Staring at the Sun E-Book

Irvin D Yalom

• Herausgeber: John Wiley & Sons
• Kategorie: Geisteswissenschaft
• Sprache: Englisch
• Veröffentlichungsjahr: 2010

Seitenzahl: 341

Beschreibung

Written in Irv Yalom's inimitable story-telling style, Staring at the Sun is a profoundly encouraging approach to the universal issue of mortality. In this magisterial opus, capping a lifetime of work and personal experience, Dr. Yalom helps us recognize that the fear of death is at the heart of much of our anxiety. Such recognition is often catalyzed by an "awakening experience"--a dream, or loss (the death of a loved one, divorce, loss of a job or home), illness, trauma, or aging. Once we confront our own mortality, Dr. Yalom writes, we are inspired to rearrange our priorities, communicate more deeply with those we love, appreciate more keenly the beauty of life, and increase our willingness to take the risks necessary for personal fulfillment.

Leseprobe

Table of Contents

Praise

Title Page

Copyright Page

Dedication

Preface and Acknowledgments

Chapter 1 - THE MORTAL WOUND

Chapter 2 - RECOGNIZING DEATH ANXIETY

OVERT DEATH ANXIETY

THE FEAR OF DYING IS NOT A STAND-IN FOR SOMETHING ELSE

COVERT DEATH ANXIETY

ANXIETY ABOUT NOTHING IS REALLY ANXIETY ABOUT DEATH

Chapter 3 - THE AWAKENING EXPERIENCE

THE DIFFERENCE BETWEEN “HOW THINGS ARE” AND “THAT THINGS ARE”

AWAKENING AT THE END OF LIFE: TOLSTOY’S IVAN ILYCH

GRIEF AS AN AWAKENING EXPERIENCE

A MAJOR DECISION AS AN AWAKENING EXPERIENCE

LIFE MILESTONES AS AWAKENING EXPERIENCES

DREAMS AS AWAKENING EXPERIENCES

THE END OF THERAPY AS AN AWAKENING EXPERIENCE

Chapter 4 - THE POWER OF IDEAS

EPICURUS AND HIS AGELESS WISDOM

RIPPLING

MIGHTY THOUGHTS TO HELP OVERCOME DEATH ANXIETY

SCHOPENHAUER’S TRIPLET OF ESSAYS: WHAT A MAN IS, WHAT A MAN HAS, WHAT A MAN REPRESENTS

Chapter 5 - OVERCOMING DEATH TERROR THROUGH CONNECTION

HUMAN CONNECTEDNESS

THE POWER OF PRESENCE

SELF-DISCLOSURE

RIPPLING IN ACTION

DISCOVERING YOUR OWN WISDOM

FULFILLING YOUR LIFE

WAKING UP

Chapter 6 - DEATH AWARENESS

DEATHS FACED

PERSONAL ENCOUNTERS WITH DEATH

FULFILLING MY POTENTIAL

DEATH AND MY MENTORS

MY PERSONAL COPING WITH DEATH

RELIGION AND FAITH

ON WRITING A BOOK ABOUT DEATH

Chapter 7 - ADDRESSING DEATH ANXIETY

WHAT DOES EXISTENTIAL MEAN?

DISTINGUISHING CONTENT AND PROCESS

THE POWER OF CONNECTION IN OVERCOMING DEATH ANXIETY

WORKING IN THE HERE-AND-NOW

THERAPIST SELF-DISCLOSURE

DREAMS: THE ROYAL ROAD TO THE HERE-AND-NOW

Afterword

Notes

About the Author

A READER’S GUIDE TO Staring at the Sun

Index

MORE PRAISE FOR

Staring at the Sun

“Irv Yalom has written a beautiful and courageous book—a book that comforts even as it explores and confronts death. Yalom helps us understand that we must all come to grips with a paradox: The physicality of death destroys us; the idea of death saves us.”

George Valliant, author,Aging Well, and director of theHarvard Medical School Study of Adult Development

“In Staring at the Sun, Irv Yalom brings uncommon wisdom as a gifted psychiatrist now in his mid-seventies to a universal human experience: the terror of death. He provides a brilliant, enriching, and transforming perspective to our fears. Staring at the Sun is riveting, compelling, and ultimately uplifting reading. A crowning achievement.”

