Death Anxiety

Death anxiety is deeply repressed and not part of our everyday experience. Gregory Zilboorg, in speaking of the fear of death, said: ‘If this fear were constantly conscious, we should be unable to function normally. It must be properly repressed to keep us living with any modicum of comfort.’

Death anxiety is so fundamental and threatening that its routine repression is a precondition of functional existence, not a pathological aberration — making its invisibility in clinical practice both comprehensible and consequential.

Yalom, Irvin D., Existential Psychotherapy, 1980thesis

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Here I am concerned with the effects of death anxiety on the internal dynamics of the individual. I shall argue that the fear of death is a primal source of anxiety.

Yalom advances the foundational claim that death anxiety is not derivative of other anxieties but constitutes the primary dynamic force shaping internal psychological life.

Yalom, Irvin D., Existential Psychotherapy, 1980thesis

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Either because of extraordinary stress or because of an inadequacy of available defensive strategies, the individual who enters the realm called ‘patienthood’ has found insufficient the universal modes of dealing with death fear and has been driven to extreme modes of defense.

Psychopathology is reframed as the symptomatic expression of inadequate or extreme defenses against death anxiety, making clinical presentation an index of failed existential coping.

Yalom, Irvin D., Existential Psychotherapy, 1980thesis

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All human beings experience death anxiety, but some experience such excessive amounts of it that it spills into many realms of their experience and results in heightened dysphoria and/or a series of defenses against anxiety which constrict growth.

Yalom locates death anxiety on a continuum from universal-normal to clinically excessive, with the latter producing both affective suffering and the growth-constricting defensive structures that constitute neurosis.

Yalom, Irvin D., Existential Psychotherapy, 1980thesis

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To ward off death anxiety, the young child develops protective mechanisms which are denial-based, pass through several stages, and eventually consist of a highly complex set of mental operations that repress naked death anxiety and bury it under layers of such defensive operations as displacement, sublimation, and conversion.

Death anxiety is the developmental engine driving the construction of the defensive psychic architecture that depth psychology studies, originating in early childhood and becoming increasingly elaborate over time.

Yalom, Irvin D., Existential Psychotherapy, 1980thesis

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The therapist views the patient’s symptoms as a response to death anxiety that currently threatens, not as a response to the evocation of past trauma and stress. Hence, the approach emphasizes awareness, immediacy, and choice.

Existential psychotherapy reorients therapeutic interpretation from the historical-causal axis of classical psychodynamics to a present-focused engagement with death anxiety as a living, immediate threat.

Yalom, Irvin D., Existential Psychotherapy, 1980thesis

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Often therapists encounter patients for whom death anxiety plays so central and explicit a role that no inferential leaps are needed. These patients are often trying, because their therapists, once they realize that there is no getting around it.

Yalom identifies a subset of patients for whom death anxiety is the manifest rather than latent organizing principle, requiring no interpretive transformation but direct therapeutic engagement.

Yalom, Irvin D., Existential Psychotherapy, 1980thesis

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When I invoked death anxiety as a central organizing principle, many disparate symptoms and events fell into a coherent pattern. Sylvia’s panic attacks, which often initiated eating and drinking binges, were almost invariably precipitated by some type of insult to her body.

The case of Sylvia demonstrates how death anxiety, once recognized as the organizing principle, retrospectively integrates a previously incoherent symptom picture spanning panic, somatic anxiety, and relational dysfunction.

Yalom, Irvin D., Existential Psychotherapy, 1980supporting

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Unconscious death anxiety. But these studies of conscious death attitudes and anxiety are of little help in understanding the role of death anxiety in psychodynamics. Several researchers have accordingly attempted to study unconscious concerns.

Yalom argues that empirical studies of conscious death anxiety have limited clinical utility, and that understanding death anxiety’s role in psychodynamics requires investigation of its unconscious dimension.

Yalom, Irvin D., Existential Psychotherapy, 1980supporting

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There is a curvilinear relationship between conscious death anxiety and death themes in dreams. In other words, those individuals who have very high or very low conscious death anxiety tend to dream of death.

Empirical research reveals a curvilinear dynamic in which both hyper-conscious and suppressed death anxiety manifest through dreaming, confirming the unconscious pressure of death-related concerns across the anxiety spectrum.

Yalom, Irvin D., Existential Psychotherapy, 1980supporting

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The most fundamental (basic) anxiety issues from the threat of loss of self; and if one fears object loss, one does so because loss of that object is a threat (or symbolizes a threat) to one’s survival.

Yalom contests derivationist accounts that reduce death anxiety to separation anxiety, arguing that the fear of self-extinction is primary rather than a symbolic elaboration of object-loss.

Yalom, Irvin D., Existential Psychotherapy, 1980supporting

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Sylvia’s death anxiety was obviously overdetermined. Not only had she had too much, too soon — early life-threatening experiences and frequent reminders of her close brush with death by her mother — but she also was not able to develop traditional denial-based defenses against death anxiety.

Sylvia’s case illustrates how death anxiety becomes clinically overdetermined when early traumatic exposure combines with impaired capacity to construct the denial-based defenses that normally contain it.

Yalom, Irvin D., Existential Psychotherapy, 1980supporting

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The eight experimental subjects (in contrast to a control no-group sample) ‘reorganized their ideas about death,’ used less denial in confronting their own deaths, and, after an eight-week follow-up, had lower death anxiety scores.

