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Death is not a simple drive, is not merely the opposite of life. Attitudes towards it are formed from experiences in early life. Death may mean in different individuals (1) escape from the unbearable, (2) a means of forcing more love from others, (3) a final sexual union with an ideal mate, (4) final narcissistic perfection and eternal importance, and (5) a gratification of masochistic tendencies.
With case material it is shewn that in hysteria, anxiety states, pseudoangina and even in one case of organic angina, death fears are related to separation from a loved one and usually a reuniting with a more perfect loved one after death (the incestuous love object being frequent). In two cases of children their destructive attitudes are the cause of fear of death as punishment. In obsessional cases two types are seen, both the result of sado-masochistic attitudes towards the love object. In one type the aggression is external and the idea of the death of others is more important. In the other type the super-ego directs aggressions towards the ego. Death is regarded here as eternal punishment, and dismembering phantasies are frequent. In depressions eternal destruction is important and in epilepsy the idea of rebirth is included in death phantasies. In schizophrenia the indestructability of the individual is connected with ideas of death. In general in the psychoses the object relation is overshadowed by narcissistic gratification.