(Margaret S. Mahler) Salman Akhtar, Ira Brenner, Stanley J. Coen, Calvin A. Colarusso , Hossein M. Etezady, Michelle Foster, Ruth Garfield, Jaswant Guzder, Leon Hoffman M.D., Eileen Johnson, Albert Ka.pdf

The Wound of Mortality
Margaret S. Mahler Series
This series of yearly volumes began appearing in 1991 and is based upon the
panel discussions presented at the prestigious Annual Margaret Mahler Sym-
posia held in Philadelphia. Each volume consists of three papers and their
discussions presented at the most recent Symposium. A thorough introduc-
tion and a comprehensive conclusion that pulls all the material together are
specially written for the book. Occasionally, one or two papers that were
not presented at the meeting but represent the cutting-edge thinking on the
topic are also included. While this format and organization gives these books
a friendly familiarity, the books’ contents vary greatly and are invariably a
source of excitement and clinical enthusiasm. Volumes published so far have
addressed topics as diverse as hatred and cultural differences in childhood
development, extramarital affairs and sibling relationship, mourning and
self psychology, and resilience and boundary violations. Among the distin-
guished psychoanalysts whose work has appeared in this series are Salman
Akhtar, Anni Bergman, Harold Blum, Ruth Fischer, Alvin Frank, Dorothy
Holmes, Otto Kernberg, Selma Kramer, Peter Neubauer, Henri Parens, Fred
Pine, John Munder Ross, and Ernest Wolf, to name a few. The vantage point
is always broad-based and includes developmental, clinical, and cultural
variables but the end point is consistently an enhancement of the technical
armamentarium of the therapist.
BOOKS BASED UPON THE MARGARET S. MAHLER SYMPOSIA
• The Trauma of Transgression (1991) • Does God Help? (2000)

• When the Body Speaks (1992) • Three Faces of Mourning (2001)
• Mahler and Kohut (1994) • Real and Imaginary Fathers (2004)
• Prevention in Mental Health (1993) • The Language of Emotions (2005)
• The Birth of Hatred (1995) • Interpersonal Boundaries (2006)
• The Internal Mother (1995) • Listening to Others (2007)
• Intimacy and Infidelity (1996) • The Unbroken Soul (2008)
• The Seasons of Life (1997) • Lying, Cheating, and Carrying On
• The Colors of Childhood (1998) (2009)
• Thicker Than Blood (1999) • The Wound of Mortality (2010)
The Wound of Mortality
Fear, Denial, and Acceptance of Death
Edited by
Salman Akhtar
JASON ARONSON
Lanham • Boulder • New York • Toronto • Plymouth, UK
Published by Jason Aronson
An imprint of Rowman & Littlefield Publishers, Inc.
A wholly owned subsidiary of The Rowman & Littlefield Publishing Group, Inc.
4501 Forbes Boulevard, Suite 200, Lanham, Maryland 20706
http://www.rowmanlittlefield.com
Estover Road, Plymouth PL6 7PY, United Kingdom
Copyright © 2010 by Jason Aronson
All rights reserved. No part of this book may be reproduced in any form or by any
electronic or mechanical means, including information storage and retrieval systems,
without written permission from the publisher, except by a reviewer who may quote
passages in a review.
British Library Cataloguing in Publication Information Available
Library of Congress Cataloging-in-Publication Data

The wound of mortality : fear, denial, and acceptance of death / edited by Salman
Akhtar.
p. cm. — (Margaret S. Mahler series)
Includes bibliographical references and index.
ISBN 978-0-7657-0699-7 (cloth : alk. paper) — ISBN 978-0-7657-0701-7 (electronic)
1. Death—Psychological aspects. 2. Fear. 3. Denial (Psychology) I. Akhtar, Salman,
1946 July 31–
BF789.D4.W68 2010
155.9'37—dc22
2009043187
⬁ ™ The paper used in this publication meets the minimum requirements of

American National Standard for Information Sciences—Permanence of Paper for
Printed Library Materials, ANSI/NISO Z39.48-1992.
Printed in the United States of America

To the memory of
Leo Madow
(1915–2009)
with respect and affection

Contents
Acknowledgments ix
Chapter 1 Freud’s Todesangst and Ghalib’s Ishrat-e-Qatra:
Two Perspectives on Death 1
Salman Akhtar, MD
Chapter 2 What Happens When You Die:
Three-to-Four-Year-Olds Chatting about Death 21
Leon Hoffman, MD, Eileen Johnson, MA,
Michelle Foster, BA, and Josephine Wright, MD
Chapter 3 Children’s Understanding of Death 37
Henri Parens, MD
Chapter 4 Symbolic Death, East and West: Metaphors in
Three Child Case Studies 51
Jaswant Guzder, MD
Chapter 5 It Is Not Over When It’s Over: Reflections on
Death and Mourning 71
Albert Kaplan, MD
Chapter 6 Fear of Death: Analyst and Patient in the
Same Boat 79
Ilany Kogan, MA
vii
viii Contents
Chapter 7 The Dead Self Must Be Reborn 97

Stanley J. Coen, MD
Chapter 8 Living to Die and Dying to Live: Normal and
Pathological Considerations of Death Anxiety 107
Calvin A. Colarusso, MD
Chapter 9 Facing Death: Intrapsychic Conflict and
Intergenerational Passage 125
Ruth Garfield, MD
Chapter 10 Eastern Intersubjectivity: Relational Homes for
Frailty and Death 135
Tooraj Moradi, PhD
Chapter 11 Demise and Illusion 155
M. Hossein Etezady, MD
Chapter 12 Is That All There Is? A Concluding Commentary
on Psychoanalysis and Death 171
Ira Brenner, MD
References 187
Index 199
About the Editor and Contributors 205

Acknowledgments
Six chapters in this book were originally presented as papers at the 40th An-
nual Margaret S. Mahler Symposium on Child Development, held on April
18, 2009, in Philadelphia, Pennsylvania. First and foremost, therefore, I wish
to express our gratitude to the Department of Psychiatry of Jefferson Medical
College, the main sponsor of this event. I am especially indebted to Drs. Mi-
chael Vergare, Chairman of the Department of Psychiatry and Human Be-
havior of the Jefferson Medical College, Bernard Friedberg, President of the
Psychoanalytic Foundation of the Psychoanalytic Center of Philadelphia,
and William Singletary, President of the Margaret S. Mahler Foundation for
their kind support for the Symposium.
Six other chapters contained here have been especially written for this
book and I am grateful to their respective authors for their efforts and
thoughtfulness. I am also thankful to my wife and fellow psychoanalyst,
Monisha Nayar, for her careful reading of my contribution to this book. Her
input improved what I had to say. There are many others who helped in
subtle and not so subtle ways; the most prominent among these are Roberta
Brenner and Gary Kaplan. To them, my most sincere thanks indeed. Finally,
I wish to acknowledge my deep appreciation of Ms. Jan Wright for her superb
organization of the Symposium and for her skillful preparation of this book’s
manuscript.
ix
CHAPTER ONE
Freud’s Todesangst and

Ghalib’s Ishrat-e-Qatra
Two Perspectives on Death
Salman Akhtar, MD
We have a complex relationship with death. To call our attitude toward

death “ambivalent” is to oversimplify matters. The gamut of our affects and
fantasies involving death is far more wide-ranging than can be captured by
the plebeian and workman-like adjective. Let us look a little closely at what
we have at hand here. To begin with, we feel a certain unease about the
topic of death, especially if it involves that of our own. A shudder of fear
rocks our hearts as we contemplate our nonexistence. We may or may not
like ourselves but, by God, we are hardly at ease in saying good-bye to “dear
old me.” As a result, we pretend that it is not going to happen to us. We play
mental games with ourselves and run after the mirage of immortality. We tell
ourselves that by staying healthy we can postpone death (perhaps forever?),
overlooking that people get killed in freak accidents all the time and are
even randomly murdered because they have been mistaken to be someone
else by a drug-ravaged or blithely forgetful hit man.
Anxiety about the limited nature of our existence delivers us to the
cushion of handed-down magic as well. We open the windows to religious
belief and dreams of heaven, hell, reincarnation, or the continuation of our
“souls” one way or the other.1 Beguiled and beguiling, we permit ourselves
all sorts of illusions and all shades of plea-bargaining in order to save our
lives, so to speak. However, such defensive maneuvers do not exhaust the
list of our reactions to the thought of our deaths. We are also puzzled and
1
2 Salman Akhtar
intrigued. Our epistemic instinct exhorts us and we concoct elaborate

hypotheses about near-death and after-death phenomena, though slyly we
refer to the latter as “after-life” phenomena. We turn our hapless anguish
on its head and crack jokes about the “Grim Reaper.” We wax poetic about
death. We paint scenes of dying, write stories and screenplays, make movies
about terminal illness, and stage operas involving death. Injecting imagina-
tion and pleasure into what seems morbid and frightening allows us a good
night’s sleep. The horrid witch of mortality becomes the maudlin muse of
our creativity.
This is not a contemporary or passing fad, however. The panorama of
dread, mockery, sentimentalization, denial, “change of function” (Hart-
mann, 1939), and creativity involving death has existed since time immemo-
rial. From Buddha to Freud, from the Sufi poets of Persia and Afghanistan
to the twentieth century existentialists of Western Europe, and from the an-
cient Hindu mystics down to California-style gurus of today, contemplative
thought has invariably found the question of death central to life. Freud’s
(1920, p. 38) declaration that “the aim of all life is death” was long preceded
by the great Urdu poet, Mirza Asad-Ulla Khan Ghalib’s (1797–1869) lyrical
pronouncement that “ishrat-e-qatra hai darya mein fanaa ho jaana.”
Literally translated, this means that the greatest ecstasy for a drop is to
fall upon a river and become one with it. Such a sentiment not only ac-
commodates the inevitability of death but ascribes to it a certain sense of
desirability and even pleasure (“ishrat” literally means delight). Ghalib,
however, is not content with portraying death as a joyous culmination of
a long journey. He adds that without the awareness of its finiteness, life
would not be as enjoyable at all. In his words, “na ho marna to jeenay ka
maza kya?”
This is only one perspective, however. An opposite viewpoint also ex-
ists, which regards death as the ultimate humiliation and a great narcissistic
injury. Death, from this perspective, is something to be feared, despised,
and combated. In the first perspective, the fear of death is moral cowardice
which results in immature clinging to illusions. In the second perspective,
acceptance of death is melancholic nihilism and a pathetic rationalization
of low self-esteem. But let me not get ahead of myself. Instead, allow me to
first address the elusive and controversial concept of “death instinct” (Freud,
1920). Following this, I shall return to the “death-averse” and “death-ac-
cepting” perspectives mentioned above. Then, I will try to elucidate how life
and death are not as categorically apart as they seem to be on surface. I will
conclude with pulling this material together and raising some questions for
us to consider.
Freud’s Todesangst and Ghalib’s Ishrat-e-Qatra 3
The Death Instinct

Based upon observations regarding children’s turning traumatic experiences
into play, certain analysands’ returning over and over again to painful past
experiences, the behavior of those who must go repeatedly through similar
calamities, and the dreadful preoccupations of war veterans, Freud suggested
that there might be a self-destructive “daemonic force” (1920a, p. 35) at
work in them. This force worked in opposition to the pleasure principle
and was aligned with a fundamental attribute of mind that searched for
reduction of all excitation to quiescence. At its deepest, this search for
quiescence—the “Nirvana principle”—was aimed at returning the living
organism to its previous, inorganic state. Freud (1920) thus gave voice to his
celebrated though controversial concept of the “death instinct.” A threat to
the self at birth, this force is deflected outward by the influence of libido and
ego using the agency of somatic musculature. Freud termed this outwardly
deflected part of the death instinct the “aggressive instinct.” In The Ego
and the Id (1923), Freud added that the death instinct operates silently. In
Civilization and Its Discontents, he emphasized that “aggressive instinct is the
derivative and the main representative of the death instinct” (1930, p. 122).
In Analysis Terminable and Interminable (1937), Freud again referred to the
death instinct and related masochism, negative therapeutic reaction, and
unconscious guilt to its derivative, the aggressive drive. And, finally, in the
Outline, he reiterated his formulation of “two basic instincts” (1940, p. 148),
one to establish unities and the other to undermine connections and destroy
things. He emphasized that the “concurrent and mutually opposing action of
the two basic instincts gives rise to the whole variegation of the phenomena
of life” (1940, p. 149).
Freud acknowledged borrowing the expression “Nirvana principle” from
Barbara Low, a Sanskrit expert. The notion of “death instinct” thus, from
the beginning, had an Eastern touch. Gustav Fechner, the renowned physi-
cist whose “constancy principle” led Freud to the “Nirvana principle,” was
himself involved in Buddhism (Jones, 1957). And Romain Rolland, from
whom Freud (1930) obtained the related concept of “oceanic feeling,” was
an avid reader and biographer of the nineteenth-century Indian mystics Sri
Ramakrishna Paramahansa and Swami Vivekananda. The Indian mystic
tradition was thus a background conceptual source for Freud’s death instinct.
This may have been part of why the concept appeared alien to Western
minds. With the exception of Klein (1933, 1935, and 1952), her followers,
and Eissler (1971), most subsequent analysts laid the postulate of death in-
stinct to rest. In the Kleinian tradition, however, the concept remains and
4 Salman Akhtar
is utilized largely to explain mental operations that seek to destroy sublime

thought, well-synthesized ego attributes, and the capacity for in-depth object
relations.
While “death instinct” may have been relegated to the heuristic periph-
ery, a close examination of psychoanalytic literature shows a recurring no-
tion that there is, in humans, a vague drivelike internal pull toward the loss
of the boundaries, if not the existence, of the psychic self. Concepts that al-
lude to this internal pull include (1) the merger fantasies, often associated
with feeding and with sleep (Lewin, 1950); (2) the deep-seated wish for
loss of human identity by “metamorphosis” (Lichtenstein, 1963); (3) the
everlasting wish for “the lost, original union with the mother” (Jacobson,
1964, p. 39); (4) in the context of neonatal life, “the drive to return to an
earlier state where all was gratified automatically” (Stone, 1971, p. 236);
(5) man’s eternal yearning to recapture the “co-anesthetically remembered
harmony of dual-unity stage” (Mahler, 1971, p. 186); (6) the “search for
oneness” (Kaplan, 1977); (7) neonates’ “inborn and immediate wish to
return to the intrauterine state” (Chasseguet-Smirgel, quoted in Akhtar,
1991b, p. 751) and man’s “nostalgia for primary narcissism” (Chasseguet-
Smirgel, 1984, p. 29); (8) the “someday” and “if only” fantasies (Akhtar,
1991a); and, (9) an attempted reconciliation of “everything” and “noth-
ing” fantasies, which occurs “transiently in dreamless sleep and in the
ecstasy of orgasm—but the promise of permanence can be realized only
after our individual lives are over” (Shengold, 1991, p.7). To be sure, these
concepts have diverse theoretical foundations, involve fantasy content not
attributable to instinctual primitivity, and contain an unmistakable libidi-
nal admixture with aggression.
Yet collectively these notions do demand contemporary reconceptual-
izations of the death instinct concept. Such examination might confirm
the ubiquitous existence in humans of a deep-seated wish for the loss of
self-boundaries, perhaps an echo of an early desire for (and memory of) fu-
sion with the mother. It might be that this preverbal pull subsequently ac-
crues fantasies from various levels of psychosexual development. Death too
may enter this scenario, though much after infancy and childhood, perhaps
truly not even until middle age. From then onward, the deep-seated desire
for fusion with mother might become intermingled with a longing for peace
via death; a “death instinct” has thus been set into motion. On the other
hand, individuals who are traumatized by early losses through death or
themselves have faced early life-threatening crises might incorporate the
notion of death into this substrate of fusion/oblivion seeking much earlier
(Settlage, 2001; Akhtar, 2001). They might give evidence of possessing
a “death instinct” even before middle age. Such a formulation of “death

instinct” is clearly different from the original one by Freud (1920). In this
reconceptualization, both death and instinct are words that seem misplaced.
Clearly, further thinking and newer terminology are needed here. A recent
paper by Schmidt-Hellerau (2006) is one such attempt to reformulate the
death drive in object relations terms. What still remains unclear, how-
ever, is whether the death instinct always leads to anxiety or could it be
a loyal and reliable guide to our final destination? In other words, do the
psychological repercussions have to be distress-producing or can they be
the source of reassuring lullabies, especially toward the end of life? This
bifurcation of perspectives is our next stop.
Freud’s Todesangst
Sigmund Freud’s declarations that “the fear of death has no meaning to a
child” (1900, p. 254) and that the unconscious “does not believe in its own
death; it behaves as if it were immortal” (1915, p. 296) have become shib-
boleths of mainstream psychoanalytic theorizing—whatever little of that
does exist—upon the issue of death. Fitting like hand and glove into the
Western (and, especially, North American) unease about the finite nature
of man’s existence, the idea that there is no such thing as one’s death in the
unconscious got firmly ensconced in our literature, overlooking the doubt
cast upon its veracity by the later views of the Master himself.
Two examples of these should suffice. Freud’s (1920) proposal of “death
instinct” as one of the two central forces (the other being “life instinct”)
of human motivation puts death squarely into the unconscious; after all, it
is the system unconscious that is the magical powerhouse where instincts
dwell and various forms of psychic energy meld into each other.2 Indeed, it
was the dreaded implosion of the self by the operation of the death instinct
that led to its forceful externalization and creation of the destructive drive.
In this conceptualization, death is clearly present in the unconscious and so
is the fear of it. Melanie Klein’s (1948) later elaboration of those notions is
a testimony to such assertion. She states:
If we assume the existence of a death instinct, we must also assume that in the
deepest layers of the mind there is a response to this instinct in the form of
fear of annihilation of life. . . . The layers arising from the inner working of the
death instinct is the first cause of anxiety. (p. 29)
This brings up the second concept of Freud (1923) which contradicts his
own assertion made over two decades before that there is no death in the
6 Salman Akhtar
unconscious. Here I am referring to his notion of todesangst, translated as fear

of death (p. 58). Freud notes that the mechanism of fear of death is that
the ego relinquishes its narcissistic libidinal cathexis in a very large measure—
that is, that it gives up itself, just as it gives up some external object in other
cases in which it feels anxiety. (p. 58)
The shift in Freud’s thinking from the absence of death in the unconscious
to the central position he accorded to the death instinct is striking. Though
Freud had been exposed during childhood to major losses (e.g., the departure
of his beloved nursemaid, the repeated pregnancies of his mother) and death
(of his younger brother, Julius, when Freud was nearly 4 years old), the events
that perhaps contributed most strongly to the shift in his thinking happened
soon after when he turned sixty. He was suffering from cancer. His sons were
involved in war. He lost his daughter, Sophie, suddenly, in 1920, and his
beloved grandson, Heinerle, in 1923. Devastated by these losses, Freud said
that “fundamentally, everything has lost its meaning for me” (letter to Kata
and Lajos Levy, January 11, 1923, quoted in Eissler, 1978, p.229).
Given such background, it’s hardly surprising that Freud would talk about
the temptation for the ego to give up its own structure and its ties to objects.
While he related such an inward pull to melancholia, later analysts (Lichten-
stein, 1963; Guntrip, 1969) went a step further and declared that the ego’s
wish to renounce the world might not be pathological but a sort of “built-in”
mechanism that stakes its claim on the psyche from the earliest periods of
life. Despite the implication that the fear of death arises de novo, other psy-
choanalysts preferred to view it as a derivative of other sources of anxiety. In
this predilection, they were lulled into none other than Freud himself who,
as we well recognize, could contradict himself with ease. In 1926, he stated
that “the fear of death should be regarded as analogous to the fear of castra-
tion” (p. 130). This notion was further propagated by Bromberg and Schilder
(1933) and McClelland (1964). The latter noted that the visualization of
death as an old man with a scythe by men supports the equation of fear of
death and fear of castration.
However, as reported in greater detail by Stolorow (1973), castration
anxiety was not the only dysphoric concern that got associated with fear of
death. The latter was regarded to be a derivative of the fear of separation
or complete and final object loss (Bromberg and Schilder, 1933; Anthony,
1940; Norton, 1963; Natterson and Knudson, 1965) as well. Yet another
perspective that evolved considered fear of death to be a derivative of fear
of being punished and therefore, a form of dreaded assault upon the ego
from the superego (Chadwick, 1929; Zilboorg, 1938). Freud (1923) himself
emphasized that
To the ego, living means the same as being loved—being loved by the super-
ego, which here again appears as the representative of the id. The superego
fulfills the same function of protecting and saving that was fulfilled in earlier
days by the father and later by Providence or Destiny. But when the ego finds
itself in an excessive real danger which it believes itself unable to overcome
by its own strength, it is bound to draw the same conclusion. It sees itself de-
serted by all protecting forces and lets self die. Here, moreover, is once again
the same situation as that which underlay the first great anxiety-state of birth
and the infantile anxiety of longing—the anxiety due to separation from the
protecting mother. (p. 58)
A little over forty years later, Wahl (1965) clearly spelled out the con-
nection between “infantile thanatophobia” and guilt-producing death wishes
against parents during childhood.
These destructive hating thoughts are doubly frightening since the child not
only fears the loss of his parents through the operation of his death wishes, but
also, since he reasons by the law of Talion (to think a thing is to do a thing;
to do a thing is to endure an equal and similar punishment to the self), he
becomes fearful of his own death. (p. 140)
Other underlying sources of fear of death have also been described. These
include the fear of ego loss by overwhelming sexual excitement (Fenichel,
1945) and infantile fears of darkness (Chadwick, 1979) and suffocation
(Harnik, 1930).
Moving on to recent writings on the subject one notices that, in accordance
with the trend in contemporary psychoanalysis at large, the contributions are
far less reductionistic. Death instinct, death anxiety, and fantasies involving
death are now located in the broader context of ego-psychology, self-coher-
ence, and object relations. Fayek (1980, 1981), for instance, notes that the
main problem posed by the “death instinct” concept lies in the difficulty of
distinguishing its psychic representations and symbolic forms. This difficulty is
compounded by the fact that we are looking for symbols of something that has
never been experienced. Fayek, however, speculates that patients’ vocabulary
around the themes of termination might offer a glimpse into the metaphorical
operation and/or representation of death. He adds that
death is the experience of the other or an experience with the other but never
with the self. Therefore, the symbolization of death has to be looked for within
8 Salman Akhtar
narcissism and especially within the emergency of secondary narcissism from

its primary form. (1980, p. 456)
Fayek (1981) emphasizes that the idea of death as a narcissistic wound

results from the refusal to consider death as one’s own; it is seen as coming
from outside the ego’s omnipotence. It does not “belong” to one, as it were.
“Death is an absence that is present” (p. 319).
Another significant contribution to the psychoanalytic study of feelings
and fantasies about death has been made by Blacher (1983), who inter-
viewed a number of patients resuscitated after cardiac arrest. They gave
evidence of fantasies of rebirth (i.e., coming back as a newborn infant),
and resurrection (i.e., coming back as oneself after having died). According
to Blacher, their religious background contributed to these ideas but was
not sufficient as an explanation since not all were religious and there were
idiosyncratic emendations to the “rebirth” and “resurrection” fantasies
that could be traced to individual childhood experiences. The fantasies
provided psychological support and helped diminish anxiety in the face
of death. Blacher concluded that, opposite to Freud’s (1915) conviction
that no one can contemplate his own death, “these patients can think of
death because they contemplate a life after dying—either a return to their
regular lives or an immortality” (p. 69). The powerful “holding” impact of
internalized culture and, most likely, of a preponderance of good internal
objects made this possible.
Finally, in tracing the reworking and refinement of “object constancy”
(Hartmann, 1952; Mahler et al, 1975) during adult development, I have
stated that
Middle age mobilizes a final mourning of the mute and unexpressed self-
representations. This is accompanied by broadening of the core self-repre-
sentation and the compensatory deepening of what one indeed has become.
Object constancy is reworked as aggression and envy toward the youth,
including one’s offspring can no longer be denied, and identifications with
one’s parents, with all their implicit oedipal ambivalent are buttressed
(Kernberg, 1980). Finally, during old age, as one approaches death, a deep
and post-ambivalent view of the world that one has lived in and is about to
leave needs to be developed in order for this final transition to be smooth.
(Akhtar, 1994, p. 445)
While these contributions underscore its object-relational context, they

hardly mask that “death anxiety” has been viewed in the psychoanalytic
literature from two fundamentally different perspectives.3 One regards it
to be a primary phenomenon and a subjective reverberation of the death

instinct (Freud, 1920; Klein, 1948) which threatens life from within not
only at the outset of life but throughout the course of the life span. The
other viewpoint holds that death anxiety is secondary and a repetition of
the mortal terror lived through in the early bio-traumatic situations of
birth (Rank, 1924) and prolonged separation from the mother during early
infancy (Freud, 1923; Stern, 1967). Additionally, it could be derived from
castration anxiety, guilt, and other childhood fears that have become exag-
gerated due to traumatic experiences. An implicit question here is whether
“death anxiety” is a regressive disguise for concerns pertaining to object
loss and/or castration or are the latter developmentally “upward displace-
ments” of the more primal fear of death? Regardless of which of the two
perspectives one contributes to, the end result is that the idea of death and
its expectations are seen as distressing and capable of stirring up all sorts of
unpleasant emotions.4
Ghalib’s Ishrat-e-Qatra
Contrary to that anxiety-producing portrayal of death, there is the view-
point that death is integral to the life experience, an inherent and, even,
enriching component of it. While I, for reasons of familiarity, have chosen
the great Urdu poet of the mid-nineteenth century, Mirza Asad-Ullah
Khan Ghalib, a similar line of thought can be readily found in sources
as diverse as advaitic Hindu mysticism (Vallabheneni, 2005) and mid-
twentieth-century European existentialism (Heidegger, 1949; Sartre,
1956; Kierkegaard, 1957), Zen Buddhism and Messianic Christianity and
Orthodox Judaism,5 and Sufi poetry of Persia and the work of certain
philosophically inclined psychoanalysts (May, 1950; Wheelis, 1966). Es-
sentially, this perspective holds that death is a part of life and not apart
from life. Far from providing a container for morbid preoccupation, the
proponents of this viewpoint regard death as offering the ultimate freedom
through renunciation of the individual self; it leads to a liberating union
(reunion?) with the cosmos at large.
Before proceeding further, though, it might not be a bad idea to insert
a few introductory remarks about Ghalib, who, unfortunately, remains un-
familiar to the Western reader. Born in Agra, the city of the Taj Mahal, in
1797, Ghalib was a classical Urdu and Persian poet who saw the great Mo-
ghul Empire collapse and be displaced by the British Empire. According to
the Oxford University scholar Ralph Russell (2000), Ghalib is “one of the
greatest poets South Asia ever produced” (p. 8) whose poetry transcended
10 Salman Akhtar
the customary romanticism and earthly preoccupations of the literature of his

time. Russell goes on to say that
in many fundamental respects Ghalib stood alone: his lack of strong sentimen-
tal attachment to the old political order, his interest in British achievements
and his own lively intelligence and inquiring mind all went to form a distinc-
tive philosophy of life. He is acutely aware of unceasing change. At every mo-
ment, something new is coming into being and something is decaying. Reality
is infinitely rich, and one who is alive to this can already see things that have
not yet come into existence. (p. 103)
Ghalib’s statements on various themes (e.g., religion, drinking, love) were

not simple exercises in the conventions of the poetry of his time but expressions
of his own unique beliefs and practices. Like many creative geniuses, he was
full of contradictions. He largely lived on state patronage but was also proud of
his reputation as a rake. He was capable of writing profoundly religious poetry
even though he was quite critical of Islamic scriptures, and, at least on one
occasion, playfully wished that he had renounced Islam and become a Hindu
(Dalrymple, 2008, p. 41). He was a bon vivant, loved to drink, and had many af-
fairs. Yet, there was a melancholic streak about him that perhaps resulted from
his exposure to the death of many loved ones. He lost his father at a young age
and his only brother during his forties. More importantly, he produced seven
children who either were stillborn or died during early infancy. Ghalib himself,
however, lived a long life, acquiring great prestige and popularity toward his
old age. His fame spread all over the country and he accumulated a large num-
ber of disciples, including many among the ruling British community in India;
Sir Thomas Metcalfe (1795–1853), the Agent of the Governor General of In-
dia, an amateur Urdu poet himself, frequently sought Ghalib’s literary counsel.
Ghalib died in Delhi in 1869. He is considered to be the most influential and
widely recognized poet in the Urdu language and his poetry is recited and sung
not only in India and Pakistan but also in the South Asian diaspora around
the world. Many movies have been made on his life and many plays have been
written about him. The School of Oriental and African Studies at Cambridge
University has a section of studies devoted to Ghalib’s work.
Returning to the theme of death and Ghalib’s discourse on it, we note
that death, for him, is the healing hand that cures all the ills of life. Consider,
for a moment, his following two couplets (taken from different ghazals) and
you might begin to appreciate the point I am trying to make.
Ghum-e-hasti ka Asad kis se ho juz marg ilaaj

