Staring at the Sun: Overcoming the Terror of Death

Staring at the Sun: Overcoming the Terror of Death

by Irvin Yalom
In this exclusive excerpt from his latest book, Irvin Yalom delves into the ultimate existential concern, and how therapists can help clients in facing death anxiety. Signed copy of book available.

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THE MORTAL WOUND (from chapter 1)

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-existentialist psychotherapist, and I will make use of his ideas throughout this work.

. . . 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.

. . . 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.

OVERCOMING DEATH TERROR THROUGH CONNECTION (from Chapter 5)



THE POWER OF PRESENCE

One can offer no greater service to someone facing death (and from this point on I speak either of those suffering from a fatal illness or physically healthy individuals experiencing death terror) than to offer him or her your sheer presence.

The following vignette, which describes my attempt to assuage a woman’s death terror, provides guidelines to friends or family members offering aid to one another.

Reaching Out to Friends: Alice

Alice—the widow whose story I told in Chapter Three, who was distressed at having to sell her home and her memory-laden collection of musical instruments—was on the verge of moving into a retirement community. Shortly before her move, I left town for a few days’ vacation and, knowing this would be a difficult time for her, gave her my cell phone number in case of an emergency. As the movers began to empty her house, Alice experienced a paralyzing panic that her friends, physician, and massage therapist could not quell. She phoned me, and we had a twenty-minute talk:

“I can’t sit still,” she began. “I’m so edgy I feel I’m going to burst. I cannot find relief.”

“Look straight into the heart of your panic. Tell me what you see.”

“Ending. Everything ending. That’s all. The end of my house, all my things, my memories, my attachments to my past. The end of everything. The end of me—that’s the heart of it. You want to know what I fear. It’s simple: it’s no more me!”

“We’ve discussed this in other meetings, Alice, so I know I’m repeating myself, but I want to remind you that selling your house and moving to a retirement home is an extraordinary trauma, and of course you’re going to feel major dislocation and major shock. I would feel that way if I were in your place. Anyone would. But remember our talks about how it will look if you fast-forward to three weeks from now—”

“Irv,” she interrupted, “that doesn’t help—this pain is too raw. This is death surrounding me. Death everywhere. I want to scream.”

“Bear with me, Alice. Stay with me—I’m going to ask that same simplistic question I’ve asked before: what precisely is it about death that so frightens you? Let’s hone in on it.”

 “We’ve gone over this.” Alice sounded irritated and impatient.

“Not enough. Keep going, Alice. Humor me, please. Come on, let’s get to work.”

“Well, it’s not the pain of dying. I trust my oncologist; he will be there when I need morphine or something. And it has nothing to do with an afterlife—you know I let go of all that stuff a half century ago.”

“So it’s not the act of dying and not the fear of an afterlife. Keep going. What is it about death that terrifies you?”

“It’s not that I feel unfinished; I know I’ve had a full life. I’ve done what I’ve wanted to do. We’ve gone over all this.”

“Please keep going, Alice.”

“It’s what I just said: no more me. I just don’t want to leave this life . . . I’ll tell you what it is: I want to see the endings. I want to be here to see what happens to my son—will he decide to have children after all. It’s painful to realize I won’t ever be able to know.”

“But you won’t know you’re not here. You won’t know you won’t know. You say you believe (as I do) that death is complete cessation of consciousness.”

“I know, I know, you’ve said it so many times that I know the whole litany by heart: the state of nonexistence is not terrifying because we won’t know we are not existing, and so on and so on. And that means I won’t know that I am missing important things. And I remember also what you’ve already said about the state of nonbeing—that it’s identical to the state I was in before I was born. It helped before, but it just doesn’t help now—this feeling is too strong, Irv—ideas won’t crack it; they won’t even touch it.”

“Not yet they won’t. That only means we have to keep going, keep figuring it out. We can do it together. I’ll be in there with you and help you go as deep as you can.”

“It’s gripping terror. There is some menace I cannot name or find.”

“Alice, at the very base of all our feelings about death there is a biological fear that is hardwired into us. I know this fear is inchoate—I’ve experienced it too. It doesn’t have words. But every living creature wishes to persist in its own being—Spinoza said that around 350 years ago. We just have to know this, expect it. The hardwiring will zap us with terror from time to time. We all have it.”

After about twenty minutes, Alice sounded calmer, and we ended the call. A few hours later, however, she left a curt phone message telling me that the phone session felt like a slap in the face and that I was cold and unempathic. Almost as a postscript she added that, unaccountably, she felt better. The following day she left another message saying that her panic had entirely subsided—again, she said, for reasons unknown.

Now, why was Alice helped by this conversation? Was it the ideas I presented? Probably not. She dismissed my arguments from Epicurus—that, with her consciousness extinguished, she wouldn’t know that she’d never find out how the stories of people close to her ended, and that after death she would be in the same state as she was before her birth. Nor did any of my other suggestions—for example, that she project herself three weeks into the future to gain some perspective on her life—have any impact whatsoever. She was simply too panicky. As she put it,
“I know you’re trying, but these ideas won’t crack it; they don’t even touch what’s here—this anguished heaviness in my chest.”
“I know you’re trying, but these ideas won’t crack it; they don’t even touch what’s here—this anguished heaviness in my chest.”

