Meeting of the Psychoanalytic Association of New York

January 16, 1978. FEAR OF DEATH, ACTING OUT, AND THE PSYCHOLOGY OF ACTION. Renato J. Almansi, M.D.

Dr. Almansi examined the role that fear of death plays in acting out. From the analysis of three patients he concluded that this fear represents a threat to the self-image and identity of the patients and that the acting out is restitutive in nature. He placed acting out tendencies in the framework of the psychology of action and examined the ego functioning underlying it.

A phobic housewife, whose childhood included repeated primal scene exposure and witnessing her younger brother's numerous epileptic attacks, developed a severe fear of death as well as identity problems and a fuzzy self-representation. In her efforts to support her weak sense of identity, she tried to create a distinctive appearance for herself and took defiant and uncompromising attitudes in her relationships. A mortician who entered analysis because of impotence had been led to his profession by his fear of death. In addition, he tried to compensate for this fear by working on projects that he hoped would immortalize him. Repeated primal scene exposures in childhood had led to murderous wishes and sadistic fantasies. His life was marked by a great deal of acting out which, in the course of his analysis, reached almost psychotic proportions. He had strong feelings of inferiority and of lacking a definite identity, seeing himself as a little, impotent nobody who needed the analyst for constant support and reassurance. The third case was a businessman with a voyeuristic perversion, hypochondriacal concerns, and fear of death. There was much acting out both within and outside the analysis. He had intense aggressive impulses and a strong sadomasochistic disposition. There were also many contradictions in his character, indicative of multiple identifications and a basic bisexual orientation. This was related to primal scene exposures in childhood, while the acting out had its genetic roots i