Shamma hur rung mein jalti hai sahar hone tak
Literally translated (and with the resulting loss of prosodic beauty), this
couplet means that just the way the beginning sunlight at the time of dawn
relieves the candle from the continued necessity to burn, the arrival of death
cures all problems of life. Before going to psychoanalytic speculations about
what Ghalib might have in mind here, let me cite another sample from his
poetry.
Partaw-e-khur se hai, shabnam ko fanaa ki taleem

Main bhi hoon, ek inaayat ki nazar hone tak.
This one, in literal translation, means that just the way warm rays of the sun
teach the dew drops the art of vanishing, one kind glance of the Creator will
readily draw me back to Him; I exist only till that graceful moment arrives.
Of note in these two examples (and I could have given many others) are
the following elements:
• Death is recognized to be a natural and expectable event without which

life remains incomplete.
• The attitude toward death, which is coming toward us all, is neither
ostrich-like denial nor masochistic celebration. It is total acceptance
and peaceful waiting.
• An admixture of relief and sacred joy is also seen to be associated with
the experience of death.
The metaphors utilized by Ghalib (e.g., “drop-river merger,” “sunshine-

dew drop connection,” “the candle’s having to burn till morning”) subtly
but unmistakably pronounce death to be a merger with something larger
than oneself, a return and fusion with the cosmos at large. This is implied
to be a pleasant, even ecstatic occurrence. Within the Western intellectual
tradition, counterparts to Ghalib’s vantage point are to be found in ac-
counts of near-death experiences (Stevenson and Greyson, 1975; Greyson,
1984) and certain mainstream psychoanalytic writings. Pollock (1975),
for instance, underscored the adaptive aspects of the idea of immortality
and traced the origin of the concept of heaven to a regressive symbiotic
reunion with the archaic mother, as a defense against object loss. His use
of qualifiers like “regressive” and “archaic” betrayed the inability to shake
loose from traditional psychoanalytic theorizing but his acknowledgment
of the potential of pleasure in such experiences was forward-looking. Take
also a look at the following excerpt from an essay on aging and death by
Madow (1997).
12 Salman Akhtar
Most writers describe death as the ultimate loss and it can clearly be seen thus,
it is also the final gain of the fusion with mother. On the way, there is an in-
creasing tropism to a more, albeit dependent, sometimes demanding, relation-
ship with caregivers. . . . As we age, we physically diminish in size. Our brains
shrink and our EEG’s become more like a child’s tracing. We lose Purkinje
cells, affecting our coordination. We lose Betz cells, impairing our motor skills.
. . . As we become more incapacitated, we lose our ability to walk and talk,
incontinence returns, and we require diapers. We become edentulous and our
diet consists of soft foods. We become more sensitive to temperature changes
as is the infant. . . . We move psychologically towards a symbiotic state, passing
in reverse through modified forms of rapprochement and practicing sub-phases
culminating in an observable and well-circumscribed event—death. (pp. 164,
165, 166)
This seems more in accordance with Ghalib than with Freud. In all fair-
ness, however, it must be acknowledged that Freud took both positions,
i.e., death is something to be feared, despised, and regarded as an enemy of
life (1923, 1926) and, death is something to be accepted, patiently waited
for, and even joyously welcomed for offering us relief from the internal and
external conflicts that inherently characterize life (1920, 1937). As a result,
what appears to be a tension between Ghalib and Freud turns out to be one
between the contradictory views of Freud himself. Yet another evidence of
this tension is to be found in Eissler’s (1955) and Weissman’s (1972) views
on death. Eissler believes that
Death always comes both too early and too late—too early because the ego
has rarely realized all its potentialities, and too late because individual life has
been a detour leading finally to what it had been at the beginning: nothing-
ness. (p. 142)
Weissman, in contrast, allows for the possibility of what he calls “appro-

priate death.” He defines this as
one in which there is reduction of conflict, compatibility with the ego-ideal,

continuity of significant relationships, and consummation of prevailing wishes.
In short, an appropriate death is one which a person might choose for himself
had he an option. It is not nearly conclusive; it is consummatory. (p. 23)
The divergence between Freud and Ghalib, between Freud and Freud
himself, and between Eissler and Weissman leaves something needing to be
resolved. Perhaps the solution lies in the fact that the psychoanalytic litera-
ture on emotional reactions to the thought of one’s death has made inopti-
mal distinction between a premature, unexpected, and violent death and a

timely, expectable, and natural death. Blurring the two types of death might,
at least in part, explain the fear-acceptance schism in the literature on the
topic. Most likely, it is the former (the imagination of which can only arise
out of unmitigated destructiveness within us) that causes “death anxiety.”
And it is the latter (death arriving like gently falling snow after a long and
emotionally rich life) that causes “death acceptance.”
It seems then that the difference ultimately might have less to do with
death than with how much and what kind of life has preceded it. The worry
about dying, in the end, might reveal itself to be a concern about living.
But, wait, this is not the whole plot. There is further confusion waiting in
the wings.
Yet Another Conundrum

The two contrasting perspectives on death delineated above do not exhaust
the list of conceptual difficulties in this realm. A problem is also posed, for
instance, by the fact that upon close inspection, life and death do not appear
to be as categorically separate as we tend to assume. Life subsumes focal and
mini-deaths on an ongoing basis. Big and small parts of our bodies are con-
tinually dying (and getting reborn) all the time; illustrations of these include
skin, brain cells, red and white blood cells, hair, fingernails, and so on. The
imperceptible yet ongoing decay of the human body as it passes through the
one-way tunnel of time provides numerous illustrations of how the animate
gradually changes into inanimate. Moved by this realization, I have else-
where (Akhtar, 2005) recorded the following episode:
One day while I was getting a haircut, my eyes went to the clumps of the previ-
ous customer’s hair on the floor. And once Tony began cutting my hair, I could
see similar samples of my own—now quite gray—hair on the floor. The sight
made me ask whether the hair that had been cut from my head still belonged
to me. It somehow did not seem to, yet to say that I did not feel any affinity or
sense of ownership toward it would also be called a lie. More significantly, I be-
came aware that, due to the decisive intervention of a pair of scissors, what was
a part of me moments ago had become an inanimate thing, cold and, frankly, a
bit distasteful to behold. Now, let me hasten to add that Tony is a gentle and
kind man. His purpose in cutting my hair is to improve my appearance, make
me feel comfortable, and sustain my social acceptability. From his perspective, it
is all a benign act. The follicular massacre that occurs daily in his shop is merely
collateral damage as far as Tony is concerned. I, however, am left a little un-
nerved. If a part of me can so readily turn into a thing, what assurance is there
14 Salman Akhtar
that the whole of me would not succumb to the seduction of eternal inertia?
Thoughts of death begin to surface in my mind. They make me uneasy. Tony
and I exchange a few polite remarks. I pay the bill and leave. Looking back, I
can see that parts of me are still lying on Tony’s floor. (pp. 182–183)
Besides such tangible icons of the occurrence of “death in life,” there are
subtle psychological matters of this very type to consider. Being emotion-
ally and interpersonally dead while being physically alive is inherent in
concepts like “dead mother” (Green, 1980) and “dead father” (Kalinich and
Taylor, 2008) denoting parents who lack or who have abdicated maternal
and paternal functions, respectively. On a different though overlapping
level, the same applies to old friends whom one has not met for, say, four
or five decades. Their representations in our internal world become psychi-
cally “calcified.” We can hardly evoke them (i.e., their facial characteristics,
their voices, etc.) with a convincing sense of vitality or vividness. Even the
self-representations that were relationally configured in the matrix of such
object ties fade away or “die” with the passage of time. The same is more or
less true of our unexpressed and unlived wishful childhood self-representa-
tions. Where is my cricket-loving, stamp-collecting, and jet black haired self
now, I would ask myself if I could bear the sadness of it all. And, whatever
happens to those innocent aspects of our selves that were ignorant of sexual
mysteries and tremblingly enamored of finding even the littlest piece of the
erotic jigsaw puzzle? Like it or not, the fact is that parts of us keep dying all
the time. We are therefore never all alive; we are always partly dead. Indeed,
there are philosophical traditions which advocate living as though one is
already dead. In Zen Buddhism,
there is a term for this experience, namely, the Great Death. In Zen, the Great
Death means dying to ordinary, dualistically conditioned consciousness in
which I am I, I’m not you, and I’m not not-I. Dying to all ideas of self, to all
dualistic clingings, to all dependency on the patriarchs, is Zen’s awakening: I
am I, I’m you, and simultemporally I am not I. (Kramer, 1988, p. 63)
The Zen exhortation is to live a life of detachment, including detach-

ment from one’s own self (which is regarded as an ever-changing process
rather than a consolidated structure). This results in healthy stoicism and
perceptual clarity (Suzuki, Fromm, and de Martino, 1963). As the Zen say-
ing goes, “ one who dies before dying never dies again” (Stryk and Ikemoto,
1963, p. 15).
In contrast is the clinically serious matter of “psychic death” in toto. Eluci-
dating this notion in the broader context of schizoid withdrawal, I (Akhtar,
2009a) have delineated the steps along the regressive pathway of self-dis-
sipation.
• The schizoid withdrawal is, at its core, an instinctive ego response to

stimuli that are experienced as noxious or overwhelming. It resembles
the amoeba’s retraction of pseudopodia and pulling the protoplasm
back.
• A related agenda is to numb the perceptual rind of the ego, dull the
“mental pain” (Freud, 1926), and go into a conservative, hibernating
mode of existence.
• Avoidance of hope which is felt as being the culprit, leading to betrayal
by the object, is also an important motivator here. However, under-
neath such resolute “self-sufficiency” lies a different scenario and this
brings up the next dynamic feature operative in this context.
• Giving up hope (of a fruitful exchange with the object) is hardly ever
complete. On the one hand, it results in a traumatic identification
(hence, merger) with the depriving object; death of the self stands
for identification with the empty and “dead mother” (Green, 1980).
On the other hand, the affect of futility itself, through the process of
masochistic libidinization, becomes an anchoring point; this psychic
position is midway between loss of its object and loss of the self. It is a
stopgap measure before the next and final step in the process.
• This consists of loss of the capacity for “mentalization” (Fonagy and
Target, 1997), horrid emptiness, depersonalization, and a state of
regressive “dehumanization” (Akhtar, 2003). Body feels unattached
to mind, seems automaton-like and foreign. Gaze avoidance appears.
Language becomes faulty and belabored. Mental processes turn brittle,
superficial, and reactive. Often mutism and shades of catatonia prevail.
This is psychic death. (p. 52)
To be sure, such scenarios of “death in life” have their counterparts in

“life in death” dioramas. These can be quite literal and concrete or abstract
and metaphorical. Examples of the first type are to be found in the blurred
boundary between what is a living and breathing human being and what
are mere inanimate objects witnessed at, say, the renowned wax museum of
Madame Tussaud’s. One almost expects the statues there to begin walking
and talking, or, at least, to say “hello” and shake one’s hand. It is astonishing
how this expected transformation of a thing into a human being is a matter
of delight while its opposite, i.e., the transformation of a human being into a
thing (encountered, for instance, in looking at an urn containing someone’s
16 Salman Akhtar
cremated remains) is sad and disturbing. Our reaction to professional mimes

in amusement parks falls in between these extremes. By adapting a statue-
like stillness and then unexpectedly showing movement (“coming alive”),
these mimics of mortality impress upon us that the line between inanimate
and animate is indeed thin. What is alive one moment can be dead the next.
In the words of the renowned Urdu poet Jan Nisar Akhtar (1972, p. 89),
Jism-o-jaan ka yeh aarzi rishta

Kitna miltaa huaa hubaab mein hai6
The “life in death” scripts go beyond the literal dimension, however. There
is the entire issue of immortality. Now, this is hardly a simple matter. Accord-
ing to Milan Kundera (1990), immortality comes in three varieties: minor,
great, and ridiculous. Minor immortality refers to the lasting memory of a person
in the minds of those who knew him. Great immortality, reserved for poets, art-
ists, and statesmen, denotes the revered posthumous presence of someone in
the minds of those who never knew him in person but were deeply affected or
moved by his work. Ridiculous immortality is accorded to one who dies under
truly ludicrous circumstances. Kundera cites the instance of the astronomer
Tycho Brahe, who died of a burst bladder because he felt too ashamed to go to
the lavatory during a festive dinner. Closer to home, the first president Bush,
had he died while he threw up on the Japanese prime minister during an impe-
rial gathering, would have earned ridiculous immortality.
To Kundera’s list, two more types can be added: genetic and clinical. Genetic
immortality (Colarusso, 1997) refers to the feeling of transcendence over death
that one experiences in becoming a grandparent. It is as if, by middle age, one
can conceptualize one’s own death and, by the time one reaches old age, even
that of one’s children, but one cannot conceptualize the death of one’s grand-
children. It seems that they will go on forever and, with them, oneself will also
go on. Clinical immortality (Akhtar, 2007) refers to the post-termination un-
forgetability consciously or unconsciously sought by some patients from their
analysts. This complexly determined phenomenon (with its many defensively
altered versions) seems to occur with greater frequency in individuals who were
not kept alive on a sustained basis in the minds of their parents.
An even more experience-near evidence of continued “life” in the “dead”
is to be found in the “linking objects” (Volkan, 1981) of the pathological
mourner. Such an object
is actually present in the environment that is psychologically contaminated

with various aspects of the dead and the self . . . the significance of this object
does not fade as it does in uncomplicated mourning. Rather, it increasingly

commands attention with its aura of mystery, fascination, and terror. (p. 101)
A noticeable aspect of linking objects is that such objects can neither be

rationally used nor discarded. They are usually hidden away in the house and
might remain so for years. Looking at them stirs up pain as well as a vague
sense of fear. Pain is caused by the physical object’s reminding one of the
original loss. Fear results from the mechanism of projective identification
that endows the physical object with menacing and accusatory qualities.
Linking objects thus are reminders of the life-death conflation though at a
different level of abstraction than other illustrations mentioned above.
Regardless of whether the evidences of the psychophysical coexistence of
life and death appear in the mundane activity of getting a haircut, a visit to
Madame Tussaud’s, watching a professional mime, or witnessing the ambiva-
lently held physical artifacts of the chronic mourner, they are reminders of
the fact that the boundary between life and death is thin and, viewed from
the floppy balcony of primary process thinking, often nonexistent. Moreover,
the confluence of the two does not have to be morbid. Indeed, under man’s
innovative capabilities, the “death in life” and “life in death” dialectics can
yield truly sublime results. Let us not forget here that the Taj Mahal, perhaps
the most awe-inspiring and life affirming man-made structure in the world,
is a tomb.7
Concluding Remarks
Juxtaposing two different vantage points on death, I have attempted to high-
light the tension that exists between attitudes emanating from denial of death
and those arising from acceptance of death. Their separation has largely been
in the service of didactics and so has been their respective attribution to the
Western and Eastern hemispheres of the world. The fact is that denial and
acceptance of one’s mortality constitutes one of those dialectics that seem
ubiquitous in the human psyche; other such dialectics involve the tension
between symbiosis and individuation, activity and passivity, homosexual-
ity and heterosexuality, and religious belief and atheism (Akhtar, 2009b).
Besides being universally prevalent, these dialectics are characterized by the
fact that each pole in them serves profoundly significant dynamic, structural,
and existential functions. Vis-à-vis death too, one can discern psychic ben-
efits of either pole of this dialectic (denial making it easier to go on living,
acceptance making the experience of life richer and more textured). Besides,
as the foregoing discourse has sought to demonstrate, there are many areas
18 Salman Akhtar
of overlap between life and death with each of them containing the other at
one or the other level of abstraction.
While all this seems to make sense we are nonetheless left with more
questions than answers in this realm. Prominent among them are the fol-
lowing:
• Can one draw a “developmental line” (A. Freud, 1963) pertaining to

feelings and fantasies about one’s death, a line that would hold steady
in “average expectable environment” (Hartmann, 1939)?
• To extend this idea further, is it “healthy” for the young to ignore death
and for the old to contemplate it?
• What role does the exposure to family members’ deaths (especially dur-
ing childhood) play in the attitude toward one’s own death?
• How does physical illness impact upon one’s feelings about death? Is a
terminally ill individual’s denial of his soon-to-be encountered mortal-
ity a “manic defense” (Klein, 1935; Winnicott, 1935) or a sign of robust
mental health?
• How do attitudes toward death differ in times of war and peace (see
Zilboorg, 1944, in this connection)?
• How has the increased life expectancy of man impacted upon the so-
called death anxiety?
• Is suicide ever a rational and mentally healthy choice?
• Can psychoanalysts learn something useful from the field of “near-
death studies” (Moody, 1975; Greyson, 1984; Greyson et al, 2009).
• What is the place of the belief in heaven and hell, reincarnation, and
the soul’s post-death continuation in psychoanalytic theory? And, in
a related way, can a true believer in such phenomena be successfully
analyzed? Or, to put it more sharply, can such a person be analyzed by
an analyst who is a nonbeliever?
• Can an analysis (especially of an older patient) ever be complete with-
out an exploration of his or her attitudes about their death?
The list can be extended, to be sure. However, the point I am trying to

make is that, as psychoanalysts, we have paid inoptimal attention to the
psychological significance to the fact that all human beings die and that
knowing this fact has enormous psychological ramifications. By ignoring,
bypassing, or downplaying this fact (and its undeniable, even if unconscious,
dynamic impact), we have imbued life, living, physical health, analysis, and
analyzing with a wishful hypomania. Allen Wheelis’s (1966) wise, if ironic,
reminder applies to all of us.
A fire becomes, not less, but more truly a fire as it burns faster. It’s the being
consumed that pushes back the darkness, illumines whatever there is of good
in our days and nights. If it weren’t brief, it wouldn’t be precious. Let me say it
flatly: we are lucky that we die, and anyone who pushes away the awareness of
death lives but half a life. Pity him! (p. 68)
The good news is that there is still time to wake up from our slumber of
repudiation and look at death squarely, deeply, and thoughtfully. By doing
so, we indeed may learn something significant about life itself, something
significant about humanity at large, and something significant about our
own minds and those of our patients. And that is what our enterprise is all
about. Isn’t it?
Notes
1. A recent Newsweek-Belief.net survey (Adler, 2005) revealed that over 85 per-
cent of people in the United States believe in life after death (e.g., heaven or hell,
reincarnation, or some other form of continuation of the soul’s existence).
2. Besides the bound and free energies and representations of the two great in-
stinctual drives (the life and death instincts), the “dynamic unconscious” also con-
tains material accrued by “primal repression,” material pushed down by the forces of
“repression,” and primal fantasies representing phylogenetic schemata. This puts the
prevalent notion that the unconscious is unstructured into question.
3. Both the terms used in this realm leave something to be desired. “Fear of death”
locates the sources of distress in the outside world and allows little space for intrapsy-
chic aspects to such dread; after all, fear refers to an emotional response associated
with anticipation or awareness of plausible danger from the outside world. “Death
anxiety” does the opposite, for we know that anxiety refers to danger that is imagi-
nary and internal in origin. Replacing both these terms by “death phobia” solves one
problem and creates another. “Phobia” invariably contains an admixture of “fear”
and “anxiety.” Using this term therefore allows for a combination of external and
internal factors to be responsible for the dread associated with the anticipation of
death. However, the implication in the term “phobia” of it being an exaggerated and
ego-compromising phenomenon precludes its use for subtler and subterranean forms
of distress pertaining to anticipation of death. This might appear to be phenomeno-
logical hair-splitting but its implications for our view of what is responsible for “death
anxiety” are far from trivial.
4. It is therefore not surprising that all sorts of defensive maneuvers are deployed
against “death anxiety.” These include (1) denial, which makes one feel immune
from the passage of time and one’s approaching mortality; (2) seeking refuge in reli-
gion and its assurances that one’s soul would continue to exist and might even unite
with loved ones who have already passed away; (3) extracting vicarious reassurance by
reading about train and automobile collisions, and natural disasters which can give
20 Salman Akhtar
“egocentric self-delight expressed the exclamation: ‘it is not I who was executed last
night; it is not I who was killed in this automobile accident, or train wreck, or earth-
quake’” (Zilboorg, 1943, p. 469); and (4) counterphobic actions (e.g., dangerous sports)
to prove that we are fearless and not afraid of death.
5. In these perspectives, death is not viewed as an enemy of life. Life and death
are not separate but bound together by God’s will. “The Lord gives and the Lord has
taken away; blessed be the name of the Lord” (Job 1:21).
6. Literally translated this couplet means “Ah, this temporary bond between the
body and the soul/how fragile like a bubble!”
7. Taking twenty years (1632–1653) to complete, the grand mausoleum was built
by the Moghul Emperor of India, Shah Jahan, in the memory of his beloved wife,
Mumtaz Mahal.
CHAPTER TWO
What Happens When You Die?

Three-to-Four-Year-Olds Chatting about Death
Leon Hoffman, MD, Eileen Johnson, MA,
Michelle Foster, BA, and Josephine Wright, MD
In The Interpretation of Dreams, Freud (1900) said, “Children know nothing

of the horrors of corruption, of freezing in the ice-cold grave, of the terrors of
eternal nothingness—ideas which grown-up people find it so hard to toler-
ate, as is proved by all the myths of a future life” (p. 254). In a footnote from
1909, he adds, “I was astonished to hear a highly intelligent boy often remark
after the sudden death of his father: ‘I know father’s dead, but what I can’t
understand is why he doesn’t come home to supper’” (p. 254).
Contrast Freud’s idea with that of a little girl who came to her future
analyst a few days after her fifth birthday. The analyst asked, “Did Daddy
tell you why he wanted you to come and see me?” Very comfortably she
said, “My Mommy died. But I have Betty and she’s going to stay forever.
My friend Robert’s dad died too. And a girl in my three’s class died. But my
Daddy didn’t die.” As she joined the analyst playing with some dolls she fur-
ther elaborated her ideas, albeit in the displaced fashion of play. “Here is a
brother and sister. Both their parents died. But they have a granny who will
live forever. She cooks pancakes and cookies and milk for breakfast! But then
it is night time, and granny says, she has a stomach-ache and if they make
any noise or cry, they will make her stomach-ache worse and she will go to
the hospital for five days and then die.”
As one can see from this brief vignette, the child verbally, directly, and
seemingly extremely comfortably reports the essentials of her mother’s death
21
22 Leon Hoffman et al.
and her current life situation in a very matter-of-fact way. Most importantly,
she claims the father’s girlfriend, Betty, as her mother’s replacement who
will stay with her forever. In her play, however, she presages what will come
to emerge in the analysis, her expression of a conviction that she caused her
mother’s death (by making noises or crying). Her mother had died of stom-
ach cancer when the girl was almost three, after being ill since the girl was
almost one with a great deal of abdominal pain and irritability.
Whether her lack of manifest distress while describing her real-life
situation is consistent with the concepts of denial or detachment as Bowlby
(1960) first described or withdrawal of cathexis from the loved object (her
mother) and the transfer of the love to her current caretaker (essentially a
new mother), as Anna Freud (1960) described, this little girl certainly intro-
duces Betty as if she were her new mother who will not disappear.
Is this five-year-old’s direct discussion about death normative of young
children, even about the death of her own mother, without any obvious
anxiety or distress? Is it true, as Freud conjectured, that children do not
conceive of the terror that the concept of death evokes in so many of us
adults? Does death evoke fear or other concerns in little children? One can
also conjecture that in a very young child, like this five-year-old, who has in
fact experienced death at such close hand, though she may not conceptually
fully understand it, or did not at age three when the death occurred, one can
clearly infer that it has evoked a fear and sensitivity to loss as well as her guilt
and fear of having caused the death as revealed in her initial play session.
In this presentation we briefly review some of the literature concerning
the developmental progression of little children’s conceptions of death. We
will describe three almost-four-year-old children talking about death in a
nursery school setting. As you will see, these children from a normal setting
talk about death in very different ways and communicate various different
affects. We will discuss some implications about these ideas.
Review of the Literature

