Flirting with Death

Psychoanalysts Consider Mortality

Corinne Masur

• Publisher: Routledge
• Year: 2018
• Print ISBN: 9781782205494
• eBook ISBN: 9780429811401
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

This volume covers a much-neglected topic: the avoidance by psychotherapists and psychoanalysts of the topic of their own mortality and that of their patients. All too often, the psychotherapist or psychoanalyst who is ill is unable to confront this reality in the presence of her patient and fails to prepare the patient for the most permanent goodbye, death. This volume includes nine essays which consider why the psychotherapist and psychoanalyst may find illness, mortality, retirement and termination so difficult.

This volume is a collection of essays by psychoanalysts covering the denial of death amongst psychotherapists and psychoanalysts and the effect on clinical practice, the effect of early childhood confrontation with mortality on the professional development of psychoanalysts, illness in the analyst, the death of patients, and termination and retirement as symbolic harbingers of death.

Chapter 1
Mortality and psychoanalysis

The analyst’s defense against acknowledging mortality and the effect on clinical practice

Corinne Masur

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To paraphrase Avery Weissman (1977), psychoanalysts like other people are afraid of death. This fear leads to the development and use of myriad defensive activities (including avoidance, denial, repression, and intellectualization) to ward off thoughts and feelings related to mortality. When overused, these defensive activities may interfere with three aspects of the analyst’s role: 1. the personal exploration of her inner experience of her own mortality, 2. the ability and willingness to facilitate her patients’ exploration of mortality, and 3. the external reality of the need to prepare for the disposition of the practice in the event of her death.

Sigmund Freud refused to give mortality psychic significance (Frommer, 2016). His views on the subject shaped a long-standing relationship between psychoanalysis and death that nullified the human struggle with mortality. And despite profound post-Freudian changes in psychoanalytic theory and practice, “[T]he human awareness of mortality continues to be treated as if it were not a defining psychic issue” (Frommer, 2016, p. 374).

Regarding the general psychoanalytic literature, Hoffman noted in 1979 that relatively little attention has been paid to the process by which the individual anticipates, reacts to, and comes to terms with his own death. De Masi in 2004 stated that “Psychoanalytic literature, in spite of its thorough exploration of the pain of mourning, has not focused its attention in an equally systematic manner on the bewilderment we feel at the thought of our own death.” Or as Weissman (1977) succinctly observed, “… psychoanalysts have avoided the whole subject.”

In 1955 Eissler wrote, “Since Freud … made death a central concept of his psychological system one would have expected that psychoanalysis would devote more effort to the study of death itself. Strangely enough, this has not happened. In general, death is still viewed as a purely biological phenomenon …” The overall thrust of Freud’s writing on death was in the direction of discounting awareness of death as a psychologically important variable in human development and psychopathology (Hoffman, 1998). To the extent that there was a discussion of this area in the literature (up until recent years) much of it was devoted either to tracing death anxiety in Freud’s theory or discussing how defensive functioning relative to the acknowledgment of mortality does or does not fit within developing psychoanalytic theory. As Hoffman (1998) noted, the opportunity to construct a much-needed bridge between the existential and the psychoanalytic perspectives on the psychological impact of awareness of death has been missed. Historically, psychoanalytic approaches have emphasized the ubiquitous human need to deny death. This perspective is derived largely from the conflict based metapsychology of psychoanalysis as well as from the limitations imposed by the study of largely healthy patients who reported death anxiety (Rodin & Zimmerman, 2008).

It is tempting – even for clinicians – to “pretend that it is not going to happen to us” (Akhtar, 2011, p. 86). This attitude is common among many of our patients as well. And for those of us who deal with people on a daily basis who struggle with the meaning of existence, who may in fact be physically ill or dying, we find that we must sometimes allow ourselves to be painfully vulnerable to being drawn into these emotional worlds precisely because of the profoundly reverberating existential issues in this material (Rodin & Zimmerman, 2008). In such cases, the opportunities for effective therapeutic process are unique. For the patient who has suffered loss whether recent or past, for the patient who has faced illness or is facing illness or end of life, in other words, for any and all patients, the recognition of the finite nature of life may be acute – and this idea and the feelings associated with it must be able to be tolerated by the analyst in order to facilitate the patient’s ability to tolerate those feelings herself.

In the last several decades, greater attention has been paid to this subject. The psychoanalytic literature now includes some articles on the death of the analyst (Garcia-Lawson & Lane, 1997; Rendely, 1999; Traesdal, 2005; Ziman-Tobin, 1989), the illness and death of the analytic patient (Buechler, 2000; Chassey, 2006; Coltart, 1996), the death of a patient’s spouse or child (Chasen, 1994; Gerson, 1994; Mayer, 1994, Mendelsohn, 1991), and the analyst’s own illness or impending death (Dewald, 1982; Fajardo, 2001; Feinsilver, 1998; Morrison, 1990; Pizer, 1997; Schwartz & Silver, 1990).

