Μια συνέντευξη με τον Irvin D. Yalom(κορυφαίος ψυχίατρος, υπαρξιακός ψυχοθεραπευτής)

A matter of life and death

By FRED BRANFMAN | Photo by Reid Yalom

"Of all the world's wonders, which is the most wonderful? That no man, though he sees others dying all around him, believes that he himself will die." -- Yudhishtara answers Dharma, from "The Mahabharata"

it is not just love that we look for in all the wrong places. If Irvin Yalom is right, it is life itself. By denying death, the psychoanalyst suggests, we misdirect our search for happiness. The true meaning of life, his work suggests, lies in engaging what we most fear.

Yalom has the credentials to make such a claim. He is the author of the highly regarded 1980 textbook, "Existential Psychotherapy" and his bestselling work "Love's Executioner" shows how such neuroses as eating disorders can be alleviated by bringing patients' death-anxieties to the surface. His novel "When Nietzsche Wept" is a thought-provoking exploration of how psychology might have fared had it been invented by the Ur-existential thinker Nietzsche rather than Freud. His new novel, "Lying On The Couch," will be published next month.

I spoke with Yalom in the office he has built next to his comfortable home on a peaceful street in Palo Alto. A quiet man, he exudes an air of mild anxiety oddly appropriate to the existential realities -- death, freedom, isolation, meaninglessness -- of which he writes. He becomes passionate mainly when affirming his strong belief in science and his skepticism about non-material or spiritual understandings of life.

Most striking was the contrast between Yalom's brilliantly successful career and the place he has reached now, at age 65. This lifelong academic has abandoned teaching and now writes novels instead. This professor who worked so extraordinarily hard at his career now urges a focus on what is important beyond work. Irvin Yalom is fascinating not only because of what he says but also because of how he lives.

Most of us feel we do not want to think about death. But you assert that confronting death is a key to living a full, authentic, happy life. I wonder if you could describe in personal terms what living authentically means to you?

Certainly as I've grown older, I've been thinking a lot more about the end of my life, which may not be too far away. My father and his brothers all died relatively young because of heart conditions.

So I think, Well, life is finite. I don't have unlimited years left, and I want to know what is more central to me and my life right now. Above all, I don't want to do anything that feels repetitious.

And I tell myself that I don't want to belong to any more committees or teach anymore, because the field is becoming drugs, pharmacotherapy. The next generation of therapists isn't going to be trained for psychotherapy because the insurance companies aren't going to be paying for it any longer.

What feels most central for me is being creative and looking at the way in which I have creative talents and gifts that I haven't used. I basically see myself as a storyteller engaged in ideas that have to do with an existential, deeper approach to life. I feel very uncomfortable with the idea of these gifts being unused.

I also really enjoy looking at those bonsai [points to trees outside his window]. I love the garden that I have out here. I turn down lunch invitations from a lot of people that I just don't want to be with. The few people I see talk about the kinds of issues and concerns that I really like.

And I feel extremely tender towards my wife. Every time I see her, I'm filled with pleasure. There's a real sense of poignancy about my relationship and feelings toward her. I'm very concerned that I do whatever I can to make her happy.

And I don't take myself very seriously. There's an old Italian proverb that sticks in my mind a lot: "When the chess game is over, the pawns, rooks, kings and queens all go back into the same box." Somehow I find that quite an important comment.

"The primitive dread of death resides in the unconscious -- a dread that is part of the fabric of being, that is formed early in life before the development of precise, conceptual formulation, a dread that is chilling, uncanny, and inchoate, a dread that exists prior to and outside of language and image." -- "Existential Psychotherapy"

You've writen that "a denial of death at any level is a denial of one's basic nature." How do most of us deny death?

We -- in the unconscious portion of the mind that protects us from overwhelming anxiety -- split off or disassociate from the terror of death. But though it is invisible to us, we can know it's in our subconscious because of those rare but real episodes when the machinery of denial fails and death anxiety breaks through in full force -- such as when a loved one dies, or when we have nightmares. As I wrote in "Existential Psychotherapy," a nightmare is a failed dream, a dream that, by not "handling" anxiety, has failed in its role as the guardian of sleep. Though nightmares differ in manifest content, their underlying process is the same: Raw death anxiety has escaped its keepers and exploded into consciousness.