Jack D. Barchas, M.D., chair and psychiatrist-in-chief,Weill Cornell Medical College, NewYork-PresbyterianHospital, Payne Whitney Manhattan and Westchester

“In Staring at the Sun, Dr. Yalom shares with us the problems of his patients linked to their mortality, his compassionate, healing insight into their death anxiety, and perhaps most movingly, his own feelings and personal experiences with death. While the existential realities of death, isolation, and meaninglessness may seem at first bleak and full of despair, Dr. Yalom’s existential approach helps his readers frame these realities in positive and meaningful ways that foster personal growth and intensify our connections to others and to the world around us.”

Harold Ramis, actor, writer, and director (Ghostbusters,Groundhog Day, andAnalyze This)

Copyright © 2008, 2009 by Irvin D. Yalom. All rights reserved.

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The names and identities of the people in this book have been changed, and occasionally some case composites have been made. But the essence of each story is accurate and true to the author’s experience. All the patients described have read the author’s text, collaborated on identity change, and approved these descriptions.

Library of Congress Cataloging-in-Publication DataYalom, Irvin D., date. Staring at the sun : overcoming the terror of death / Irvin D. Yalom. p. cm. Includes bibliographical references and index.

ISBN 978-0-7879-9668-0 (cloth)

Dedicated to my mentors who ripplethrough me to my readers:John Whitehorn, Jerome Frank,David Hamburg, and Rollo May

Preface and Acknowledgments

This book is not, and cannot be, a compendium of thoughts about death, for throughout the millennia, every serious writer has addressed human mortality.

Instead, this is a deeply personal book stemming from my confrontation with death. I share the fear of death with every human being: it is our dark shadow from which we are never severed. These pages contain what I have learned about overcoming the terror of death from my own experience, my work with my patients, and the thoughts of those writers who have informed my work.

I am grateful to many who have helped along the way. My agent, Sandy Dijkstra, and my editor, Alan Rinzler, were instrumental in helping me shape and focus this book. A host of friends and colleagues have read parts of the book and offered suggestions: David Spiegel, Herbert Kotz, Jean Rose, Ruthellen Josselson, Randy Weingarten, Neil Brast, Rick Van Rheenen, Alice Van Harten, Roger Walsh, Robert Berger, and Maureen Lila. Philippe Martial introduced me to the La Rouchefoucauld maxim on the title page. My gratitude to Van Harvey, Walter Sokel, Dagfin Follesdal, my dear friends and long-term tutors in intellectual history. Phoebe Hoss and Michele Jones provided excellent editing. My four children, Eve, Reid, Victor, and Ben, were invaluable consultants, and my wife, Marilyn, as always, forced me to write better.

Most of all I am indebted to my primary teachers: my patients, who must remain unnamed (but they know who they are). They have honored me with their deepest fears, given me permission to use their stories, advised me about effective identity disguise, read some or all of the manuscript, offered advice, and taken pleasure in the thought of rippling their experience and wisdom to my readers.

Chapter 1

THE MORTAL WOUND

Sorrow enters my heart. I am afraid of death.

GILGAMESH

Self-awareness is a supreme gift, a treasure as precious as life. This is what makes us human. But it comes with a costly price: the wound of mortality. Our existence is forever shadowed by the knowledge that we will grow, blossom, and, inevitably, diminish and die.

Mortality has haunted us from the beginning of history. Four thousand years ago, the Babylonian hero Gilgamesh reflected on the death of his friend Enkidu with the words from the epigraph above: “Thou hast become dark and cannot hear me. When I die shall I not be like Enkidu? Sorrow enters my heart. I am afraid of death.”

Gilgamesh speaks for all of us. As he feared death, so do we all—each and every man, woman, and child. For some of us the fear of death manifests only indirectly, either as generalized unrest or masqueraded as another psychological symptom; other individuals experience an explicit and conscious stream of anxiety about death; and for some of us the fear of death erupts into terror that negates all happiness and fulfillment.

For eons, thoughtful philosophers have attempted to dress the wound of mortality and to help us fashion lives of harmony and peace. As a psychotherapist treating many individuals struggling with death anxiety, I have found that ancient wisdom, particularly that of the ancient Greek philosophers, is thoroughly relevant today.

