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January 17, 1966. REMARKS ABOUT FEAR OF DEATH AND NEUROSIS. Max M. Stern, M.D.
Dr. Stern introduced as an addendum to the classic psychoanalytic technique, the working through of the fear of death which seems to him to be imperative for successful termination. To ward off fear of death and the depression emerging from its inevitability, the neurotic uses gratification of infantile symbiotic needs which in the past protected him against trauma. Working through the fear of death makes possible dissolution of the amalgamation of the past trauma with that threatening in the future. Material about fear of death appears early in associations. When understood, not only the patient's present preoccupations with death but also memories of past struggles with the fact of death come impressively to the fore. The symbiotic fixation often takes the form of wishes to remain infantile; the patient is afraid to grow up and to die.
The author cited several cases, including one of perversion and one of fetishism, that were terminated successfully by the working through of fear of death. In these cases the early mother-child relationship had been especially disturbed. Consequently the transference was strongly ambivalent and involved wishes for fusion with the analyst as protection against death, together with strong defenses against it. The insight gained by the interpretation of the transference as an irrational attempt to escape death elicited sings of marked depression: feelings of emptiness and despair, paralysis of activity, and an alarming dimming of the sensorium felt as haziness. In the wake of the depression, strong ambivalent symbiotic wishes for fusion with the analyst or with the mate emerged. Their working through made possible successful mastery of the once deficient separation-individuation and led to ego maturation in terms of establishment of identity, object relations, and a sense of reality.
Elaborating on Freud's equation in The Ego and the Id of mortal