death

Death
The essential, basic arch-anxiety (primal anxiety) is innate to all isolated, individual forms of human existence. In the basic anxiety human existence is afraid of as well as anxious doubts about its being in the world…only if we understand this can we conceive of the seemingly paradoxical phenomenon that people who are afraid of living are also especially afraid of death. (Medard Boss as cited in Becker, 1976, p. 208)

The subject of death is one that does not usually come up in "polite society" except in the form of titillating anecdotes or in the retelling of broadcast news and gossip, which are, at times, on and the same. We watch death on television and in the movies. Everyone dies in the movies, sometimes more than once. Soap operas are especially gifted when it comes to resurrecting the dead. But to talk about it, to really get into it and begin to contemplate the nature of death and our relationship to it and to actually communicate with other human beings about our fears concerning death, our rage at the prospect of losing our lives and our loved ones is somehow wrong. It is called morbid and useless.

Those who do venture into the domain of death and its psychological effects are labeled neurotic or depressed. Or they are told that "you just think too much. You really
should get a hobby."

Death is the only thing in life that we, as humans, can be absolutely sure of. Death is always with us, even when we choose to avoid its presence. French philosopher and writer, Georges Bataille (1954) writes "we only have two certainties in this world-that we are not everything and that we will die. To be conscious of not being everything, as one is of being mortal, is nothing. But if we are without a narcotic, an unbreathable void reveals itself" (p.xxxii).

Everyone has a theory or two about death and usually these "theories" are nothing more than attempts to prevent ourselves from "thinking too much" And we shan't want to wander too deeply lest we become neurotic or too abstract. The irony is that once we do come face to face with death it is not an experience of abstraction but rather an "in your face", concrete wake-up call to the way things are as opposed to the way we think they should be.

In Herman Feifel's book, The Meaning of Death, C. Wahl, in The Fear of Death, is cited as saying, "One cannot look directly at the sun or death" (1963, p.214). Unfortunately this quote is true. We put on our shaded glasses and feel protected but unlike looking at the sun which can make you blind, facing death will not make you dead.

Adolf Meyer said, "Why focus on bitter and immutable reality?" (As cited in Yalom, 1980 p.29). Why? Why not? Everyone is an individual, but it seems ironic that despite such `autonomy’ we, as a culture, are guilty of one of the biggest conspiracies of all time. How is it that we have become so metaphysically lazy? How is it that we have managed to trivialize something so human to the point of disinterest? Something so profound and mysterious to the point of boredom? These are questions that should be asked about the Zeitgeist in which we live, However, they can also be asked of the Psychological community.

In commenting on Herman Feifel’s paper, "Death—A Relevant Variable In Psychology", Gordon Allport (1960) says, "Of course it is a relevant variable. Why is it at this late date we still need to be persuaded?" (As cited in May, p. 94).

A common objection by psychotherapists to examining the influence of death in a client's life is "Don't clients have enough to fear and enough dread without the therapist reminding them of the grimmest of life's horrors?" (Yalom, 1980, p.29). Casting such dramatics aside, if the truth were to be known the question would probably be rephrased as, don't I have enough to do without having to deal with my own fears of death that come to the surface as I do my job? Irvin Yalom (1980) quoted Adolph Meyer when he described the general attitude toward death in therapy, "Don't scratch where it don't itch" (p. 29). This is another common bit of caution to those who would help to heal. But isn't it true that some of the best back scratches occur when the scratcher doesn't limit the scratching to only the itchy parts?

The point is that we do tend to experience life in ways that are safe and comfortable. `Ignorance is bliss' is the old adage to which we cling in the face of threatening phenomena. While we cling to avoid fear and pain, we lose much of the vitality and brilliance which life can offer and these losses can wound us deeper than what we set out to avoid in the first place.

This is not to say that by talking about death, either to ourselves, our children or parents, or to clients and therapists, we will always feel good in the final analysis or that everyone's problems are rooted in death. Death is a serious topic and should be dealt with appropriately whether in our personal or professional lives.