So ideas didn’t help. But let’s examine the conversation from the perspective of relationship. First, I spoke to her on my vacation, thereby indicating my full willingness to be involved with her. I said, in effect, let’s you and I keep working on this together. I didn’t shrink from any aspect of her anxiety. I continued inquiring into her feelings about death. I acknowledged my own anxiety. I assured her that we were in this together, that she and I and everyone else are hardwired to feel anxious about death.

Second, behind my explicit offer of presence, there was a strong implicit message: “No matter how much terror you have, I will never shun or abandon you.” I was simply doing what the housemaid, Anna, did in Cries and Whispers. I held her, stayed with her.

Although I felt fully involved with her, I made sure that I kept her terror contained. I did not permit it to be contagious. I maintained an unruffled, matter-of-fact tone as I urged her to join me in dissecting and analyzing the terror. Although she criticized me the following day for being cold and unempathic, my calmness nonetheless steadied her and helped allay her terror.

The lesson here is simple: connection is paramount. Whether you are a family member, a friend, or a therapist, jump in.
The lesson here is simple: connection is paramount. Whether you are a family member, a friend, or a therapist, jump in. Get close in any way that feels appropriate. Speak from your heart. Reveal your own fears. Improvise. Hold the suffering one in any way that gives comfort.

Once, decades ago, as I was saying goodbye to a patient near death, she asked me to lie next to her on her bed for a while. I did as she requested and, I believe, offered her comfort. Sheer presence is the greatest gift you can offer anyone facing death (or a physically healthy person in a death panic).

SELF-DISCLOSURE

A great deal of a therapist’s training, as I’ll discuss in Chapter Seven, focuses on the centrality of connection. An essential part of that training should, in my opinion, focus on the therapist’s willingness and ability to increase connection through his or her own transparency. Because many therapists have trained in traditions that stress the importance of opaqueness and neutrality, friends willing to reveal themselves to one another may, in this regard, have an advantage over professional therapists.

In close relationships, the more one reveals of one’s inner feelings and thoughts, the easier it is for others to reveal themselves. Self-disclosure plays a crucial role in the development of intimacy. Generally, relationships build by a process of reciprocal self-revelations. One individual takes the leap and reveals some intimate material, thereby placing himself or herself at risk; the other closes the gap by reciprocating in kind; together, they deepen the relationship via a spiral of self-revelation. If the person at risk is left hanging without the other reciprocating, then the friendship often flounders.

The more you can be truly yourself, can share yourself fully, the deeper and more sustaining the friendship. In the presence of such intimacy, all words, all modes of comfort, and all ideas take on greater meaning.

Friends must keep reminding one another (and themselves) that they, too, experience the fear of death. Thus, in my conversation with Alice, I included myself in discussions of death’s inevitability. Such disclosure is not high risk: it is merely making explicit what is implicit. After all, we are all creatures who are frightened at the thought of “no more me.” We all face the sense of our smallness and insignificance when measured against the infinite extent of the universe (sometimes referred to as the “experience of the tremendum”). Each of us is but a speck, a grain of sand, in the vastness of the cosmos. As Pascal said in the seventeenth century, “the eternal silence of infinite spaces terrifies me.” The need for intimacy in the face of death is heartbreakingly described in a recent rehearsal of a new play, Let Me Down Easy, by Anna Deavere Smith. In this play, one of the characters portrayed was a remarkable woman who cared for African children with AIDS. Little help was available at her shelter. Children died every day. When asked what she did to ease the dying children’s terror, she answered with two phrases: “I never let them die alone in the dark, and I say to them, ‘You will always be with me here in my heart.’”

Even for those with a deeply ingrained block against openness—those who have always avoided deep friendships—the idea of death may be an awakening experience, catalyzing an enormous shift in their desire for intimacy and their willingness to make efforts to attain it. Many people who work with dying patients have found that those who were previously distant become strikingly and suddenly accessible to deep engagement.

RIPPLING IN ACTION

As I explained in the previous chapter, the belief that one may persist, not in one’s individual personhood, but through values and actions that ripple on and on through generations to come can be a powerful consolation to anyone anxious about his or her mortality.

Alleviating the Loneliness of Death

Although Everyman, the medieval morality play, dramatizes the loneliness of one’s encounter with death, it may also be read as portraying the consoling power of rippling. A theatrical crowd pleaser for centuries, Everyman played in front of churches before large throngs of parishioners. It tells the allegorical tale of Everyman, who is visited by the angel of death and learns that the time of his final journey has arrived.

Everyman pleads for a reprieve. “Nothing doing,” replies the angel of death. Then another request: “Can I invite someone to accompany me on this desperately “lonely journey?” The angel grins and readily agrees: “Oh, yes—if you can find someone.”

