Pathological Fear of Death, Panic Attacks, and Hypochondriasis

The relationship between neurotic disorders and attitudes toward death, especially a fear of death, remains unclear. This area of study has largely been neglected or avoided, which can be at least partially explained by the following:

1. A commonly held view that fear of death is mostly irrelevant for psychopathology, since it is a component of normality and “everyday life”;

2. Reluctance or avoidance on the part of many psychiatrists and psychotherapists to deal with the subject of death, possibly because of their own inordinate death fears (Livingston and Zimet, 1965; Eagle and Marcos, 1980);

3. Continuing influence of the classical psychoanalytic theory, that is, of Freud's postulation that death does not exist in the unconscious and that fear of death rarely, if ever, can be a part of unconscious neurotic conflicts (Freud, 1923, 1926), the presence of which has been deemed necessary for the diagnosis of neurosis.

Nevertheless, a number of psychoanalytic and psychoanalytically oriented authors attempted to establish general or more specific links between neuroses, attitudes toward death, and the fear of death (Bromberg and Schilder, 1936; Wahl, 1958; Loeser and Bry, 1960; Stern, 1968; Meyer, 1975; Stolorow, 1979; McCarthy, 1980). Some of this work speculated even about the crucial role of the fear of death in the etiology of various neurotic disorders (Wahl, 1958; Loeser and Bry, 1960; Meyer, 1975).

The literature has introduced a controversy whether a fear of death can be a neurotic phenomenon at all (Fenichel, 1945; Meyer, 1975), and also whether it is a primary experience or a derivative of another, more basic, fear (Freud, 1923; Klein, 1940; Zilboorg, 1943; Heidegger, 1949; Choron, 1963; Becker, 1973). In regard to neurotic conflicts, there have been attempts to connect more or less specific neurotic conflicts with the fear of death (Bromberg and Schilder, 1936;