Indeed, in my work as a therapist, I take as my intellectual ancestors not so much the great psychiatrists and psychologists of the late nineteenth and early twentieth centuries—Pinel, Freud, Jung, Pavlov, Rorschach, and Skinner—but classical Greek philosophers, particularly Epicurus. The more I learn about this extraordinary Athenian thinker, the more strongly I recognize Epicurus as the proto-existential psychotherapist, and I will make use of his ideas throughout this work.

He was born in the year 341 B.C.E., shortly after the death of Plato, and died in 270 B.C.E. Most people today are familiar with his name through the word epicure or epicurean, to signify a person devoted to refined sensuous enjoyment (especially good food and drink). But in historical reality, Epicurus did not advocate sensuous pleasure; he was far more concerned with the attainment of tranquility (ataraxia).

Epicurus practiced “medical philosophy” and insisted that just as the doctor treats the body, the philosopher must treat the soul. In his view, there was only one proper goal of philosophy: to alleviate human misery. And the root cause of misery? Epicurus believed it to be our omnipresent fear of death. The frightening vision of inevitable death, he said, interferes with one’s enjoyment of life and leaves no pleasure undisturbed. To alleviate the fear of death, he developed several powerful thought experiments that have helped me personally face death anxiety and offer the tools I use to help my patients. in the discussion that follows, I often refer to these valuable ideas.

My personal experience and clinical work have taught me that anxiety about dying waxes and wanes throughout the life cycle. Children at an early age cannot help but note the glimmerings of mortality surrounding them—dead leaves, insects and pets, disappearing grandparents, grieving parents, endless acres of cemetery tombstones. Children may simply observe, wonder, and, following their parents’ example, remain silent. If they openly express their anxiety, their parents become noticeably uncomfortable and, of course, rush to offer comfort. Sometimes adults attempt to find soothing words, or transfer the whole matter into the distant future, or soothe children’s anxiety with death-denying tales of resurrection, eternal life, heaven, and reunion.

The fear of death ordinarily goes underground from about six to puberty, the same years Freud designated as the period of latent sexuality. Then, during adolescence, death anxiety erupts in force: teenagers often become preoccupied with death; a few consider suicide. Many adolescents today may respond to death anxiety by becoming masters and dispensers of death in their second life in violent video games. Others defy death with gallows humor and death-taunting songs, or by watching horror films with friends. In my early adolescence I went twice a week to a small cinema around the corner from my father’s store and, in concert with my friends, screamed during horror movies and gawked at the endless films depicting the barbarity of World War II. I remember shuddering silently at the sheer capriciousness of being born in 1931 rather than five years earlier like my cousin, Harry, who died in the slaughter of the Normandy invasion.

Some adolescents defy death by taking daredevil risks. One of my male patients—who had multiple phobias and a pervasive dread that something catastrophic could happen at any moment—told me how he began skydiving at the age of sixteen and took dozens of dives. Now, looking back, he believes this was a way of dealing with his persistent fear of his own mortality.

As the years go by, adolescent death concerns are pushed aside by the two major life tasks of young adulthood: pursuing a career and beginning a family. Then, three decades later, as children leave home and the end points of professional careers loom, the midlife crisis bursts upon us, and death anxiety once again erupts with great force. As we reach the crest of life and look at the path before us, we apprehend that the path no longer ascends but slopes downward toward decline and diminishment. From that point on, concerns about death are never far from mind.

It’s not easy to live every moment wholly aware of death. It’s like trying to stare the sun in the face: you can stand only so much of it. Because we cannot live frozen in fear, we generate methods to soften death’s terror. We project ourselves into the future through our children; we grow rich, famous, ever larger; we develop compulsive protective rituals; or we embrace an impregnable belief in an ultimate rescuer.

Some people—supremely confident in their immunity—live heroically, often without regard for others or for their own safety. Still others attempt to transcend the painful separateness of death by way of merger—with a loved one, a cause, a community, a Divine Being. Death anxiety is the mother of all religions, which, in one way or another, attempt to temper the anguish of our finitude. God, as formulated transculturally, not only softens the pain of mortality through some vision of everlasting life but also palliates fearful isolation by offering an eternal presence, and provides a clear blueprint for living a meaningful life.

