Death Anxiety and Clinical Practice

Robert Langs

• Publisher: Routledge
• Year: 2018
• eBook ISBN: 9780429912573
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

Robert Langs argues that death anxiety is neglected - in part, because of treatment failures due to countertransference interferences during treatment. He then discusses the technical issues connected with this, whilst introducing the controversial concept that mental activities are derived from immune system activities.

PART ONE

DEATH ISSUES:
BASIC PERSPECTIVES

CHAPTER ONE

A ubiquitous but elusive dread

The existential mix of human existence couples the celebration of life with the awesome awareness of the eventuality of death. Indeed, personal mortality is a compelling issue for every human being from early childhood on. Given the universality and intensity of this adaptive issue, we would rightfully expect that death-related concerns have a great bearing on emotional well-being and psychological dysfunctions—and on the psychotherapies designed to ameliorate the more disturbing consequences of death-related conflicts.

The long reach of death into human life, emotional adaptation, and the intricacies of the therapeutic process are the central concerns of this book. Given the scarcity of psychoanalytic writings in this area, the hope is to provide the reader with a deeply wrought set of much-needed perspectives and insights into the many ramifications that death anxiety has for all patients and therapists as they struggle together, in whatever fashion, to resolve a patient’s emotional maladaptations in the course of a treatment experience.

AN EVOLUTIONARY PERSPECTIVE

Death and the awareness of death are products of evolutionary history. Bacteria, the first living organisms capable of metabolism and replication, are, in one sense, immortal. They flourish in their accustomed environments and do not die, but keep on dividing. They have been alive in an unbroken chain of existence for some four billion years (Margulis & Sagan, 1995).

Nature and evolution, through variation and natural selection, “elected” over very long periods to trade simplicity, asexuality, and immortality for complexity, sexuality, and mortality. Through incorporative symbiosis, one bacterium played host for another, and in time protoctists, the first multicellular organisms, evolved from these cooperative arrangements. These organisms, the first to possess nuclei, no longer simply divided by themselves but generated offspring by combining their cells with cells from similar organisms by means of an innovative sexual process. Inexplicably, this new form of replication was accompanied by the first indications of ageing and genetically programmed death—the final step in the internal metabolic histories of these new species.

As Margulis and Sagan summed it up: Death “… was the first—and is still the most serious—sexually transmitted disease” (1995, p. 41).

LEVELS OF AWARENESS OF DEATH

The possibility of death is an adaptive issue for all living organisms, who must, per force, possess the means of sensing and responding successfully to threats of annihilation if they and their species are to survive. This implies that the existence of death is an inevitable part of life and that inherently it calls forth a variety of defensive operations directed against the possibility of individual demise. Indeed, the danger of death appears to be the most fundamental and universal source of adaptive and defensive structures, and historically it has operated as a selection pressure for the development of protective activities from the beginnings of life.

The intimate connection between death and defence is sustained throughout evolution, including our own species, Homo sapiens sapiens. Thus, death anxiety is a significant motivating factor for all manner of emotionally relevant mental and interpersonal or behavioural defences in human beings. As we shall see, death anxiety as a critical motivating force is quite unappreciated in both psychoanalytic theory and psychotherapy practice.

The finding that 99% of all species who have inhabited this earth no longer exist—having been selected out or deleted through natural selection—attests to the great difficulty that organisms have on the deepest biological level in achieving any measure of success over the powerful threat of extermination. This adaptive problem carries over to ourselves and to the struggle that each individual inevitably wages against death, even as it becomes clear that for virtually all species—at times, including the bacteria—defeat is inevitable. The inordinate potency of the instruments of death, whether from within or outside an organism, is a remarkable and unique feature of death as an adaptation-evoking stimulus, one that affords a special cast to the defences that we and other organisms have created in order to combat and lessen its powers.

An essential feature of adaptations designed to improve chances of survival for both individuals and species is some type of awareness of the awesome danger of death. If we recognize that this sense of danger need not be specified definitively or articulated through language, we can define this sensibility as broadly as possible to include all types of receptor sites that evoke self-protective responses by organisms to life-threatening situations. In this light, the first vestiges of this decisive realization can be seen in the bacteria that began the evolution of biological species. Expressed in the form of an automatic chemical-based sensitivity to danger, bacteria are responsive to environmental threat—toxins and such—and they have the capacity to avoid or escape potentially fatal conditions.

In the ever-present struggle for survival, all organisms have environmentally directed sensors—sensory organs that are essential for the continuation of their lives and the opportunity to create offspring. As the nervous systems of living species increased in complexity, sensitivities to danger situations were sharpened, and the sense of threat to one’s integrity became more and more palpable. Automatic and reflexive responses to peril also became increasingly complex and sophisticated.

As evolution moved forward and the neuron evolved, consciousness and awareness were developed via the introduction of brains and, thereby, minds. Organisms were able to sustain their automatic responsiveness while adding other important features to their self-protective capabilities. Mammals and other species became capable of cognitively recognizing in some non-language form the specific danger of death, primarily in the immediate moment, but with memory for situations in which their lives had been in jeopardy—places and predators that needed to be carefully avoided. By these means, they were able to create and utilize a wider range of protective and defensive measures than is possible on a reflexive basis. Chances of reaching safe quarters and of survival were greatly enhanced by these developments.

