Ch. 2: Life, Death and Anxiety Flashcards
Role of death in psychopathology and psychotherapy. The basic postulates:
- The fear of death haunts like nothing else, always rumbling under the surface, “at the rim of consciousness”
- The child is pervasively occupied with death at an early age and a developmental task is to deal with the fear.
- We erect defenses against this fear but ones that are based on denial result in clinical syndromes.
- A robust and effective approach to psychotherapy can be constructed on the foundation of death awareness.
“Don’t scratch where it doesn’t itch,” Adolph Meyer.
Question is: is death something everyone always has in mind anyway, so why further remind the grimness of it?
Yalom argues that death itches all the time.
Yalom’s two arguments about death
- Life and death are interdependent:
- they exist simultaneously, not consecutively;
- death whirs continuously beneath the membrane of life and exerts a vast influence upon experience and conduct. - Death is a primordial source of anxiety and thus the primary fount of psychopathology.
Quotes about life & death
Yalom: “Learning to live well is to learn to die well; learning to die well is to learn to live well.”
Cicero: “To learn to philosophize is to prepare for death.”
Seneca: “No man enjoys the true taste of life but he who is willing and ready to quit it.”
Montaigne: “Why do you fear your last day? It contributes no more to your death than each of the others. The last step does not cause fatigue, but reveals it.”
Yalom: “Although the physicality of death destroys man, the idea of death saves him.”
Heidegger’s two modes of being
- State of forgetfulness of being
- World of things, “leveled down”, absorbed in “idle chatter”, lost in the “they”.
- Not aware of one’s authorship of one’s life and world
- “Fleeing”, “falling” - State of mindfulness of being
- One marvels not about the way things are but that they are
- Also called the “ontological mode” (Greek ontos = “existence”)
- Only in this mode one is in touch with self-creation and can grasp the power to change oneself
- Full self-awareness: of the transcendental ego (constituting) and empirical ego (constituted)
- Embracing freedom and nothingness - and is anxious in the face of them
Switching from mode’s of being
Heidegger said that one doesn’t go from the first being to the second one just by simple contemplation or gritting one’s death. Rather, through urgent experiences, “border” or “boundary” or “limit” situations. Death is the condition that makes it possible for us to live life in an authentic fashion.
How death is thought of generally
WW1
American Flirtation
Claim: we don’t generally think of death as something with positive value to life, but “life shrinks when death is denied.” During WWI, Freud: “Life has indeed become interesting again; it has recovered its full content.” When death is not involved, we lose sight of the stakes involved - “as shallow as an American flirtation where it’s understood from the first that nothing will happen”.
Giredoux’s dialogue between Jupiter and Mercury
Giraudoux’s dialogue between Jupiter and Mercury about making love to a mortal: “We miss something, Mercury - the poignance of the transient - the intimation of mortality, that sweet sadness of grasping at something you cannot hold?”
Necrophilia or Life-denial
Yalom doesn’t argue for necrophilia or life-denial, but simply that denying death is a denial of one’s basic nature. Embracing death plunges us into more authentic life modes.
Tolstoy’s War and Peace: Pierre
Tolstoy’s War and Peace provides an excellent illustration of how death may instigate a radical personal change: Pierre the protagonist feels deadened by the meaninglessness of Russian aristocracy. Captured by Napoleon’s troops, he is sentenced to death. As the 6th in row, he watches how five others are shot before him in terror, only to be freed for no reason himself. The rest of the book he lives purposefully.
Golden Gate survivors
6/10 Golden Gate survivors had changed their views of life. “I can now sense other people’s existence.”
Similar stories from clinicians who work with suicidal patients who survived by mere chance. Also similar stories from people who had near-death experiences (automobile accidents, drownings, mountain climbing etc.) - strong sense of the preciousness of life, increasing the ability to live in the moment (Noyes).
Chinese pictogram for “crisis”
combination of two symbols: “danger” and “opportunity”
Cancer patients
*Kübler-Ross’s stages of dying
Cancer patients also report changes, although from Yalom’s study with women who had cancer, most of them did not report changes before cancer and “now” (after the onset). Yet for the ones who did, almost for everyone it was towards growth.
- One patient said Kübler-Ross’s stages of dying are skewed towards a hospitalized population and overlooks the “golden period” that occurs if a patient has time to assimilate his confrontation with death.
Story of Jane: “I do not know what is going on.”
Jane was someone who was in chronic retreat from life. Failing kept Jane young, kept her protected, kept her from having to make choices.
Jane got news that she might have a tumor in her lymph node, and in a group therapy session she realized on a deep level that no matter what she did, no matter how she enfeebled herself, ultimately she would face death alone - no one could die her death for her.