The remainder of the play consists of Everyman’s attempts to recruit someone to be his companion on the journey. Every friend and acquaintance declines; his cousin, for example, is indisposed by a cramp in her toe. Even metaphorical figures (Worldly Goods, Beauty, Strength, Knowledge) refuse his invitation. Finally, as he resigns himself to his lonely journey, he discovers one companion, Good Deeds, who is available and willing to accompany him, even unto death.

Everyman’s discovery that there is one companion, Good Deeds, who is able to accompany him is, of course, the Christian moral of this morality play: that you can take with you from this world nothing that you have received; you can take only what you have given. A secular interpretation of this drama suggests that rippling—that is, the realization of your good deeds, of your virtuous influence on others that persists beyond yourself—may soften the pain and loneliness of the final journey.

The Role of Gratitude

Rippling, like so many of the ideas I find useful, assumes far more power in the context of an intimate relationship where one can know at first hand how one’s life has benefited someone else. Friends may thank someone for what he or she has done or meant. But mere thanks is not the point. The truly effective message is, “I have taken some part of you into me. It has changed and enriched me, and I shall pass it on to others.”

Far too often, gratitude for how a person has sent influential ripples out into the world is expressed not when the person is still alive but only in a posthumous eulogy. How many times at funerals have you wished (or overheard others express the wish) that the dead person were there to hear the eulogies and expressions of gratitude?
How many of us have wished we could be like Scrooge and eavesdrop on our own funeral?
How many of us have wished we could be like Scrooge and eavesdrop on our own funeral? I have. One technique for overcoming this “too little, too late” problem with rippling is the “gratitude visit,” a splendid way to enhance rippling when one is alive. I first came upon this exercise at a workshop conducted by Martin Seligman, one of the leaders of the positive psychology movement. He asked a large audience to participate in an exercise that, as I recall, went along these lines:

Think of someone still living toward whom you feel great gratitude that you have never expressed. Spend ten minutes writing that person a gratitude letter and then pair up with someone here, and each of you read your letter to the other. The final step is that you pay a personal visit to that person sometime in the near future and read that letter aloud.

After the letters were read in pairs, several volunteers were selected from the audience to read their letters aloud to the entire audience. Without exception, each person choked up with emotion during the reading. I learned that such displays of emotion invariably occur in this exercise: very few participants get through the reading without being swept by a deep emotional current. I did the exercise myself and wrote such a letter to David Hamburg, who had been a superbly enabling chairman of the Department of Psychiatry during my first ten years at Stanford. When I next visited New York, where he lived at this time, we spent a moving evening together. I felt good expressing my gratitude, beamed with pleasure when reading my letter. As I age, I think more and more about rippling. As a paterfamilias, I always pick up the check when my family dines at a restaurant. My four children always thank me graciously (after offering only feeble resistance), and I always say to them, “Thank your grandfather Ben Yalom. I’m only a vessel passing on his generosity. He always picked up the check for me.” (And I, by the way, also offered only feeble resistance.)

Rippling and Modeling

In the first group I led for patients with terminal cancer, I often found the members’ despondency contagious. So many members were in despair; so many waited day after day listening for the approaching footsteps of death; so many claimed that life had become empty and stripped of all meaning. And then, one fine day, a member opened our meeting with an announcement: “I have decided that there is, after all, something that I can still offer. I can offer an example of how to die. I can set a model for my children and my friends by facing death with courage and dignity.”

It was a revelation that lifted her spirits, and mine, and those of the other members of the group. She had found a way to imbue her life, to its very end, with meaning.

The phenomenon of rippling was evident in the cancer group members’ attitude toward student observers. It is vital for the education of group therapists that they observe experienced clinicians leading groups, and I have usually had students observing my groups, sometimes using TV monitors but generally through a one-way mirror. Although groups in educational settings give permission for such observation, the group members generally grumble about the observers and, from time to time, openly voice resentment at the intrusion.

Not so with my groups of cancer patients: they welcomed observers. They felt that as a result of their confrontation with death, they had grown wise and had much to pass on to students and regretted only, as I mentioned earlier, that they had waited so long to learn how to live.

Note: Signed copies of Staring at the Sun and other Ivin Yalom books are available here.

Copyright © 2008 Jossey-Bass. Reprinted with written permission from the publisher.
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Irvin Yalom Psychiatrist and author Irvin Yalom, MD has been a major figure in the field of psychotherapy since he first wrote The Theory and Practice of Group Psychotherapy in 1970 (now in it's 5th edition). Other significant contributions have included Existential Psychotherapy, and NY Times Bestseller Loves Executioner and Other Tales of Psychotherapy. He has written four novels on psychotherapy: When Nietzsche Wept, Lying on the Couch, The Schopenhauer Cure, and The Spinoza Problem.  His works, translated into over 20 languages, have been widely read by therapists and non-therapists alike. Visit Dr. Yalom's website.


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CE credits: 1

Learning Objectives:

  • Consider ways in which the fear of death impacts the life experience of all clients.
  • Increase understanding of how to be with clients? fear of death in a way that is therapeutic.