Death on the couch

The instinct to live, that is, to not die, does not just drive physiological reactions and some baser instincts, it has a powerful effect on the human psyche. In fact, there is a school of thought known as existential psychotherapy that identifies death as perhaps the underlying driver of human psychology. For adherents to this school of thought, anxiety and neuroses are not, as Freud postulates, the results of repressed urges or childhood trauma. No. They are symptoms of our underlying fear of death, be it literal or metaphorical.

Irvin Yalom is the most preeminent practitioner of existential psychotherapy and his book Love’s Executioner is the collection of ten case studies which inspired this post. (As an aside, the book is a brilliant account of how therapy, as an interpersonal exercise between therapist and patient, is actually achieved. It is far more poignant and transparent than, say, Freud’s Three Case Histories, which has Freud ‘objectively’ looking at the symptoms and diagnoses of three patients who he barely treated himself, if at all.) For Yalom there are four human givens that are relevant to this mode of psychotherapy:

1. Death is inevitable for us and those we love.
2. We are ultimately alone in an existential sense, especially in facing death.
3. Life is absent of an obvious meaning or sense.
4. We are free to make our lives as we will.

The most interesting of these to me is the last one, the idea of free will or choice, which itself ends up being a metaphor for death. Yalom makes the observation that the words ‘decide,’ ‘suicide,’ and ‘homicide’ all have the same linguistic root. He believes this to be no accident and to have far-reaching consequences in the lives on individuals. "Decision invariably involves renunciation: for every yes there must be a no, each decision eliminating or killing other options. Thus...[choice can be a] renunciation of that possibility signifying diminishment and death." (p. 11)

Irvin Yalom: Likes Flowers, Thinks About Death

Americans of my generation seem to be undergoing an epidemic of depression and anxiety disorders. I believe, based on personal observation mixed with a dangerously small amount of clinical and theoretical knowledge, that the seemingly infinite choice before us is a significant contributing factor to these illnesses. We have unprecedented choice in our studies, work, geographic mobility, purchasing behaviors, dating, information, etc. The very idea of that we might be limited in the choices at hand seems anathema to our cultural values (both political and consumerist) and in direct contradiction with the largess of modern technological innovation.

Now, if we are to believe Yalom and the existential psychotherapists then with each choice we cause an untold number of little deaths (homicides or suicides, take your pick). And since we have more choices (or at least the illusion of more choices) at our fingertips today than at any other time in human history, then each time we make a choice today we put to death more unselected options than any people who ever lived. We are our species' greatest symbolic murderers. If, as humans, there are psychological consequences to all this metaphorical carnage, then it should be no surprise that America in 2008 is overrun with the clinically anxious and depressed. Too neat and clean for you? Let me offer one not-so-small piece of evidence for my conjecture.

One of the most common symptoms of these conditions is the panic attack. From a physiological standpoint a true panic attack is the result of a misdirected unleashing of the Fight or Flight instinct. The symptoms (e.g., palpitations, sweating, nausea, diarrhea, trembling, etc., etc.) are in line with the natural adrenaline release and consolidation of the body's resources necessary to flee or do battle. Thus panic attacks are the body (and mind) trying to protect itself from a perceived threat. But this threat seems absent. Its nature can only be revealed by peeling back layers of the psyche’s elaborate symbolic processes. So, might the increased incidence of panic attacks be attributable to the difficulties of coping with the renunciation of today's ever-widening possibilities, with confrontations with ever-increasing signs of symbolic death?