Pinpointing the development of a concept such as death is, of course, prob-
lematic, considering that even intelligent adults often cannot come to a con-
sensus on when life begins and ends. Religion has shaped the imaginings of
many people throughout history so as to aid them in coping with the myster-
ies of life and death. Think about questions such as: “When does life begin?”
“Does abortion mean that you are killing a human life?” “When does death,
actually, occur?” When the brain stops functioning irreversibly or when the
heart stops beating irreversibly?” Thinking about the concept of death as a
What Happens When You Die? 23
permanent separation may be confusing to a little child who learns about re-
ligious beliefs of the afterlife. For example, a little boy of six once said, “How
come momma was crying so much in Church when Grandpa died? Everyone
said he was going to be with Jesus. Isn’t that a good thing?”
Many have written how many cultural inventions, including the creation
of an afterlife, have been attempts to cope with adults’ anxiety and terror of
death (Wirth, 2003). Wirth extensively discusses Freud’s ambivalent atten-
tion to and disregard of the import of death to a person’s psychology. In fact,
Freud (1923) considered that the fear of death was secondary or equivalent
to the fear of castration (p. 58).
In an early extensive review of the literature on children’s understanding
of death, Speece and Brent (1984) identify three fundamental properties that
encompass a “mature understanding of death”:
• Irreversibility
• Non-functionality
• Universality
Irreversibility refers to “the understanding that once a living thing dies,

its physical body cannot be made alive again,” that there is no “undoing”
of death and no returning to life following death. Non-functionality refers
to the consideration of the finality of death—that after death, a person no
longer breathes and eats, and, even more complex, does not dream or think.
In other words, the child understands that life and “life-defining functions”
cease. Speece and Brent emphasize that an individual can demonstrate an
understanding of non-functionality while simultaneously believing in an
afterlife. The third condition required for a mature understanding of death is
that it is universal. Death occurs for everyone and can happen at any time.
They note that many children understand that the elderly die, but younger
children often do not think it is possible to die at any time and that they
won’t die. It is interesting to note that during World War I, Freud (1915)
was forced to address his theory that it was impossible to conceive of one’s
own death in one’s unconscious. How could one reconcile this conception of
one’s immortality with the omnipresence of death during the Great War?
After reviewing roughly 25 empirical studies investigating how and when
children understand these three components of death, Speece and Brent (1984)
conclude that most children acquire a full understanding of the three compo-
nents, irreversibility, non-functionality, and universality, between the ages of
five and seven, although a full understanding of death may not be achieved
until eight or nine or later (Lansdown and Benjamin, 1985). For example, Kane
(1979) (cited by Speece and Brent, 1984) notes that only one in ten three-year-
olds understood irreversibility, 18 percent of three- and four-year-olds under-
stood non-functionality, and none of the three-year-olds and only 42 percent of
the four-year-olds understood the concept of the universality of death.
Before achieving the concept of irreversibility, death is viewed as temporary
and reversible: dead things can become alive again spontaneously, by doctors
intervening, by eating or drinking, or through magic. Before appreciating non-
functionality, children may believe that some functions are absent (blind) or
diminished (hard to hear or cannot eat); in terms of not conceiving the univer-
sality of death, they may believe that only old people may die or one can avoid
death by luck or otherwise. Although children as young as eighteen months
can have some idea about death, certainly between three and four (the age of
the children we will describe) most children do not have a real concept of the
finality of death. Death is reversible, functions may be diminished, but all have
not ceased permanently and certainly death is not universal.
These findings confirm Nagy’s (1948) earliest findings of three stages of
children’s (three to ten years old) ideas about death:
1. Children from three to five deny death to be a regular and final pro-
cess.
2. Between about five and nine years death is personified.
3. At about nine years the child recognizes death as a life process, and as
inevitable.
Nagy conceptualized the first stage in this model (ages three to five) as
approximately corresponding to Piaget’s preoperational phase (from about
two to six years).
Thus, it is important to highlight Piaget’s developmental sequence briefly.
From birth until about two the child’s focus is on mastering his or her sen-
sory-motor system. As language and symbolization begin to develop toward
the end of the second year of life, pre-operational thought is more evident. It
is first centered according to emotion and is not objective; later, pre-opera-
tional thought is more rule- and reality-bound. During the pre-operational
period the child’s thinking is much more bound with his or her emotions
(Dowling, 1982, p. 164) and is very much tied to action (Busch, 1989).
Children in this phase of development tend to use magical thinking in order
to make sense of experiences and concepts that are difficult for them to com-
prehend. They thus do not conceptualize death as a final event, and consider
it as a temporary and reversible condition (even after witnessing a burial in
some cases); they often have difficulty differentiating between thoughts and
deeds, hence holding the common belief that angry thoughts coinciding with
a death are actually causal (Webb, 2002; Kaplan and Joslin, 1993).
During Piaget’s Concrete Operational Stage (ages seven–eleven), chil-
dren have an increased capacity for reasoning which is based on realistic
rule-bound assessments that allows them to begin to understand that death
is irreversible, although they still may not acknowledge the possibility
that they could die at any time. Instead, many still believe that death is
only something that happens to the elderly (Webb, 2002). “However it is
only during adolescence that one first becomes capable of cognitively and
emotionally committing oneself to future possibilities (Inhelder and Piaget,
1958). It is this fact which makes the possibility of death so overwhelming
for adolescents” (Schowalter and Lord, 1972, p. 194).
It is important to note that despite his voluminous productions, Piaget
did not delineate a developmental sequence concerning the conception of
death. Irwin Hoffman (1979) notes: “Piaget, whose entire system is indeed
concerned with cognitive development, does not take up the issue of the de-
velopment of a concept of death. His study of the differentiation of the ani-
mate and the inanimate world (1963) is not concerned with the evolution
of a concept of human mortality as such. Perhaps Piaget’s adherence to the
paradigm of conservation in closed physical systems and his emphasis upon
the development of ‘reversibility’ limit the scope of this theory and stand in
the way of making the idea of death, the ultimate irreversible event, a subject
of inquiry” (p. 262). Piaget (1963) does note that children very often believe
that the dead are born again (p. 352).
Can one conjecture that Piaget’s eight months of an “unfruitful analysis”
with Sabina Spielrein in 1921, the originator of Freud’s concept of the death
instinct, may have influenced Piaget’s seeming avoidance of the topic of
death? In an interview in 1975, Piaget noted
Yes, of course I’ve been analyzed—if not, I wouldn’t be talking about analysis! B:
Why did you stop? P: I stopped because I was—everything I saw in it was inter-
esting. It was marvelous to discover all one’s complexes. But my psychoanalyst
learned that I was impervious to the theory and that she’d never convince me.
She told me it wasn’t worthwhile to continue. (Schepeler, 1993, pp. 258–259)
More recently, Slaughter and Griffiths (2007) have summarized an ex-

panded sequence of tasks that children master between age five and ten years
in developing a mature concept of death in a more or less sequential order:
1. Inevitability—the acknowledgment that living things must die even-

tually
2. Universality or applicability—the understanding that death must hap-

pen to all living things
3. Irreversibility or finality of death—the recognition that the dead can-
not come back to life
4. Cessation or non-functionality—the understanding that death is char-
acterized by bodily processes ceasing to function
5. Causation—the understanding that death is ultimately caused by a
breakdown of bodily function.
In a study of ninety children between the ages of four and eight, Slaughter
and Griffiths (2007) found that there were less fears about death the more
maturely the child understood the death concept (age and general anxiety
were controlled). Items were administered to judge the death concept and
scoring criteria established a developmental hierarchy of the death concept.
Slaughter and Griffiths calculated Mean Score and Standard Deviations
(SD) for each subcomponent and found that none of the children in this
sample were near a mature concept of death. A totally mature concept of
death would require a score of 10 (2 for each component). This group of
children had a Mean (SD) summed Death Concept Score of 5.66 (2.06).
Causation and applicability were the least developed concepts, with Means
(SD) .73 (.90) for Applicability and .99 (2.06) for Causation. The very large
standard deviation for Causation, which reflects a complete understanding
of the biological cause of death, indicates that item is subject to the greatest
developmental variance. Some children develop that sub-concept very early
and others much later.
Although mourning and responses to loss is not the focus of this com-
munication we should note that while cognitive psychologists have focused
on children’s conceptualization of death, psychoanalytic theory has focused
on the development of the emotional capacity to mourn and grieve, includ-
ing debates about when children develop the capacity to mourn (see Lerner,
1990, for one review) and the levels of ego development required to compre-
hend the concept of death and the idea of its finality. Regardless, all psycho-
analytic authors agree that early object loss can be a significant trauma for
a child as first described by Bowlby (1973). It is interesting to think about
how a child may not be capable of mourning and grief, yet undoubtedly and
in a far-reaching way be traumatically affected by loss. And, of course, the
mourning process may set in much later, when developmentally possible.
As Lerner (1990) cogently concludes with regard to the impact of early ob-
ject loss, “although the impact is dramatic and pervasive, it is also complex
and depends on a multitude of internal and external factors including the
mitigating aspects of defense, the availability of substitute objects, and the

degree to which inner psychic structures have become autonomous from the
supporting objects” (p. 80).
In the next section we will listen to three almost four-year-old children
talk about their ideas of death. The setting is a day care/nursery school for
children from two years to six years. The children are mainly middle-class
children whose parents work. The center is in a major metropolitan center
and follows psychological/psychoanalytic principles of the importance of lis-
tening to children—allowing and encouraging them to express their feelings,
without the usual procedure of quickly distracting them if they touch on a
subject which makes the adult uncomfortable. The use of videotaping is not
an unusual procedure in this center. We obtained written consent from the
parents to utilize these tapes. The names are disguised.
The discussion about death emerged as a result of the teacher overhearing
the children spontaneously discussing death among themselves when they
were seated together at lunch time. She decided to tape the conversations
and to try to elicit their thoughts in such a way as not to influence them.
Children Talking about Death

Bold statements are the interviewer’s comments.
Now, you know what I was going to ask you about was—what are the kinds
of things that worry you? What do you worry about?
(Lily raises her hand)
Lily: My cousin’s pet goldfish.
You worry about that?
(Lily nods)
Why?
Lily: Because it’s dead!
It’s dead? You worry about that?
Lily: Yep and it’s for real, for real. (Yeah). It, it really is.
Robert: Well, my brother thinks his mom and dad are gonna die, my mom
and dad are gonna die, at a very shortly longly but they’re gonna die at very
long, long—long, long, long time. Right?
Lily: But David’s not gonna die, right?
David: No-mm. (David shakes his head no.)
Robert: Of course, he will.
David: No, we won’t.
Robert: Yes, you can die.
David: I won’t die!
Robert: Yes, you will.
David: No, I won’t.

Robert: Yes, you can die. You, you, you’ll most likely die at the age of like
sixty, uh, three, or like sixty-four.
David: No, I won’t die.
Robert: Or like sixty-eight.
David: I won’t die.
Robert: You only, like, go up to zero.
David: No. I won’t die at all!
Robert: And then zero, and then zero one.
David: I won’t die at all!
Robert: And zero one and zero two.
David: I won’t die at all I said, Robert! Why won’t—I di—I won’t die.
Are you going to die Robert?
Robert: Well, yes. Everyone is gonna die.
David: I won’t die!
Lily: I won’t die either.
Okay, but, tell me about Robert. What do you think is going to happen
when you die?
Robert: They, they. (pointing at the other children)
When are you gonna die, Robert? (5 seconds) When you’re little or when
you’re old?
Robert: Old.
Old. And what happens then?
Robert: Well, it’s like, well, it’s like, um, well dying is like sleeping. (Okay) Ex-
cept it’s like, except you don’t hear yourself snoring, except you’re not snoring.
Right. And what happens to you then?
Lily: You turn into a stone.
You turn into a stone? Robert, what do you think happens then?
Robert: You’re not in the stone, you like just, like you keep like, like you keep
like for like, lying down, for like, all, like, all of the ‘nother weeks. (Mm-hm.)
Lily: And you will be not talking forever or not hearing forever or not
smelling forever or not looking . . . forever. (Says this last “forever” with a low,
scratchy, almost demonic voice.)
Robert: You like, you like have your eyes closed but, but like some like
people, but if you’re, like, blind then they die the same way blind. And then if
like you’re not blind, you’re like (opens eyes wide without blinking) like your eyes
are like (opens eyes wide) and don’t blink.
David: You’re under a rock.
Robert: But like you’re like, in like a place called like, like you’re like in
like a place, like wherever like you went, like wherever you went and like, like
you should like be alive in like, like, like a place like you should die and like
heavens.
Heaven?
David: In the sky.

Do you ever hear of heaven?
David: Know what? Wheely died.
Who’s Wheely?
David: She’s my dog’s grammy. She’s in the sky.
She’s an old dog?
David: Yeah, she died.
She’s in the sky?
David: Yeah. (regretful tone)
How did she get up there?
David: . . . (Laughs) I don’t know. (Uh-huh) She’s in cat heaven (Okay)
. . . in the sky.
Lily: Sometimes I’m worried about my mom dying. I, I, I wish I could hug
her when, when we die.
Okay.
David: Know what? (Dog’s name?)’s gonna go to doggy heaven in the sky.
You want to go to doggy heaven? You wouldn’t mind dying if you went
to doggy heaven. Is that right?
David: I won’t die.
You’re never, never gonna die?
(David shakes his head “no” vigorously.)
Well, how—what is it that makes people die?
Lily: Cause you’re old!
You’re old? Any other things that make people—
Robert: Well, like—
David: And you get big, big, big (mm-hmm)
Robert: Like, you’re like too old (yup) and like when you’re like, like died,
like when you like die, then you like grow like very old and then you like get
weird. Like you like, get into like, like your face is like weird.
When you get old?
Robert: Yeah.
Yeah, what do you mean weird?
David: And you need a walking stick!
And you need a walking stick?
Robert: Like very like, like when you like, like when you like died, like when
you died, you like grow like up to like, you grow a little longer, like about up
to like, this long (indicates an eye’s height with hand), a little longer about this,
a little longer, and like, um, then like your face like . . . (goes weird?) Yeah.
Like all of the skin’s like all . . . up. (pinches at skin on face)
Lily, what do you want to say?
Lily: I’m worried about my mom dying and I wish I would hug her when she
died, but . . .
You’re worried about your mom dying?
Lily: Yeah, because I can’t hug her anymore.

Yeah. What do you think about your mom dying?
David: Uh . . . uh . . . I don’t like her when she dies and she’s like . . . and I
don’t like her when she dies when, when, when one of my toys died.
Your toys can die?
David: Yeah, they can do magic.
Toys can, toys can do magic?
David: Yeah.
Robert: No.
What is magic anyway? Do you know any magic things? Like what?
What’s a magic thing, Lily?
Lily: Well, magic would make something disappear.
Something disappear? What does magic mean?
Robert: Like, make a mouse appear.
Make a mouse appear? Mm-hm. What does magic mean, David?
Robert: A cow!
Yeah. Is there really such a thing as magic?
Robert: Maybe the, maybe the, maybe the magician would throw the cow
up in space.
A machine? Did you say magic? A magician. A magician would throw a
cow up into space. Yeah.
Robert: Yeah, and on to like, um, the planet Pluto.
David: You know what? When, when me and mommy in the forest, um, um,
um, I’m afraid if she’s gonna die in the forest. (laughs)
How could somebody die in the forest? What would happen to them in
the forest?
Robert: Like, they could die like animals. The animals . . . (yeah) . . . could
like bite off their skin.
Yeah . . . right. What other things could make somebody die? Lily?
Lily: Um, when, um, when I’m in the woods, I fe—, I fear that animals
are around me, but they are, but I, but I hear their footsteps coming, coming
towards me behind my back, coming, following me and they get louder and
louder and louder and then they bite me. And that’s where I got the, and that’s
where I got the bites.
Yeah, well, what other bad things could happen to you? David?
David: Mmm . . . mmm . . .
Robert: I know! Well like, my brother is like, he thinks he’s like, he thinks
our mom and dad will die. My brother.
He thinks that, yeah.
Robert: But I don’t think so. He thinks they’ll die at a short age, but I think
they’ll die at a long age.
Is he worried about that?
Robert: Yeah . . . why does he like fight about like a long, long time ago?
Hmm. Why is he worried—

Robert: Like a long, long time ago that he doesn’t know.
That’s right. That’s right. He doesn’t really know that, right? You don’t
know about that. You don’t really know about that, right?
Robert: Yeah, because he would like get like you get bigger, you get bigger,
then you get younger and then older and then like you like are very old and
then after that you die.
But your parents are not very old, are they?
Robert: No. They’re too young!
They’re too young to die, right?
Robert: Yeah.
Yeah. Lily, what?
Lily: You could swish in the air if you die.
You could swish in the air if you die?
Lily: Or you could . . . (rubs hands vigorously on the table)
Really? When you die? That could happen? Yeah? You turn into some-
thing else?
Lily: Yeah.
Oh. Do you have magic powers when you die?
Lily: Yes.
Oh.
Lily: Like, you could jump.
David: What about you die in a toy store?
Oh my goodness. Dying in a toy store? How would that happen?
Robert: Yeah, like . . .
But what do you mean, die in a toy store?
Robert: Like, um . . .
David, what do you mean by that?
David: Maybe someone would hit you in the ear and you would die in the
toy store.
Hit you in the ear? Who’s gonna hit you in the ear?
Robert: Well, what about like . . .
Wait a minute. Who’s gonna hit you in the ear? A bad guy?
David: No. A good guy.
A good guy? Why would a good guy hit you in the ear?
David: ’Cause, because I would fight the good guy.
Oh, you’d be the bad guy?
David: Yeah.
Oh, okay.
David: I’m super strong.
Okay, Lily you need to sit up on the chair, otherwise we can’t take a
picture of you if you’re over there.
David: You know, I can lift the slide at the backyard up.
Yeah. Now, tell me about—are there bad guys out there? Does anybody
know anything about bad guys? Have you heard about bad guys?
Robert: I know, like, um, something. You could die like about like, like
somebody like, like shooting something at you like stomach, or like in your
eye, ear. That’s the hardest place you can get.
Mm-hm. Have you heard about that, Lily?
Lily: Nope. But I heard about something else about goldfish. A little fish
that you could eat. They die. (Yeah). Yeah, one day, my cousin found a gold-
fish and he had nothing . . . he just felt something wiggling in his throat. And
that was a real fish.
How did it get in his throat?
Lily: . . . I don’t—he just ate it and then swallowed it until it was so big it
just got stuck in his throat and that’s how he got sick. (Yeah.) And now he’s
not sick anymore cause he . . .
Robert: You should like take the bones out first.
Take the bones out of the fish?
Lily: . . . because he died but he’s not dead anymore.
Now, so, alright, we’ll finish up but I just want to talk about, David, you
said you’re definitely not going to die?
David: Yeah.
Even if—would you not like to go to heaven?
David: Yeah.
What is heaven anyway, David?
David: Goes in the sky.
But what is it like up there?
David: It’s like, it’s like an airplane.
What do you think heaven is like?
Robert: It’s not like an airplane. It’s just like a house, but like, when you
like die in heavens, like, like when you like come into heavens, then like, then
like, when you like come into the door of heavens you like see black fire.
Black fire? Mm-hm.
David: No, it looks like an airplane.
Is it nice there?
Robert: It doesn’t fly. It’s just a house.
But is it nice?
Robert: Well, you have to die there.
Yeah.
David: Well, it looks like an airplane, ‘cause it has really short wings.
Well how do you get up there?
David: Like you cli—you get a ladder.
Okay.
Robert: No.
Well, Lily, what do you think it’s like in heaven?
Robert: It doesn’t have wings.

M: I don’t know.
You don’t know? Do you think there’s black fire there?
Robert: There’s no wings.
Yeah? You think it’s an airplane (to David) and you think it’s like a house
with black fire. (to Robert)
Robert: In it. (In it?) Inside. (Inside.)
And do you get burned in the fire?
Robert: Well, like, you like, you like, climb, like, on, like, a bed, like, up-
stairs, like, on like, on like, like when you like are just about to die then you
like have to like drink like a glass of water or something.
Okay . . . hmm.
David: But you know what? When you climb up to heaven you can blow
the smoke away?
Can you? Uh-huh . . . What smoke?
David: The fire. You can blow the fire away.
So, it’s a house with fire and you could blow the fire away?
David: Yeah.
Uh-huh. And then you lie down on a bed? And then what happens?
Robert: You like, when you’re just about to die, you drink a glass of water
and you like after like you drinked it then you like died. (Okay.) Then you’ve
like died.
Died, yeah. And your eyes are closed?
Robert: Yeah, but only if you’re like blind, then your eyes are closed like the
same, like the same times. (Oh, okay. Okay.) And like if you’re like not blind
then your eyes are like . . .
Now, okay, are there other people there?
Robert: Yeah, like there’s like a bad guy in heavens and like a good guy and
like another one like that.
So and there are dogs there too. David said there’s a doggy heaven? So,
there’s dogs there too?
David: Yeah.
Hmm.
David: And cats.
And cats? Yeah. Hmm. Some people are getting tired. Maybe we should
finish up? Do you want to go outside?
Robert: There’s not fish heaven.
There’s no fish heaven? No?
Discussion
In this extended interchange we see the powerful effect of a warm, caring,
empathic, non-judgmental attitude. The interviewer encourages the young
children to express their ideas and feelings and listens to them. The children
open up because they know that the adult is listening to them and is inter-
ested in their ideas and feelings.
Globally we can see immediate differences among the three children.
Lily opened the discussion, referring to her cousin’s pet goldfish, which died;
Robert seemed to be trying to integrate his older brother’s ideas about death;
and David was most insistent that death will not occur. Certainly anxiety
was prevalent throughout the interview, with the children expressing their
anxiety in a variety of ways and coping in different ways. Certainly the im-
ages of death were far from benign (such as fire and blindness) and the cause
of anxiety, in contrast to Freud’s implicit conjecture that children have be-
nign conceptions of death. What seemed important was the minimal expres-
sion of loss if someone died or sadness about such a loss (only Lily expressed
missing her mom’s hugs if she died). Instead the children were struggling to
understand what this idea of an unknown, or perhaps unknowable, state,
this death concept, was all about. Clearly these children have not been
traumatized by loss associated with a death, as in death of a parent. It does
raise the question as to what impact the experience of traumatic loss due to
death in early life has on the early conceptual formations and the different
components of the death concept.
This interview was conducted in an open-ended way without consider-
ation of trying to elicit the various sub-components of the death concept.
If we briefly look at the sub-components we can categorize some of the
children’s spontaneous expressions.
Inevitability (the acknowledgment that living things must die eventually)
Lily says, “David is not going to die”; David says, “No I won’t”; Robert
answers, “Yes, You will.” Clearly the children are struggling with the concept
of inevitability.
Universality or applicability (the understanding that death must happen to all
living things)
Robert says, “Well, yes. Everyone is going to die.” [When?] “Old.” In other
words, even though he has the concept that everyone dies, it only happens
to old people. As Robert had earlier said, his brother is worried that their
parents will die soon, he thinks that they are “gonna die at very long, long—
long, long, long time. Right?” In other words, he is not sure when death can
occur. When David said, “one of my toys died,” he clearly did not have the
concept that only living things die.
Irreversibility or finality of death (the recognition that the dead cannot come
back to life)
Lily says, “I’m worried about my mom dying and I wish I would hug her
when she died but . . .” There is some recognition that when the person dies
you can no longer do the activities of daily life with them. It is not clear
whether they can come back.
Cessation or non-functionality (the understanding that death is characterized by
bodily processes ceasing to function)
Lily: [When you die] “You could swish in the air if you die.” This is clearly
an example that functions still continue. When Robert talks about heaven
he says, “It’s not like an airplane. It’s just like a house, but like, when you
die in heavens, like, like when you come into heavens, then like, then like,
when you come into the door of heavens you like see black fire.” In other
words, functions do not cease but are different.
Causation (the understanding that death is ultimately caused by a breakdown
of bodily function)
[What makes people die?] Lily: “Cause you’re old.” David: “And you get
big, big, big . . . mmmm.” Robert: “Like, you’re too old. . . . you like get weird
. . . like your face is like weird.” There is no understanding of the biological
processes involved in death.
Concluding Remarks
In these excerpts of young children we see how they are struggling to under-
stand a concept that is beyond their immediate experience. Certainly these
data demonstrate that it is not only possible to talk to children about a topic
difficult for adults but that, in an empathically attuned situation with very
young children who do have facility with language, important information
can be gathered. This kind of normative data are extremely important to sys-
tematically obtain in order to (1) facilitate the development of psychoana-
lytic theory which is in harmony with normal developmental expectations
and (2) help clinicians and parents talk with children when they are exposed
to or suffer a traumatic loss.
In future work, in addition to trying to replicate and extend the work of
Slaughter and Griffiths (2007), it will be important to try to include systematic
explorations of psychoanalytic themes, such as differentiating those children
who focus on loss and those who focus on damage to themselves or their bod-
ies. Are there gender differences? What are effects of older siblings and new-
born and younger siblings? Robert was clearly influenced by an older sibling.
For example, the five-year-old girl whose mother had died focused on loss
and replacement, Lily worried that she could not hug her mom, and Robert
and David focused on the dangers of death. Are fears of damage to the body
more prominent in boys and fears of loss of a loved one more prominent in
girls? Leon Hoffman (2008) has described a different reaction to the birth of
an opposite-sexed sibling in a pre-latency boy and a pre-latency girl, with the
boy more concerned with his body integrity and the little girl with loss of her
mother. In addition, consider a thirteen-year-old boy who had been told that
his mother, who had been ill with cancer, finally died. The first thing he did
was check his body out to make sure it was all there. Confounding factors in
case studies, of course, prevents us from making generalizations. However,
clinical data seem to point to a hypothesis that girls and boys may react dif-
ferently to stressful events such as thinking about death. Such a hypothesis
would have to be systematically validated or disproven.
Finally, one needs to evaluate the interaction between the cognitive func-
tions and the particular emotional themes in the young child.
CHAPTER THREE
Children’s Understanding of Death

Henri Parens, MD
Hoffman has selected an informative review of the literature on children’s

evolving understanding of death, what it is, what follows from it, and most
resistant to their reality-based understanding, the thought: “I shall die,” that
is, the child’s thinking of his/her own eventual death. I want to add some
comments to it. But in addition, I thank him for making our search to under-
stand the child’s experience of death—and with it “I know I shall die”—by
leading us to think about it while simultaneously we may marvel at the
evolving of one of the most awesome developmental processes of life—the
evolving of the child’s mind. I’ll comment to this as well.
On Hoffman’s Review of the Literature

It is striking how Freud, the magnificent thinker, so widely missed the mark
on children’s experience and thinking about death. You may think I am
uncharitable to say this about Freud. But here’s what I wonder about. Hoff-
man tells us that “Wirth [2003] discussed Freud’s ambivalent attention to
and disregard of the import of death to a person’s psychology, [and that] in
fact, Freud (1923) considered the fear of death [to be] secondary or equiva-
lent to the fear of castration (p. 58)” (Hoffman, p. 4). I am not saying the
master teacher should have or could have known more than he knew. My
question arises from the fact that, according to his personal physician Max
37
38 Henri Parens
Schur (1972)—who also became a well-known psychoanalyst—Freud had a

