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“You will die and it will all be over. You will die and know all or cease asking.” This pithy statement from Tolstoy's War and Peace (1869, Book V, Chapter 1) posits
an insight into the limits of our knowledge of the experience of death and of what, if anything, follows death. However, as living beings we continuously wrestle with the fact of our eventual mortality, and our struggle can take many forms: enlivening acceptance, denial both subtle and gross, health concerns, the creation of a legacy or the envy of the young. Andrew Stein has chosen to examine death through the lens of his work with nursing home residents, and more specifically the topic of death as an obsession or central preoccupation of nursing home residents. His book is a work of compelling scholarship that I hope will find a wide audience as he has much to say that is novel, thought-provoking and clinically relevant.
In exploring this topic, the author uses Freud's dual-drive theory of life and death drives, as well as Lacan's consideration of death as an event horizon where the Symbolic breaks down (the Symbolic encompasses the domain of language and signifiers, as distinct from the Imaginary, the early world of images, or the Real which refers to the natural world). In his introductory chapter, he acknowledges the variety of historical and cultural forces, such as the post-war culture and postmodernism, that acted together to depopularize Freud's gloomy view of how death and destructive fantasies permeated human experience. Stein seeks to correct this and argues that we are obsessed with death due to a perpetual struggle between Eros and Thanatos, as the death drive pushes toward a return to an inorganic state while the life instincts seek “ever more complicated detours” to delay this return. He recognizes the need to escape the pain of existence through negation, fantasy and magical thinking, but he argues that we cannot rely too much on such flights without exacting a heavy cost.
In considering