Meetings of the New York Psychoanalytic Society

DISCUSSION: Dr. Victor H. Rosen emphasized the relation of the fear of death to separation and castration anxiety and the connection between death wishes, rage equivalents, and destructive impulses that are directed toward the need satisfying object. The condensation of the idea of destruction of the object with self-extinction could be more economically explained by invoking a stage in the development of the body image, where it is conceived as existing within the already differentiated external object. Object relations in the anal phase may be most propitious for this development, but as a result rather than as a cause. Fantasies of identification with the foetus sibling in utero may be of special importance. As the result of vicissitudes of introjection, projection, and identification the repressed destructive impulses return to consciousness only in terms of the destruction of what is within the object. Dr. Joseph M. Krimsley described how children during cardiac illnesses, anesthesia, or visual disturbances experience body sensations which can produce a distortion of body image. The fear of dying is related to memory traces of these experiences. He disagreed with the formulation of the contributions of the anal phase as causal, considering them rather as contributive. Dr. Kenneth T. Calder questioned whether extinction of the ego must be understood as extinction of the self-image. The latter may be observed in narcissistic individuals. Dr. Martin H. Stein, in discussing the wish behind the fear of death, stressed its libidinal value in preoedipal, Oedipal, and rebirth fantasies. Dr. Bernard Meyer distinguished between neurotic and realistic fear of death. To surgical patients, pain, motility, and other stimuli may constitute elements in the sense of identity. Its absence may not only create ideas of depersonalization, but an extreme anxiety fear of imminent death, or confusion that it has occurred. Dr. Andrew Peto gave further clinical material r