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Death Anxiety in Psychotherapy


In 1957 a group of archaeologists excavated an ancient burial site in Sunghir, Russia (32,000 BC), subsequent study of these ancestral Paleolithic people suggests that this is the earliest evidence showing human reflection on an afterlife. It could be argued that these ancient Russian graves with their elaborate decorative beads[Gerard Mo1] were the first experiences of death anxiety or Thanatophobia. Over millennia, many human civilisations, great philosophers and religious theologians have responded to the question of ‘what happens next?’.

In our own sphere of psychotherapy, several theorists have written on this most fundamental of subjects, but none more eloquently than the existential psychotherapist Irvin Yalom, who writes about our reflective capacity to understand the finitude of life.

“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.”

Staring at the Sun (Yalom, 2008)

So why does this three word question matter to us so much? According to Hasker & Taliaferro (2019) it matters because

· of our concern for loved ones and the questions we have around an afterlife; where will they go? How will they cope without us? or will we meet them again in a better place (or worse)?

· many of us live our daily life, behave and make choices based on belief systems, which are connected to a notion of an afterlife.

· historical ideas of whether there is an afterlife (or isn’t) are now inevitable and will shape the experience of future generations.


How can philosophy and psychotherapy support us in watching the sand trickle through this human hourglass of mortality, or should we comprehend mortality as an end? The history of philosophy, psychotherapy and religion is replete with ideas around what is arguably, this most important of existential questions. Ancient Greek philosophers such as Plato in his Phaedo (360 BC) develops on the concept of the immortal soul, which exists before and after our corporal life is over in another realm. Contrastingly, other Greek philosophers such as the Stoic Epicurus (341-270 BC) reject the idea of an immortal soul. Epicurus argued almost agnostically that when life ends, there is ‘neither pleasure nor pain’ and no advantage is gained by worrying about questions of an afterlife.

Then there is the 19th century philosopher Friedrich Nietzsche’s famous declaration ‘God is dead’. Nietzsche challenges us to reject the relics of our religious past and stop cowing before idols and he urges us to embrace life and boldly choose our own destiny without caring about an afterlife. More recently, thinkers such as Ernest Becker argues in his book THE DENIAL OF DEATH (1973), that we try to heroically organize our lives into an ‘immortality project’, which is usually through work, obsession with cultural trivia or by tranquilising ourselves with substances, and this distracts us from the painful reality of our own death.

Looking to the writings of the great psychotherapists, Freud (1927) in his THE FUTURE OF AN ILLUSION suggests that religion is a childish illusion, which protects us from the knowledge of our inevitable death. Jung writes about viewing death as a goal rather than something to be feared.

With Pew’s (2012) research indicating that 84% of world’s population still ascribes to a religious based faith, religion arguably influences attitudes to an afterlife more than any other form of belief system. A defining feature of most world religions is the conception of an existence beyond our material world. Abrahamic religions tend to envision some form heavenly realm where our souls can ascend to exist alongside a religious deity, after we have hopefully lived a morally perfect life. Eastern traditions look to transcend our current mortal existence through a process of re-incarnation or attaining an enlightened state.


So where does this leave us as therapists?

Evidence suggests religious beliefs buffer individuals against death anxiety (Kerr et al. 2014). However, contemporary data also suggests that Irish society is becoming less religious and more secular in our beliefs year on year (Irish Census, 2016). Mortality presents many faces in our clinical space, the sense of downward trajectory as we become older, the struggle to keep living for the suicidal, the many loved ones that we will lose as we pass through our life. Each of these confrontations our clients have with mortality encompasses a smorgasbord of spiritual, personal, philosophical values and beliefs, which are as unique as an individual fingerprint. So how should we position ourselves in our clinical work, when faced with clients with death anxiety?

I will end this piece, as I began with the thoughts of the psychotherapist Yalom, who has said more about death anxiety than any other. As he approaches the end of his own full life, Yalom suggests that therapists tend to avoid the subject death anxiety in therapeutic space. Ultimately, in the myriad of human responses to mortality, each of will find our unique understanding of ‘what happens next?’ Yalom’s imperative is to embrace this individuality of human experience and he offers the following guidance for therapists working death anxiety.

• The therapeutic process is the central foundation upon which all work with death anxiety begins. Therapists should ensure they take their time to establish a strong therapeutic alliance, before any exploration of client material dealing with death.

• There should be an ongoing [Gerard Mo2] emphasis on Roger’s genuineness in discussing existential issues with no concealing your own humanness ‘remember we are in the same boat’.

• Central to this work is using the ‘here and now’ between therapist and client to gain a deeper understanding of thoughts and memories, which emerge around mortality during the session.

• Use self-disclosure in your work and be honest about your own beliefs and model openness.

• In Greek mythology Hynos (God of sleep) and Thanotos (God of death) are twin brothers. Yalom points to the ancient relationship between dreams and death. He advocates the use client dreams ‘as the royal road’ to understanding anxieties around mortality.


Gerry Meehan is currently a student on the Doctorate in Psychotherapy programme at DCU. He has previously completed a Masters in Psychotherapy, Professional Diploma in Clinical Supervision and BA in Humanities (Major in Psychology) at the school of Nursing, Psychotherapy and Community Health in DCU. Gerry works in Healthy Living Centre on the DCU campus and with the Pieta organisation.


References:

Epicurus (1998), The Philosophy of Epicurus, Dover Thrift Editions

Freud, S., (2002). The future of an illusion, Penguin

Hasker, W., & Taliaferro, C. (2019). Afterlife. In E. N. Zalta (Ed.), The Stanford Encyclopedia of Philosophy (Spring 2019). Metaphysics Research Lab, Stanford University. https://plato.stanford.edu/archives/spr2019/entries/afterlife/

Irish Census (2016), Profile 8 Irish Travellers, Ethnicity and Religion, https://www.cso.ie/en/releasesandpublications/ep/p-cp8iter/p8iter/p8rrc/


Jung, C. (1999). “The Soul and Death”. In Yates J. (Ed.), Jung on Death and Immortality (pp. 11-20). Princeton University Press

Kerr, C. W., Donnelly, J. P., Wright, S. T., Kuszczak, S. M., Banas, A., Grant, P. C. & Luczkiewicz, D. L. (2014). End-of-life dreams and visions: A longitudinal study of hospice patients’ experiences. Journal of Palliative Medicine, 17(3), 296–303. doi: 10.1089/jpm.2013.0371

Nietzsche, F., (2000), The Gay Science, Cambridge University Press.

Pew Research Centre (2012), The Changing Religious Landscapehttps://www.pewforum.org/2017/04/05/the-changing-global-religious-landscape/

Plato (1966), Phaedo, Plato in Twelve Volumes, Harvard University Press & William Heinemann Ltd.

Yalom, I. (2008). Staring at the Sun, Hachette Digital.

[Gerard Mo1]Have you a picture you want me to upload [Gerard Mo2]Should this be ongoing?

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