This paper is concerned with how people think about change and the causes of change. A prominent way of conceptualizing change and causation is derivative of death—rebirth fantasies (DBF), defined as the fantasy that for something to grow or come into existence, something else must be sacrificed, die, or be diminished. Such fantasies concern notions of how we change, and may entail theories of pathogenesis, treatment, and cure. Clinical material from neurotic, schizophrenic, and borderline patients illustrates DBF. Some psychoanalytic theories of change and growth are then considered. Finally, linguistic, analytic, developmental, and biological theories of the development of the concept of causation are explored, to address the question of why DBF is so ubiquitous in our fantasies and thoughts about change.