lifelong preoccupation with the death of his younger brother Julius, which
occurred when Sigmund was two years old. Schur holds that this loss gave
rise in Sigmund of an intense sense of guilt. Schur quotes from a letter Freud
wrote to Ferenczi on December 9, 1912: “All [my] attacks [of intense anxiety
and even fainting] point to the significance of very early experiences with
death (in my case a brother who died very young, when I was a little over
one year old)” (Schur, 1972, pp. 267–268). Schur footnotes that Freud was
“nearly two years old at the time.” Furthermore, in the same letter of 1912,
Freud wrote, “The war atmosphere dominates our daily life . . . [and added
that at the time he had] three sons on the war front” (Schur, p. 268). Else-
where (Parens 1979 [2008]), I have written that I have wondered if this
preoccupation with death and his self-blame for the death of Julius might
have compelled Freud to find a central place for the influence on him of this
preoccupation with death and he did so by asserting that hostile destructive-
ness in humans is the representative in the psyche of a death instinct (Freud,
1920). In other words, I have wondered if Julius’s death was so powerful a de-
terminant in Sigmund’s life experiencing that it led him to conceptualize the
death-instinct based theory of aggression. So I ask, what could have given
rise to “Freud’s disregard of the import of death to a person’s psychology” and
his holding that “the fear of death is secondary or equivalent to the fear of
castration”? Given this lifelong preoccupation with death, was it less anxi-
ety producing to think of it as secondary to castration, than to plumb again
the nature of his guilt, as unreasonable as that guilt was? I’ll later comment
briefly on some effects on a very young child of the loss of a sibling and on
why children blame themselves irrationally for events that befall them.
I find Dr. Hoffman’s survey beyond Freud informative and to correspond
with my own clinical findings with children’s conceptualizations of death.
Hoffman rightly reminds us of Piaget’s (1937, 1954, 1963) cognitive develop-
ment theory, with its superbly researched, even if criticized, major evolving
stages from the earliest sensori-motor intelligence (birth to nearly two years),
to that of pre-operational intelligence (two to about six or so years), then the
stage of concrete operational intelligence which coincides with what I believe
to be evidence of a new brain maturation which leads those children who
have tended to invert letters to no longer do so (from about seven years on
extending to eleven years), to the adolescent stage of formal operational intel-
ligence, that stunning stage of cognitive development when kids, now teenag-
ers, develop abstract thought and can think logically. For one who has long
marveled at the evolving of the infant into the adult, to hear the new level
of thought and social mindedness revealed at dinner time among and with
Children’s Understanding of Death 39
our three adolescent sons was just awesome, with alternating smiling and
jaw-dropping ad maximum! Piaget’s conceptualization of cognitive develop-
ment elucidated greatly the mind functions that so determine the limits of
the child’s intelligence. Peter Wolff (1960) was, as was I, so taken by it that
he attempted to integrate Piaget’s developmental epistemology with psycho-
analytic developmental theories, which he achieved with but limited success,
given the impediments that present when attempting to integrate concepts
and languages of different disciplines. (This is a barely veiled plea for think-
ing outside the box, which I insist will not harm psychoanalysis.)
I welcomed learning that Nagy as early as 1948, soon after Piaget had pub-
lished his early work on the child’s “construction of reality” (1937), scanned
kids’ behaviors to tell us that their grasp of death is a slow and gradual process
which, as Dr. Hoffman notes, has a corollary befuddlement which I’ll touch
on briefly in a moment, namely, the question of children’s ability to mourn.
Regarding kids’ grasp of what death is, I find the large review by Speece and
Brent (1984) and their proposition that understanding the “irreversibility,
non-functionality, and universality” of death are prerequisites for a mature
understanding of what death is to be, of course highly plausible, and the
study and model elaborated by Slaughter and Griffiths (2007) for the child’s
evolving conceptualization of death to be quite helpful in ascertaining the
child’s understanding of it. Their findings correspond well with my clinical
experience with children who have encountered, factually or in thought,
the question of death. I want to say a few words about two cases (on whom
I have reported before) to demonstrate this correspondence with the collec-
tive findings Hoffman reports on and from which I learned much about these
matters; and I want to also comment on a pertinent discussion that took
place in a long-past Mahler Symposium.
One of the children I want to mention came from our longitudinal obser-
vational project wherein we saw infants and their mothers twice weekly for
two-hour sessions over the child’s preschool years—note that at the time of
study preschools were uncommon and most kids started school at five years
of age. The second case is that of a young teenager I saw in analysis for a
number of years.
Bernie
In our project, we saw Bernie from a few weeks after his birth, his sister having
been one of our subjects when we started in 1970. He was a healthy young-
ster, developing quite well. His mother had already shown much evidence of
progressively becoming a “growth-promoting” mother (Parens, 1993). Their
relationship was quite positive, Bernie’s attachment to his mother quite secure.
40 Henri Parens
We only occasionally saw the children with their father; therefore, we could
not assess Bernie’s attachment to him.
When he was just past three, Bernie’s father sustained a lethal work-
related injury and was hospitalized for ten months (see Parens, 2001). To
support the family, mother now again worked outside the home. Early during
the then temporarily less regular sessions they attended, Bernie, his sister and
mother all seemed subdued. Gradually they adapted to father’s hospitaliza-
tion and seemed less oppressed. Father returned home for several months,
terribly debilitated. His condition worsened and when Bernie was 4 years and
3 months of age, father was again hospitalized.
When Bernie was four-and-a-half years old, his father died. I saw Bernie
one week later. I had never seen him so sad, holding onto and molded into
his mother. She in turn was depressed and spoke very little. Three days later
Bernie was despondent on his mother’s lap. Since his father died, mother
said softly, Bernie has been very upset and wetting the bed. Mrs. Z. said that
Bernie talks about his father having died (but that his now six-year-old sister
does not). As we talked about matters of concern—which was our practice
in the project—still on his mother’s lap, Bernie listened. We talked about
how angry we become when a person we love gets sick, because, even though
we may not be aware of thinking it, we’re afraid we may lose them, and then
when that person dies, we feel even angrier. Then, because we have been
angry with Daddy, sometimes a child feels that his anger is what made Daddy
sick and die. Of course that’s not true, I said. And we need to explain, even
many times, that being angry with Daddy is not what makes a Daddy become
sick and die.
The next session, Mother and Bernie appeared sad; his sister seemed
somewhat less so. Mrs. Z. said that she didn’t understand some things Bernie
was saying, that they made no sense. How should she deal with that? For
instance, she said that Bernie had said to her that maybe they could bring
Daddy out of the ground, take him to the hospital and Dr. Parens could make
him better again. What could she say to that? She knew that it would not be
helpful to say that Bernie was being silly; she just didn’t know what to say or
do. I pointed out that in the four-year-old’s mind the limits of what is pos-
sible are not yet established. One might think that they believe in magic, but
it’s not that. They don’t yet know what’s possible. So to us, Bernie’s thought
seems quite unreasonable, but it’s not. It’s a wish, a hope. And the way to ad-
dress it with the child, I think, is to take the child’s question seriously, to just
be upfront with the child, and even while feeling sad, explain to him what is
possible and what is not. I emphasized that it is important to allow the child
not only to feel sad and comfort the child as best as Mom can, but to also
allow the child to say whatever the child thinks and feels and to address it as
truthfully as she can. I reiterated this many times with regard to dealing with
a child’s feelings of loss, of sadness, of anger, etc.; many occasions presented
themselves. This case helped us talk with the mothers about how they can
help their children deal with sad, painful experiences.
Nearly four months after father’s death at home, he tells his mother from
time to time that he is feeling sad that Daddy is not here. Both mother and
Bernie do look sad at times alternately, at times simultaneously. I learned
that in his therapy sessions with Dr. B., Bernie was also able to talk about
his father’s death, and to play at crashes, accidents, and attach them to his
father’s death. Gradually his phallic aggression returned, and his mood re-
turned to his usual pre-loss state. At home, mother told us he was looking at
girls in a magazine. Mother grinned and said that when she asked him which
one he would like to marry, he surprised her by saying “you.” From this time
on we saw the re-emergence of sexual, aggressive, Oedipus complex, and
conflict behaviors (Parens, Pollock, Stern, and Kramer, 1976), which we had
not seen since his father died. We assumed that his development had been
transiently put on hold as he tried to cope with the loss of his father, the
sadness it struck in him as he attempted to accommodate to the large change
this loss brought into his life.
Guy
Guy was a brilliant thirteen-year-old boy riddled with anxiety (see Parens,
1988). Following from his associations, this anxiety seemed predominantly
attached to his having sadistic fantasies toward his parents—stirred in him
by much marital harshness. While his anger toward them was understand-
able, it was nonetheless more intense than warranted by what I knew of their
behavior toward him. His love feelings toward them were at the same time
sufficiently strongly valenced, so that his guilt was rather hefty and often
manifested in his being troubled with himself for having sadistic fantasies
toward them. He had recently started having difficulty falling asleep because
he dreaded that he would “die in his sleep.” He became increasingly preoc-
cupied with thoughts of his own mortality and experienced actual fear of it
at night.
In the transference, Guy seemed compelled to try to control and sadisti-
cally manipulate me. As he seemed pressured to enact in the transference
the sadism he felt toward his parents, he would invariably manage to fail in
his efforts when he was on the verge of causing me injury, physical and/or
narcissistic. The intrapsychic conflict caused by his intense ambivalence was
palpable. His sadistic feelings were as equally perceivable as was his warmth
42 Henri Parens
and concerns about me. He was quite positively responsive to interpretation

which helped notably to contain his occasionally mounting sadism. Gradu-
ally, progressively his sadistic fantasies decreased, he became less provocative
at home and in the transference, and his schoolwork improved as did his peer
relations. He also seemed less conflicted over masturbation.
His associations from time to time turned to the threat of nuclear disaster
and he twice enacted such scenarios in narrative form and twice dreamt
of a nuclear disaster. Associations to these suggested a link with his dread
that he would die in his sleep. He had watched a television program about
nuclear war but in neither dream was he personally threatened. Gradually he
was able to talk about his recently having come to be aware of, and became
preoccupied with, the thought that being dead really did mean that this was
the end of life. I postulated that the dread that he might die in his sleep was
contributed to by, at the aegis of his rather harsh conscience, his turning
some of the rage he had long felt toward his parents against himself. Over the
more than four years of analysis his harsh conscience seemed most resistant
to analysis and were it not to modify over time, might well over the years
continue to be a significant contributor to his fear of dying.
Young Children’s Experience of Death, Loss, and Mourning

As Dr. Hoffman observed, when talking of children understanding the mean-
ing of death, the concern about their experience of object loss and their
ability to mourn is never far away; indeed, these invite themselves into our
deliberations about what and how children experience serious life events.
Especially compounding the question of their understanding of death and
their ability to mourn is the crucial question of the effects on young children
of loss. As Hoffman says of Lerner’s (1990) study, the impact of object loss,
known to us so well for the last sixty years from the work of Spitz (1946,
1950, 1965), Bowlby (1960, 1980), and others, is “complex and depends on
a multitude of internal and external factors including the mitigating aspects
of defense, the availability of substitute objects, and the degree to which in-
ner psychic structures have become autonomous from the supporting objects”
(Lerner, 1990, p. 80). Bernie showed so clearly the impact of loss, not only
in his reaction of sadness and inhibition of motoric activity, that cardinal
sign of depression in children, but also in the interruption of his otherwise
quite normal developmental process, indeed at a time of high intrapsychic
activity, i.e., during the experiencing and organizing of his Oedipus complex.
Crucial, I found, was his mother showing so convincingly the critical role
the emotionally available mother can play in the child’s coping with such a
loss. And I would add that this case showed us in vivo how an emotionally
available and empathic parent can help the child engage in a childhood
mourning process, documentation for which lay in the visible mother-child
interactions, the content of their verbal communication about father’s death
and missing him, the three-month interruption of Bernie’s developmental
process—which for this age I considered a substantial mourning period—and
Bernie’s yearly anniversary reactions to the death of his father which de-
creased in intensity as time passed.
Thus, while Bernie did not understand the finiteness of his father’s death
until efforts were made to help him understand this fact, the loss, and the
mother’s tolerance of his loss affects, fantasies, and questions, her facilitating
his coping with these, inform us of the complex challenge it is for the child
to mourn. But at the same time, it defies the oft-said notion in child analysis
that “children cannot mourn.”
In fact, it was in preparation for the Fifth Margaret S. Mahler Symposium
in 1974 which addressed the issue of object loss in childhood and its effects
on separation-individuation that I started to question the assertion that chil-
dren cannot mourn (Wolfenstein, 1966). In preparing for this symposium,
our child analysis study group reviewed the videotape to be presented by
Humberto Nagera. The aim of Nagera’s 1974 presentation was to illustrate
the findings on which he had reported in 1970, namely, that it is too difficult
for young children to mourn the death of a parent. The video showed the
nursery school activities of three-year-olds. Among them, one child’s mother
had just died of cancer. Given Nagera’s thesis, we were surprised to find
that in five instances, the child spontaneously made some comment about
a hospital, illness, and her mother. Also surprising, we found that in each
instance, the nursery school teacher redirected the child’s preoccupation,
asking her to focus on the activity going on in class. While this, we thought,
might occur in a “regular” nursery school, this was a nursery that was part of
a psychiatric clinic and research center. After some time I eventually came
to think that many empathic adults find it difficult to tolerate a young child’s
experiencing intense psychic pain. We know in our field that helping such a
child deal with his/her feelings, thoughts, and fantasies is extremely painful
not only for the remaining sensitive parent, but also for such teachers, and it
is even taxing for therapists. Yet, we know that we cannot help a child cope
with painful experiences without empathetically allowing the child’s affects
to resonate within our own psyche, with our own experiences of object loss,
an experience unavoidably painful to a greater or lesser degree for each of us.
Such empathy is unavoidably painful, in addition to its resonating with our
own childhood experiencing but also, as Schlesinger said at this 1974 Mahler
44 Henri Parens
Symposium, because none of us can completely resolve the loss of our own
libidinal objects, given that early-life libidinal cathexes are indelible (Freud,
1939), and therefore remain within our psyches even well after mourning
fades. I’ll come back to this reasoning below in another pertinent context.
This latter factor is reflected in Jacobson’s (1964) and Mahler’s (Mahler,
Pine, and Bergman, 1975) view that we all retain yearnings for reunion with
the mother of symbiosis. And Zetzel’s (1965) admonition to us was insight-
ful, that we all must learn to tolerate depression because it is a constituent of,
an unavoidable experience in, normal development. It strikes directly to the
point I am addressing which is that adults who cannot well-enough tolerate
their own traumatizing inner and outer life experiences will most likely not
be able to help children mourn. This case showed that given a child’s ability
and tendency to manifest his affective experiencing and say what he thinks,
in complement with the remaining parent’s emotional availability and toler-
ance for the child’s affectively manifest pain and thoughts, even quite young
children can mourn. And don’t adults, in fact, also need emotionally avail-
able objects to be able to mourn effectively and sufficiently (Kogan, 2007)?
This is further compounded by the fact that many adults still strongly hold
the erroneous view that children are too young to suffer, to understand, to in-
ternalize, and to remember traumatic events to which they are exposed. For
example, in a given reported instance, five-year-old Rose walked into kin-
dergarten and exclaimed dramatically, “Oh, I had such a terrible bus ride!”
To this her well meaning and quite sophisticated young teacher had replied,
“Rose, we’ll like you even if your bus ride was very pleasant,” feeling, as she
told Rose’s mother, that Rose was just seeking attention. The teacher seemed
not to hear the child’s inner pressure and efforts to tell her that by the age of
five she had already had two traumatic ear surgical procedures, had witnessed
a hemorrhagic catastrophe occur to her mother, had been painfully dropped
by a disturbed relative who soon after died of cancer, and for some time now
her mother and father were constantly arguing and threatening separation.
What made this teacher unable to hear Rose’s affective and anxiety-ridden
appeal for help? Such reports abound. We have all too often witnessed a
rather general multi-determined tendency in too many adults to encourage
children to deny and repress painful affects and threat-perceived real events,
often to the child’s detriment.
About Hoffman’s Sample of “Children Talking about Death”

Fortunately, in the conversation reported to us by Dr. Hoffman (Hoffman et
al., this volume), the nursery teacher was clearly much better prepared than
was the teacher in Nagera’s nursery to hear the children talk about death.
But before I proceed with some remarks about this stunning childhood con-
versation, I want to say this.
One of the factors that keep child therapists young is the marvel of the
young child’s multi-linear development (A. Freud, 1963). And nowhere is
it more awesome than in listening to what some children say. When Selma
Kramer, Joe Rudolph, and I would meet, formally or socially, one of us
would invariably have some story to tell about “what this kid said”—invari-
ably because it was just so stunning. One story I have told again and again
is of two-and-a-half-year-old Jane. Seeing her there, sitting on her mother’s
lap, thumb in mouth, pensive and subdued, not really expecting a response
from her, I said, “Hm, I wonder what Jane is thinking about.” She sat up a
bit, pulled her thumb out of her mouth and, pointing to the floor where her
twelve-month-old sister was napping, she said, “She stole my mommy!” I was
stunned. Not by the idea but by the fact that at two and a half Jane could
verbalize it so outright, so concisely, so meaningfully. What children say!
We have this awesome factor demonstrated here too, in the three-to-four-
year-olds of Dr. Hoffman’s nursery. The dialogue unequivocally demonstrates
that they cannot meet the criteria for understanding what Hoffman and the
reviewed researchers refer to as the “mature understanding” of death. And
the children’s struggle to conceptualize it is evident. Of course their healthy
narcissistic competition for who really has the best explanation for what death
is, this too is evident. This is so even in the face of their having no assured
knowledge that life really ends, and yet somehow they resist Lily’s telling them
that her cousin’s goldfish is dead, to which Lily is compelled to insist that
“it’s for real, for real. . . . It, it really is.” Yet, they know something about it:
to the teacher’s question, “Are you going to die, Robert?” Robert says, “Well,
yes. Everyone is gonna die.” But then, David says he won’t, and Lily joins in,
“I won’t die either.” To Robert’s repeating that everyone dies, David holds
insistently, saying again and again, “No, I won’t die at all!” Young Robert
seems to have grasped something his peers have not, perhaps because he can-
not shake his older brother’s telling him so. But note how Robert says it, “My
brother thinks his mom and dad are gonna die,” but perhaps struggling with the
fact that his brother and he have the same mom and dad, he concedes, “my
mom and dad are gonna die,” and now anxiety seems to set in—inferred from
his rather stumbling verbalization—“at a very shortly longly but they’re gonna
die at very long, long, long, long, long time. Right,” he adds perhaps hoping
otherwise: “Right?” Lily, perhaps swayed a bit by Robert’s insistence, ventures,
“But David’s not gonna die, right?” She too is not so certain. “Right?” she says.
Which is then followed by the classic interchange between two pre-latency
46 Henri Parens
age kids: David says “No,” shaking his head “no” to affirm it. To which Robert
says: “Of course, he will” and off we go, “No I won’t,” “Yes, you will,” repeated
several times. Then Robert yields some, note his words and his stumbling:
“Yes, you can die.” (It is no longer “you will die,” now it is “you can die.”) “You,
you, you’ll most likely die at the age of like sixty, uh, three, or like sixty-four.
. . . Or like sixty-eight.” Perhaps made anxious by Robert’s insistence, David
counter-insists, “I won’t die.” Robert ups the ante, though a bit oddly, “You’ll
only, like, go up to zero.” But David, perhaps more anxious now, affirms his
conviction—however uncertain it is given his need to be so insistent—“No, I
won’t die at all!” And Robert, anxious? competitive? perhaps both, holds the
line while yielding, “and zero one, and zero two.” David heats up even more,
“I won’t die at all I said, Robert!” The teacher judiciously now intervenes,
shifting the focus back to Robert. “Are you going to die Robert?” to which he
answers “Well, yes. Everyone is gonna die.” Pushing a bit more, the teacher
asks, “When are you gonna die Robert?” Robert’s answer is slow to come; the
teacher helps: “When you’re little or when you’re old?” “Old,” Robert answers
briefly, curtly!
There is some knowledge about death, but what? It is not easy to brush
aside the competition between the children, a factor so prominent in pre-
latency because the ego and the child’s sense of self are young and insecure;
their challenged primary narcissism comes to the rescue and each child
insists he is right. But, brushing this aside, anxiety plays a role here. And it
poses a problem to explain: why this anxiety, if they don’t know the finality
of death? Here, I wonder this.
Children react dramatically to loss; we all know that; the literature and
clinical experience have informed us amply on this point. Might the anxi-
ety in talking about death come from the fact that while the child does not
understand the mature meaning of death, the child has an imagination, has
the capacity for fantasy, that creative adaptive function1 amply used by chil-
dren to explain events and phenomena they experience? And in a moment
I’ll take note of Lily’s demonstrating her imagination at work. But first, of
course, children grasp the concept of loss; its origins lie in separation anxiety,
that universal painful experience of loss when mother “disappears,” that is,
as Piaget (1937) explained2 and Spitz (1950) discovered and demonstrated,3
that is, when mother walks out of the child’s visual field. So children can
imagine loss; they have many times experienced its threat. And let me add
that given that the earliest cathexes are indelible, we carry within us, life-
long, the tendency to separation anxiety and the threat of loss.
So, even though she does not have a mature understanding of death, Lily
can imagine: “Sometimes I’m worried about my mom dying. I, I, I wish I
could hug her when, when we die.” Her thinking is a bit fuzzy; there’s some
condensation, “I wish I could hug her when, when we die.” And while the
focus of the children’s discussion shifts to another large topic I’ll comment
on in a moment, Lily comes back to this troubling thought wrought by her
imagination. She seemed pressed to do so because the teacher says, “Lily,
what do you want to say?” To this Lily says: “I’m worried about my mom
dying and I wish I would hug her when she died, but . . .” and stops mid-
sentence. Thoughtfully and well trained, the teacher just repeats, “You’re
worried about your mom dying?” “Yeah [Lily says], because I can’t hug her
anymore.” And Lily’s is not the only imagination stirred by her fantasy. The
teacher pushes some more: “Yeah. What do you think about your mom dy-
ing?” Whether she had directly asked him or not, David answers: “Uh . . . uh
. . . I don’t like her when she dies and she’s like . . . and I don’t like her when
she dies when, when, [and changing the subject of the teacher’s inquiry]
when one of my toys died.” The teacher kindly lets herself be diverted, “Your
toys can die?” David latches on, “Yeah, they can do magic,” and the kids’
imagination churns on, magic makes things disappear, like a mouse, like a
cow, and a cow being thrown up in space, um, like to the planet Pluto. The
imaginative discussion continues with non sequiturs, humor, leaps of fantasy.
But then the thought, the anxiety remain, and to the teacher’s “What other
bad things could happen to you? [She turns to] David?” David thinks, “Mmm
. . . mmm . . .” And Robert picks up: “I know! Well like, my brother is like,
he thinks he’s like, he thinks our mom and dad will die. My brother . . . But
I don’t think so.” And he fumbles, “He thinks they’ll die at a short age, but
I think they’ll die at a long age.”
In his discussion, Dr. Hoffman notes how “anxiety . . . [expressed] in a
variety of ways . . . was prevalent throughout the interview” (p. 19). It might
be interesting to attempt to sort out what defenses were elicited as each child
attempted to cope with that anxiety. For instance, when David says: “You
know what? When, when me and mommy in the forest, um, um, um, I’m
afraid if she’s gonna die in the forest” and he laughs! That common reaction
formation often triggered by anxiety, to laugh, and so often misconstrued
by parents and teachers alike as an offensive reaction. Dr. Hoffman is right
that, as I noted earlier, given the impact on two-year-old Sigmund of the
loss of his infant brother, Freud’s “implicit conjecture that children have
benign conceptions of death” may of itself have been a defensive operation
on Freud’s part. I propose that it eventually, by means of sublimation—which
I no longer consider simply as a defense given its creative function—yielded
an enormously creative act on his part, even if I am in disagreement with it,
that is, his proposing a large role for a death instinct in humans.
48 Henri Parens
And thinking of Freud, Hoffman is right to ask what the consequences

of the loss of a sibling might be on a young child. In addition to what I
have speculated about Freud and the impact on him of the loss of his baby
brother Julius, in her important book on childhood bereavement, Erna Fur-
man (1974) describes how a twelve-month-old seemed to be constantly
searching for something in the house, looking everywhere the child could.
The parents were puzzled since this was new behavior in the child. Furman
quickly learned that the child’s older brother had recently died and while the
parents assumed it would not affect the infant, she helped them recognize
that indeed it had and postulated that the infant was looking everywhere for
the brother who had disappeared. While Furman’s book is entitled A Child’s
Parent Dies, and it is predominantly about that, the loss of other family mem-
bers is considered as well. No doubt, both the child to whom Furman refers
as well as young Sigmund Freud would have had thoughts about the concept
of death that would differ and be more mature than those had by Lily, Rob-
ert, and David. From their associations I too would assume that the children
in the Hoffman nursery “have not been traumatized by loss associated with
death” (p. 19).
Our experience with Bernie and the admirable effectiveness with which
his mother helped him tolerate not only the loss of his father but also, I
believe, achieve a significant degree of mourning that loss, leads me to be in
accord with Hoffman that, stated in my own words, I too have advocated,
(1) that we hone our psychoanalytic developmental theories to accord with
observable manifestations of unconscious process in children’s behaviors (A.
Freud, 1965) and in what they say, and (2) that studies as these show how
clinicians and parents, and I would add other child caregivers as well, can
facilitate a child’s coping with traumatic loss, and trauma in general.
A Few Closing Thoughts

Hoffman notes that Slaughter and Griffiths, in their study of ninety children,
found that “children between the ages of four and eight. . . [experienced]
less fears about death the more maturely the child understood the death concept”
(Hoffman, p. 9; italics added). This finding would of course surprise none
of us since we know that talking to children about sad, painful, frightening,
worrisome events and phenomena lessens their fear of them—because in
the telling they do some working-through which facilitates mastery. This is
furthered by our knowledge that people’s fantasies—even though the fantasy
function is in the service of adaptation—and bad dreams tend to be worse
than reality.
But in addition, it touches on what I believe may underlie learning, which

is that children have to have explanations for events that occur and phe-
nomena they experience. I have pointed out—a bit tongue in cheek—that
neonates come into this world never having been here before. This is why
they explore all they can; it drives their practicing subphase. I think that not
knowing, not having an explanation causes children, and perhaps not just
children, to experience anxiety, the degree of anxiety corresponding to the
importance to the self of the specific knowledge. We find, as Lily, Robert,
and David demonstrated, that not having explanations, they fantasize, they
hypothesize and, often erroneously, they will theorize. This is why two-to-
six-year-olds ask so many questions; and why parents are foolish to not try to
answer them. And perhaps this is when researchers are born.
Why do pre-latency age children take on blame for untoward events? Stating
matters simply, we know that children have wishes to transgress, to appro-
priate another’s possession, to destroy anything or anyone that prevents the
child’s attaining a highly prized goal. But in addition to our understanding
that youthful guilt and shame drive self-blame, we must add this as well.
There is a progressive differentiation of cognition—which not only gives
due, increasingly more realistic dimension to the power of impulse, affect,
and thought—but also increasingly specifies the parameters of cognition as
those spelled out by Piaget, then Speece and Brent (1984) and more recently
Slaughter and Griffiths (2007). This means that for a period of time the child
exists in a state of not always knowing what causes what. Side by side with
the anxiety of not knowing that thrusts learning, many a child may feel safer
when he/she assumes that everything arises from “my doing,” “I am in con-
trol, I make things happen.” Rather than ascribing it to omnipotence as some
colleagues do, I ascribe it to primary narcissism. There is a biological basis for
primary narcissism: it is the compulsion of living substance to maintain life.
The biological dictate to preserve the species demands it. I postulated three
decades ago that this “thrust to maintain” life drives aggression, both non-
destructive and hostile destructive (see Parens, 1979 [2008], chapter 3). This
biologic dictate “to preserve the species” brings with it a “biologic imperative
to self-value” which is represented in the psyche as primary narcissism. In
some children the pressure of primary narcissism may lead to the unconscious
decision to take responsibility for everything that happens rather than accept
the condition of helplessness which is part of the young child’s reality. And
the basic psychoanalytic tenet of Freud’s second theory of anxiety, namely
that ego helplessness leads to anxiety (Freud, 1923, 1926) anxiety may bloat
the child’s primary narcissism into a defensive sense of omnipotence. For
some, it is better to be foolishly omnipotent than helpless. Thus all that
50 Henri Parens
happens that is frightening is taken on as being produced by “me.” To be

sure, this would facilitate taking on responsibility for one’s baby brother dy-
ing, as Freud did.
Another issue the children’s verbalized thoughts brought to mind is a
phenomenon I have often wondered about: What is it that makes many a
pre-latency and latency-age child turn away with anxiety from old people? I don’t
altogether understand it. So I find the few comments the Hoffman nursery
kids say about it informing. Again, Robert is so expressive, as well as quite
anxious in telling what he thinks: “then you like grow like very old and then
you like get weird. Like you like, get into like, like your face is like weird . . .
then like your face like . . . ([teacher suggests] goes weird?) Yeah. Like all of
the skin’s like all . . . up (pinches at the skin on his face).” It does not tell us
much about why wrinkling skin is so frightening. Should we consider that
wrinkling skin is somehow adult-“monstrifying”4 to kids? Mhh!
Notes
1. The fantasy function allows us to imagine what might happen without having
to live it out to have the answer. If I fantasize jumping out the window, I can imagine
what would happen; I don’t have to actually do it to find out.
2. Piaget is responsible for our understanding that before the advent of “evocative
memory,” when the child can image an object he has seen before but is now not in
his visual field, the infant cannot invoke the image of the mother who has walked
into the kitchen, i.e., out of the child’s visual field.
3. Spitz was the first to inform us of the child’s experiencing “separation anxiety”
when the mother walks out of the child’s visual field.
4. Given that I have just invented this word, for the puzzled I should define it: “to
make look like a monster.”
CHAPTER FOUR
Symbolic Death, East and West

Metaphors in Three Child Case Studies
Jaswant Guzder, MD
The body dies. The body is just what the soul possesses or the soul was
in. The soul lives on.
—Susie Billie, age 102, Seminole, 1993
We talk to Wakantanka and are sure he hears us; yet it is hard to explain
what we believe about this. It is the general belief of the (First Nations)
that after a man dies his spirit is somewhere on the earth or in the sky;
we do not know exactly where, but we are sure that his spirit still lives.
Sometimes people have agreed together that if it were possible for spirits
to speak to men, they would make themselves known to friends after
they died, but they never come to speak to us again, unless, perhaps, in
our sleeping dreams. So it is with Wakantanka. We believe that he is
everywhere, yet, he is with us as the spirits of our friends, whose voices
we cannot hear.
—Mato-Kuwapi Chased by Bears, 1918
While young children achieve some recognition of the finality of death in

the latency years, the multiple influences of their cultural identity will affect
their processing of death and bereavement in various ways. Since symbolic
metaphors of death are deeply embedded in the collective unconscious of
religious and mythic imagery, the pathways of culture imagery are often
51
52 Jaswant Guzder
crucial in determining the meaning or impact of death on life. Using clinical

vignettes, this chapter will focus on three children. Their variations of devel-
opmental and mythic organizations of Judeo-Christian and Hindu develop-
mental paradigms impacted their grieving processes as children encountering
death at the cusp of identity formation prior to adolescence. The therapy nar-
ratives will be based on the working-through of early parental death impact-
ing a young Jewish boy, aged nine, whose previously healthy, vigorous father
died in his arms; a nine-year-old Hindu boy whose bipolar father’s death by
suicide occurred just prior to his mother’s sudden migration west; and lastly,
a nine-year-old Hindu Canadian boy whose absent father died, leaving him
with a psychotic mother. Cultural frames of reference remained important to
each of these boys as they processed their encounters with death. Maternal
transference issues influenced by the East-West paradigms of meaning also
emerged as part of the transitional phenomena inherent to their therapeutic
work, perhaps influenced by working with a therapist of Asian origin.
While North American life is actually a confluence of influences with
myriad migrant influences and primarily First Nations and Judeo-Christian
foundations, contemporary childhood universally draws from the imagery of
local and parental story telling, fairy tales, comic books, and a visual river
of video material. The resilience that grounds the child’s capacity to process
loss of a parental object in young life will be situated in their individual
constitutions, temperament characteristics, object relations history, social
supports and the evolving narrative of their life events, so generalizations
are not possible. Cultural imagery, however, can be helpful to access directly
a child’s affective organization through drawings or dream material in the
process of therapeutic work as elaborated by many studies.
Young children equate absence with being “gone,” whether the reason is
“a journey, a dismissal, an estrangement or a death” (Freud, 1900, p. 254).
They are continuously and actively organizing the threads of experience
and affect according to their developmental stage and cognitive level of
understanding of such gaps (Knowles, 1983; Schneiderman, 1979; Sahler,
1978). As they enter latency, and certainly by the age of eight or nine, the
irreversibility and finality of death emerges for that age children, along with
the fears and concerns around its permanence. Individually there are wide
variations—as many researchers have indicated—such as the comments of
Weininger (1979), who talks about wide variations where half of the nine-
year-olds in his study still played out phantasies of death as non-permanent
and reversible phenomena. Play at that stage of age nine allows a close
coincidence of meaning between verbal expression and symbolic play. The
“phantom overseer” may emerge as the child’s imagined idea of his lost par-
Symbolic Death, East and West 53
ent when a widowed parent approaches remarriage, since the child may be
concerned of the acceptability of such a plan in the mind of the deceased
parent. Organizing fears of death, protecting a living parent or loved ones,
eluding death with various strategies, worry about the contagious nature
of death, personifications of death (e.g., the bogeyman), the remoteness of
personal death, and concretization of versions of cause and effect of death all
intersect in this psychic event.
Participation in mourning rituals is especially important to provide some
concrete demonstration of the death event. Adult explanations need to
counter the child’s phantasies of cause-and-effect; previous experiences
(such as previous loss or death of a pet) impact the realism of the event. The
family’s beliefs and religious orientations may become the strongest organiz-
ing factors in the phantasies and processing of the fear and realism of death’s
finality or non-finality. While universally we accept that the later stages of
adolescent individuation will bring another level of abstract thinking and
emotional processing, the cultural matrix of the life event and the ritual
imagery of death may nonetheless vary with each family’s cultural life.
Cultural Influence as a Dynamic