Controlled evidence from death-desensitization workshops demonstrates that structured confrontation with mortality can measurably reduce death anxiety and diminish reliance on denial as a defensive strategy.

Yalom, Irvin D., Existential Psychotherapy, 1980supporting

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‘A person,’ Searles writes, ‘cannot bear to face the prospect of inevitable death until he has had the experience of fully living, and the schizophrenic has not yet fully lived.’

Drawing on Searles, Yalom argues that the schizophrenic’s inability to tolerate death anxiety is a consequence of having never consolidated the experience of full living — suggesting that aliveness is the precondition for bearing mortality.

Yalom, Irvin D., Existential Psychotherapy, 1980supporting

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Her paramount experience was a terrifying loneliness — a loneliness that she had always perceived on the edge of consciousness and had always dreaded. In that meeting Jane realized on a deep level that no matter what she did, no matter how she enfeebled herself, she would ultimately face death alone.

Jane’s confrontation with possible mortality discloses the existential inseparability of death anxiety and isolation anxiety, as the recognition that death is non-transferable catalyzes transformative psychological change.

Yalom, Irvin D., Existential Psychotherapy, 1980supporting

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Bowlby concludes — and this conclusion is widely accepted by clinicians — that separation is the primal experience in the formation of anxiety: separation anxiety is the fundamental anxiety; and other sources of anxiety, including the fear of death, acquire emotional significance by equation with separation anxiety.

Yalom presents and then critically interrogates Bowlby’s derivationist position, which subordinates death anxiety to separation anxiety, in order to establish his own counter-argument for death anxiety’s primacy.

Yalom, Irvin D., Existential Psychotherapy, 1980supporting

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Only much later did we learn that we therapists had played an active role in keeping the group superficial. When we could tolerate our anxiety and follow the patients’ leads, then there was no subject too frightening for the group to deal with explicitly.

The therapist’s own unresolved death anxiety is identified as an active clinical variable that can systematically impede the therapeutic process, keeping discourse about mortality at a defensive, superficial level.

Yalom, Irvin D., Existential Psychotherapy, 1980supporting

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The child repressed this conclusion, and its associated anxiety, which remained unconscious until triggered by the anniversary — by the patient’s attaining the age when her parent died.

Death anxiety originating in the childhood encounter with parental mortality can remain latent for decades before being triggered by anniversary phenomena, illustrating the temporal depth of its unconscious operation.

Yalom, Irvin D., Existential Psychotherapy, 1980supporting

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The young children (and the adolescents) had a much greater emotional response to death-related words than had the latency-aged subjects. The authors concluded that latency is a benign period, the ‘golden age’ of childhood.

Galvanic skin response data reveal heightened death anxiety at developmental bookends — early childhood and adolescence — while latency represents a period of relative quiescence, suggesting a phase-dependent pattern of death-awareness.

Yalom, Irvin D., Existential Psychotherapy, 1980supporting

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Individuals are asked to imagine their deaths — ‘Where will it occur?’ ‘When?’ ‘How?’ ‘Describe a detailed fantasy.’ ‘Imagine your funeral.’

Structured death-awareness exercises employing guided fantasy and imaginative engagement with one’s own death are presented as therapeutic techniques for reducing death anxiety through deliberate desensitization.

Yalom, Irvin D., Existential Psychotherapy, 1980supporting

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On deeper inquiry both women evinced much concern about existential issues which I would never have been able to recognize had I not had the appropriate psychological set.

The clinical recognition of death anxiety as an organizing dynamic in apparently ordinary presenting problems depends on the therapist’s theoretical orientation — it is consistently present but only visible when sought.

Yalom, Irvin D., Existential Psychotherapy, 1980supporting

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The research even remotely relevant to my present discussion attempts to investigate the following issues: the incidence of death anxiety, correlative studies of the degree of death anxiety and a number of variables — demographic, personality factors, and life experiences.

Yalom surveys the empirical literature on death anxiety and finds it predominantly correlational, methodologically limited, and poorly suited to illuminating the psychodynamic role of death fear in clinical settings.

Yalom, Irvin D., Existential Psychotherapy, 1980supporting

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Periodically each was thrown into a confrontation with Charles’s death and his or her own.

The presence of a terminally ill group member functions as a repeated confrontation with death anxiety for all other members, catalyzing existential awareness that cannot be sustained by abstract knowing alone.

Yalom, Irvin D., Existential Psychotherapy, 1980supporting

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Displacement: of death anxiety, 44-49; of responsibility, 225-27.

The index entry confirms displacement as a primary mechanism by which death anxiety is deflected from its original object and redistributed across clinical presentations.

Yalom, Irvin D., Existential Psychotherapy, 1980aside

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Clinical case reports: death anxiety omitted from, 55-56.

The index documents Yalom’s finding that death anxiety is systematically omitted from clinical case reports, reflecting the broader professional and cultural denial of mortality.

Yalom, Irvin D., Existential Psychotherapy, 1980aside

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Research: on death anxiety, 49-54, 152-58; empirical, 23; inattention to death in, 56-57; on psychopathology and death anxiety, 152-58.

Index references locate the systematic empirical and theoretical treatment of death anxiety within the text, marking its dual treatment as research subject and clinical organizing principle.

Yalom, Irvin D., Existential Psychotherapy, 1980aside

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