering against the reinforced glass with the kind of spiteful persistence you only find north of Hadrian's Wall. I am currently hiding in the doctors’ mess, nursing a lukewarm instant coffee that tastes faintly of despair and burnt plastic, having just spent the last forty minutes chemically restraining a retired civil engineer named Arthur.

Arthur is eighty-four years old. In his prime, he helped design municipal water systems that likely saved thousands of lives from cholera and dysentery. Tonight, however, Arthur's tau proteins and beta-amyloid plaques have reached a critical threshold, effectively dissolving the man who built reservoirs and replacing him with a terrified primate who believes the night nurses are a roving gang of IRA paramilitaries coming to execute him. He was attempting to barricade his door with a mattress when I arrived, wielding a plastic butter knife with surprising vigor for a man whose spine resembles a crumbling stack of Jenga blocks.

A small dose of haloperidol has since sent him off to a chemically induced truce with his demons, but the encounter left me with a familiar, creeping sense of existential dread.

If you ever harbor any lingering dualist sympathies—any sneaking, comforting suspicion that the human "soul" sits apart from the meat, that your essential you-ness is an ethereal pilot navigating the bone-mech—I prescribe a six-month rotation in old-age psychiatry. It is the most brutally effective atheism factory on the planet. You watch the self get unspooled, neuron by neuron, synapse by synapse. You see how easily love, dignity, and a lifetime of accumulated wisdom are overridden by a UTI or a micro-infarct in the frontal lobe.

I’ve written before in these parts about the necessity of having children, if only to ensure you have someone to hold your hand when the lights go out. I stand by that. Having a loving family is the difference between dying in a sterile room surrounded by indifferent agency staff making minimum wage, and dying in a familiar bed. But even that is merely a mitigation strategy, a way of softening a blow that remains fundamentally intolerable.

We have, as a civilization, achieved a horrific kind of half-victory. Modern medicine—my profession, which I love and despise in equal measure—has become incredibly adept at preventing you from dying. We can stent your coronaries, dialyze your kidneys, and pump you full of broad-spectrum antibiotics. We have defeated the acute killers that historically pruned the human herd. But we have utterly failed to extend healthspan in tandem with lifespan. We have built a remarkably efficient pipeline that funnels the elderly past the quick, clean deaths of yesteryear and deposits them directly into a decades-long purgatory of cognitive and physical decay.

And the NHS, Moloch bless its sclerotic, crumbling heart, is entirely unprepared for the demographic tsunami that is already making landfall. We are warehousing hollowed-out shells of human beings in care homes at exorbitant expense, draining the wealth of the middle class to fund the agonizingly slow dissolution of their parents.

In India, we largely avoided this until recently. The timeline was historically accelerated by a lack of widespread preventative care, infectious disease, and an abundance of unfiltered diesel exhaust. You had a heart attack at seventy and dropped dead in your garden. It was tragic, but it was fast. Now, the Indian upper-middle class is importing the Western model of senescence. My own grandfather, whom I revere and who practiced surgery into his eighties, is now in his late nineties. He is loved, he is cared for at home, but the sheer indignity of his physical decline is a heavy tax levied on a proud man.

This brings me to a realization that constantly separates me from the normies, the trad-caths, and the romanticists who populate the broader culture war spaces.

People look at my bio—amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi (attain immortality, or die trying)—and assume I am driven by a narcissistic fear of death. They wheel out the tired, poetic cope that "death gives life meaning," that finitude is the necessary canvas upon which human beauty is painted.

This is Stockholm Syndrome for the Reaper. It is the ultimate rationalization of the abused ape.

I am not primarily terrified of death, in the sense of non-existence. I was dead for billions of years before 1998 and it didn't inconvenience me in the slightest. What I am terrified of is this. I am terrified of the natural order. Mother Nature is a blind, idiot butcher who designed us to reproduce and then practically programmed us to self-destruct to make room for the next generation. The natural lifecycle of a human being is a tragedy that ends in profound humiliation.

To look at the rotting wards of a geriatric hospital and conclude that this is a "natural cycle" that should be respected is a moral failing. It is a grotesque aesthetic preference masquerading as wisdom.

This is why I am a transhumanist, and why I frankly do not care if my views are considered uncouth, unnatural, or hubristic. I want to cure aging. I want to rip the telomeres out of our cells and rewrite them. I want to treat senescence with the same aggressive, militarized response we reserve for smallpox.

And this is also why I remain so sanguine—perhaps dangerously so—about the looming specter of Artificial General Intelligence.

I read the doom-posting on LessWrong and Twitter. I understand the alignment problem. I am perfectly capable of following the Bayesian logic that suggests a superintelligence might trivially turn us all into paperclips or computationally optimal soup. I don't deny the math.

But what the doomers fail to weigh appropriately in their utility functions is the default trajectory.

If we don't build the machine god, what is the alternative? The alternative is that I will slowly lose my mind. My girlfriend will eventually stop recognizing our children. We will rot, inexorably, in a warming world with an inverted population pyramid, fighting over the scraps of a collapsed welfare state while our joints fuse and our memories evaporate. That is not a hypothetical risk; that is a 100% guaranteed outcome under the current paradigm.

I will happily roll the dice on a 30% chance of AGI-induced extinction if it buys me a 70% chance of reaching escape velocity. Give me the ASI. Let it fold our proteins and solve cellular senescence. If it kills us, at least it will likely be fast, clean, and computationally elegant—which is a damn sight better than sitting in a soiled diaper in a Bromley care home, screaming at a nurse because you think you're back in the Blitz.

The rain has finally stopped. My pager is buzzing again; another patient on the ward is likely trying to pull out their catheter. I'll go do my job. I will patch them up, prescribe the meds, and keep the grim reaper at bay for another week, because that is the oath I took.

But I'm not going to pretend it's a victory. The only real victory lies in conquering the biology that condemns us. See you at Heat Death. Or at least, let's hope we make it far enough to try.

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Pub: 24 Feb 2026 18:36 UTC

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