In the broadest sense, the Western world embraced a cultural shift to a sci-
entific matrix of meaning progressively from the time of Kepler and Galileo
(Freedberg, 2002, p. 1) that was a collision of scientific inquiry with the
imaginative speculations based in religious text. Science was turning thought
to firsthand observations, creating an alternative cultural space that appeared
to reject “the stale and obscure passages of antiquity.” In fact, the mythic or-
ganization of the body and the soul with religious explanations never seemed
to be entirely renounced in the West though science gained ground as the
dominant explicit cultural motif. In the East, however, a clearer bicultural
space remained that maintained a dominance of living oral and ritual tradi-
tions of mythic and religious tenets with pragmatic integration of scientific
application and knowledge. Literacy and visual imagery opened various doors
to translating these mythic underpinnings and certainly shaped the inner
world of the children presented here.
In addition, our understanding of variations in cultural emphasis has
evolved with an appreciation of the creolization of cultural metaphors and
metaphor in the migrant multicultural setting of North America, as well as
the contrasting intrinsic mythic solidity in ethnocentric or more traditional
communities such as Judaism or Hindu orthodoxy. Greenberg and Witzum
(2001) have elaborated the primacy of this group’s spiritual and cultural life
54 Jaswant Guzder
with rejection of the scientific paradigms in their work with orthodox Juda-
ism in Jerusalem. They posit an emphasis in their approach on the suspen-
sion of disbelief on the part of the therapist who may proceed in therapeutic
work by reframing intervention ideas in alternate cultural metaphors. Kakar
(1978), Obeysekere (1990), and others explored the variations of Hindu life
impacting development and childhood stages elaborating the usual parental
emphasis on collective values, a comfortable lifelong dependency and a pro-
longed early symbiosis. Like Greenberg and Witzum (2001), Kakar (1982)
emphasizes the place of mystic and religious values in shaping a different
elaboration of meaning and healing pathways that leave space for object
relations or constitutional agendas side by side with the rich parameters of
religious imagery and meaning. The primacy of a concept of karma or karmic
causation based on deeply held belief in reincarnation and the impact of
previous legacies of action on the appearance of suffering in the life cycle is
a crucial tenet of Buddhist and Hindu cultural frames to understand trauma.
These elaborations begin early in the life cycle and already have considerable
impact by latency.
Creolization of Culture
Globalization has homogenized cultures and created a hybridized mythic
space which young people now visit in cyberspaces, literary, and visual
modalities. This creolization (Bibeau, 1997) is particularly influential for
migrant children and families or those who live within minority spaces in
North America. The constant tension between the various cultural motifs
which promote or resist a global homogenization of culture vary within the
family as well as in the wider social space of school. Since identity forma-
tion will be consolidated by seeking a coherent translation of generational,
internal, and external mythologies, the territories of personhood are revised
continuously by migration. The symbolism that binds the familial references
of history and memory are often cemented by ritual, language, and mythic
metaphors yet the transitional spaces of identify formation allow for many
options (Winnicott, 1971). The child in his play has a fluid imaginative
space to externalize his loss of firm territories that are offered by traditional
symbols from a more homeostatic world. One of the children chose Star Trek
stories as a space where the aliens and alienist could interact freely while
another child (into adulthood) inhabited the fictional world of comic super-
heroes like Batman and First Nations stories, where the dislocations, death,
and heroism vicissitudes could be safely explored.
As children develop the individual identities that build on the core de-
fining experiences of the body and gender, they continue to seek subtle and
overt ways to interpret and reinvent themselves with the lost father’s body
significantly absent externally though not in phantasy. The family hierarchies
and rituals of orthodox Judaism and Hindu childhoods generally provide an
anchoring within the group collective to reinforce the continuity of familial
identifications and memories thus stabilizing the latency-aged boy in work
and play. The disruptive impact of the loss of a father, complicated by the
minority identity agendas, put all of these boys in a dissonant space where
cultural metaphors have a highly charged transformative influence. Migration
or minority identity can stretch the mythic and symbolic fabric that binds
the inner world, and each of these children struggled with destabilization of
their personhood. Their self-representations emerged from a childhood with
only maternal mooring and confused cultural “markings” of ritual markings
to guide their emerging masculine sexuality and identity. The creolization of
metaphors can operate as a relief that allows for a creative fluidity of iden-
tity options, at the same time that it may lead to confusion and anxieties
without the father’s real presence. The additional stressor for these boys was
the loss of systemic intra-generational input of grandparents who can often
stabilize the child while they create and organize their self-representations
given the predominant role of the maternal figure in their lives.
Though the transcultural literature continues to debate the context of de-
velopment (Roland, 1988; Prince, 1992, Kareem and Littlewood, 1992), the
universal aims of secure attachment and consolidation of parental identifica-
tions despite traumatic gaps remains the focus of therapeutic child manage-
ment. In each of these children, the subtle task of discerning cognitive levels
of understanding, phantasy, constitutional vulnerabilities, and developmen-
tal aims were the backdrop of working with personal narratives in a context
of systemic and intra-psychic dynamics.
Traditional Hindu Childhood

Kakar (1978, 1989) has written several papers on the vulnerability of the
male child within the matrix of the Hindu family where extended family dy-
namics and gendered hierarchies may often promote an indulgent, entitled,
sensuous, and intense mother-son relationship. Kakar (1978, 1988, 1989),
Kurtz (1992), and Obeysekere (1990) have explored various cultural factors
that promote the individuation of the male child separating him ritually at
pre-pubertal stage in Brahmin Hindu families with the traditional “thread
ceremony” ushering him toward the collective realm of the male family
56 Jaswant Guzder
members, just as the Bar Mitzvah in Judaism “marks” the son as part of his
male maturation joining the father’s world more explicitly. The maternal-
son relationship remains consolidated as a lifelong loyal bond, as an ally in
his early life and his dependent if she is widowed or elderly in the Hindu
joint family. When the Hindu son marries, his wife will enter his mother’s
domestic domain as her daughter to be managed or assisted in extended fam-
ily duties and caretaking roles, sometimes as a rival for his affection amongst
other females in the joint family. The differentiation process of the male
from his intense maternal affiliation is another interrupted process for boys
who lose their fathers in their early childhood.
The interplay of the death and loss of the father, with the differentiation
of feminine and masculine domains, remains a special dissonance for these
sons. Kurtz (1992) has emphasized that the ethnocentric lens of the West
has misconstrued the importance of the extended family in Indian child
rearing where strong intra-familial connections are modulated by multiple
feminine bonds while the strongest dependency bond remains with the
mother. Severance of the extended family system by the migration agenda
adds another mitigating factor to the child’s identity process. Trawick
(1990) also affirms from her observations of South Indian Hindu Tamil
families that early child rearing is not symbiotic but in fact an alternately
indulgent and frustrating, even harsh, process within an extended family.
The paternal grandparents and other familial relationships constantly draw
the son into affiliations that might denigrate his mother or disrupt their
intimate dynamic as part of the differentiation process. The predicament
of Indian women in the nuclear family shifts from strong intra-familial
support but also diminishes her rivalries with other female relatives for her
son’s affection. In these clinical vignettes the predicament of the sons was
complicated by migration agendas, the impact of widow or single mother
status (often denigrated in traditional Hindu context). This complicates
the first son’s special entitlement in a working family system as initially
in his life a relatively omnipotent, valued child who is now thrust forward
with duties and roles beyond his capacities. For one Hindu son deprived
in his early life, death moved him forward precociously to maturity, while
for the other more indulged child, death of his father created a regressive
disintegration of overwhelming anxiety. The more precariously the mother
is positioned within the extended family the more likely that the son will
feel her need to possess or rely on his affections, which some posit as the
normal “oedipal triumph” of the Indian son. If he is blessed with the bal-
ance of the intra-generational extended family, undisrupted by premature
death of key male figures, there are continuous mediating and containing
aspects of his object relations vicissitudes to promote resilience. In addi-

tion, parental duties toward older generations consolidate mutuality and
balance the intensity of the son-mother bond. Sons never have to separate
so clearly from their parents as daughters do when the marital commitment
is made (Guzder and Krishna, 1991; Roy, 1992).
Kakar (1988, 1989) has commented on his clinical analytic experiences in
Indian context, that the Indian male has a more fluid and flexible cross-gen-
der identification, fostered by the cultural specific developmental and mythic
paradigms. The clear hierarchical entitlement of the patriarchy actively
consolidates his masculine identity as he identifies with paternal authority.
However, the parallel identification of obedience to his father reinforces a
feminine identification with his maternal unconscious identity. The vulner-
ability of the male child to fears of engulfment within the feminine sphere
of influence may be resisted by denigration of feminine attributes and later
restraint in spousal relationships. In the case examples, all three of these sons
found intimacy problematic and feminine engulfment as well as counter-
phobic homosexual identity became issues, with the deaths of their fathers
playing a significant role. The subtle agendas of maintaining multiple at-
tachments, and building on lifelong interdependent parental bonds for sons,
fulfills generational filial duties (having a son maintains the legacy of blood
lines), and promotes separation-individuation agendas markedly different
from Western or North American norms. Though shifts toward an ascetic
life were a solution for some of these boys, who had no father, the Hindu
culture often normalizes the moksha (release to spiritual aims) and the Judaic
tradition organizes ritual boundaries of male and female spaces to protect the
ascetism of spiritual spaces from familial attachments.
Both Obeysekere (1990) and Kakar (1989) have discussed the symbol-
ism inherent in Hindu mythologies. The ego-ideal of Lord Shiva with his
sons in Indian mythology, with the more idealized Ganesh (the ascetic,
devoted spiritual son especially close to his mother, Parvati) and his other
son, the virile “phallic” son, Kartikeya or Skanda (the warrior, hero, and
adventurer), are symbolic of two masculine identification pathways. The
alternate possibilities of either masculinity lend less or more weight to the
integration of feminine identity of the Hindu male. In Judaism, however,
the male child is ritually marked by circumcision at birth and the progres-
sions of masculine identity tend to move to nuclear family units within
the collective setting though intense maternal-filial bonding may remain
operative. The impact of the death of the father must be considered within
the unique systemic, cultural, and object relations narrative of each child
and family.
58 Jaswant Guzder
To Be Shiva or Captain Picard? A Clinical Vignette

Kumar was a small, dark, thin, very anxious nine-year-old Hindu Brahmin
boy who was progressively school-phobic and on the first anniversary of
his father’s collapse into a disintegrating anxiety state. He had migrated to
Canada with his widowed mother, who was a postgraduate fellow, and his
precociously mature, attractive twelve-year-old sister, Anuradhe. Kumar’s
father had had a long history of bipolar psychosis and addictions, dying in
a coma after a cardiac arrest related to his possibly accidental overdose. His
mother had been blamed for the father’s death and psychotic illness by his
extended family and had decided precipitously to migrate, escaping from a
very difficult situation as a widow following the death rituals. The eldest son
plays a crucial role in such rituals and Kumar had been present but had not
lit the funeral pyre as he was yet a child. While the intense death rituals last
for twelve days, the widow remains in ritual mourning for at least a year and
the son also participates in yearly mourning offerings for his father’s death
anniversaries similar to Judaic customs of memory and ritual grieving.
Kumar had been referred from a children’s hospital emergency room, pre-
senting with a post-migration history of phobias, tantrums, nightmares, en-
uresis, suicide threats, overanxious behaviors, and school problems, refusing
to return to school when a substitute teacher had appeared in his class. He
had had a good bond with his regular teacher who had “disappeared” for fam-
ily reasons. He felt angry with his mother for “punishing him” by sending him
to school, for migrating and causing him to lose his father. He had overheard
his paternal grandparents accusing her of implicit murder and had begun to
accuse her of “killing my father.” He had many dreams of reuniting with his
father, and also had fears that he would die imminently as his father had died
(mimicked by his panic symptoms of chest pain and shortness of breath).
He had wondered, prior to leaving India, if he should become a Christian in
order not to be like his deceased father. When we met, he insisted I call him
by his “new name”—John. Both children spoke of their distress in losing the
familiar comforts of their Indian extended family, servants, and friends, to
be transplanted into a small flat with a working single mother in the deep
freeze of Canadian winter. In school, Kumar was particularly phobic of his
French class and gym, which he found “too different” from his Indian experi-
ence. He secluded himself at home into a regime of Star Trek programs and
videogames. His phantasy life allowed him to transform himself from John to
Captain Jean-Luc Picard, who seemed invulnerable. As Captain Picard, he
could handle alien races and “shoot others with gizmos into outer space.” He
repressed conscious memories of his father, who appeared in his dreams “to
come and get me,” while consciously he could barely recollect his father’s face
or voice and denied remembering any of the trauma of the death or funeral.
At other times, he was concerned in the dark that his father’s ghost might
possess his body: “Uppa is inside me.” He related that dream after a visit to
the seashore with his mother and family. He had been concerned that his
mother wanted him to die and would let him be killed by the tide that was
approaching the shore or would bring him on an airplane so that he would
die “in a crash.” These fears appeared to be connected to traumatic scenes
after his father’s death when the family had been abusive to his mother and
he had felt overwhelmed, dreading the flight out of India which was also his
longed-for escape home.
The boy was referred with his mother, as the consultant in the emergency
found her cultural premises against remarriage as a widow and her orthodox
Hindu culture alien and “untreatable.” He commented that “the women
appeared to do better in this family than men.” Kumar’s mother was in fact
highly educated and had been a student in America before her arranged mar-
riage. She felt interpreted by the consultant as “primitive or crazy” for her
cultural beliefs and had been very concerned to have treatment for Kumar
as he regressed significantly. She had requested individual therapy which
had not been offered to her, though hospitalization for Kumar had been sug-
gested.
When seen alone during our initial consultation visit, Kumar progres-
sively shifted from fearful and anxious to enraged with his mother. “I hate it
here . . . I want to go home . . . This was her idea.” He was openly abusive to
his mother, at times hitting her or vandalizing property during tantrums at
home which in part seemed to be triggered by his overwhelming separation
anxiety. At the same time, he was terrified of aggression in peers, particu-
larly of male peers and those who he saw as “bullies” at school, sometimes
running away from school to come home and watch television alone. When
asked how he might magically set his life right, he replied: “First, I want all
the toys in the world; second, I want to be Lord Shiva (Lord of Death) and
to be King of the world, so I could destroy whoever I want to; and third, like
Lord Shiva, I would rule the world and live on the Starship Enterprise and
think Big in life like Captain Picard.” He spent much of his sessions draw-
ing starships which fired rockets and avoided danger. His working-through
was focused on deciphering death and destructive forces, avoiding alien cul-
tures, and seeking new worlds where he could remain in charge or be utterly
indulged as a prince. He shared his loneliness for India while in this new
cultural space, speaking of his drawings: “This is as lonely as a ghost might
feel on an alien planet.”
60 Jaswant Guzder
When we explored his father’s death after his long psychotic and violent
episodic outbursts, he shared, “I am not sure if I wanted my father to die or
not.” He harbored fears of his father’s temper and had clearly had some death
wishes toward him. He was angry that no one listened to him when he had
earlier spoken of wanting to die: “I told my teacher and she just looked at
me and didn’t say anything.” When he was angry with his mother for setting
limits with him, he often resorted to suicide threats to manipulate her but
“I don’t really want to die. I want to go home.” His anxiety was debilitating,
school refusal was a significant issue, and his mother did not want him to be
hospitalized. We continued individually and in family sessions, using some
antidepressant medication for a few months in view of his inability to sleep
or manage his phobic anxiety and aggression. Kumar progressively improved
until his significant regression after an episode of bullying which reactivated
his school refusal for a short time. His mother also was seen for some sessions
individually as she worked through her grief and anguish, sharing a complex
marital history and her ambivalence about returning to a traditional social
setting. She tried to decide whether to return to India or migrate to the
United States where there would be options for her autonomy.
Kumar’s sister, Anuradha, also shared her concerns about remaining
outside of India. She brought to a session a paper she had written with a
surprisingly mature analysis of post-modern Indian women writers based on
novels that her mother had bought for her. She voiced her concern that
she might “change too much here” and “never fit back into Indian spaces
or friendships if they stayed too long,” which may have been her dread of
following in her mother’s identity path. She had seen her father’s violence
toward her mother and had ambivalent feelings about his death. She felt
she did not want to uncover these feelings especially as she felt that her
role was the main support of her mother in Canada, and the situation was
too threatening, with Kumar “falling apart” already. She later confided in
her mother that she had created a false story at school that her father was
still alive in India waiting for them so that she would not need to discuss his
death with her Canadian peers.
Kumar improved but remained fragile. He was adamant that he wanted
to return to his maternal grandparents who lived in another Indian city
distant from the paternal relations and the memories of his father. When
his school refusal improved, his anxiety shifted to passive dependency and
oppositional behavior as those initial symptoms remitted. Eventually his
mother decided to return to India with her children and decided to send
Kumar ahead alone by plane. After many tantrums and accusations that she
had arranged to shoot down the plane, he agreed to go. He arrived safely
and appeared to adapt well into a school close to his maternal grandparents’
home. His mother continued in sessions with me to work through her grief
and the complex traumas of her marital life. She wrote later that the return
to India had settled Kumar and that she felt she had made the right choice
for her children.
Identifying with Ramakrishna: Another Clinical Vignette

A ten-year-old Hindu boy, Anil, who spoke Gujarati, French, and English,
was brought by his South Asian social worker along with his Gujarati-speak-
ing schizophrenic mother. His father had disappeared, and apparently died,
early in the boy’s life. He knew very little about his father who was Hindu,
but had not married his mother, abandoning her before his death when she
was psychotic, pregnant, and alone. His social worker was retiring after fol-
lowing the mother-son dyad for many years without placing the son. She felt
Anil was doing well in school, showing intelligence and maturity beyond
his years. However, she was concerned about his withdrawal and felt that he
should be seen individually (“I am handing over this child to you”), since his
father had died and his mother was clearly a fragile paranoid schizophrenic.
Anil was a handsome, shy, withdrawn child who was virtually “invisible”
in his francophone elementary school, where no one was aware of his home
predicament nor his cultural differences from his peers. He had actually de-
veloped a peer network of support and was engaged in sports. This supportive
connection with his male peers in sports was a continuing bond well into his
twenties with the same group. His maternal grandparents in Gujarat were
his psychological parents and intermittently had visited him. He had been
sent to them as an infant and recalled his terror at age four being met at the
airport by “this strange woman—my mother.”
Despite their distant home, the grandparent attachment was a strong
bond. They had stayed involved mainly by brief visits, phone calls, and let-
ters. Their abiding religious faith and rituals of prayers, their karmic belief
system and their devotion to their Guru Ramakrishna, had been his strong
identity links with them. From a young age, they had delegated to him the
role of caretaker of his fragile mother who was too ill to work and managed
on a welfare subsidy. This predicament was a burden, an identity, and yet also
reinforced his positive self-identity while negating paternal identification
as his father had abandoned his mother and died. They had often told him
his mission was to be a success; that would allow them in their later years
to migrate to Canada to be with him. However, both of them died before
realizing this plan while he was in his twenties. They had another psychotic
62 Jaswant Guzder
daughter who had remained in their natal village where the grandfather was
a retired post-office worker and they had a large network of relations. Two
other aunts had migrated after marriage to Australia and Europe, though they
offered Anil no support or resources.
At age ten Anil would come to sessions on his own, as his mother unfor-
tunately felt threatened by his relationship with me. He would arrange to
come without her knowing. At times if I would call to change a time over
the many years we worked together, his mother would alternately be friendly
or slam down the phone, always refusing to convey a message. While Anil
welcomed the opportunity to come for sessions, which continued into his
early twenties, the absence of his deceased father and his unavailable mater-
nal grandfather led me to suggest a male mentor when he was aged twelve.
Unfortunately, his mother developed a delusional erotic transference to this
male mentor who then also had to meet Anil secretly.
During our sessions together, Anil would often sit by the door. He would
sometimes miss sessions but would always leave a message. At times when
he discussed his loneliness or the rage that he felt toward his mother as he
entered adolescence, he would begin speaking and then would fall asleep in
the session briefly. Other times he would ask to leave the session early but he
was intent on maintaining the continuity of our contact. There were inter-
mittent crises or turning points in our work together, particularly when his
grandfather died when he was in his early twenties. This event revived issues
of his father’s death, leaving him feeling lonely. At some point, he reframed
this to feel that a present father might be an oppressive force like his mother.
His mother’s delusional and agitated periods filled him with a mixture of
concern, rage, avoidance, and fear. He would at times avoid coming home
and seemed to stay out late at sports events, though somehow managing to
do well at school. When he was aged fourteen, his mother decided to go to
India alone as she was considering living with her parents. He was put in
foster placement with a French family, which raised many issues for him.
He was suddenly aware of how much of his childhood had been lonely and
neglected, as he largely fulfilled the instrumental tasks of procuring groceries,
doing the banking, and managing for his mother. He was not used to having
caretakers and felt if his mother did not return soon, he was not sure that
he could tolerate his old caretaker role and would “want to stay forever.” He
felt his loyalty to his grandparents committed him to his role as father and
mother to his ill parent.
At age seventeen, he took up a community volunteer job and in his
therapy he had identified with my role, considering following a career in
mental health work. As he began to work with youth, some of them confided
in him, including a young boy who had been sexually molested by an older
man. This filled him with panic and repressed memories of an earlier similar
episode in his life emerged. Working through this episode was difficult. It
revived memories of his lost father, forced him to reconsider his fragile capac-
ity for closeness and distance and his overburdened role with his parent. His
rage toward his mother began to emerge, suppressed largely by his guilt and
efforts to identify with the strong code of containment and asceticism set by
his grandparents. He felt that the homosexual assault opened up catastrophic
anxiety. He also worked at differentiating from his mother’s psychotic iden-
tity, his fear of being like her or becoming psychotic.
At age twenty-one he had a disappointment with a girlfriend and felt
deeply betrayed. He appeared to move to Internet romances after that inci-
dent. He was unable to study and left the university, though he got a stable
income from a hospital job, continuing in sports as his alternative activity.
He began to withdraw socially and attended less often; somatic symptoms be-
came a concern. We began to deal with his inability to live with his mother,
his guilt and his rage at her intrusive dependency. He began to fear that he
could harm her or hit her. Eventually he was able to speak about his need to
split off his feelings about me, when I had spoken of his mother’s illness. He
had promised his maternal grandparents that he would remain a devotee of
Ramakrishna, and that there “was no such thing as schizophrenia.” Accord-
ing to his grandparents, he must do his puja (ritual prayers) every day, say his
mantras, and his mother would become well. We spoke at length about his
beliefs and his need not to believe my “western views” on schizophrenia “in
order to survive our relationship” with a fear that his real feelings would be
seen as “crazy.” He had also voiced his comfort with several Indian objects in
my office, that had become familiar. We spoke at length about the life of Ra-
makrishna (Mumukshananda, 2002) who many thought was a great mystic
while others considered a psychotic saint (Kakar, 1991). Ramakrishna often
immersed himself in the Mother Goddess Kali, appearing to see her and hear
her (just as Anil’s mother spoke to the refrigerator and answered voices).
Over a period of years, he was able to release himself from his guilt and
eventually placed his mother in a foster home. This was very difficult for
him and he was aware of his death wishes toward her at the same time as his
guilt. The absence of his father brought up a great gap of loneliness for him.
He also began to consider marriage as an untenable option. He did go back
to India in his midtwenties when his grandfather died, and his grandmother
had wanted him to accept an arranged marriage, but he decided he could
not tolerate the responsibility of looking after another woman in his life nor
could he agree to his grandparents’ plan to burden a young wife with looking
64 Jaswant Guzder
after his mother. He had organized meaning around karmic principles and
felt that his life was sustained by his religious rites that he had learned from
his grandparents. He had also shared that seeing a picture of Vishnu and
Shiva in my office had been important for him as it sustained another level
of his split transference with me as part Canadian and part Indian mother for
him. His negative identification with his deceased father continued to be an
underlying issue in his identity struggle and his stabilization of a meaningful
identity appeared to settle into a positive negotiation between his duty to his
mother and entitlement of a life for himself.
Batman Returns: The Final Clinical Vignette