But despite the staunchest, most venerable defenses, we can never completely subdue death anxiety: it is always there, lurking in some hidden ravine of the mind. Perhaps, as Plato says, we cannot lie to the deepest part of ourselves.

Had I been a citizen of ancient Athens circa 300 B.C.E. (a time often called the golden age of philosophy) and experienced a death panic or a nightmare, to whom would I have turned to clear my mind of the web of fear? It’s likely I’d have trudged off to the agora, a section of ancient Athens where many of the important schools of philosophy were located. I’d have walked past the Academy founded by Plato, now directed by his nephew, Speucippus; and also the Lyceum, the school of Aristotle, once a student of Plato, but too philosophically divergent to be appointed his successor. I’d have passed the schools of the Stoics and the Cynics and ignored any itinerant philosophers searching for students. Finally, I’d have reached the Garden of Epicurus, and there I think I would have found help.

Where today do people with unmanageable death anxiety turn? Some seek help from their family and friends; others turn to their church or to therapy; still others may consult a book such as this. I’ve worked with a great many individuals terrified by death. I believe that the observations, reflections, and interventions I’ve developed in a lifetime of therapeutic work can offer significant help and insight to those who cannot dispel death anxiety on their own.

In this first chapter, I want to emphasize that the fear of death creates problems that may not at first seem directly related to mortality. Death has a long reach, with an impact that is often concealed. Though fear of dying can totally immobilize some people, often the fear is covert and expressed in symptoms that appear to have nothing to do with one’s mortality.

Freud believed that much psychopathology results from a person’s repression of sexuality. I believe his view is far too narrow. In my clinical work, I have come to understand that one may repress not just sexuality but one’s whole creaturely self and especially its finite nature.

In Chapter Two, I discuss ways of recognizing covert death anxiety. Many people have anxiety, depression, and other symptoms that are fueled by the fear of death. In this chapter, as in those to follow, I’ll illustrate my points with clinical case histories and techniques from my practice as well as with stories from film and from literature.

In Chapter Three, I will show that confronting death need not result in despair that strips away all purpose in life. On the contrary, it can be an awakening experience to a fuller life. The central thesis of this chapter is: though the physicality of death destroys us, the idea of death saves us.

Chapter Four describes and discusses some of the powerful ideas posited by philosophers, therapists, writers, and artists for overcoming the fear of death. But, as Chapter Five suggests, ideas alone may be no match for the terror surrounding death. It is the synergy of ideas and human connection that is our most powerful aid in staring down death, and I suggest many practical ways to apply this synergy in our everyday life.

This book presents a point of view based on my observations of those who have come to me for help. But because the observer always influences what is observed, I turn in Chapter Six to an examination of the observer and offer a memoir of my personal experiences with death and my attitudes about mortality. I, too, grapple with mortality and, as a professional who has been working with death anxiety for my entire career and as a man for whom death looms closer and closer, I want to be candid and clear about my experience with death anxiety.

Chapter Seven offers instruction to therapists. For the most part, therapists avoid working directly with death anxiety. Perhaps it is because they are reluctant to face their own. But even more important is that professional schools offer little or no training in an existential approach: young therapists have told me that they don’t inquire too deeply into death anxiety because they don’t know what to do with the answers they receive. To be helpful to clients bedeviled by death anxiety, therapists need a new set of ideas and a new type of relationship with their patients. Although I direct this chapter toward therapists, I try to avoid professional jargon and hope the prose is clear enough for eavesdropping by any reader.

Why, you may ask, take on this unpleasant, frightening subject? Why stare into the sun? Why not follow the advice of the venerable dean of American psychiatry, Adolph Meyer, who, a century ago, cautioned psychiatrists, “Don’t scratch where it doesn’t itch”? Why grapple with the most terrible, the darkest and most unchangeable aspect of life? Indeed, in recent years, the advent of managed care, brief therapy, symptom control, and attempts to alter thinking patterns have only exacerbated this blinkered point of view.

Death, however, does itch. It itches all the time; it is always with us, scratching at some inner door, whirring softly, barely audibly, just under the membrane of consciousness. Hidden and disguised, leaking out in a variety of symptoms, it is the wellspring of many of our worries, stresses, and conflicts.

