The fear of death has been hardwired into all of us, but therapists can help patients with death anxiety by providing powerful ideas along with a powerful human connection, said Irvin D. Yalom, MD,1 professor emeritus of psychiatry at the Stanford University School of Medicine, California. He is the author of a number of books on existentialism and psychotherapy, and most recently has written Staring at the Sun: Overcoming the Terror of Death.
Dr Yalom said that therapists may hesitate to discuss death anxiety with their patients because this is not an easy topic to explore. “Psychiatrists should be willing to engage patients who have fears about issues that are existential,” he said. “Death anxiety does not frequently enter into the therapeutic dialogue. Patients may not voice fear about death unless they feel the therapists wants to hear it.”
Therapists should be trained on how to discuss death with their patients because overcoming the fear of death can help patients live. Patients can be helped by learning how to live in the here and now. “If you’re able to deal with this issue, we have the ability to go with patients into these realms and assuage the terror of death,” he said.
Yalom discussed death anxiety as being the mother of all religions. “Religions come in a rainbow of hues throughout the millennia, and they all offer an antidote to our pain of mortality,” he said.
Yalom said this points to specific issues that can be explored with patients. “We are meaning-seeking creatures who are unfortunate enough to have been hurled into a universe that is devoid of meaning,” he said. “And so we have to invent a meaning that’s sturdy enough to support our lives. And maybe then need to perform this acrobatic feat, that we need to pretend that this idea wasn’t invented, it was discovered; this meaning that’s been out there all the time.”
The fear of death continues to stay with us throughout life, said Yalom. In contemporary times, many people who have turned away from religion in the past may look to therapists for help. But, he wondered whether therapists are trained to offer something to treat these patients. “A concept I’ve used throughout my book is that although the physicality of death destroys us, the idea of death saves us,” he said. “It helps us live more authentically.”
When working with cancer patients, he found that the patients had changed the way they lived after diagnosis. “They were less concerned about which parties they had not been invited to,” he said. “Instead, they were more likely to be attuned to the change of seasons. They said no when they didn’t want to do something, and they spent more time with the people they loved to be around.”
“So how do we make people aware of this earlier in life, before they are actually facing death,” he asked. “When working with patients with death anxiety, focus on what’s happening between the 2 of you. It’s helpful to share personal thoughts on death with patients, which builds the relationship.”