A ten-year-old adopted observant Jewish boy, Jacob, witnessed the sudden
unexpected death of his father then forty years old, while home alone with
him. He had an especially close camaraderie with his active father and
shared with him a world of sports and comic book heroes. He was referred
for individual therapy by a family therapist who found him overanxious, with
episodic rage episodes. He continued in individual sessions until his early
twenties with an extended grief process, a sense of a void of “endless blank-
ness” and negotiation of his identification with his father. He later pursued
a successful career by his early twenties but avoided any committed relation-
ships, then returned in his late twenties when his anxiety re-emerged with
obsessional thoughts that he might be homosexual or on the verge of death.
The return to therapy in his late twenties was also triggered by positive feel-
ings for his infant niece, whose birth had fostered his first thoughts of having
his own family and an immediate fear of his death.
For several years from age ten to thirteen he attended family therapy with
his mother and a younger adopted sister. He usually was wrapped in a large
coat and would remain silent in the group family sessions. He remained mod-
erately obese until his late teens when he became more confident, sexually
active with multiple partners, and athletic. Though his mother later remar-
ried, he remained in her home, saying they would only be separated by death
as he was her guardian.
He relinquished all interest in Judaism from the time of his Bar Mitz-
vah, when the absence of his father, a crucial gap in the ritual moments,
filled him with rage and despair. He was an articulate, intelligent young
man with a lively imagination and engaging philosophical interest in death
and creative endeavors. Comic book heroes, First Nations stories, and Rus-
sian novels of Tolstoy’s era were significant in many of his metaphors and
identity struggles. He felt estranged from Jewish culture and from his “time
and place.” He could not bring himself to leave his mother yet longed to
“disappear into some distant remote island covered with snow and lacking
machines or technologies.”
Initially he was preoccupied centrally with his lost father who remained
the central focus of his sense of despair. He maintained a deeply denigrating
and negative relationship with the referring female family therapist after she
had forced his hospitalization at age thirteen for possible psychosis. At that
time he was increasingly oppositional at home, working through his terrible
anguish that his father could not be there for his Bar Mitzvah, and had bro-
ken down a door at home in his rage. He replaced the door with cellophane
that allowed his mother to look in on him at all times. He was inconsolable
in his grief for his absent father and enraged that God would take his father
so unjustly: “what kind of God would do this terrible thing to me.” In his
rage at God, he renounced his Judaism at that time and became an atheist.
This hospitalization event had been deeply traumatic as he was placed in
an adult psychiatric setting amongst psychotic adult men, feeling helpless
and unprotected. Prior to this hospitalization he had had a rather symbiotic
relationship with his anxious and overprotective mother. The hospitalization
was experienced as another forced trauma reinforcing the helplessness expe-
rienced as he had held his father dying in his arms, yet also reinforced his
capacity to survive without her protection. I had arranged his rapid release
from the hospital and he was never treated with medications, though over
the early years of treatment there had been a somewhat hypomanic quality
to some periods of his distress, alternating with depressive periods. He was
always highly functional. He experienced the admission as a wound to his
integrity and an empathic gap or void. He often voiced his fear that no one
would be able to comprehend this gap, contain his anguish, or withstand his
affective distress and often found this void or gap represented in the comics
he read where heroes died, retreated into the gap, and were often revived or
reborn. He regularly attended his sessions for many years but displaced his
acting out to school attendance until age sixteen when he settled into hard
work. He had in fact been dismissed from several schools, eventually graduat-
ing with honors and finishing a honors university degree.
Throughout his treatment he maintained a highly respectful idealizing
transference and constructed me as an Asian mother who was an option to
his engulfing anxious Jewish mother. He maintained that he had no interest
in finding his birth mother and worked through various phantasies about her
abandonment of her child at birth. He maintained a somewhat symbiotic,
alternately denigrating and enmeshed relationship with his mother. Though
he felt he was left as her guardian on the death of his father, he also felt that
66 Jaswant Guzder
maturation might lead him to renegotiate this internal contract with his fa-
ther. He felt uneasily that his stepfather was “inadequate to care for anyone,”
so he felt he could not leave his mother once she remarried in his late teens.
He maintained an idealized relationship with his deceased adopted father,
which was a counterpoint to his transference in the therapy. On death an-
niversaries for many years he experienced intense grief reactions.
In his therapy process, he spent initial years enraged at or despairing in
the death of his father. From the time of his Bar Mitzvah, which was a crucial
ritual moment for his identity formation, he began to show refusal to attend
school and other oppositional behaviors, defying all institutional controls or
limits. While he alternately idealized his adopted mother for rescuing him
from his biological mother, he denigrated her as she could not replace his
adopted father. He adamantly refused affiliation with Judaism but also felt
deeply identified with the threat of anti-semitic anguishing that “they will
come to us and take us away someday, there is so much hate out there for
Jews.” By maintaining a marginal autonomous curriculum, he was able to
complete schooling with little affiliation with teachers, particularly avoid-
ing male teachers. His closest male peers were often acting-out adolescents
though he himself never engaged directly in antisocial or substance abuse
behaviors; he would enjoy “joy rides” with them into his late teens, then later
moved into affiliations with artists. At age seventeen, he was shattered by
his school’s misinterpreting an idealized relationship with a female teacher
as sexually inappropriate. Though deeply wounded by this accusation, he was
unable to move from his position as her guardian and unrequited love.
Later, in university, he had done very well but refused scholarships for
further studies. He engaged in multiple sexual encounters but avoided any
close engagements with women as partners, implicating women as scheming,
possessive, and intrusive as he depicted the dark side of his family women. Of-
ten he alternated with periods of Buddhist asceticism or withdrawal from all
intimacy. His idealized woman remained a Chinese martial arts heroine, who
could kill anyone who would approach her in the event that he could not be
there to guard her, and whose face would be inscrutable and beautiful.
On return to therapy some years later, after the birth of his sibling’s child,
he felt overwhelmed by his affection for the baby, triggering death anxiety
(for her and himself) as well as a growing apprehension that he might be ho-
mosexual. These anxieties seemed connected with this new vulnerability and
openness to loving the child or reconsidering his own strivings for intimacy,
a partner or home of his own. He returned to his earlier themes from age ten
which focused on his early identifications with Batman who had watched his
parents die in front of him and then battled to be the protector or guardian.
He reviewed these preoccupations and defenses against his vulnerabilities

and desire for the risk of intimacy, recognizing the frozen reaction to his
initial trauma on losing his beloved father. The relinquishing of his dead
father as his central love object to give space for other creative endeavors
or investment of his libido became a reworking of his death anxiety and his
identification with his dead father.
Discussion
These three young boys each experienced death in early life of their fathers
as well as progressive anxieties connected with their maternal objects. The
absence of their fathers complicated the differentiation from their maternal
objects creating problematic, anxious ambivalences as well as over-identifi-
cations. The complicated grief of their early losses of the significant parent of
the same sex continued to pervade their emotional life. The anxiety of death
was mirrored in their processing of identifications, impeding intimacy; it was
evident in their therapeutic struggles to varying degrees.
In addition the cultural framework and family systems issue of single-
mother-son dyads was a complication that left few alternate transforming
objects to facilitate differentiation. The loss of cultural rituals and supports
also fell away with the disorganization of the family system after loss of the
fathers, complicated by migration, dislocation, psychotic parenting, and
parental overanxious responses. A discourse with death and its shadow con-
tinued to fall across the lives of these young men, though I have no follow-up
of the young boy who left for India.
The catastrophic anxieties in each of these young lives varied with their
traumatic narratives. The boy who wished to be Shiva was merged with
this father internally. He feared he was possessed by his father’s ghost and
feared the murderous phantasized power of his mother’s Kali-like destructive
capacity. In fact, his mother was cast in this demonic role by his father and
his father’s family. Anil, in contrast, identified with the Guru Ramakrishna
through the instruction of his maternal grandfather. Ramakrishna had iden-
tified with the Goddess Kali, or Durga—feminine merger identification,
while Anil lived with a Kali-like mother, a psychotic, unboundaried mother
who threatened to engulf him at home. The reframing of split Kali images,
one that can contain her energy to offer benedictions and the other part
who can unleash her destructiveness, was perilously close to his actual object
relationship situation with a psychotic mother.
In each case the therapeutic work involved the efforts of each child to sta-
bilize and internalize his absent father (Gill, 1991), a process that normally
68 Jaswant Guzder
proceeds through incorporation (phantasy of ingesting an external object

without assimilating the object into pre-existing structures), introjection
(taking over the functions of an external object without assimilating the ob-
ject by its mental representation inside the subject’s self), and identification
(internal organization and synthesis involving conscious and unconscious
phantasies of being or becoming like the other person). The level of dif-
ferentiation from their primary maternal objects, the quality of the parental
relationship and constitutional endowment, all contributed to stabilization
of the father’s internalization.
Kumar was an anxious child who possibly had many previous cumulative
traumas given his father’s erratic behavior and witnessing violence in the
marital relationship. He appeared to have significant anxiety as his psyche
was pervaded by the phantasies of the threatening ghost of his father as
well as the homicidal threat of his mother. Embodiment of identification
issues with the dead father was paramount. These anxieties constantly broke
through and overwhelmed him with catastrophic moments acted out in his
school phobias, flight-and-fight responses to internal signals, with a limited
capacity to sublimate in usual latency activities.
In both traditional Jewish and Indian paradigms, the gendered hierarchies
are clear. Family structure supports and ritualizes the gradual shift of the male
child from the close maternal affiliation to the company of the male collec-
tive. In some of these clinical processes, the fusion with parental objects was
problematic due to traumatic events early in childhood, collapse or loss of
ritual spaces and markers, as well as loss of extended family supports which
could have provided the nurturing and containment of the alternate family
objects. The clinical interventions in all these cases involved parental treat-
ment as well as individual involvement since the holding function of the
parents was impaired in all these subjects. Disavowal of hatred or fear of the
dead father or the psychotic mother was another aspect of the process which
progressed with therapeutic work.
In shifts from traditional societal options with migrations there may be gains
and losses in facilitating children’s development. It would seem that Kumar
and his sibling worried about their mother shifting too far from the stabilizing
identifications of her parents’ generation. Perhaps the boy’s fears that she could
harm him related to both the traumatic enactments of the family as well as
his discomfort with a paradigm shift in his mother from the maternal pativrata
(“good wife”) to the unrecognizable autonomy of her single-parent identity
which may have seemed uncontained for him. His sister also voiced her fear
that identifying with the Western peer group might leave her far from the
matrix of her father’s world, a further rupture beyond his death.
Each of these narratives of encountering death in the early life of these

boys has intra-psychic, familial, and cultural components that remain tran-
sitional issues in their identity consolidation. The psychotherapeutic agenda
was then set in a complex interaction of an internal, familial, systemic,
and culture stage that presented obstacles or facilitations for the grief work.
Cultural metaphors were rich in meaning and mystery and invaluable as ele-
ments of this process.
CHAPTER FIVE
It Is Not Over When It’s Over

Reflections on Death and Mourning
Albert Kaplan, MD
Dr. Jaswant Guzder has offered us much to ponder and appreciate in her
rich, humane, and stirring contribution. She has been able to provide the
boys with such invaluable aid over twenty years and constructed hefty cables
for our much frayed societal safety net that desperately needs so much more
fortification.
Let me apologize now for what I fear will be my lament—we have desper-
ate need of a genius to synthesize the reams of often fascinating clinical and
experimental data. We have been enriched by so many scientific, artistic,
humanistic disciplines that work overtime to chart and understand the conti-
nents of early human development. If only a crusade on the nature of the hu-
man genome, the man on the moon, or the war on cancer could be launched
that would provide the way and resources to protect these children from the
damage of not good enough parenting and environment! Oops! I see I’ve
lapsed again seeking an “overarching theory that covers everything, but one
needs see what works best under what situations” (Goldberg, 2007).
These three lads were walloped so young and in so many ways. We tear
and shudder upon hearing a child must cope with adoption, death of a father,
immigration to a new land with a new culture, climate, language, absent
loving family, and an emotionally avalanched single parent. We attempt
to comprehend the impact of these skewers of development. How will the
71
72 Albert Kaplan
child meld their individual “vis a tergo” of development? How will he “turn
out”? How will the inevitable heightening of death issues be therapeutically
buffeted? What coping mechanisms will be fortified? Specifically, what will
be the impact of these breaches of their “average expectable environment”?
I will quote Dr. Guzder’s vivid, impacting, succinct language:
In addition, the cultural framework and family systems issue of single mother-
son dyads was a complication that left few alternate transforming objects to
facilitate differentiation. The loss of cultural rituals and supports also fell away
with the disorganization of the family system after the loss of the father, com-
plicated by migration, dislocation, psychotic parenting, and parental overanx-
ious responses. A discourse with death and its shadow continued to fall across the
lives of these young men. (emphasis added)
Unfortunately I am still at the learning stage of Imitation as I approach

the century-enriched language and symbolic world of Vishnu, Brahma, and
Shiva; of Kali and Durga and Ramakrishna; and of karma and reincarnation.
Though this Thomas Jefferson University lecture hall is very adequate, imag-
ine our advantages were we in a Hindu temple with its ambience of the art
and statuary of the centuries (and not the Bat Cave either).
Dr. Guzder cites the work of Dr. Harwant Gill on fatherlessness. The
processes of Internalization describes how our primary others influence us
so powerfully. Gill (1991) emphasizes Internalization includes Incorpora-
tion—the phantasy of ingesting an external object without assimilating the
object into preexisting structures; Introjection—taking over the functions
of an external object without assimilating the object by its mental repre-
sentations inside the subject’s self; and Identification—internal organiza-
tion and synthesis involving conscious and unconscious phantasies of be-
coming like the other person. Without the constant contacts with a living
dad, the process of internalization is bereft of the forces of reality molds his
idealized introject. The child’s oedipal constellation is now skewed toward
obtaining the mother and perhaps Jacob’s flair of symptoms including his
fears of becoming homosexual as an adult that prompted him to return to
therapy after the birth of his niece demonstrates latency-age fixations sud-
denly reopened.
Contrast the chances of these fatherless boys to the two-year-old Barack
Obama (1995), whose father suddenly disappeared to attend Harvard
graduate school (i.e., sudden for a two-year-old). Letters, phone calls, and
cards continued to flow along with his hearing his family speaking with
many modulated emotions likely displayed by his admiring yet deserted
mother who continued her studies of anthropology in Barack’s birthplace
It Is Not Over When It’s Over 73
of Hawaii, much supplemented by her parents who loved and lavished

upon their growing bright grandson. He benefited from continuity of the
culture he was enmeshed in. Grandfather continued to take him to his
haunts that included a bar where he heard an Afro-American poet, former
confrere of Langston Hughes, recite his poetry. A few years later mother
supplemented his school education, awakening him at 4:30 a.m. with
lessons in language, literature, and life and then there was whatever his
Indonesian stepfather imparted in banking, local customs, and ambition.
Peers and opportunities to explore a new apparently basically safe world
reigned. Then, the ten-year-old is a Punahou Junior High School student
in Hawaii; though Barry is dreading embarrassment and ridicule from the
scheduled visit of his proud Harvard PhD father’s appearing among his
classmates, dad wins the respect, applause, and admiration of his teacher
and peers as he exudes an infectious confidence, success, and pride while
describing his Kenyan world to them. Barry is able to pass a month with
his proud, English-speaking dad and to hear the retelling of his earlier
adventures in Waikiki. They continued to correspond the ten years pre-
ceding dad’s death in a Kenyan auto accident. (I don’t know when he
returned to being Barack again.)
These are some of the thoughts that stream through our consciousness as
we listen to this paper of the almost unmitigated environmental buffeting
of Kumar, Anil, and Jacob. What damages did each child’s psyche sustain?
At the Mahler Symposium we are disposed to listen keenly to areas that
psychoanalytic methods have enlightened, and we are not disappointed.
Still, so much of the murky unknown persists. How does a latency-aged
ego, already confronted by adoption, parental psychosis, and drug abuse
now buffer the new climate, language, and aloneness of a new, cold cli-
mate, French-English speaking society; or—in the world of Jacob—of a
loved (previously healthy?) father who dies in his ten-year-old’s arms and
while he continues to be alone however long? How is he then embraced
and comforted? Did he attend the funeral? Did he begin individual psycho-
therapy then, or when he was imprisoned in that terrifying adult psychiat-
ric in-patient unit their family therapist committed him to and from which
Dr. Guzder was able to rescue him?
Many articles and books portray our work with father’s death and ab-
sence—the loss of that “first significant other” does skew that child’s world.
Mother’s world is different, so child’s world tilts and quakes. James Herzog’s
(2004) studies on father hunger emphasize most important consequences
stemming from father loss and a poem apparently most grade school German
children have memorized—Goethe’s “Erlkonig” that inspired the teenager
74 Albert Kaplan
Franz Schubert to compose this most haunting, stirring, opus-1, “Der Erlko-
nig,” to introduce Herzog’s book “Father Hunger”:
Who is riding so
late through dark and wind?
It is the father with his child.
He has the boy snug in his arms
He holds him safely; he keeps him warm.
“My son, why are you scared and hiding your face?”
“Father—can’t you see the Erlking, the Erlking
With crown and robe?”
“My son, it is a wisp of cloud.”
“You, darling child, come, go with me!

I will play the lovely games with you.
There are heaps of bright flowers on the shore,
My mother has lots of golden clothes.”
“Father, father, can’t you hear what the Erlking

Whispers and promises me?”
“Hush, don’t fret, my son, it is the wind
Rustling in the dry leaves.”
“Pretty boy, will you come with me?

My daughters shall look after you nicely,
Every night they will dance the round
And will rock and dance and sing you to sleep.”
“Oh father, oh father, can’t you see the Erlking’s

Daughter over there at that dismal place?”
“My son, my son I can see it plain;
It is the willows that gleam all gray.”
“I love you, your beautiful shape excites me,

And if you won’t come willingly, I will use force.”
“Father, father, now he’s taking hold of me!
He has hurt me, the Erlking has!”
The father is terrified, he rides fast,

He holds the groaning child in his arms
It is all he can do to reach the farm,
In his arms the child was dead.
I emphasize this poem for several reasons. I found one theme that can’t
be pursued, now expressed so poignantly in Schubert’s personal musical and
emotional growth from the seventeen-year-old’s anxiety, fear drenched Opus
1 of “Der Erlkonig” to the thirty-one-year-old dying genius who gave the
initial performance of his beautifully parsed last work, Piano Sonata in B-
flat D 960, just several weeks before the lurking death from syphilis he knew
was rapidly approaching. Schubert’s adolescent expressed his complex adult
spectrum of such nuances of cadence, volume and emotions.
The contributions from so many of the arts and sciences and so many
other human endeavors of our culture shine their own lights to help us elu-
cidate a gap: a potential space we know exists for all. This is the continent
that has been proving itself to be far richer and far more difficult to explore
and integrate into our cultures than even Columbus’s. Who can know what
practical, pleasurable, humane silver, gold, tomatoes, and corn riches await
our discoveries in this hemisphere of loneliness, the stages of consciousness,
the uniqueness of the emotions and shores of each child’s personal immature
grief? Dr. Donald Winnicott’s powerfully expressed poetic psychoanalytic
papers in the International Journal of Psychoanalysis—transitional objects and
phenomena (1953) and the location of cultural experience (1967) delineate
this ubiquitous, developmentally crucial potential space we need to plumb,
value, develop, and comprehend. Dr. Winnicott allows us to appreciate how
we are inclined to be so limited in our ability to appreciate, empathize, and
value these transitional boundaries which we must penetrate and live in to
better appreciate the powerful cauldron of magic, of creation, of play and
symbolization. Only then will we be able to forge that better comprehension
of this yet mysterious ether all of us harbor. The early-nineteenth-century
Romantic poet Schiller was prescient when he declared, “Man is most
authentically himself when at play.” We are likely in an area with many re-
semblances to physics before Galileo, Newton, atomic theory, relativity, and
quantum mechanics. Our guides have included Sigmund and Anna Freud,
Melanie Klein, John Bowlby, Bion, both Margaret and Gustave Mahler,
Winnicott, Spitz, Stern, Ogden, Fonegy, Main. We hope our endeavors
won’t run up against a postmodern condition where there will be many dif-
ferent requirements for the many situations we work with in our everyday
clinical practices that outsiders to our various disciplines will often view us
as repeating the state of time of the tower of Babel. Let us be blessed with
our Newtons, Maxwells, Rutherfords, Curies, Einsteins, Paulis, Plancks,
Heisenbergs, and Bohrs, who can synthesize the findings of all our allied
disciplines—art, music, poetry, literature, linguistics, anthropology, sociol-
ogy, neurobiology, psychoanalysis, and all the numerous fields of psychology,
76 Albert Kaplan
and on and on to make vivid the transitional spaces that Winnicott shone
his genius upon. But we lack satellite space telescopes and superconducting
supercolliders. Will PET scans and MRIs pave a path? Dr. Guzder has my
thanks for so much, but especially her employment of the linguistic term
creolization which she shows us is employed in transcultural psychiatry to
meld much. She gifts us a familiar and expandable word that leads us to a
progression occurring to our language facilities when immigrants bring their
language and cultures to a foreign shore. But the two languages that will
create a creole have time and sufficient support to create a third language
for the next generations after containing sufficient speakers and conditions
to form and grow that new language enriched by both (and whatever would
happen in Quebec where French is the major language but English is another
presence?). I fear at least our Indian lads would be in the earliest phases of
pidgin culture when they so desperately require creole. They seem so adrift
and alone. Dr. Guzder writes:
Literacy and visual imagery open various doors to translating these mythic
underpinnings and certainly shaped the inner world of the children presented
here.
In addition our understanding of variations in cultural emphasis has evolved
with an appreciation of the creolization of cultural metaphors and metaphor in
the migrant multicultural setting of North America.
I don’t fear being branded a snob when I can’t just accept the contribu-
tions of comics and TV and superheroes and Star Trek as but approaching the
richness and symbolization potential and depth of the Vedas, the Torah, and
the Native American Indian culture that could furnish the epigraphs that
crown this rich paper. Sure Captain Picard provided a string in Dr. Guzder’s
skilled hands to attach Kumar to a therapeutic process allowing him to forge
a stronger alliance to Dr. Guzder and then a stronger transference could
ensue that rooted and grew for at least two decades and permitted psychic
development and mourning to proceed for Kumar. Captain Picard helped
Kumar withstand “alien races and shoot others with gizmos into outer space
and people his dreams.” The boys could seize the metaphors provided in our
media, comics, video games and movies to become competent men, a mag-
nificent achievement. We lust to know how Kumar continued this creative
symbolic growth when he returned to India, the birthland of Shiva, to live
with his mother’s family and be touched by new opportunities for psychologi-
cal growth. We all know the power of touch, but its multifaceted significance
is evident by the fact that the Random House Dictionary of the English Lan-
guage (1987) lists sixty-four meanings of the word. Then I was surprised to
discover that the championship of polysemy—ninety-four meanings—must

go to PLAY, something I will soon speculate upon. Dr. Guzder writes that
Kumar’s ability to mourn sufficiently in his therapy that
his father could now “come and get me,” while consciously he could barely
recollect his father’s face or voice and denied remembering any of the trauma
of the death or funeral. At other times he was concerned in the dark that his
father’s ghost might possess his body. “Uppa is inside me.”
The word “ghost” provides a creative linguistic tool for mankind to wan-
der into that crucial potential transitional space that Winnicott stresses.
Our minds are stimulated to comprehend those massive, dramatic changes
while confronting those dramatic, ubiquitous physical and psychological
changes following death. What happens then to the body? Many (all?)
cultures coin words such as soul, spirit, specter, and ghost. Since the de-
ceased clearly continues to influence us in our thoughts, our body postures,
and dreams, we know there exists what is perceived as a continuous space
often blending into another world whether the deceased has been buried
or cremated or incinerated. Dr. Hoffman spoke about three- and four-year-
olds chatting about death, but recall your first and subsequent responses to
Hamlet and his father’s ghost in the first act of Shakespeare’s singular play.
Could the Elizabethans be in the midst of what could prove to be a fatal
error in tripping too casually in this heated religious dispute between the
Catholics purgatory and the new Protestant sects (485 Garber) which had
a couple of decades before banished this space above heaven. Reincarna-
tion has a formal status in Hindu and Buddhist teachings and a human
psychological need continues an area of ambiguity for various reasons, but
we gain stimulus for our introspection to employ whatever probe possible
to synthesize a satisfactory understanding. Our vivid memories of the dead
demand our attention.
Since we often keep open our concepts of death even for decades, espe-
cially in a culture that fears death and is mandated to defeat it in a hospital
rather than accept a witnessed gradual death at home with loved ones ob-
serving and attempting to comfort the dying and the dying speaking to the
family who often place extra value on their last words that are often held to
have a heightened truth value and a world where our children at least can
be a party to the day-by-day process when many unusual mental processes
have a heightened chance of occurring. They can observe their families’
statements, discussions, arguments, bargaining, and acceptance, easing their
ability to meaningfully memorize Dr. Kubler Ross’s stages of dying. And they
do wish to be included.
78 Albert Kaplan
An adult psychoanalytic patient linked “The Wound of Mortality” with

castration after uncovering his repression of having been informed of his be-
loved uncle’s death. He recalled awakening to an urgent ringing of the bell
and pounding on their door at 4 a.m. To comply with religious prescriptions,
an immediate funeral ensued which he could have attended. But instead
he returned to sleep so he could take a college exam later that day. In later
decades he often angrily blamed his family for not telling him or including
him, for abandoning him and without acknowledging his own defensive
behaviors. Upon the sudden death at age seventy of Philadelphia Phillies
baseball Hall of Fame star and then-radio announcer Richie Ashburn, he
dreamed of his large tree falling upon his fence and his having to use an
inadequate hacksaw to cut it up. His associations substituted chain saw for
hacksaw and asserted that hacksaws are used to cut up body parts like legs
and shoulders. And suddenly he loudly denounced his almost lifelong adula-
tion of Babe Ruth: he was a drunk and a cheat! He pictured a small black
hole as his voice faded into a depressed tone to flare into defiant anger again
as he was disinheriting his much loved non-dating thirty-year-old daughter
who is denying him the grandson who will then render him eternal—from
castration to defense via dwelling on death and its inevitable and frightening
accompanying emotions.
Now return to Dr. Guzder’s nine-year-old boys. Opportunities for the
incorporation, introjection, and identification with loved adults are com-
promised by their developmental age, their at least relatively unsupported,
distraught mothers, interfamily conflicts, and soon immigration and all the,
at best, accompanying unfamiliarity of starting anew in this strange land with
new customs, mores, bureaucracies added to these other included factors.
I was going to ask Dr. Guzder originally a series of questions to establish
various sequences and details of her patients and their therapy so I could
construct a more complete narrative. But I began to realize these children’s
incomplete scattered narratives reproduced their most discontinuous lives.
Perhaps we can better empathize with their chaotic states. We have many of
the crucial facts—death, wounds of mortality disrupting parents, disintegrat-
ing families, children transported to lonely new worlds, defenses and desper-
ate behaviors mobilized, attempts to utilize less costly, sturdier processes and,
as conditions unpredictably permitted, mourning—the means to move ahead
into development and the river of life.
CHAPTER SIX
Fear of Death
Analyst and Patient in the Same Boat
Ilany Kogan, MA
In the Judeo-Christian Western world, death essentially represents a power

over which we have no control, a giant in whose grip we are weak, whose
coming may be swift, but whose summons must be obeyed. Death is invisible,
intangible, and therefore of a quality so unknown that it is terrifying, like
the feeling of complete helplessness experienced in a confrontation with a
mighty, unvanquishable foe.
In his book, Staring at the Sun: Overcoming the Terror of Death, Yalom
(2008) writes that our mortality has haunted us since the beginning of his-
tory. As an example, he brings the Babylonian hero Gilgamesh, who, four
thousand years ago, reflected on the death of his friend Enkidu, saying, “Thou
hast become dark and cannot hear me. When I die shall I not be like Enkidu?
Sorrow enters my heart. I am afraid of death.” Gilgamesh, says Yalom, speaks
for all of us. As he feared death, so do we all—each and every man, woman,
and child. Since our existence is forever shadowed by the knowledge that
we will grow, blossom, and inevitably die, we may find ourselves wounded
by our mortality.
In ancient times, classical Greek philosophy dealt with the place of death
in human life. Epicurus (341–270 BCE), in particular, wrote about this
subject, stating that at the root of human misery is our omnipresent fear of
death. The frightening vision of inevitable death leaves no pleasure undis-
turbed. Contemporary philosophy, as well, deals with the impact of death on
79
80 Ilany Kogan
our lives. One of the leading theorists in the area of fear of death, Heidegger,
discusses the meaning of death for a human being in his book Being and Time
(1962). He states that even though death teaches us nothing about itself, it
teaches us something about life. According to Heidegger, man is certain of
the imminence of his death, even if he does not know its exact time: “mors
certa, hora incerta.” Death, therefore is an “absent presence” (Landsberg,
1953, p. 6) in a person’s life. Because of his constantly anticipated death,
argues Heidegger, man is either “running away” from, or “running toward”
death. Fear of death has an impact on the way a person acts or lives.
Humankind has generated various mechanisms for dealing with the anxiety
associated with death (such as denial of death, splitting, or enactment). Other
mechanisms deal specifically with the isolation that is part of death. These
mechanisms include merging with nature (oceanic feelings), with a loved one,
with a cause or a community, in an attempt to transcend the painful separate-
ness of death. Religious beliefs, such as the belief in an eternal presence, allevi-
ate the universal fear of being isolated by death, as the existence of an eternal
presence means that we are never alone, neither in life nor in death; the reli-
gious concept of eternal life (life in another world, another form of existence,
and so on), also enables a person to transcend the fear of death.
I will now briefly review the analytic literature on fear of death, especially
Freudian, post-Freudian, and contemporary theories. I will also present the
different origins of fear of death in males and females, focusing on fear of
death that is closely associated with menopause in women.
The Analytic Literature