I feel strongly—as a man who will himself die one day in the not-too-distant future and as a psychiatrist who has spent decades dealing with death anxiety—that confronting death allows us, not to open some noisome Pandora’s box, but to reenter life in a richer, more compassionate manner.

So I offer this book optimistically. I believe that it will help you stare death in the face and, in so doing, not only ameliorate terror but enrich your life.

Chapter 2

RECOGNIZING DEATH ANXIETY

Death is everything And it is nothing.

The worms crawl in, the worms crawl out.

Each person fears death in his or her own way. For some people, death anxiety is the background music of life, and any activity evokes the thought that a particular moment will never come again. Even an old movie feels poignant to those who cannot stop thinking that all the actors are now only dust.

For other people, the anxiety is louder, unruly, tending to erupt at three in the morning, leaving them gasping at the specter of death. They are besieged by the thought that they, too, will soon be dead—as will everyone around them.

Others are haunted by a particular fantasy of impending death: a gun pointed at their head, a Nazi firing squad, a locomotive thundering toward them, a fall from a bridge or skyscraper.

Death scenarios take vivid forms. One person is locked in a casket, his nostrils stuffed with soil, yet conscious of lying in darkness forever. Another fears never seeing, hearing, or touching a loved one. Others feel the ache of being under the ground while all one’s friends are above it. Life will go as before without the possibility of ever knowing what will happen to one’s family, friends, or one’s world.

Each of us has a taste of death when slipping into sleep every night or when losing consciousness under anesthesia. Death and sleep, Thanatos and Hypnos in the Greek vocabulary, were twins. The Czech existential novelist Milan Kundera suggests that we also have a foretaste of death through the act of forgetting: “What terrifies most about death is not the loss of the future but the loss of the past. In fact, the act of forgetting is a form of death always present within life.”

In many people, death anxiety is overt and easily recognizable, however distressing. In others, it is subtle, covert, and hidden behind other symptoms, and it is identified only by exploration, even excavation.

OVERT DEATH ANXIETY

Many of us commingle anxiety about death with the fear of evil, abandonment, or annihilation. Others are staggered by the enormity of eternity, of being dead forever and ever and ever and ever; others are unable to grasp the state of nonbeing and ponder the question of where they will be when they are dead; others focus on the horror of their entire personal world vanishing; others wrestle with the issue of death’s inevitability, as expressed in this e-mail from a thirty-two-year-old woman with bouts of death anxiety:

I suppose the strongest feelings came from realizing it would be ME who will die, not some other entity like Old-Lady-Me or Terminally-Ill-and-Ready-to-Die-Me. I suppose I always thought about death obliquely, as something that might happen rather than would happen. For weeks after a strong panic episode I thought about death more intently than I ever had and know now it is no longer something that might happen. I felt as though I had awakened to a terrible truth and could never go back.

Some people take their fear further to an unbearable conclusion: that neither their world nor any memories of it will exist anywhere. Their street, their world of family gatherings, parents, children, beach house, high school, favorite camping sites—all evaporate with their death. Nothing stable, nothing enduring. What possible meaning can a life of such evanescence contain? The e-mail continued:

I became acutely aware of meaninglessness—of how everything we do seems doomed to oblivion, and of the planet’s eventual demise. I imagined the deaths of my parents, sisters, boyfriend and friends. Often I think about how one day MY skull and bones, not a hypothetical or imaginary set of skull and bones, will be on the outside rather than the inside of my body. That thought is very disorientating. The idea of being an entity separate from my body doesn’t really wash with me so I can’t console myself with the idea of the imperishable soul.

There are several main themes in this young woman’s statement: death has become personalized for her; it is no longer something that might happen or that happens only to others; the inevitability of death makes all life meaningless. She regards the idea of an immortal soul separate from her physical body as highly unlikely and can find no comfort in the concept of an afterlife. She also raises the question of whether oblivion after death is the same as oblivion before birth (an important point that will come up again in our discussion of Epicurus).

A patient with death panics handed me this poem at our first session:

Death pervades.Its presence plagues me,Grips me; drives me.I cry out in anguish.I carry on.

Every day annihilation looms.I try leaving tracesThat maybe matter;Engaging in the present.The best I can do.

But death lurks just beneathThat protective façadeWhose comfort I cling toLike a child’s blanket.The blanket is permeableIn the stillness of the nightWhen the terror returns.