Death can hurt us so much when we lose what is dear and important to us. The experience of losing someone can be horrendously painful and the aftermath can be marked by extraordinary anguish. The person who is dying can also feel tremendous pain, physically and/or emotionally. To lose one's life is to lose the world and everything and everyone in it. From the loss of loved ones to the loss of the color blue. It is important to never forget that. However, Viktor Frankl once said: "If you want to endure life, prepare yourself for death" (As cited in Yalom, 1980, p.58).

So, by conveying these opinions about the current era's avoidance of death and its effects, it is not to make light of death but rather to demonstrate the fatuous nature of our attitudes. To avoid or deny even what seems to be an insignificant part of a human being is to deny one's humanity and to trivialize one's suffering.

Death is indeed a fearful piece of brutality; there is no sense pretending otherwise. It is brutal not only as a physical event, but far more so psychically: a human being is torn away from us, and what remains is the icy stillness of death. There no longer exists any hope of relationship, for all the bridges have been smashed in one blow. (Jung, 1961, p. 314)

For many people to approach the subject of death with courage is frightening, otherwise courage would not be needed. However, for many people to approach the subject of death is what is needed in order to heal. Death strikes one of the hardest blows against a person's psyche and it is baffling to see how most in the field of psychology avoid it.

Heidegger said that "Only when our defenses against death anxiety are removed do we become fully aware of what they shielded us from" (As cited in Yalom, 1980, p. 30). The prospect of the termination of life is frightening for most people. Some people have great fear and anxiety about death that they hold tightly within themselves. Wondering alone about what may or may not be. With one eye opened and one eye closed some imagine what it would mean to die; to be no more. For some people death is a scary monster, for others it is not. There is one thing that is accepted by people in general and that is that we do not talk about it unless it is absolutely necessary. One question arises and that is who is better off? The person who is fully shielded?

The person who is not?

German Philosopher, Martin Heidegger believed that

there are two states of Being; state of forgetfulness in that:

one lives in the world of things and immerses oneself in everyday diversions of life: one is leveled down absorbed in idle chatter, lost in the they. One surrenders oneself to the everyday world, to a concern about the way things are. In a state of mindfulness of being: One marvels not about the way things are but that they are. Continually being aware. (as cited in Yalom, 1980 p.28)

Generally, people are living in the former. Such "living" is the result of the inability to question. When one continues to live life day after day within a den of unchanging habits, growth is suppressed. Heidegger refers to this as "inauthentic living". Life inherently means growth and it is apparent that a life which is devoid of growth is in a sense devoid of life. If psychology really is interested in human beings then it would encompass all of what it means to be human.

In his book, Existential Psychotherapy, Dr. Irvin Yalom (1980) describes four postulates of death:

"The fear of death plays a major role in our internal experience; ...It is a dark, unsettling presence at the rim of consciousness.

The child, at an early age, is pervasively preoccupied with death, and his/her major developmental task is to deal with the terrifying fears of obliteration.

To cope with these fears, we erect defenses against death awareness, defenses that are based on denial, that shape character structure, and that are maladaptive, result in clinical syndromes.

4. A robust and effective approach to psychotherapy may be constructed on the foundation of death awareness." (pp. 27-28)

"Psychopathology (in every system) is, by definition, an ineffective defensive mode. Even defensive maneuvers that successfully ward off severe anxiety, prevent growth and result in a constricted and unsatisfying life" (Yalom, 1981, p.110). Dr. Yalom appears to be the champion of existential issues in the area of psychological health. Knowing the dynamics of these otherwise avoided issues, he fully integrates them within his assessment and treatment of psychological pathologies. He has successfully shown that treatment involving the basic human concerns helps to clarify, and most importantly, to heal. In some ways he is a pioneer in that he does not profess to have cures for these issues. He does not use medication to suppress death anxiety. He does not attempt to "cure" the person of their existential situation. Instead he helps the person to face their fears of these existential issues and helps the client to deal with them in healthy ways.