The extent and form of the awareness that a given event may prove to be annihilatory varies among animals and is most sharply realized in humans because of our ability to define and represent threats of death through language. The conscious representation of life-threatening dangers and of the inevitability of death as it pertains to self and others creates anxieties and adaptive issues, but these language-based depictions provide us with the most versatile repertoire of self-protective survival measures available in the animal kingdom.

These capabilities are, however, not without their cost. This cost factor arises primarily because language allows for the anticipation of the future and the definitive realization of eventual personal demise. Death anxiety and its maladaptive consequences are the price humans pay for their extraordinary language-based survival-enhancing skills.

* * *

Several complications related to these problems materialize as we move up the evolutionary scale. On the one hand, the evolution of neurons and neural networks—and eventually brains and minds—included the extensive development of more and more sophisticated and efficient externally directed sensory organs such as smell, touch, vision, and hearing. In addition, new internal protective mechanisms like immune systems provided a fresh array of defences against external threat, especially from microscopic predators.

But, on the other hand, along with these developments, the causes of death expanded to include not only more pervasive external threats through toxins and predators, but also through internal forms of peril resulting from dysfunctions within the organism. While many internal diseases are provoked by external events, some diseases—for example, metabolic disorders, some forms of cancer, and failures of vital organs—arise in essence from within the physical self. As a result, natural selection favoured organisms with self-healing capabilities and sensory nerve endings that were directed internally; pain endings were a central feature of this newly emerging inner-directed warning system.

In all, an arms race developed, with more and more pervasive forms of lethal danger arising from within and outside higher species such as humans on the one hand, while on the other humans became more and more efficient at detecting and combating external threat. They also proved capable of developing the practice of medicine as a means of enhancing efforts to combat the physical threat of death posed by internal and many externally caused ills. The struggles between new causes of death and new means of defeating them is an ever-present issue for all species—and for humans in particular.

PREDATORY THREAT

There were long spans of time very early in evolutionary history in which organisms thrived without the threat of predators, but as organisms evolved there came a shift from a separation of environmental niches to a sharing of space and resources that led to both cooperation and predation. The increasing complexity and fecundity of organisms and their metabolic requirements created competition for resources and also led to predatory activities—indeed, with time predators became a very real danger for virtually all living species. Predation is almost as old as multicellularity and reflects the dire necessity for organisms to supplement nonliving sources of nutriment with living sources.

Predation, in the form of external or internal (via incorporated organisms) attack, is a major impetus for measures of defence. Here, too, an arms race inevitably developed between the skills of a given predator and the defensive resources of its victims—with individual and species survival the prize for the winner. The predator–prey arms race has been a major evolutionary force and selection factor throughout the history of biological species.

Predation can be conceptualized broadly to include any form of threat to a particular individual organism. In this light, we can trace an evolutionary history of predatory dangers, recognizing that threats arise largely from other species but may also come from some conspecifics (members of the same species, as seen in human cannibalism and wars). In general, these predatory threats manifestly endanger the survival of the victim in that the situation involves the blatant threat of violence and death.

The development of language and other cognitive capabilities has again placed Homo sapiens sapiens in a unique position vis-à-vis these issues. Humans are faced with many forms of predation that are not specifically endangering physically, nor are they concretely death-related. Nevertheless, these threats, which include non-fatal forms of physical harm and a wide range of evident and latent psychological assaults, place many human conspecifics in the role of psychological predators, who arouse intense forms of death anxieties and may, if pressed to an extreme, actually destroy their victims. We see again that humans possess the most elaborate resources that any species has mobilized to combat death, but they also face equally or perhaps more elaborate sources of danger.

For example, early parental deprivation or psychological assault, while not direct attempts at murder, nevertheless threaten the emotional stability of the child and usually arouse significant forms of death anxiety. The emotional maladaptations that tend to follow may be life-endangering to some degree. Other individuals may behave in ways that disturb or plague a person emotionally to the point of physical illness or self-inflicted injury. In addition there is, through language and language-related communication, an ever-present background awareness that personal death inevitably lies in the future—a psychological realization that also intensifies conflicts of humans with their predators. We see, then, that the evolved complexities of human thought, language, and emotional life both enrich our existence and complicate it greatly.

The death-related threat of self-harm highlights the mixture of external and internal factors in death anxiety in humans—environmental threats lead to inner responses that may ultimately lead to self-destructive behaviour. The latter is virtually absent in lower biological forms, which emphasizes the extent to which, in humans, self may be predator of self. A wide range of personal genetic (childhood and developmental) and psychodynamic factors play a role in these developments, and, as I shall show, so does the evolved design of the emotion-processing mind. The predatory issues faced by humans have a considerable influence on both physical and mental development and especially on the formation of both physical and mental defences. The role of death as an ever-present potential danger situation has strong and complex effects on emotional adaptation.

EXISTENTIAL DEATH ANXIETY

In addition to intensifying predatory death issues, language has created the basis for existential death anxieties—the universal human recognition and dread of eventual personal demise. By facilitating the development of the human sense of identity and self, and the capacity to anticipate the future, language enabled the well-defined articulation of the beginning and end of human life. Evidence for the connection between la...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Foreword
• Part One Death issues: basic perspectives
• Part Two Death issues and the patient
• Part Three Death issues and the therapist
• References
• Index