There will be no more selfTo breathe in nature,To right the wrongs,To feel sweet sadness.Unbearable loss, thoughBorne without awareness.

Death is everythingAnd it is nothing.

She was especially haunted by the thought expressed in her last two lines: Death is everything / And it is nothing. She explained that the thought of becoming nothing consumed her and became everything. But the poem contains two important comforting thoughts: that by leaving traces of herself, her life will gain in meaning, and that the best she can do is to embrace the present moment.

THE FEAR OF DYING IS NOT A STAND-IN FOR SOMETHING ELSE

Psychotherapists often assume, mistakenly, that overt death anxiety is not anxiety about death, but is instead a mask for some other problem. This was the case with Jennifer, a twenty-nine-year-old realtor, whose lifelong nightly death panic attacks had not been taken at face value by previous therapists. Throughout her life, Jennifer frequently awoke during the night, sweat-drenched, eyes wide open, trembling at her own annihilation. She thought of herself vanishing, stumbling in darkness forever, entirely forgotten by the world of the living. She told herself that nothing really matters if everything is ultimately slated for utter extinction.

Such thoughts had plagued her since early childhood. She vividly recalls the first episode when she was five. Running to her parents’ bedroom shaking with fear about dying, she was soothed by her mother, who told her two things she has never forgotten:

“You have a very long life ahead of you, and it makes no sense to think of it now.”

“When you’re very old and approach death, then you’ll be at peace or you’ll be ill, and either way death won’t be unwelcome.”

Jennifer had relied on her mother’s words of comfort all her life and had also developed additional strategies for ameliorating the attacks. She reminds herself that she has the choice whether or not to think about death. Or she tries to draw from her memory bank of good experiences—laughing with childhood friends, marveling at mirrored lakes and pillared clouds while hiking with her husband in the Rockies, kissing the sunny faces of her children.

Nevertheless, her dread of death continued to plague her and strip away much of her life contentment. She had consulted several therapists with little benefit. Various medications had diminished the intensity but not the frequency of the attacks. Her therapists never focused on her fear of death because they believed that death was a stand-in for some other anxiety. I resolved not to repeat the errors of previous therapists. I believe they had been confounded by a powerful recurrent dream that first visited Jennifer at the age of five:

My whole family is in the kitchen. There is a bowl of earthworms on the table, and my father forces me to pick up a handful, squeeze them, and then drink the milk that comes from them.

To each therapist she had consulted, the imagery of squeezing worms to obtain milk suggested, understandably, penis and semen; and each, as a result, inquired about possible sexual abuse by the father. This was my first thought also, but I discarded it after hearing Jennifer’s account of how such inquiries had inevitably led to wrong directions in therapy. Although her father was extremely frightening and verbally abusive, neither she nor her siblings recalled any incidents of sexual abuse.

None of her previous therapists explored the severity and the meaning of her omnipresent fear of death. This common error has a venerable tradition, its roots stretching back to the very first publication in psychotherapy: Freud and Breuer’s 1895 Studies on Hysteria. A careful reading of that text reveals that the fear of death pervaded the lives of Freud’s patients. His failure to explore death fears would be baffling were it not for his later writings, which explain how his theory of the origins of neurosis rested on the assumption of conflict between various unconscious, primitive, instinctual forces. Death could play no role in the genesis of neurosis, Freud wrote, because it has no representation in the unconscious. He offered two reasons: first, we have no personal experience of death, and, second, it is not possible for us to contemplate our nonbeing.

Even though Freud wrote poignantly and wisely about death in such short, nonsystematic essays as “Our Attitudes Toward Death,” written during the after-math of World War I, his “de-deathification,” as Robert Jay Lifton put it, of death in formal psychoanalytic theory greatly influenced generations of therapists to shift away from death and toward what they believed death represented in the unconscious, particularly abandonment and castration. Indeed, one could argue that the psychoanalytic emphasis on the past is a retreat from the future and from confrontation with death.

From the very beginning of my work with Jennifer, I embarked on an explicit exploration of her fears of death. There was no resistance: she was eager to work and had chosen to see me because she had read my text Existential Psychotherapy and wanted to confront the existential facts of life. Our therapy sessions concentrated on her death ideas, memories, and fantasies. I asked her to take careful notes of her dreams and her thoughts during death panics.

