Staring at the Sun

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.