There is a considerable amount of support for the thesis that death attitudes and anxiety play a large role in the occurrence of psychopathology. R. Skoog (As cited in Yalom, 1980) reports that 70% of all patients with a severe obsessional neurosis had at the onset of illness a security disturbing death experience. Concerning unconscious death anxiety Feifel's research showed that:

on a conscious level over 70% of individuals denied a fear of death. On the fantasy level 27% denied fear of death, 62% answered ambivalently, and 11% gave considerable evidence of death anxiety. At a level below awareness, most of the subjects gave evidence of considerable aversion to death. On the more conscious level older subjects and religious subjects perceived death in a "fairly positive vein" but succumbed to anxiety at the gut level. (p. 52)

Rosenzweig and Bray present data that indicates that among schizophrenic patients, when compared with a normal population, with manic depressive sample, and with a general paretic sample, there is a significantly greater incidence of a sibling dying before a patient's sixth year...and "if one considers loss of a parent as well as loss of sibling, then one finds in Rosenzweig's research that over 60% of schizophrenic patients suffered an early loss. Perhaps the schizophrenics had too much too soon. (Yalom, 1980 pp. 104-105)

Research of this type presents the psychological community a door to understanding our relationships with the profound.

In addition, some interesting facts about some of Freud's most popular cases have been brought forth. Yalom (1980) notes two in particular:

Frau Emmy von N. developed her illness immediately after the death of the person closest to her, her husband. Freud hypnotized her and asked for important associations. She reeled off a litany of death related memories: seeing her sister in a coffin (at age 7), being frightened by her brother dressed as a ghost and by siblings throwing dead animals at her, seeing her aunt in a coffin (at age 9), finding her mother unconscious from a stroke (at age 15) and then, (at age 19) finding her dead, the death of her brother and the witnessing the sudden death of her husband. (p.63)

Anna O's illness first developed when her father fell ill, (and succumbed to the illness ten months later) Breurer noted Anna O's preoccupation with death. He commented that, although she had 'bizarre and rapidly fluctuating disturbances in consciousness, the one thing that nevertheless seemed to remain conscious most of the time was the fact that her father had died. (p. 62)
It is obvious that there was more going on with these two clients than the suppression of sexual desire. Reading over some textbooks from previous psychology classes, the only mention of death in relation to Freud is the "death instinct" that theorizes that we all have a subconscious wish to die. While there are allusions to sexual abuse when Anna O is referenced, there is no mention of death whatsoever.A question arises when one thinks about the concept of death and how it affects people and even more so, the concept of death in children and how death affects them. Our denial of death begins early in life for most people. Parents believe that they can protect their children from the reality of death but to try is futile and even dangerous to young minds. Parents attempt to quiet the questions regarding death by shielding them from actual experiences with death, whether it be the death of family member or otherwise. However, children are still faced with death on other, less overt levels. Most ironically, some of the vehicles for death-related issues are provided by the parents who wish to keep them uninformed. For instance, there are many children who are taught to say nightly prayers. There is the one that goes, "Now I lay me down to sleep….if I should die before I wake…There are also lullabies that have extremely overt themes about death.

Listening to parents of young children it is apparent that they cannot believe that such young children think about death. One mother, curious about whether her own children actually have ideas of death, asked her 5 and 6 year old children about death they told her that they knew all kinds of things about it and that they do in fact think about it. "Parents say (of children), what they don't know won't hurt them, but in reality, what they don't know they invent" (Yalom, 1980, p. 80).