She didn’t have long to wait. Just a few weeks later, she experienced a severe death panic after viewing a movie about the Nazi period. She was profoundly rattled by the complete capriciousness of life portrayed in the film. Innocent hostages were arbitrarily chosen and arbitrarily killed. Danger was everywhere; nowhere was safety to be found. She was struck by the similarities with her childhood home: danger from her father’s unpredictable episodes of rage, her sense of having no place to hide and of seeking refuge only in invisibility—that is, by saying and asking as little as possible.

Shortly afterward, she revisited her childhood home and, as I had suggested, meditated by her parents’ graves. Asking a patient to meditate by a grave may seem radical, but in 1895 Freud described giving those very instructions to a patient. When standing by her father’s gravestone, Jennifer suddenly had a strange thought about him: “How cold he must be in the grave.”

We discussed that odd thought. It was as if her child’s view of death with its irrational components (for example, that the dead could still feel cold) was still alive in her imagination side by side with her adult rationality.

As she drove home from this session, a tune popular during her childhood crept into her mind, and she began to sing, surprised at her total recall of the lyrics:

Did you ever think, as a hearse goes by,That you might be the next to die?They wrap you up in a big white sheet,And bury you down about six feet deepThey put you in a big black box,And cover you up with dirt and rocks,And all goes well, for about a week,And then the coffin begins to leak!The worms crawl in, the worms crawl out,The worms play pinochle on your snout.They eat your eyes, they eat your nose,They eat the jelly between your toes.A great big worm with rolling eyes,Crawls in your stomach and out your eyes,Your stomach turns a slimy green,And pus pours out like whipping cream.You spread it on a slice of bread,And that’s what you eat when you are dead.

As she sang, memories trickled in of her sisters (Jennifer was the youngest) teasing her unmercifully by singing this song repeatedly, without regard for her obvious and palpable distress.

Recalling the song was an epiphany for Jennifer, leading her to understand that her recurrent dream about drinking the milk of earthworms was not about sex but about death, grave worms, and the danger and lack of safety she had experienced as a child. This insight—that she was keeping in suspended animation a childhood view of death—opened up new vistas for her in therapy.

COVERT DEATH ANXIETY

It may require a sleuth to bring covert death anxiety into the open, but often anyone, whether in therapy or not, can uncover it with self-reflection. Thoughts of death may seep into and permeate your dreams no matter how hidden from your conscious mind. Every nightmare is a dream in which death anxiety has escaped its corral and menaces the dreamer.

Nightmares awaken the sleeper and portray the dreamer’s life at risk: running for one’s life from a murderer, or falling from a great height, or hiding from a mortal threat, or actually dying or being dead.

Death often appears in dreams in symbolic form. For example, a middle-aged man with gastric problems and hypochondriacal concerns about stomach cancer dreamed of sitting on a plane with his family en route to an exotic Caribbean resort. Then, in the next frame, he found himself lying on the ground doubled up with stomach pain. He awoke in terror and instantly realized the meaning of the dream: he had died of a stomach cancer, and life had gone on without him.

Finally, certain life situations almost always evoke death anxiety: for example, a serious illness, the death of someone close, or a major irreversible threat to one’s basic security—such as being raped, divorced, fired, or mugged. Reflection on such an event will generally result in the emergence of overt death fears.

ANXIETY ABOUT NOTHING IS REALLY ANXIETY ABOUT DEATH

Years ago, the psychologist Rollo May quipped that anxiety about nothing tries to become anxiety about something. In other words, anxiety about nothingness quickly attaches itself to a tangible object. Susan’s story illustrates the usefulness of this concept when an individual has disproportionately high anxiety about some event.

Susan, a prim, efficient, middle-aged CPA, once consulted me because of conflict with her employer. We met for a few months, and she eventually left her job and started a competing, highly successful firm.

Several years later, when she phoned to request an emergency appointment, I could hardly recognize her voice. Ordinarily upbeat and self-possessed, Susan sounded tremulous and panicky. I saw her later the same day and was alarmed at her appearance: usually calm and stylishly dressed, she was disheveled and agitated, her face red, her eyes puffy from weeping, a slightly soiled bandage on her neck.