In spite of the fact that death and fear of death were central to Freud’s think-
ing, fear of death has not occupied an important place in analytical theory
and technique. Some authors who have, nevertheless, attempted to deal with
this subject from different perspectives referred to how little has been written
on fear of death in the psychoanalytic literature (Anthony, 1940; Barnes,
1964; Brodsky, 1959; Bromberg and Schilder, 1933; Chadwick, 1929; Eissler,
1955; Furman, 1964; Grotjahn, 1955; Kastenbaum, 1959; Nagy, 1959; Wahl,
1958; Zilboorg, 1943; Stern, 1968). In his work regarding the dying patient,
Eissler (1955) is struck by the failure of psychoanalysis to build upon Freud’s
original formulations. He writes:
Since Freud has made death a central concept of his psychological system, one
would have expected that psychoanalysis would devote more effort to the study
of death itself. Strangely enough, this has not happened. In general, death is
Fear of Death 81
still viewed as a purely biological phenomenon unless it is consciously or un-

consciously induced by man himself. (p. 39)
Similarly, Weissman (1977) observes that psychoanalysts have avoided

the subject:
Schur’s contemporary study of Freud’s thoughts about death and extinction un-
derscores this anomaly. Suffering as he did from incurable cancer, Freud wrote
much that would be useful for analysts. However, the clues that Freud offered
have virtually been ignored. Psychoanalysts have preferred to revise the inexo-
rability of death into a more acceptable form, which can then be “analyzed” as a
symptom of something else, and whisked away. Like other people, psychiatrists
are afraid of death. (Schur, 1972, p. 112; cited in Hoffman, 1979)
Fenichel (1945) epitomizes the common psychoanalytic view that aware-

ness of death and anxiety about death are not primary fears, but derive from
other sources. He refers to the fear of death in the following way:
It is questionable whether there is any such thing as a normal fear of death;

actually the idea of death is subjectively inconceivable, and therefore probably
every fear of death covers other unconscious ideas. (pp. 208–209)
Freud explores the narcissistic wound caused by death. He postulates an

inevitable tendency to avoid facing death because of the narcissistic injury
that knowledge of its reality inflicts. In his view, the belief in immortality is
more compatible with our capacity to conceive of life. In “On Narcissism,”
Freud (1914) states:
The child shall have a better time than his parents; he shall not be subject to
the necessities which they have recognized as paramount in life. Illness, death,
renunciation of enjoyment, restrictions on his own will, shall not touch him;
the laws of nature and of society shall be abrogated in his favour; he shall once
more really be the centre and core of creation—“His Majesty the Baby”, as we
once fancied ourselves. At the most touchy point in the narcissistic system, the
immortality of the ego, which is so hard pressed by reality, security is achieved
by taking refuge in the child. (p. 91)
Eissler (1955) agrees with Freud on the development of an awareness of

death in the child. He writes:
As Freud has shown, the problem of death is beyond the child’s mental capac-
ity. The utmost he can comprehend is the concept of absence. . . . Refined
82 Ilany Kogan
research into this matter might show that the child’s inquiry into the genera-
tive processes is a secondary edition of an earlier and short-lasting inquiry into
death. Possibly the child turns away from such an inquiry because of the ac-
companying horror and because of the utter hopelessness and ensuing despair
about any possible progress in his investigation. (p. 62)
Post-Freudian theories, which have as a focal concern the evolution of

man’s sense of “being”—whether it be in terms of ego, person, identity, or
self—address the psychological impact of the prospect of death. These theories
claim that only a differentiated sense of self can give rise to fear of death in the
full sense of the term. Sociologist Philip Slater (1964) expresses this clearly:
Fear of death is not at all primitive, elemental or basic. Animals have no such
fear, nor do small children. It depends upon the rather advanced and sophis-
ticated awareness of the self as a separate entity, altogether detached from the
natural and social environment. For the individual who feels blended with
the world and his society, his own death has little meaning. It is only when
he comes to view himself as a unique differentiated entity, with an existence
which is separable and apart from other men and objects, that he can begin to
have anxiety about the termination of that existence. (p. 19)
Post-Freudian theorists such as Erikson and Kohut regard the acceptance

of the finality of life as an important achievement in human development.
Both lean toward an ideal of adaptation to mortality which is free of conflict
and anticipatory grief (and thus, in my view, free of the fear of death).
With regard to self-conscious reflective adaptation to mortality, Erikson
(1959) mentions the polar concepts of integrity and despair as alternative
ways of dealing with this issue, and the possible conflict between the two
that could result. Erikson says:
Lacking a clear definition [of integrity], I shall point to a few attributes of this
state of mind. It is the acceptance of one’s own and only life-cycle and of the
people who have become significant to it as something that had to be and that,
by necessity, permitted of no substitutions. . . . [T]he lack or loss of this accrued
ego integration is signified by despair and an often unconscious fear of death:
the one and only life cycle is not accepted as the ultimate of life. (p. 98)
Kohut (1966) views the process of coming to terms with transience (and
thus overcoming the fear of death) as among the highest achievements of
human development and a proud achievement of wisdom. The cognitive
aspect of acknowledging one’s mortality is intertwined with progressive self-
definition through acceptance of limitation. Just as the concept of the sep-
Fear of Death 83
arateness of objects is necessary for the articulation of the boundaries of the

self in social and physical space, the idea of one’s own death is not an inert,
merely intellectual concept, but a dynamic factor in coming to know the
boundaries of the self in time.
Kohut picks up on the attitude toward anticipated loss that Freud describes
in “On Transience,” and offers it as the ultimate expression of psychological
health (Kohut, 1966, pp. 265–266). Like Freud, Kohut (1977) dichotomizes
healthy adaptation and pathological maladaptation along the lines of tran-
quil acceptance and utter nihilism (pp. 241–242). In his view, the essence
of the achievement of wisdom is the maximal relinquishing of narcissistic
delusions, including the acceptance of the inevitability of death, without
abandoning cognitive and emotional involvements. The ultimate act of cog-
nition, i.e., the acknowledgment of the limits and the finiteness of the self, is
not the result of an isolated intellectual process but is the victorious outcome
of the lifework of the total personality in acquiring broadly based knowledge
and in transforming archaic modes of narcissism into ideals, humor, and a
supra-individual participation in the world (Kohut, 1966, p. 269).
Hoffman (1979) criticizes both Kohut’s and Erikson’s views of the ac-
ceptance of mortality. Hoffman believes that Kohut fails to consider the
advanced level of development associated with a tolerance of an ambivalent
relation to death—one which includes existential “dread” and anticipatory
mourning as well as self-affirmation. Perhaps the ultimate wisdom lies not
with a “cosmic narcissism” that transcends individual narcissism and results
in a calm acceptance of mortality (Kohut, 1966, pp. 265–266), but with an
ability to maintain awareness of both sides of the paradox posed by the pros-
pect of death, namely that death renders life meaningful and meaningless,
precious and valueless at the same time (Hoffman, 1979).
There has been a recent dramatic groundswell of scientific interest among
psychoanalysts in the psychology of death and dying, or “thanatology.”
Nearly a century after Freud shared his thoughts about death, Sekoff (1999)
notes that psychoanalysis has a history of beckoning death into its reach,
only to push it away. He observes that death can hardly compete with sex,
attachment, or self at the center of recent analytic discourse. Attempts to
think about the subject, such as Green’s (1986) or Ogden’s (1996) descrip-
tions of deadness as a fundamental entity, often drew criticism for manifest-
ing an unnecessary grim vocabulary. Although more works have appeared
on the impact of death (Weininger, 1996; Weatherhill, 1999; Laub and Lee,
2003; Willock, 2007; Bohm and Curtis, 2007), we still have the tendency
to shun this morbid topic, or as Freud put it, “to hush it up” (Freud, 1915,
p. 289).
84 Ilany Kogan
Origin of the Fear of Death

Freud was aware that fear of the inevitable end surely exists, though mostly
denied. In his writings he searched for the origins of this phenomenon. In
“The Ego and the Id” (1923, p. 58), and in “Inhibitions, Symptoms, and
Anxiety” (1926, p. 130), Freud claims that the fear of death (“Todesangst”)
may have its origins in the fear of castration as well as in the fear of losing
the love object. Freud argues that castration becomes imaginable through
the daily experience of parting with the contents of the bowel and through
the loss of the mother’s breast which is experienced in weaning; but noth-
ing similar to death has ever been experienced, or if it has been, it has left,
like fainting, no demonstrable trace. He therefore maintains that the fear of
death is analogous to the fear of castration (Freud, 1926).
With regard to the fear of losing the object, Freud (1926) suggests that
the fundamental origin of the fear of death is found in one of the earliest
stages of human development. He states that anxiety, in general, is basically
connected with the helplessness in the infant caused by realization of the
mother’s absence should she be lost to sight, and the fear that she may never
return. It is an inborn fear that includes the fear of death. This helplessness
is a wound to the primary narcissism of the dawning ego-structure.
Freud (1926) differentiated between the origin of the fear of death in
males and females. He maintained that in males the fear of death is analo-
gous to the fear of castration, and in females, to the loss of love. Fear of death
is found in childhood as well as in adolescence. He explains that castration
anxiety in a boy is a result of paternal threats made in reply to his sexual
activities. In a girl, the absence of a penis is experienced as a wound, which
she attempts to deny, to compensate for, or to remedy.
Chadwick (1929) states that fear of death, in its more superficial form, is
connected with conscious guilt, by way of religious teaching and educational
admonition. It is clearly a concomitant of the ego-ideal, and thus gains a
conspicuous place during adolescence, when an attempt is frequently made
to find relief in religious practice. He stresses the close connection between
adolescent guilt and fear of death which is linked to adolescent masturba-
tion, which often breaks out anew at this time and proves a source of great
anxiety to the boy or girl. The former, especially, will frequently receive
some sort of warning for the purpose of awakening guilt, that the practice
is a sin of a serious nature, causing death of the soul and often laying the
foundation of physical disease which in time will also destroy the body. At
a deeper level, we find the boy, even without warnings from outside sources,
frequently alarmed by his first nocturnal emissions at this time, as is also the
Fear of Death 85
adolescent girl at the appearance of blood, when the menstrual flow has not
been explained to her beforehand. Both conditions appear to signify disease
or impending death to the adolescent mind and awaken apprehensions ac-
companied by extreme guilt, which probably revive old situations of a similar
type connected with masturbation or enuresis in early childhood.
But, in contrast to Freud, who regarded castration anxiety as the primary
fear and analogous to the fear of death, Chadwick (1929) regards the fear of
death as the primary fear. He claims that castration anxiety may be a deriva-
tive of the primary fear of death, as the fear of death prevails equally in both
men and women. He adds that in primitive times, love and life were equated,
especially in the case of the girl, whose value in the home depended upon her
usefulness to her mother and her capacity to please her father. Accordingly,
it is easy to see why especially the woman learned from childhood onward
that it was her duty to please, and associated fear of loss of life with the loss of
love associated with this capacity to please. That is why the fear of death in
primitive times manifested itself in such close union with a woman’s primary
narcissism. In contrast to men, a woman knew that her beauty and usefulness
were prime factors in her ability to please.
Chadwick stresses that in the case of women, the fear of death may be
closely associated with the end of menstruation, which is experienced as a
diminution in beauty as well as usefulness. Fear of death often manifests itself
with the approach of menopause, which many women regard as a foreshad-
owing of death and fear it as such.
In this essay, I wish to demonstrate the impact of the fear of death on
both patient and analyst during the course of analysis by means of a clini-
cal vignette of one of my case studies (Kogan, 1996, 2007a). Chadwick’s
theory and its association with the end of a woman’s childbearing years,
and thus her usefulness, may enable us to better understand the case illus-
tration which is presented below. The case study is about a female patient
who uses “manic defenses” (Klein, 1935; Winnicott, 1935; Akhtar, 2001)
to run away from aging and death by endlessly attempting to conceive
and produce new life, thus holding on to everlasting youth and usefulness.
Analysis consisted of a struggle with the patient’s manic defenses gener-
ated by her unconscious death anxiety—her denial of inner reality and
her omnipotent attempt to replace it with delusional fantasies that she felt
compelled to enact.
As the analytic couple included two women in their mid-lives, both were
facing the end of youth and their childbearing years, which each experienced
as the foreshadowing of death. As a result of the impact of the fear of death
on the analyst as well, she was almost persuaded during certain phases of
86 Ilany Kogan
analysis to collude with the patient’s wish to postpone aging and death by
means of her recurrent attempts to conceive.
Clinical Vignette
Dina was a forty-one-year-old woman, married for the second time and
mother of two children. In analysis, she revealed her bisexual longings,
which culminated in parthogenesis—the wish to have a baby without a man
(Deutsch, 1933; Fast, 1979). She was not deterred by the fact that she was
over forty years of age, that her husband was sixty-three and sterile, and that
he did not want any more children. During the treatment, Dina’s wish to
give birth to a child developed into a psychotic obsession which she felt com-
pelled to realize. Dina had left her first husband when she was five months
pregnant. Her first child, a son, was the fruit of her first marriage, and her
second child, a daughter, was conceived by artificial insemination.
From the earliest stages of analysis, Dina toyed with the idea of having
a third child, and to this end she underwent artificial insemination. After
prolonged unsuccessful monthly artificial inseminations, she underwent
gynecological tests, followed by complex abdominal surgery to ascertain the
cause of her infertility. Pregnancy became an enormous challenge for her, a
way of overcoming the limitations of age, which she unconsciously experi-
enced as a foreshadowing of death. Her entire discourse in analysis during the
early stages, her dreams and fantasies, revolved around her wish to become
pregnant. Her life focused entirely on checking her temperature each morn-
ing, taking urine tests, undergoing artificial inseminations, and awaiting
results. Dina denied feeling any anxiety over not knowing the identity of
the donor of the sperm or its quality. She convinced herself that the donors
were probably medical students who needed the money but who were highly
intelligent and talented individuals.
Dina appeared to be living for a single goal—to become pregnant. After
each insemination she was convinced that she had conceived, and would
come to analysis in an elated mood. With the appearance of her period, Dina
felt that she had lost a baby, and went into a state of mourning and depres-
sion: “Each time I miscarry a dream,” she said.
For the first two years, I believed that Dina wanted to have this baby with
me, as in the transference I represented her mother (Pines, 1993). I was the
partner with whom she shared all of her exhausting efforts to become preg-
nant. But, at the same time, I felt like a helpless, castrated partner, as she did
not accept any of my interpretations. Even my meek reference to the tremen-
dous effort that she was willing to make to reach her goal was experienced by
Fear of Death 87
her as a lack of empathy. I felt as if I were a “dead” partner, not yet realizing
that Dina’s partner was not actually dead, but nonexistent.
After two-and-a-half years of failed attempts to become pregnant and
much frustration, Dina decided that if she did not conceive within the next
three months she would abandon the idea. This time period was then ex-
tended to five months, at which time Dina actually became pregnant. After
a short while, she decided to leave analysis.
I felt the powerful, aggressive nature of the blow that Dina had directed
against me by her decision. I felt frustrated, used, and discarded. Gradu-
ally, it dawned on me that during her childhood Dina herself must have
gone through the experience of being held and discarded. Only after Dina
returned to analysis five months later were we able to link her relationship
with me in analysis to her complex and painful relationship with her mother.
I also realized that Dina had placed me in the role of her first husband, whom
she left five months after becoming pregnant. Dina had never loved her hus-
band, but had always praised his “high-quality sperm.”
My attempts to make her aware of her hate, of her using me as a sperm
provider (penis) or milk (breast), and then discarding me after “having her
fill,” were pointless. Dina declared her love for me and explained that she
had decided to leave analysis as her fight against her “addiction to treat-
ment.” Over the next few months we tried to understand Dina’s wish to stop
analysis at this stage. It eventually became clear that not only was she fight-
ing her powerful dependency needs, but Dina also regarded me as a dangerous
agent who was forcing her to be in touch with her own feelings of impotence
and mourning in the face of aging and death. “Analysis makes a person both
wiser and sadder,” said Dina. “I don’t want that; being mature is not my goal.
I came here pursuing happiness. Now that I am pregnant, I can leave.” Fur-
ther attempts to point out to Dina that she was using her pregnancy to ward
off depressive feelings fell on deaf ears. On parting, I stressed that I would
be there for her should she need me. Dina left analysis in her fifth month of
pregnancy.
A month later Dina’s husband phoned to inform me that Dina had mis-
carried the previous night. She had asked him to call and let me know that
she had been through a terrible experience, and to try to arrange a session at
the hospital, if possible. The next day I went to see Dina in hospital. She was
emotionally overwhelmed, and spoke incessantly of the trauma. Apparently
the fetus had died some time ago and she needed to undergo an induced de-
livery. The problem was that despite running a high fever for days, Dina had
refused to cooperate with the doctors. Only after being told that her life was
in danger did she agree to induce the delivery, certain that she was destroying
88 Ilany Kogan
a live baby and hoping all the time that someone would halt the murder. Nor
was this the end of her plight: after she was persuaded to push and deliver the
dead fetus, she was told that some of it had remained in her womb and had
to be surgically removed. Dina surprised her doctors by asking them the sex
of the fetus. She was told that it had been a female. The physical pain of the
delivery was small compared to the pain of her aching psyche.
I listened to Dina very quietly, feeling overwhelmed by feelings of loss
and impotence. “What can I do for her?” I thought to myself. This baby
had been an investment of her entire life and future, and now it was lost. I
realized that these must also have been partly Dina’s feelings, which she was
projecting upon me and with which I was identifying. Dina was now relying
on my promise to be there for her in case of need. Before I left the hospital,
Dina smiled and said that she was grateful I had agreed to see her under such
unusual circumstances.
Two weeks after leaving the hospital, Dina came to me in a state of anxi-
ety that masked her depression. She couldn’t stay still for a moment, couldn’t
sleep, and had developed all sorts of compulsive rituals. She asked for help,
to which I immediately agreed. Clearly, we still had a long and painful road
ahead of us.
A short while after resuming treatment, it became evident that Dina was
unable to accept her feelings of pain and loss. In spite of my efforts to ease her
suffering by being an empathic listener, Dina was not able to work through
her feelings. Instead, she acted out by again attempting artificial insemina-
tion. Thus, the monthly cycle of hope and depression was renewed; so was
the wall of manic defenses. This time, however, I felt that I was struggling
with a psychotic obsession that was being used as a defense against an un-
bearable threat to her psychic survival, against the danger of disintegration.
During this period, Dina first cast me in the role of the ineffective gy-
necologist who had performed an unsuccessful “plumbing job.” Like him, I
was obviously impotent, since I could not impregnate her through analysis
and thus fulfill her wishes. Later on, there was a shift in her feelings in the
transference, and she began to view me as the murderer of her babies. The
following dream, which she dreamt during this period, illustrates this: “I
dreamt that I had arrived at the hospital; before I had time to get into a bed
I delivered a baby, but the baby wasn’t able to come out of the amniotic
sac. I shouted to the midwife, “Open the sac quickly, he can’t breathe.” She
slapped the baby halfheartedly, but he still couldn’t breathe. She said there
was nothing she could do, that the baby was dead. I was angry with her, she
did nothing to save him.” In the transference, I referred to Dina’s feelings of
being my aborted fetus whom I was unable to save.
Fear of Death 89
Dina confirmed this interpretation through her recurring dreams. She

dreamt that a bus almost ran over herself and her little daughter; or that she
was on a ship that was steered into a typhoon by its incompetent captain. In
both cases, she felt that she had to leave analysis, to run for her life.
Dina bestowed upon me the power of the rapist-killer, the murderer of
her most pressing wishes: “If this baby is going to be born, it will happen in
spite of you and not because of you. I feel that to give up trying to become
pregnant is to give up life; for you it is probably a beginning, for me it’s the
end.” It became clear to me that Dina was struggling against accepting the
limitations of aging (which represented the finitude of life), and that this
struggle was vital for her psychic survival.
It eventually occurred to me that throughout this period, in which I was
cast in different roles vis-à-vis her pregnancy, I had been unaware of Dina’s
fantasies of having a baby without a partner. I slowly realized that Dina was
denying the need for a partner (me in the transference) in order to conceive.
When I pointed this out to her, she accepted this interpretation without any
resistance. That was indeed what she felt; she wished to create this baby by
herself.
The negative feelings in the transference now became increasingly
stronger. Resuming the process of artificial insemination which she had
abandoned for a short while, Dina was haunted by nightmares of recurring
miscarriage as a result of her doctors’ incompetence. In her dreams, she saw
a fetus with a smashed head, severed limbs, and a squashed abdomen with its
guts hanging out.
In the countertransference, I began to feel guilty about my detrimental
impact on Dina’s life through analysis. I would emerge from the analytic
session with her booming voice and powerful arguments pursuing me ev-
erywhere: if she couldn’t have a child, which meant that she was getting
old, with death just around the corner, what was the meaning of life? And
what about the void she would feel in her life if I were unable to fill it with
meaning? Dina claimed that she had come to analysis to find meaning, but
somehow, through the same process, she came to the conclusion that she
had to give up what was most meaningful to her, having another child. I felt
lost, impotent to answer her questions, and overcome by depression. I now
realized that we had reversed roles, and that Dina had almost demolished my
analytic prowess. Cast into the role of victim, I dreaded Dina’s power to shat-
ter my belief in myself and my analytic role. In this difficult phase in analysis,
I understood that I myself had been drawn into believing in the worthiness of
Dina’s goals, that I had almost been persuaded that her goals were commend-
able. This realization helped me reassume my analytic role.
90 Ilany Kogan
It then occurred to me that our transference-countertransference prob-

lems were a reflection of Dina’s complex relationship with her mother. I
consequently pointed out to her my belief that beneath her anger and aggres-
sion toward me was a great need for love and support. I also added that she
was probably unconsciously trying to make me feel the painful experience
she herself had undergone in childhood. For the first time in a long while
Dina listened to my interpretation without immediately rejecting it. The fol-
lowing session she brought me a gift, a cloth on which she had painstakingly
embroidered the following words: “Ambivalence is the basic condition of the
human mind.” This was a breakthrough in her hate, and a turning point in
the transference relationship toward me.
Working through the therapeutic relationship, Dina elaborated upon
her difficult relationship with the maternal representation. Dina could now
recall that, throughout life, her mother had suffered from a manic-depressive
disorder. She had never been institutionalized, but was treated with lithium.
Dina remembered her mother’s mood swings, and when they changed for
the worse, she would feel let down and discarded. Mother would lie in bed
for days, bitter and angry with everyone. She would complain about her
unfortunate lot in life, about being abandoned by Dina’s father, about the
fate of women. During those times, Mother was irritable, dissatisfied with
whatever Dina did. Dina had a painful memory of her mother being angry
and slapping her face, which made Dina feel ashamed and humiliated. Dina
did everything to appease her mother’s wrath, imagining that through her
good deeds she could restore her loving mother, yet at the same time feeling
impotent and frustrated.
Reviewing the different phases of the analysis in my mind, I understood
that through the transference relationship Dina was playing the roles of her-
self and her unstable mother, placing me in the complementary roles. In the
first phase, Dina was my adoring and idolizing little girl who wanted to merge
with me narcissistically, while harboring the murderous wish of swallowing
me up and destroying me. This fantasy made her afraid of my retaliation, of
being devoured and lost inside me. This phase gave way to the more powerful
feeling of being my “victim,” transforming me into a dangerous and aggres-
sive mother who not only neglected her babies, but actually murdered them.
Alternately, Dina cast me in the role of the girl whose psychic existence
was threatened by a ferocious and aggressive woman, embodied by herself.
My countertransference feelings of impotence, caused by being unable to
help her, and my feeling threatened by her engulfing wrath, must have been
exactly what Dina had experienced over the course of many years from her
mother.
Fear of Death 91
The long and painful working through of Dina’s relationship with her
mother eventually led to a greater understanding of her mother’s plight and
to forgiveness, her hate for her mother mitigated to a certain extent by her
love for her. As a result, Dina’s feelings of guilt and persecution diminished,
and the pressing need to counteract her murderous wishes toward her mother
by producing life decreased greatly. Dina still occasionally underwent artifi-
cial insemination, but was now better able to accept the fact that she might
never realize her wish of having another child. She no longer felt that I was
the murderer of her babies, and her love toward me resurfaced.
It was during this period that Dina became pregnant. Dina believed that
she had succeeded in becoming pregnant because she felt less pressure to
vanquish death. She expressed doubts about whether this baby would ever
be able to fill the “void” that she felt in her soul, but “a concrete solution,”
said Dina, “just postpones dealing with aging and death. I will still need
analysis for that.” In contrast to her previous pregnancy, Dina felt no urge to
run away from analysis. Her pregnancy, however, was regarded as high-risk.
Dina asked the doctors to sew up her uterus to prevent a miscarriage. In the
transference, we understood on a symbolic level that Dina was asking me to
sew up the analytic womb so that the new aspect of her personality, which
had just begun to bud in her, would not miscarry.
Dina gave birth to a baby girl, and remained in analysis until the child was
almost two years old. Her relationship with her little girl added a new dimen-
sion to the transference relationship that enabled us to continue the elabo-
ration of Dina’s own infantile experiences with her mother. This, in turn,
increased Dina’s capacity to love her child, as well as to better accept herself
as a woman. “I found the bluebird of happiness in my very own kitchen,” she
said. Both of us realized that through a lengthy process of growth in which
she struggled so much with pain, mourning, and the fear of death, Dina was
finally able to “give birth” to some good parts of her own self.
Moving from an unconscious fear of death to greater toleration of life and
its finitude is a process of growth and development, as it is shown by the
above-described case. I will begin with a discussion of the impact of the fear
of death on the patient, and the manic defenses against change and growth
which it aroused. I will continue with the examination of the impact of the
fear of death on the analyst and her temporary collusion with the patient’s
attempts to conceive produced by it. From there, I will proceed to evaluate
the success of the treatment: to what extent was the patient’s fear of death
overcome and her manic defenses relinquished? I will end by referring to the
extent the acceptance of the finitude of life was achieved by both patient
and analyst alike.
92 Ilany Kogan
The Impact of Fear of Death on Patient and Analyst

Dina experienced the limitations of age which included reaching the end
of her childbearing years as a powerful narcissistic blow and a foreshadow-
ing of death. Dina was threatened by maturity, as maturity meant giving
up her manic defenses—her infantile omnipotent fantasies—and gracefully
accepting the limitations of age. She could attain maturity only by mourn-
ing losses that she felt were irretrievable (such as childbirth and youth). To
accept these losses, she would have to acknowledge the passage of time and
relinquish her omnipotent fantasies of immortality, but this relinquishment
threatened her psychic survival. To overcome her fear of death, she devel-
oped manic defenses in order to avoid the pain and mourning incurred in
growth and change, and to escape from death.
Although it was necessary for Dina to relinquish her manic defenses in
order to achieve growth and maturity, at certain points in analysis, I felt
that the relinquishment of her manic defenses was not only impossible, but
would actually be detrimental to her. As analysis progressed, it became clear
that Dina’s wish for parthenogenesis was a psychotic obsession that served
as a manic defense against fragmentation. Not only was Dina denying real-
ity, she was also trying to replace it with delusional fantasies which she felt
compelled to enact. She used this enactment to possibly avoid a psychotic
breakdown at this stage of life.
As the analyst, I was faced with a grave dilemma by Dina’s struggle with
her unconscious fear of death: since pregnancy and childbirth seemed to be
so vital to her psychic survival, was I supposed to fight against this need? Was
Dina capable of giving up her manic defenses, and if so, at what cost? And if
my role was to put her in touch with an overwhelming fear of death, could I
take responsibility for the outcome?
Today, looking back at this analysis after the passage of many years, it
is clear to me that in dealing with this patient, I too had been affected by
an unconscious fear of death. I wonder to what extent my doubts about the
feasibility of the patient achieving maturity in this case stemmed from the
patient’s massive projective identification throughout the treatment, and to
what extent they were due to my own countertransference feelings that were
evoked by the patient’s intense encounter with the “mid-life crisis” (Jacques,
1965). The painful issue of aging and relinquishing childbirth and youth was
not unknown to me—it is universal to all women of this age. I became aware
that Dina, who was only two years my senior, evoked conflicting feelings in
me about the passage of time and its accompanying limitations. This may
have been one of the main reasons why, at a certain point in analysis, I was
Fear of Death 93
almost persuaded that her manic defenses (attempting to conceive yet again)
might contain a positive element. To quote Grinberg, who so eloquently de-
scribes the impact of maturity and change on both members of the analytic
couple:
It is a painful truth and one which has been avoided until then: that of the full
recognition of the passage of time as much in the analyst as in the analysand,
in which illusory timelessness is transformed into a real temporality with the
limitation of the omnipotent fantasies and those of immortality. These limita-
tions are experienced many times as a partial death. (1980, p. 29)
There was also another reason why Dina tried to postpone aging and death
with omnipotent, magical, everlasting life-giving. She was under enormous
pressure to achieve this concrete solution because she was unable to achieve
sublimation and thus transform her goal of procreativeness into creativeness,
Sublimation, as a process that underlies creativeness, is an affirmation of life
(Winnicott, 1971; Grinberg, 1992; Kogan, 2007b) and, in my view, it may
lessen the fear of death. In this case sublimation was inhibited and failed.
I believe that Dina’s fear of growth and aging expressed through her obses-
sion with generating life, as well as my collusion with Dina’s wish to avoid
the pain incurred in maturation, constituted part of an unconscious fear of
death that affected us both. Thus, sometimes I would wonder—wasn’t Dina’s
struggle to postpone aging and death a universal one? Are we not all in the
same boat in this regard? Freud’s wise words about our inability to consciously
realize the existence of death come to mind:
We were of course prepared to maintain that death was the necessary outcome
of life. . . . In reality, however, we were accustomed to believe as if it were
otherwise. We showed an unmistakable tendency to put death on one side,
to eliminate it from life. We tried to hush it up . . . as though it were our own
death. . . . [I]n the unconscious everyone is convinced of his own immortality.
(1915, p. 289)
Success of Treatment or Compromise Formation?