The cancer did turn out to be benign, but Jane had already grown, she took over the helm of her own life. “I think I know what’s going on.”
She had tried to defeat death by staying young, by avoiding choice and responsibility, by choosing to believe her myth that there would always be someone who would choose for her. Growing up, choosing, separating oneself from others also means facing loneliness and death.
Anxiety as a beacon
Though therapeutic work extends in many directions, therapists use anxiety as a beacon: they work toward anxiety, uncover its fundamental sources, and attempt to uproot and dismantle these sources.
Death transcendence
Hegel quote
Death transcendence is a major motif in human experience - from our nightmares, to monuments, theologies, ideologies, our addictions, our belief in progress, our yearning for lasting fame.
Freud believed the first humans huddled together out of a fear of separateness. We perpetuate the group to perpetuate ourselves.
Hegel: “History is what man does with death.”
Robert Jay Lifton, 5 modes to achieve symbolic immortality:
- The biological mode - living on through one’s progeny (endless chain of biological attachments)
- The theological mode - living on in a “higher” plane of existence
- The creative mode - living on through one’s works (Lifton suggests that therapists strive to this through their patients as well)
- The theme of eternal nature - one survives through rejoining the swirling forces of nature
- Experiential transcendent mode - through “losing oneself” in a state so intense that time and death disappear and one lives in the “continuous present”
Norman Brown, Ernest Becker, and Robert Jay Lifton
Norman Brown, Ernest Becker, and Robert Jay Lifton have brilliantly demonstrated how the fear of death has permeated the fabric of our social structure. I shall argue that the fear of death is a primal source of anxiety which affects the internal dynamics of the individual.
Interchangeable terms
death anxiety, fear of death, mortal terror, fear of finitude.
Diggory and Rothman’s research (7)
Researchers have suggested that fear of death is a composite of smaller related fears. Diggory and Rothman’s research resulted in the following ranking:
- My death = grief for friends and relatives
- All my plans and projects would come to an end
- The process of dying might be painful
- End of experiences
- Not able to care for people who depend on me
- Fear of life after death
- What happens to my body after my death
Chronon distinguishes three types of death fear
1) what comes after death,
2) the event of dying,
3) ceasing to be.
Yalom will focus on the third.
Anxiety vs Fear
Anxiety = fear of no thing
(Kierkegaard: “A nothing with which the individual has nothing to do.”)
Fear = fear of something
How do we combat anxiety?
By displacing it from nothing to something.
- Kierkegaard: “the nothing which is the object of dread becomes more and more of something.”
- This helps to mount a self-protective campaign: we can start avoiding it, seek allies against it, develop magical rituals to placate it etc.
DEATH ANXIETY: CLINICAL MANIFESTATIONS
Form of death anxiety
Anxiety wanting to become fear confounds clinical work - death anxiety is rarely encountered in its original form. Usually denial-based, complex set of operations to repress it.
Car-accident after lunch
Yalom once had a fairly serious car-accident after lunch and although he could even get on a plane and give a lecture the same night at another university, he later developed intense anxiety for lunch period with colleagues (“Would I have interesting things to say”; “Would I make a fool of myself”). Other smaller fears as well, cycling, skiing, driving. Further, the world lost its feeling of hominess (Heidegger: “uncanniness” unheimlich).
Mexican cemetery
*Side story from A Green Tree in Geddes: there is a Mexican cemetery that’s divided into two parts: the “dead” who are remembered by the living who still bring flowers etc.; the “truly dead” whose grave sites are no longer maintained because no one remembers them.
Clinical case of Joyce
fell in love at 15, married at 21, divorced at 30, because she did not want to be with him anymore, but wanted him to continue loving her, because as she said: “everyone wants to be remembered”. Without their union, she felt her memories would perish.
She also did not fully complete tasks, she dreaded being “finished”, feared failure, because she had always been successful. Now a failed marriage hit extra hard. She believes she is special and can win a Nobel prize within 5 years and if that fails then write an astonishing novel. All of these were connected to death anxiety, and dealing with them helped her give up her neurotic needs for Jack. They actually re-established the marriage.
Clinical case of Beth
single in her 30s, always making the “wrong” choice in terms of partners, but now was looking for a good one. She was concerned about her age and childbearing years passing by. Yet when her current partner wanted to discuss marriage she panicked. She was worried about being too fixed, and she also realized that she always “tried to stay ahead” with daily things as well - thinking of dessert while eating the main course. For Beth then the realization was that her press towards marriage and fear of marriage were stemming from a death anxiety.
Patients with obsessional neurosis
R. Skoog reports that over 70% of patients with obsessional neurosis had a near death experience at the onset. Disgust, decay, illness, germs related to fear of personal annihilation. Also found to play a large role in hyperventilation panic, hypochondria, depersonalization syndromes.