Case studies support the assertion that children are not as "blissfully ignorant" as we assume them to be:

Erik Erikson reports the case of a four year old child whose grandmother died, and who had an epileleptiform attack the night after he saw her coffin. A month later he found a dead mole, asked about death, and again had convulsions. Two months later he had a third series of convulsions after accidentally crushing a butterfly in his hand. (Yalom, 1980, p. 77)

Yalom presents four conclusions of death and children based on prior research and clinical work:

1. When behavioral scientists choose to investigate the issue closely, they invariably discover

that children are extraordinarily preoccupied with death. Children's concerns about death are pervasive and exert far-reaching influence on their experiential worlds. Death is a great enigma to them, and one of their major developmental tasks is to deal with fears of helplessness and obliteration, whereas sexual matters are secondary and derivative.
2. Not only are children profoundly concerned with death, but these concerns begin at a much earlier age than is generally thought.
3. Children go through an orderly progression of stages in awareness of death and in methods they use to deal with the fear of death.
4. Children's coping strategies are invariably denial based: It seems that we do not, perhaps cannot, grow up tolerating the straight facts about life and death. (p. 81)

According to Yalom, there are two basic forms of death denial and each carries particular types of psychopathology as a result. The first is `specialness'. It is not unlike the term that developmentalists usually assign to teenagers, adolescent egocentrism concerning "personal fable" (Santrock, 1992, p. 395).

Specialness refers to a belief that one is somehow different from the rest of the world, that death or illness happens to others but does not exist for me. This form of death denial is very resistant to ideas of the mortality of the individual. However, it also is the form of denial that is easiest shattered upon the learning of a terminal illness or an experience of death awareness.

According to Yalom, (1980), there are specific pathologies related to Specialness; "compulsive heroism", "workaholism", "narcissism", and "problems with aggression & control" (p118).
Compulsive heroism occurs when the specialness defense becomes "overextended". It can be found in the behavior of those who engage in extremely hazardous activities. This raises questions in regards to current trends in psychological diagnoses and treatment. How many clients who exhibit such behavior are encouraged to examine their behavior from this point of reference?
Specialness may also play a part in some of the more offensive maladaptive behaviors we encounter. "All persecutory trends and ideas of reference flow from a core of personal grandiosity; after all, only a very special person would warrant that much attention, albeit malevolent attention, from his environment" (Yalom, 1980, pp. 117).

"The compulsive heroic individualist represents a clear example of the defense of specialness which is stretched too thin and fails to protect the individual from anxiety or degenerates into a runaway pattern" (Yalom, 1980, p. 121). This runaway pattern that Yalom describes is found in people who are "consumed" by their work. But the explanation in psychological terms reflects back to the denial of death and its subsequent anxiety. He says, "time is the enemy not only because it is the cousin to finitude but because it threatens one of the supports of the delusion of specialness: the belief that one is eternally advancing." He also says that "a frantic fight with time may be indicative of a powerful death fear".

Narcissistic personality disorder is the most commonly diagnosed syndrome in psychoanalytic centers in recent years and it is described as having a pattern of a grandiose sense of self-importance, often combined with feelings of inferiority (Bootzin, Acocella & Alloy, 1993, p.279). According to the textbook of Abnormal Psychology edited by the above mentioned, the genesis of this "disorder" is debatable among those psychologists coming from different schools of thought. However, there was no mention of the connection to death anxiety.

Dr. Yalom has often come across narcissism during his years as a psychiatrist and he clearly points to "specialness" as the catalyst of this phenomenon. Self-centeredness is a key function of the "Narcissist" as well as the escape route for those with a "thinning" of the defense against mortality.

Aggression and control is another way that "Specialness" is manifested. "One's own fear and sense of limitation is avoided by enlarging oneself and one's sphere of control" (Yalom, 1980, p. 127). When one thinks of the ways people seek control in their life one cannot avoid the question, why? Why this demand for control? It makes sense to answer this question with the paradigm of death anxiety and "specialness". People who are the most fearful of the unknown are understandably drawn to situations and behaviors that can tone down the feelings of anxiety.