This chapter is not devoted to the topic of the history of thought about death in psychoanalysis, or the debate over the existence of the death instinct, but to the impact which the denial of death (versus the conscious awareness of the finite nature of life) has on the psychoanalyst herself and on the clinical practice of psychoanalysis and psychoanalytic psychotherapy.

It is important to consider this subject not in the realm of past or present theory building but inside the consulting room. In that space the therapist ultimately faces herself and her patient and, in so doing, faces certain very basic existential issues. Both the therapist and the patient vacillate between conscious acknowledgement and defensive retreat from a variety of issues including the universal struggle to accept the reality of one’s own death. Death is “the most fundamental and terrifying problem of human life” (Stern in Lord, Ritvo and Solnit, 1978, p. 2) and if the feelings related to death cannot be experienced, expressed, and understood within the confines of the analytic experience then where (other than church, mosque, or synagogue) is the patient to deal with them? Harold Searles held the conviction that every psychoanalytic therapy should help the patient to explore the deep meaning that the patient attributes to his or her own death. Furthermore, he believed that as psychoanalysts we should not limit ourselves to exploring issues related to death with those rare patients who face a serious illness, but we should help every patient to develop her capacity to tolerate the thought of the transience of human life (De Masi, 2004). It is to this end that this chapter, and indeed, this volume is devoted.

In this chapter, three aspects of the therapist’s role in regard to confronting her own feelings regarding death and those of her patients will be discussed. The therapist’s defensive reaction to the exploration of her own mortality will be examined first. Second, the difficulties facilitating the patient’s exploration of the subject will be looked at, and third, the external reality of having to prepare for the disposition of the therapist’s practice in the event of her own death will be delineated.

The therapist’s relationship with her own mortality

The limited nature of human existence is a topic which generates anxiety in both patient and analyst. It is a phenomenon which is painfully difficult to approach directly. As such, patients in analysis often avoid the matter. Therapists, and analysts who once were analytic patients themselves may have experienced the wish to avoid this material – or they may have done so without having been aware of their avoidance and their analysts may have permitted this avoidance in a process of mutual collusion. I am describing a process of transgenerational transmission in which avoidance is allowed by the analyst in part because she was allowed to do so in her own analysis. This is not to say that issues of loss, sadness, mourning, and the like are not common material in analyses, especially during the termination phase, but rather that the issue of one’s own death – as patient – and that of one’s analyst – may be different and more difficult to confront than the loss of others in one’s life. Similarly, the loss of individual functions or parts of oneself must be mourned despite the temptation by analyst, patient, or both to circumvent these issues.

In 1915 Freud observed that it is impossible to imagine our own death. But how can this be? Many have fantasized their own deaths and dreamed their own death. Rather, what Freud may have been suggesting is that what is difficult or impossible to imagine is what it is to actually cease to exist. This is what is inconceivable and horrifying. The idea of ceasing one’s existence evokes anxiety, panic, and immeasurable grief. Moreover, as Akhtar states (2011), death is the greatest narcissistic injury, the most profound humiliation we can imagine experiencing. Human beings live in the moment, experiencing a multiplicity of sensations at any one time and to cease to experience these sensations, the pleasure and the pain of life – well, that is unimaginable.

Freud suggested that the unconscious is “convinced of [its] own immortality” (1915b). As such, immortality would be a basic, primitive tenet of human life. In so doing, Freud reified and universalized what may have been his own personal failure of imagination (Frommer, 2016). Instead, I suggest that, in general, the human being (ego and id, conscious and unconscious) is aware of the finiteness of being and defends mightily against the awareness of this fact in order to avoid the tremendous anxiety, terror, sadness, and other potentially overwhelming affects which would be experienced if this were acknowledged. To cease to experience, to lose the capacity to love and be loved, to smell, taste, feel, breathe, remember the past, imagine the future, to learn, to be productive, to create, and to be is to lose everything. And to acknowledge the inevitability of this enormous loss, to admit that we will inevitably lose consciousness forever – is something so difficult to accept, so narcissistically injurious, that man has had to create a variety of ways to avoid the acceptance of this inevitability.

Religious belief is only one of a variety of such ways which have been constructed to cope with the reality of the finite nature of man’s existence. Hoffman (1979) believes that the concept of immortality is a restitutive response to the impact of a cognitive appreciation of the meaning of death. If we can believe that we continue to live on after death, albeit in different form, then we need not fear death or contemplate the finite nature of existence. Life is not finite, after all, if there is an afterlife. Those who believe in an afterlife need not fully confront the temporal limitations imposed on the lifespan. The cessation of consciousness is no longer at issue. The religious person reassures herself that there is a continuity of consciousness after death. As Akhtar (2011) says, “Anxiety about the limited nature of our existence delivers us to the cushion of handed down magic. We open our windows to dreams of heaven and hell, reincarnation or the continuation of our ‘souls’ in one way or another” (p. 88).

For those who do not hold a strong belief in the continued existence of the soul or who do not believe that the soul maintains a continuity of consciousness, there can still be a narcissistically comforting belief that immortality is maintained through creation and procreation. Some believe that we live on through our children and some believe that we live on through the creative work we leave behind, whether that work be academic, architectural, or artistic. The creation of art or music, of institutions or the production of written work can feel like a substitute for the continued existence of the corporeal or spiritual self.

