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Preoccupation with death and dying in the absence of physical illness is a frequent neurotic symptom. This paper is concerned with a patient's neurotic anxiety about death and its relationship to unconscious feelings about exclusion from the primal scene. A syndrome of death anxiety, sleep disturbances, and a form of voyeurism referable to a primal scene experience is described and its various components are interrelated.
In this paper a distinction is made between fear and anxiety. Fear is the emotion of dread evoked by the perception of a real, external danger. This results in a fight or flight reaction. Fear of dying probably exists in all organisms capable of perceiving imminent annihilation. This would correspond to a mental representation of the instinct of self-preservation. Anxiety is the reaction of dread to an internal or fantasied danger which the individual can neither flee nor fight. The danger in this instance is anachronistic, and the feeling of dread refers to an earlier life experience.
Shakespeare said of death, “But that the dread of something after death, the undiscovered country from whose bourne no traveller returns.” Yet the widespread fear of death implies that many of the living have reached those shores, at least in fantasy.
A number of interpretations concerning death anxiety have been advanced in the psychoanalytic literature. Freud stated 17 that it was questionable whether there is any such thing as a normal fear of death; actually the idea of one's own death is subjectively inconceivable, since by definition, no living person has ever experienced it, and therefore probably every fear of death must be derived from other ideas, many of them unconscious. To understand them, one has to find out what ideas are connected with the concept of death.