Haltingly, she related her story. George, her adult son, a responsible young man with a good job, was now in jail on drug charges. Police had stopped him for a minor traffic violation and found cocaine in his car. He tested positive and, because he was in a state-sponsored recovery program for previous DUI citations and this was his third drug-related offense, he was sentenced to a month’s jail time and twelve months in a drug rehabilitation program.

Susan had not stopped crying for four days. She couldn’t sleep or eat and had been unable to go to work (for the first time in twenty years). During the night she was tormented by horrendous visions of her son: guzzling from a bottle in a brown paper bag, filthy and with rotting teeth, dying in the gutter.

“He’s going to die in jail,” she told me, and went on to describe her exhaustion from pulling every string, trying every possible avenue, to obtain his release. She was crushed when she gazed at photos of him as a child—angelic, curly blond hair, soulful eyes—with an abundant, infinitely promising future.

Susan thought of herself as enormously resourceful. She was a self-created woman who had achieved success despite ineffectual and dissolute parents. In this situation, however, she felt totally helpless.

“Why has he done this to me?” she asked. “It’s rebellion, a deliberate sabotage of my plans for him. What else could it be? Didn’t I give him everything—every possible tool for success—the best education, lessons in tennis, piano, riding? And this is how he repays me? The shame of it—imagine my friends finding out!” Susan burned with envy as she thought of her friends’ successful children.

The first thing I did was to remind her of things she already knew. Her vision of her son in the gutter was irrational, a matter of seeing catastrophe where there was none. I pointed out that all in all, he had made good progress: he was in a good rehab program and in private therapy with an excellent counselor. Recovery from addiction is rarely uncomplicated: relapses, often multiple relapses, are inevitable. And, of course, she knew that; she had recently returned from an entire week of family therapy at her son’s recovery program. Moreover, her husband shared none of her great concerns about their son.

She also knew that her question, “Why has George done this to me?” was irrational, and she nodded in agreement when I said she had to take herself out of this picture. His relapse was not about her.

Any mother would be upset by her son’s drug relapse and by the thought of him in jail, but Susan’s reaction seemed excessive. I began to suspect that much of her anxiety had been displaced from some other source.

I was particularly struck by her profound sense of helplessness. She had always envisioned herself as enormously resourceful, and now that vision was shattered—there was nothing she could do for her son (except to disentangle herself from his life).

But why was George so hugely central in her life? Yes, he was her son. But it was more than that. He was too central. It was as if her whole life depended on his success. I discussed how, for many parents, children often represent an immortality project. That idea aroused her interest. She recognized that she had hoped to extend herself into the future through George, but she knew now that she had to let that go:

“He’s not sturdy enough for the job,” she said.

“Is any child sturdy enough for that?” I asked. “And what’s more, George never signed up for that job—that’s why his behavior, his relapse, is not about you!”

When, toward the end of the session, I inquired about the bandage on her neck, she told me that she had just had cosmetic surgery to tighten her neck. As I continued to inquire about the surgery, she grew impatient and strained to return to her son—the reason, she pointed out, for having contacted me.

But I persisted.

“Tell me more about your decision to have the surgery.”

“Well, I hate what aging has done to my body—my breasts, my face, my drooping neck especially. My surgery is my birthday present to myself.”

“Which birthday?”

“A capital B birthday. Number six zero. Last week.”

She talked about being sixty and realizing that time was running out (and I talked about being seventy). Then I summed up:

“I feel certain that your anxiety is excessive, because part of you knows very well that relapses occur in almost every course of addiction treatment. I think some of your anxiety is coming from elsewhere and being displaced onto George.”

Supported by Susan’s vigorous nodding, I continued, “I think a lot of your anxiety is about yourself and not about George. It is connected to your sixtieth birthday, your awareness of your aging, and about death. It seems to me that at a deep level you must be considering some important questions: What will you do with the remainder of your life? What will provide meaning, especially now when you realize that George is not going to fill that job?”

Susan’s demeanor had gradually shifted from impatience to intense interest. “I haven’t done much thinking about aging and time running out. And it never came up in our previous therapy. But I’m getting your point.”

At end of the hour she looked up at me: “I can’t begin to imagine how your ideas are going to help me, but I will say this: you caught my attention these last fifteen minutes.