As such, the motivations for creative and professional accomplishment are myriad but most fundamental is the complaint against mortality. Human beings want desperately to live on. And if we accept that immortality is not actually possible then we can strive to make it partially so, enjoying the feeling that our work will live on beyond our own life spans. We take pleasure in the fantasy of being remembered. Behind this idea is the unconscious and irrational belief that we will be present to watch as others read our work, look at our art, sit in the auditoriums named for us, or walk in the buildings we helped to create. And further comfort is supplied by the thought that those who do so will remember us. As Becker (1973) says in his comprehensive book, The Denial of Death, “The idea of death, the fear of it haunts the human animal like nothing else; it is the mainspring of human activity, activity designed largely to avoid the finality of death, to overcome in some way that it is the final destination for man” (p. ix). The books and articles we write, the schools and departments and hospitals we build up, live on in journals and bookshelves and libraries, in our colleagues’ and students’ memories, in universities and cities after we are gone. Or so we hope and fantasize. We strive to be published in better journals and by bigger publishing houses and to speak to larger audiences, for the greater the audience, the more likely we are to be remembered and the less we have to fear disappearing entirely. Belief in a literal afterlife softens the blow of mortality as does the belief in a professional afterlife, a written record of our existence, a collective memory of our work.

The recognition of the finite nature of life is a goad for productivity and creativity. Just as understanding that there is only one more day before an important examination can motivate us to study longer and harder than on previous days, the understanding that our lifetime is limited can motivate us to move forward productively with creative work. As Akhtar (2011) says, “The horrid witch of mortality becomes the maudlin muse of our creativity” (p. 88). Similarly, Shabad, in his discussion of Frommer’s paper said, “I have faith that if I am able to feel my death, I will also feel an urgent mandate to realize my life to its fullest potential” (2016, p. 394). Maintaining a knowledge of death, of keeping our mortality in mind also puts life into better perspective; petty spats are just that and each day takes on greater value.

Moreover, as Thomas, Soloman, and Pyszczynski (2015), describe in their terror management theory, the hope for symbolic mortality is offered by culture in the sense that we are part of something greater than ourselves that will continue on after we die. This is why human beings strive to be part of meaningful groups which have a lasting effect on the world – whether the group be civic, religious, academic, etc. This, they say, gives people a sense of reality with order, meaning, and permanence.

Similarly, they say that the path to symbolic and literal immortality also requires that we each feel some degree of self-esteem. They argue that self-esteem shields us “… from the rumblings of dread that lie beneath the surface of everyday experience. Self-esteem enables each of us to believe we are enduring, significant beings rather than material creatures destined to be obliterated” (p. 9).

Defenses against mortality

The yearning for immortality is universal. The need and desire to defend against an ongoing awareness of mortality affects all mankind including the psychoanalyst. Zilboorg (1938) states, “If the fear of death were constantly conscious, we should be unable to function normally. It must be properly repressed to keep us living with a modicum of comfort” (p. 17). He continues, “Man could not possibly be productive or content while simultaneously experiencing, at every moment, the awareness of his own death. While he understands that he will one day cease to exist, he puts that aside through repression to concentrate on the act of living” (p. 18). Zilboorg’s statement reflects his own feeling that ongoing functioning and productivity would be interfered with more than a universal reality. Akhtar (2011) suggests that this is not so. In cultures other than the Judeo-Christian, for example, in Eastern societies, death is not kept so far from personal awareness. Those from a Judeo-Christian background may have greater difficulty accepting the inevitability of death than those in the Muslim, Hindu, and Buddhist worlds. Akhtar suggests that it is, in fact, not impossible to live with a knowledge, indeed, a feeling of our impending end, and that denial may be culturally sanctioned and influenced.

The psychoanalyst in Western culture, like individuals of certain other professions (clergy, for example), bears a responsibility not only to herself but to her patients to keep in mind the reality of death, the fear of death, and all the feelings associated with acknowledgement of death. So, while repression and denial are understandably tempting responses to the anxiety created by the acknowledgement of death, what is the analyst to do when confronted by material involving the patient’s feelings and questions regarding his or her own mortality and, indeed, the analyst’s mortality?

Clearly, many individuals resort to repression and denial. There are some for whom it is especially hard to avoid such defensive maneuvers. In those individuals for whom narcissistic omnipotence is a component of the character, the acknowledgement of limitations of any sort including those temporal limitations imposed by the finite nature of the lifespan may be particularly difficult (Hoffman, 1979). As Kohut stated, the acknowledgement of death requires maximal relinquishment of narcissistic delusions (...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Acknowledgements
• About the editor and the contributors
• Preface
• Introduction
• 1 Mortality and psychoanalysis: the analyst’s defense against acknowledging mortality and the effect on clinical practice
• 2 Psychoanalytic reflections on limitation: aging, dying, generativity, and renewal
• Early exposure to danger and loss
• Illness
• When a patient dies
• When an analyst dies
• Retirement
• Index