We simply put it out of mind by immersing ourselves in what Becker calls "immortality projects," or by using other techniques to deny our creature-deaths, like the idea of a supreme "ultimate rescuer" and the idea of "specialness," that somehow you yourself are immune to natural biological law. This often translates into some kind of belief in the supernatural, a para-reality in us that is going to transcend reality as it is.

After reading your and Becker's work, I assumed that there would be a huge debate within the psychology community on the importance of helping people confront their fears of death. But the subject, by and large, seems to have been ignored. Why is that?

Psychotherapists and psychologists are themselves in denial of death. They are not really very different in this regard than the general population.

"A real confrontation with death usually causes one to question with real seriousness the goals and conduct of one's life up to then. So also with those who confront death through a fatal illness. How many people have lamented: 'What a pity I had to wait till now, when my body is riddled with cancer, to know how to live!'" -- "Love's Executioner"

How might the knowledge of death enrich our lives?

What comes to mind right now is a friend of mine who's so caught up in the rat race for success in his field that he's never taken a sabbatical. The university is willing to give him a year off and he has not taken it. It's insane.

In talking with him, I've pushed him to look at the fact that he is not going to have his children at home forever, and to think about what an experience like a sabbatical would mean for him and them. I mean, I've been at Stanford all these years, and I can't remember one year from the next -- they all sort of blur together. But I spent a year in London, another year at Oxford and another year in Paris. And every day of those years stands out for me and was very rich for my children.

But what if your friend said he enjoyed his work, that working hard is his core?

You know, I've never heard anyone near death say -- and I've never heard of anyone who's ever known anyone near death say -- "I wish I had spent more time at work."

Nobody ever says this. Everybody, everybody, says, "God, I wish I'd spent time doing the things I wanted to do -- reading more, writing more, traveling, seeing all these places, being closer to people, to my children." Everybody says things like that. So that means something.

Do you also believe it would be useful for people in their 20s and 30s to break through their denial of death?

Well, based on the patients I've worked with, I think that's true. Adolescents, by and large, have a pretty keen awareness of these issues. They tend to have less denial operating for them than perhaps we do at most other ages of life. But when they finally get thrown out into the world, other needs -- needs for economic success, or raising a family -- begin to press in. And to satisfy these needs, their fear of death gets pushed into obscurity or the unconscious.

If people in their 20s had more death awareness, would that in fact temper their ambition or drive? My hunch is yes. It would certainly do something for those who are most ruthless, who tend to make others most miserable. Some sort of greater awareness of their own finiteness and what their time on earth really is, and what they really want to do with their lives, could help improve them.

I asked a young guy the other day how he felt and he said, "Terrific! I'm enjoying my work. I just started dating a woman. Life is great!" Now, it seems to me that he wasn't engaging his primal death anxieties. Would you recommend that he consider doing so?

Hmm. Well, the first thought that occurs to me concerns his relationship. My sense is that if he were to engage his unconscious existential concerns, the relationship might be much richer, more tolerant, more loving. When we see the other person as a fellow creature in the same type of life situation, we often have a greater appreciation. There might be less of a chance of him using or being used by her, and more of a possibility that he would be looking for some sort of deeper communion.

How might his work be affected by engaging death?

That's a much more problematic issue for me. I've always had a sense that engaging the fear of death can be quite injurious to work for many people. If one doesn't have the option of changing a job one does not like, a heightened awareness of death could increase dissatisfaction.

But if one does have the luxury of changing distasteful work, the confrontation with death might be a wake-up call. He or she might see how the repetitious quality of the work is deadening and might think, "I'll do whatever I can, move, get to another part of the country, do something to change my work."

What is the mechanism whereby engaging death leads to a more authentic life?

Well, one way to describe it is through a disidentification exercise we have conducted with cancer patients. People answer the question "Who am I?" on cards and then arrange them by priority. They then start letting go of the less important cards, for example,"I am someone who is very concerned about whether people love or like me."

