Psychoanalytic Psychotherapy and the Fear of Death

There is a fundamental relationship between separation anxiety, depression, and the fear of death that persists in its psychodynamic interplay in personality functioning throughout human life. On the basis of the contributions by Sullivan, Horney, and Fromm, death anxiety-or the fear of death in the physically healthy person-can be most clearly understood in terms of those psychological difficulties inherent in depression and neurotic living. The analysand's fear of death needs to be examined in all of its dimensions in relation to the individual's experienced threats to the self and fear of loss of the self. As an aspect of neurotic defensiveness, death anxiety influences character traits throughout life, and it arises in psychoanalytic treatment at points of internal psychological separation as well as in resistance. I am suggesting here that death anxiety in the healthy adult represents the depression and failures in psychic separation inherent in neurotic living. The fear of death is both a symptom and a defense against those painful affects that arise in therapy as the neurotic self attempts growth. This dynamic interplay between death anxiety, depression, and separation anxiety is illustrative of both Erikson's concept of identity confusion and the existential notion of distorted purpose in life as the central core problem of neurosis. This conception of neurotic death fears also concretizes Fromm's view of the fear of death being synonymous with the fear of life and hence the fear of freedom.1

It is the fate of the self in relation to the internalized parents that often provides the psychodynamic key for understanding death anxiety in both children and adults. Schachtel's2 term “embeddedness” beautifully describes the experience of the self without mature differentiation which the neurotic, like the child, grapples with in trying to arrive at more legitimate self-definition and autonomy. The myth of Narcissus, as Rank interpreted it, the myth of P