Yalom even goes so far as to say that there are professions that are "death-related" such as soldier, doctor, priests and morticians. He did not include psychiatrists and psychologists but perhaps they too should be added. Herman Feifel has researched this topic and the results are fascinating. He found that "although physicians have less conscious death concern than contrast groups of patients or the general population, they have, at deeper levels, a greater fear of death" (As cited in Yalom, 1980). Yalom translates this as an assertion that "conscious death fears are allayed by the assumption of power, but deeper fears, which in part dictated the choice of the profession, operate still". (p. 127)

However, for most people this shield is not reliable nor impenetrable. It only takes one brush with death, one experience with the "reality" of a terminal illness or sudden tragedy to shatter our shields and plunge us into the abyss of the (being just like everybody else) ordinary. The realization that one is not special and that in fact one will die is extremely traumatic in its rapidity. To be faced with death, knowing that life will go on without you is a hard pill to swallow.

There is no cure for mortality and maybe realizing this is the only thing that can save us. "One can face it, fear it, ignore it, repress it, but one cannot be free of it" (Yalom, 1980, p. 167).
The second belief that people can use in dealing with death anxiety is that of the "Ultimate Rescuer". It is the belief that someone or something is going to save you. It can be in the form of a personal God, or a fellow human being, particularly one who is caught in the grips of the assumption of "Specialness". One of the commonalities among religions is that of the savior.
In our times of trouble we seek help from those whom we deem capable. We go to doctors to cure our ills, lawyers to defend our rights, and priests to save our souls. Death in itself is one of largest woes. We escape thinking about it by following a leader. The temptation of immortality is the sweetest fruit on the vine so we drink of the wine pressed by the ultimate rescuer and become drunk from the joys of everlasting life...until, of course, we collide with an event that brings death to the forefront.

What Heidegger would call "a breakdown in the machinery", Yalom (1980) calls the "collapse of the rescuer" (p. 132). Again, the realization of a terminal illness as well as depression can shatter the faith in the `rescuer'. In these instances often there are related problems concerning isolation because of an internal push to reconnect with a `rescuer' outside oneself.
It is important to note that there is not an assumption that death is the only cause of anxiety that can generate pathologies and emotional distress, nor that these two forms of denial (rescuer and specialness) are independent forces. Yalom stresses that there are highly interconnected sources of death anxiety and denial. Oftentimes they are not able to be separated from one another.

The crux of this part of the human being's experience with death and finitude is the reality that death does play an important role in pathologies as well as in the process of growth. Yalom offers many case studies that focus on the area of death anxiety. He has helped a great number of clients by using his knowledge of existential issues. He has successfully integrated the issue of death and the other issues within the framework of group therapy. There have been times when he would bring a person with a terminal illness into a group with "healthy" individuals and he has put a "healthy" individual into a group that consisted of people with terminal illnesses such as cancer. The dynamics and growth that took place in these groups are amazing to note.

As I probe further into this area of existential issues and psychology I am beginning to understand the human being far better than I ever have been able to. I understand enough to know that we all walk around with our question marks, heavy on our minds. Most of us carry our inner experiences alone as if there were some metaphysical ordinance dictating our silence. In our daily lives we rarely share our most frightening and painful sufferings with others. In this truth may lie the key to healing.

Unlike anything else that wounds us, these issues are inescapable. What if our silence is doing more harm to others? Yalom (1980) said, "that maybe it is not translation into other less "deathy" anxieties that the neurotic patient needs; he or she may not be out of contact with reality but instead, through failing to erect "normal" denial defenses may be too close to the truth" (p.190).

In other words, anxiety related to death is a genuine and significant component of the human being. To the extent that it is recognized, confronted and dealt with properly, it is normal. However, if a person does not possess the abilities to take death as a part of one's existence or to deal with their fears and anxieties, pathologies may result. For psychotherapists and counselors to ignore the presence of death anxiety because they themselves have not dealt with these issues, is to inhibit the growth of their clients.

What if in our attempts to shield ourselves we are in fact helping to create sickness by helping others to detach themselves from and to ignore the realities of our human condition? If this is true, therein lies our greatest malady.