And they have to let go of their bodies, because their bodies are riddled with cancer. But then they often discover that there is something beyond the body, other things that are more important. It kind of gives you more courage. It doesn't make any difference anymore if people like you or not.

Heidegger makes the distinction between being absorbed in the way things are in the world and being aware that things are in the world. And if you do the latter, you're not so worried about the everyday trivialities of life, for example, petty concerns about secrecy or privacy.

Another way of saying it is that death cures psychoneurosis. In a sense all these neurotic concerns -- fear of rejection, interpersonal concerns -- seem to melt away, and people get another perspective on their lives. The important things are really important, and the trivia of life is trivialized.

In a study we did of bereavement, we found that rather impressive numbers of widows and widowers had not simply gone back to their pre-loss functioning, but grown. This was due to a kind of increased existential awareness that resulted from this confrontation with the death of another. And I think it brought them in touch with their own death, so they began to experience a kind of preciousness to life that comes with an experience of its transiency.

"[There is] a juncture to which full awareness inevitably leads. One stands before the abyss and decides how to face the pitiless existential facts of life. Of course, there are no solutions. One has a choice only to be 'resolute,' 'engaged,' courageously defiant, stoically accepting or to, in awe of mystery, place one's trust in the providence of the divine." -- "Love's Executioner"

As you sit here now, would you say you are in denial of your death or engaging it?

I'll be 65 in eight days or so. So I'm at that time. I'm filled with ideas about death, and my nights and dreams and certainly dream-thoughts are filled with that kind of imagery.

What does it feel like?

Well, it's different in the middle of the night and in a waking state. In the middle of the night, actually, it's kind of attenuated terror. There are times when the anxiety rather overtakes me. I've never imagined getting to a point where that won't happen. I feel like it's too intrinsic to us.

If it gets to be particularly anxious, I like to think of Lucretius' doctrine: "Where death is, I am not; where I am, death is not." The two are never coexistent in a sense. I find that, in a strange way, a very comforting thought.

Sam Keen has described waking up at night feeling incredible terror at his death. And he wants to push it away but doesn't because all his training has taught him to stay with it. And his terror is then followed by a tremendous joy at being alive, as he leans over and embraces his wife. What is it like for you?

I do not have that kind of experience at night. It's harder for me to dispel the anxiety at night. Whereas when I think about it later on, when I wake up in the morning, or later on during the day, then I do experience real joy. I can't switch from one mode to the other at night.

As you stand before the abyss, where are you -- resolute, engaged, courageously defiant, stoically accepting or in awe before the mystery, placing your trust in the divine?

Stoically accepting, I guess.

And what about feeling awe before the mystery?

Well, you can say "awe" in the sense that I am in awe at the elegance and complexity of the way that our brains happen to have evolved. Happen to have evolved. You know, not designed, but happen to have evolved. I can say "awe" there. But I'm separating that from a kind of supernatural religious belief.

It seems to me that "awe" argues against belief. Awe leads to no belief, to "don't know."

Yes, I have some awe of mystery. But it's sort of tempered by a belief that ultimately we'll be able to comprehend it all. I'm more of a scientific positivist in that regard.

Last night I was reading Sam Keen's famous deathbed interview of Ernest Becker. You know, Becker did not give much credence to the reality of religious belief-systems in "Denial of Death" ...

Oh, sure, I agree with every word he said ...

... But at the very end of Becker's life Keen asked him about the possibility of a transcendence of death. And Becker said, "I would have to agree that the transcendence of death, symbolically or from the point of view of the whole universe, may be very real." He left the door open for a transcendent reality.

Well, I think at that point he may have been quite frightened, and the wish for continued persistence may have been very strong.

And if I on my deathbed embrace that wish, I don't consider that proof of anything, except that I am frightened.

I find the idea of dying, of not existing for the next 5 billion years and beyond, chilling. It takes my breath away. Can you offer any comfort?

Well, did the last 5 billion years bother you? I mean, it seems to me that what happens after we die is not really the problem. It is a kind of peace. The challenge for us is how we live between now and then, whether we have the courage to stop denying it and use our anxieties to live more authentic, meaning-filled and purposeful lives.

Fred Branfman is a veteran political activist and commentator. He is a regular contributor to Salon.