Viewing the success of treatment from the vantage point of the termination
phase of analysis and afterwards, I will now examine the extent to which the
treatment goal of relinquishing manic defenses against aging and death as a
result of the diminishing of the fear of death were met in this case. I have
chosen to view the treatment from the termination phase because this phase
often recapitulates separation from the mother in early childhood and also
94 Ilany Kogan
activates fantasies about completion vs. incompletion, castrated vs. phallic,

life vs. death (Arlow, 1970).1 I will address the following issues: What were
the results of this treatment from the perspective of the patient and from
the perspective of the analyst? What was the analyst’s attitude toward the
apparently successful outcome of the treatment, as viewed at the end of this
analysis, and did this view change now, many years later?2
I believe that from the patient’s point of view, as well as my own, this
treatment achieved a number of positive results. In my opinion, Dina’s work-
ing through her disappointment and hatred in the transference inclined the
balance between hate and love toward love. Dina was able to recall deep,
unconscious memories of hate toward the maternal object because these
memories were mitigated by her love. Her fear of death and destruction was
somewhat moderated by her emotional experience in analysis and by the
work of mourning which was an integral part of the entire analysis. Dina
declared that she had been able to conceive because she felt less threatened
by death. Perhaps she was able to become pregnant and give life because she
experienced something in herself as life-giving. From this perspective, the
treatment had a positive outcome for patient and analyst alike.
On the other hand, I often wondered what structural changes had taken
place in my patient. The “immaculate conception,” producing a baby
without a man, was a manic defense with a successful outcome. By means
of her manic defenses, the patient had succeeded in avoiding the pain and
mourning inherent in growth. In contrast to the first time that she became
pregnant during treatment, this time Dina remained in analysis, stating
clearly that she did not regard the pregnancy and the baby as a means of
“filling her life with meaning.” But could she ever complete the process of
mourning necessary for accepting her monosexual destiny and the inevita-
bility of her death, a process which she began before the birth of this child?
To what extent did this “success” help her avoid her fear of death? Could
this success have been the result of an unconscious defensive collusion on
the part of both of us in the face of aging and the finitude of life? From this
perspective, this analysis ended in a compromise solution, and was far from
being completed.
Analysts’ difficulties with the incomplete results of analysis have been
reviewed by Schachter (1992). Ticho observes that “countertransference
difficulties play a larger part in the termination phase than in other phases
of the analysis” (1972, p. 328). Siegel states that:
The story of the well-analyzed patient is a myth which is told and retold by
analysts and patients alike in the interests of hope or to justify the long and
Fear of Death 95
expensive treatment process or for other reasons associated with problems in

self-esteem. (1982, p. 396)
Dewald (1982a) similarly notes that the limitations of analytic treatment

may evoke narcissistic injury in the analyst. This may lead to an indefinitely
prolonged analysis in the attempt to avoid such injury. In this regard, Cooper
writes as follows:
It is during the termination phase that we become most intensely aware of all
the personal and professional hopes with which the analysis began. . . . We are
likely to experience with a new clarity the disappointments, the unresolved,
and even untouched issues of analysis, as well as the gratification of knowing
how much was achieved. (1985, p. 1)
Over a long period of time I was unable to complete the recording of this
interesting treatment because of my doubts as to its success. Some of the
many questions which preoccupied me were: Did the patient understand her-
self better at the end of the work? Did she achieve in analysis enough growth
and maturity to be able to face aging, did her fear of death diminish? Should
this analysis be regarded as a partially successful one? If so, what would have
been a fully successful outcome?
These questions were answered unexpectedly about a year ago when,
by chance, I ran into Dina on the street. Although she looked older, I was
struck by the fact that she was dressed smartly and more femininely than I
had ever seen her before. She shook my hand warmly and, as if sensing my
unvoiced questions, said: “I’m all right, you know. I’m working as a teacher
and am very happy with my work. I like the high school children; teaching
is creative, important for future generations and it also satisfies my need for
an audience. I am very happy with my family, my children are wonderful.”
She was quiet for a moment, then added, smiling: “I’m about fifty-four years
old now and I know it, but I don’t mind my age anymore. I am not always in
a euphoric mood but I’m quite satisfied with who I am and what I have. And
I am very grateful to you for what you did for me.”
Listening to Dina for just these few minutes on the street, I realized to my
satisfaction that her analysis was not only terminated but, indeed, had been
successful. Dina appeared to be clearly able to deal with the conflicts she
encountered without me, by using what she had learned in analysis. I knew
then that, at the end of the work, she understood herself better, and had also
acquired the tools to enable her to achieve further growth. In her case this
meant that apparently she could, to a certain degree, realize her limitations
and give up her perfectionist and infantile expectations, thus relinquishing
to a large extent her manic defenses.
96 Ilany Kogan
The working through of the patient’s fantasies and feelings, which began
during analysis and continued after it, enabled both of us to transpose our
fear of death from the unconscious to the conscious realm and work through
this fear, achieve some tolerance of the psychic pain contained in maturation
and growth, and facilitate our ability to mourn. For myself, as an analyst, part
of this working through meant facing the limitations of what therapy can
achieve. Schafer (1973) expressed this eloquently:
These limitations concern the therapist in quite a powerful, personal way.

Through them, he must recognize that his effectiveness as a healer is quite lim-
ited, which means that important narcissistic ideas about himself and ideals for
himself are forcefully contradicted by experience. The roots of these ideas and
ideals lie in infantile fantasies of omnipotence, which no-one ever renounces
completely. (p. 141)
Both of us, patient and analyst alike, were better able to move on from
our manic defenses and do the work of mourning necessary for overcoming
to some extent the fear of death, accepting our limitations and the finitude
of life, and continuing life in a creative way.
Notes
1. It is noteworthy that, in contrast to the finitude of life, analysts refer to
the “interminability” of analysis. Grinberg (1980) expands on this topic, viewing
self-analysis as an outcome of the “interminability” of the process of searching for
mental growth and integration. According to him, the termination of the dynamic
interaction between analyst and patient allows the analysand to reach a new “take-
off” point, from which he can control the development of his mental growth and
maturation by himself. The “interminability” of the process fits the current view that
there is no such thing as an ideal termination; that the symptoms never disappear
completely; that the patient does not achieve all the structural changes one would
like; nor does he manage to acquire a totally integrated personality. The literature
of the last few years deals with interruptions, situations of “impasse” and re-analysis.
This supports Freud’s early opinion that, “We do not always achieve our aim to its
full extent—that is, do not achieve it thoroughly enough . . . portions of the old
mechanism remain untouched by the work of analysis” (1937, p. 229).
2. In his brilliant paper “Termination of psychoanalysis: Treatment goals, life
goals,” Ticho states: “The analyst should know what he considers a mature human
being to be” (1972, p. 318). This statement, which demands of the analyst secure
knowledge regarding the goals of the treatment, made me feel uneasy. As I stated
above, I harbored doubts and felt insecure about my analytic goals in this case.
CHAPTER SEVEN
The Dead Self Must Be Reborn

Stanley J. Coen, MD
I have to confess that I began writing this commentary feeling indeed that
Ilany Kogan’s perspective toward death moved the focus away from facing
the pain of her patient’s early relationship with her mother. But I ended
with the same feeling. By taking this stance, am I avoiding my own terrors of
death? But the clinical material, at least to my mind, seems to be less about
the patient’s fears of dying than about the horrors of a child not being pro-
vided with essential care. When patient and analyst address the patient’s rage
at her mother and at the mother in the transference, the patient’s pressure
to generate life abates.
It certainly is true that, in order to lead our lives, we need to avoid our ter-
rors of death. When patients become preoccupied with mortality and dying,
they feel panicky, unable to enjoy being alive. Mortality may make life mean-
ingful but we must be able to balance our fear of dying with our joy in living.
But I think it is not merely the existential fact that someday we will die that
makes mortality so difficult. Rather it is the uses we can make of this fact.
Reflections upon Ilany Kogan’s Contribution

By the analyst’s taking the position that her patient’s pressure to conceive
was a manic defense that needed to be interrupted so that the analysis could
proceed with the mourning of limitations, the analytic couple became caught
97
98 Stanley J. Coen
up in struggle. The patient insisted that she needed to become pregnant

while the analyst saw the patient’s pressure to become pregnant as preclud-
ing the work of the analysis. The analyst’s insistence that the patient was
engaged in defensive activity against her depressive feelings led patient and
analyst to pursue different agendas. Later in the analysis, it became possible
to link the patient’s relationship with the analyst to her earlier relationship
with her mother. Once they were able to do so, the work of the treatment
became easier, although painful.
So were patient and analyst indeed in the same or in different “boats”
(see the title of her chapter)? Does the analyst need to emphasize what they
shared in common (concerns about menopause and aging) to reassure against
the early struggle in the treatment between them? Is this early struggle a con-
tributing factor to the analyst’s ongoing distress about this treatment and a
reassurance when she encounters her patient? Where is the sick/bad mother
early in the treatment? Why can’t analyst and patient find her? Kogan does
not describe in detail her own concerns about menopause and aging, about
having and not having children. If indeed, as she implies, these concerns got
in her way, how did they do so? If the analyst felt that she had relinquished
her wishes to become pregnant as no longer possible or appropriate, how
difficult would it have been to tolerate her patient’s refusal to accept these
same limitations (see Kofman and Imber, 2005)? And could it not have
been reasonable for her patient to want to have another child before it was
too late, despite the desperation of her efforts? How else were patient and
analyst in the same boat, what else did they share in common which might
have contributed to a struggle about producing life? Did they share a history
of trauma, Holocaust or otherwise, that called for restoration? The patient
insisted on bringing forth life while the analyst, just as vigorously, insisted on
mourning what was not possible.
Of course, the analyst does not need to tell us in detail about herself and
about her own feelings and motivations. But then psychoanalytic readers
cannot imagine their way into this treatment scene. When there is struggle
between analyst and patient, readers need access to some of this struggle in
order to be able to feel their way into the consulting room. So too does the
analyst need access to her own contributants to this struggle with her patient
in order to get the two of them unstuck.
Besides and Before Interpretation

For a bleak, traumatized patient (as this patient was as a child in her rela-
tionship with her disturbed mother), it may not be possible to mourn the
The Dead Self Must Be Reborn 99
past until there is some more hopefulness in the present in the current
relationship with the analyst. Repeating the negativism and hopelessness
in the analytic transference of the early mother/child relationship may be
unbearable until the patient has become convinced that the analyst is very
different from her disturbed mother. At the start of treatment, negativistic,
schizoid patients are now thought to require an affirmative attitude rather
than interpretation of conflict or search for meanings. Before the analyst
can interpret to the schizoid patient, the patient needs to feel the analyst’s
matching, attunement, holding, and affirmation (Killingmo, 1989, 1995;
Sanville, 1991; Rayner, 1992; Ghent, 1992, 1993; Meares, 1993; Meares and
Anderson, 1993; Akhtar, 1994; Teicholz, 1995; Rustin, unpublished; Coen,
2003, 2005). It was Salman Akhtar who introduced me to Killingmo’s work
as well as to this affirmative attitude. Such analytic provision is now regarded
as legitimate by these authors. The analyst’s generative role as facilitator of
the patient’s uncompleted development has been integrated within tradi-
tional psychoanalysis by Tähkä (1993) and by Settlage (1994). The analyst’s
matching and attunement (Rayner, 1992) aims to enhance the patient’s core
self and sense of togetherness. Such work precedes interpretation which leads
instead to differentiation.
For example, with a patient of my own, when his hopelessness becomes
too intense as he remembers and repeats his remote, unsatisfying relation-
ships with both father and mother, he closes down, pulls away, doesn’t
want to come to his sessions, complains that I haven’t helped him. He also
indicates that what we have recovered from his past is too painful. When I
and his psychopharmacologist both become more concerned about him, I
shift toward emphasizing that it makes him anxious to acknowledge the dif-
ferences in our treatment relationship from his past relationships with each
parent. I think that for now he needs to be sustained through what is good
in his relationship with me, that we need not overwhelm him with the hor-
rors of his early life. He insists on more control over the treatment process,
which helps him feel less helpless and disabled. I struggle to tolerate accom-
modating myself to what he insists upon. When he is less controlling with
me, it is easier for me to like and enjoy him despite his enormous negativistic
barrage.
Or, a fine younger colleague presents a difficult, negativistic young woman
patient in a seminar. After the group’s first meeting, she feels enthusiastic
that she can approach her patient’s treatment disengaged from the pull to
repeat the role of the critically dissatisfied mother. As the analyst approaches
her patient more positively, affirmatively, lovingly, acknowledging what the
patient needs from her and how anxious such caring makes her, both patient
100 Stanley J. Coen
and analyst seem more comfortable. For the first time, the patient reports
tender memories of being with both mother and father. The colleague has to
struggle with her impatience and critical feelings so as to value what her pa-
tient brings rather than to emphasize what the latter is avoiding. It is striking
to the observer that when the analyst is feeling caring with her patient, the
latter can hear her interpretations, of the patient’s anxiety in craving close-
ness with the analyst, as helping and containing rather than critical. This
opens up rather than closes down possibilities for mutuality between them.
Negativistic, schizoid patients may begin treatment by insisting explicitly
or implicitly that the analyst accept as valid their needs to distort reality
while they impose this need on the analyst and on the treatment. Current
authors (Steingart, 1983, 1995; Coen, 2003, 2005) advise analysts to accept
the negativistic, schizoid patient’s initial presentation without struggle and
only later interpret why this was necessary. The analyst begins by accepting
the assigned role he is forced to play in enactments with borderline or narcis-
sistic analysands (Steingart, 1983, 1995). Such patients struggle for control
over what is to be regarded as real and unreal about the analytic relation-
ship, sadistically coercing the analyst to their view. “Empathic withholding
of interpretive interruption,” as Leo Stone (1981) expressed it, allows the
patient to use the analyst and the treatment as he needs without premature
disruptive challenge from the analyst (Balint, 1968; Kohut, 1971; Khan,
1974; Bromberg, 1983; Steingart, 1983, 1995; Slochower, 1991, 1992, 1996).
Because of the schizoid patient’s terror of human relatedness, the analyst has
to find creative ways to preserve the treatment. It becomes the analyst’s task
to welcome his schizoid patient to join him in sharing a common world that
is sufficiently safe and nurturing for the patient to risk opening up his imagi-
nation and his human needs. He will not be able to do so on his own. The
analyst needs not impose on his schizoid patient or on himself his ordinary
expectations of a typical analysand and a typical analysis. He needs to accept
the patient’s presentation, not to struggle with the impossible, outrageous,
or unreasonable. He affirms the legitimacy of his patient’s hidden longings,
helping to make the unreasonable reasonable, affirming the positive in the
negative. The course of such analyses may be very different from what most
of us would ordinarily expect.
Both patient and analyst have to tolerate the patient’s imperative need
to preserve his rigid psychic structure, omnipotent control, and grandiosity,
as he keeps repeating the same fixed defensive activity to protect against
profound vulnerability. Because the patient fears that his inner world can be
deeply disrupted by the analyst, the latter may not be able to be an interpre-
tive helper or inquirer for a prolonged time. The schizoid patient aims to
have a closed mind that is concretely focused away from what terrifies him.
He does not want to know or imagine what this can be. He has tried not to
know, not to feel, not to need. The analyst may need to tolerate the patient’s
negative relating for a prolonged time before anything else is possible. Such
patients may hear the analyst’s interpretation of conflict as critical, accusa-
tory, blaming, or at least as making them prematurely responsible for manag-
ing themselves (see also Bromberg, 1983).
Back to Ilany Kogan’s Clinical Material

In the present case, do analyst and patient become too caught up at literal in-
terpretation of what each wants from the other? The patient seems to think
she wants only the analyst’s assistance and support to become pregnant.
The analyst wants the patient to relinquish her manic pressure to become
pregnant and to analyze her depressive feelings. Each one seems to feel that
the other is opposed to what she needs. Eventually the analyst is able to con-
nect this with the patient’s very troubled relationship with her mother. Did
the intensity with which each one felt that her needs were being blocked
by the other so that they must be pursued even more vigorously, keep them
both from grasping that this was an essential transference repetition between
them? Initially the analyst thought that she was to be the patient’s partner in
becoming pregnant, while later she felt that the patient wanted to become
pregnant without a partner. The analyst repeatedly felt discarded before she
was able eventually to grasp and interpret that this must have been a basic as-
pect of the mother/child relationship. It can be so easy to become convinced
that the patient is really interfering with the work of the treatment so that
it becomes impossible to feel with the patient what she really seeks. I have
collected a series of cases in the literature on erotic transference (and four of
my own) where patient and analyst became frozen at literal interpretation
of the patient’s transference demands (Coen, unpublished). When patients
pressure their analysts intensely for what they feel they must have, their ana-
lysts too may become caught up in such intensely pressured need. How and
why they do so may vary based on what patient and analyst each craves, can
or cannot tolerate, feels ashamed and guilty about, defends against or actively
seeks, and so on. There can be many combinations and permutations to this
interplay whereby the analytic couple become stuck in the pressures of their
needs so that they view their interaction literally, missing more metaphoric
meanings. In the cases I reviewed, analysts became trapped at literal interpre-
tation of their patients’ transference demands when their own feelings and
needs and defenses against them became unbearable so that analysts needed
102 Stanley J. Coen
to repudiate what they had become caught up in. Common factors in analysts
becoming stuck included wishes for and defenses against intense early need,
rage, hatred and violence, sadism, sadomasochism, and homoerotic desire.
Patients who need to pressure their analysts intensely for connection, nega-
tively or positively, will find a way to succeed at drawing in their analysts,
no matter who they are. More needy and hence vulnerable analysts will have
most trouble with such intensely pressuring patients. A typical example from
these cases was an analyst who was able to grasp that her anxiety with her pa-
tient came from her wish to surrender to his erotized sadomasochistic torture
of her. Once she could feel her own excitement when he was dominating and
torturing her, then she could interpret to him that his efforts to dominate her
protected him from feeling helpless with her.
Erotic transference wishes are so easily interpreted by both patient and
analyst in a literal way, making it difficult for each one to grasp broader, more
metaphoric meanings. The life-and-death quality of the patient’s pressure on
the analyst can make the analyst anxious, angry, avoidant, stirred up, want-
ing to struggle with and against the patient’s demands. When the analyst,
too, fears the life-and-death intensity of what the patient’s demands stir up
in him, he, too, must go into survival mode in order to protect himself. Then
he can no longer analyze. In the throes of life-and-death dangers, analysts
become as frozen as their patients are. In these cases, when analysts became
able to tolerate and grasp what they had not been able to feel and to see,
they could restore their analytic perspective. Crucial here is analysts’ ability
to move outside of their stuckness to view it analytically so that they can get
out of it and become able to move forward by understanding what they have
had to live out with their patients.
In the present case, patient and analyst may have had to play out with
each other for an extended time the mother/child scene in which each seems
to be opposed to the other’s needs. But if the patient had merely wanted to
become pregnant, why was she in analysis? What did she want from her ana-
lyst? Or, underneath her manifest wish to become pregnant, what more did
she want? The patient insisted she needed to create life. The analyst insisted
this was defensive against depressive affect. The patient needed to create life
and to have her analyst understand why this was such a desperately pressing
need for her.
Could the analyst have taken the patient’s side in her pressure to conceive
by agreeing with the patient that indeed it was imperative that a child be
brought to life? Perhaps then slowly the analyst might have been able to
interpret that the child who needed to be brought to life was the patient
herself. The baby who cannot breathe, who needs to be rescued, resuscitated,
the patient and daughter who are almost run over, being on a ship steered
into a typhoon by an incompetent captain, all can refer not only to the
analyst not protecting the patient in her attempts to become pregnant but to
her complaints about her early relationship with her mother. Similar images
include her nightmares of miscarriage because of her doctor’s incompetence
or a smashed, destroyed fetus “with its guts hanging out.” Dina’s attempts to
fill her life with meaning by becoming pregnant could be traced back to the
horrors of her early life with her mother. Giving birth to a child may have
been her way to make her life meaningful, as if it had not been meaningful
thus far. There is a literature about pregnancy as a way to make an empty
woman feel filled up (e.g., Lester and Notman, 1986; Imber, 1990). Once the
analyst was able to grasp and interpret that they were repeating the patient’s
early struggles with her mother, we suddenly learn about the bipolar mother,
bitter, angry, unavailable to her young daughter. We might even be able to
connect mother slapping her face with the dream image of a midwife slap-
ping a baby unhelpfully to help him breathe. Then rage between patient and
mother can more clearly and understandably come into the treatment trans-
ference. We get to a murderous mother and a murderous daughter, played
out between patient and analyst. The analyst is able to interpret that anger
and aggression is not all that the patient feels toward her; she also needs
the analyst’s love and support. And the analyst is able to interpret that the
patient had needed to show the analyst the pain she had lived through as a
child with her mother. Dina brings the analyst a gift in which she embroiders
the analyst’s interpretation, acknowledging that she does not only hate the
analyst. I am convinced by the author that working through Dina’s rage at
the analyst/mother helped to reduce her guilt and persecutory anxiety and
hence reduce the urgency of her need to create life.
Dina was significantly helped by the reconstruction and working through
of the hate-filled mother/daughter relationship and by countering it with a
more accepting and loving relationship with the analyst. So even though
patient and analyst were both facing the end of their childbearing years, I do
not (of course, I am a man) feel the tensions of menopause, aging, and death
in this clinical material. Since we get only brief glimpses of the analytic ma-
terial, it certainly may be there.
When Kogan adds to Dina’s fear of aging, her fear of growth and change,
this makes more sense to me. I assume Dina had major problems with separa-
tion and separateness so that she was terrified of change—terrified of moving
away from her internal relationship with her (bad) mother. That is the con-
text within which I would want to situate her endless repetition of becoming
pregnant in order to hold on to her tie with her mother and to try to rescue
104 Stanley J. Coen
the child in herself from her early fate. Kogan connects Dina’s sewing up
her womb so that she would not miscarry with Dina’s new budding self. She
could miscarry by staying connected with her murderous mother, refusing to
live her life as well as she could. The danger of miscarriage could come from
outside, from the bad mother/doctor, as well as from inside, from the angry
self-destructive part of herself, which refuses to live. Could these have been
the reasons Kogan had remained unsure of the efficacy of the analysis until
she happened to meet Dina in the street? Wouldn’t the analyst have had to
go on wondering after the end of the treatment how the balance between
Dina’s self-destructive and self-propelling forces would play itself out? Given
the intensity of Dina’s hunger for mothering, early disappointment, and rage
at her mother, there would have to be serious questions about how well Dina
would be able to let herself do on her own. Kogan feels reassured by her very
brief encounter in the street with Dina but I would suppose these concerns
would have to remain despite this reassurance.
Death and Deadness

Here are links to Kogan’s references to Green (1988) and Ogden (1996)
on deadness. Here we could imagine wishes to be dead, to destroy life and
meaning, to cling to a dead mother, to deadness. But then I would think here
of wishes for death and deadness as the context for the fear of death. Dina’s
mother may have seemed to destroy life in the mind of her child but Dina
too could want to destroy life or invite the bad mother/analyst to destroy her
life. Then the context becomes clearer for the antithesis between destroying
and producing life, in both mother and child.
So I am assuming that Dina’s wishes for death and deadness, wishes to
hold on to her dead mother, and her murderous hatred and guilt about it are
the context within which to understand her fears of aging and dying. Have
I defensively avoided facing fears of dying directly? Or are we unable to face
our fears of dying more directly unless death is imminently knocking at our
door? I do think from this case and from my own clinical experience that in
psychoanalysis we analyze fears of dying most effectively as expressions and
derivatives of something else. This is clinically helpful, not necessarily de-
fensive on the part of analysts. Nevertheless, we analysts, just like all human
beings, seek to avoid facing our mortality.
At the Program Committee of the American Psychoanalytic Association
there was considerable opposition to having a panel on the aging analyst at
work. Curiously, comments about aging seemed to fill the room throughout
the day. Many colleagues preferred that the focus be shifted to issues of the
analyst’s age throughout one’s career, away from the “aging analyst.” This
came despite an enormously moving talk by Shelley Orgel at the American
Psychoanalytic Association meetings in June 2008, describing what he has
had to contend with in himself as an analyst at work as he has grown older.
Just as Kogan describes about death and dying, the psychoanalytic literature
about the aging analyst is very meager (Lax, 2001, 2008; Goldberger, 2008).
There is much to consider about the needs, temptations, and vulnerabilities
of the aging analyst at work, especially with younger patients. Consider, for
example, envy of our younger patients, their opportunities and potentials;
our wanting to hold on to analytic patients for fear that we won’t be able to
replace them; decisions about which patients to take on and which to refer
to colleagues; narcissistic temptations of seductiveness and idealization by
appealing younger patients, which may become more difficult to view analyti-
cally because of analysts’ greater need; tolerance of limitations and difficulties
that come with aging; threats of serious illness and death in contrast to the
health and vigor of younger patients; acceptance of who the analyst has be-
come in contrast to earlier hopes and wishes—which also includes enjoying
what is good about aging analysts’ emotional growth, maturity, and wisdom.
What satisfaction and pride analysts can take from their ability to face
death in their patients and in themselves so as to be able to help their pa-
tients do so too. I remember vividly with great admiration colleagues who
were able to address their death with friends, colleagues, and with their
patients. They set a model for the rest of us toward which to strive. I think
of a senior colleague in another city whom a child of mine consulted. He
did a fine assessment but told her that he could not treat her because he
was dying. He handled the consultation very well, referring her to another
analyst. I think of a friend and colleague who handled his chronic illness and
death with courage, dignity, and openness. But I also think of an analyst who
avoided acknowledgment with his patients of his grave illness and depres-
sion, leaving them thoroughly unprepared for his suicide. It becomes much
more complicated with analysts who really cannot predict the course of their
serious illness as to what to share with patients, colleagues, and friends. And,
of course, there is the risk of burdening patients with one’s own concerns
when the sick analyst feels anxious, vulnerable, and needy (Dewald, 1982b;
Abend, 1982; Silver, 1982; Lasky, 1990; Gabbard and Lester, 1995).
For example, Jørstad (2002) published a case which he considered a suc-
cessful treatment in which it appears to the reader that the author, threat-
ened by cardiac disease with life-threatening arrhythmia, engaged in bound-
ary violation with his needy woman patient. From this case report, he seems
to have put much too much of his own need into his patient. She seemed to
106 Stanley J. Coen
be signaling him what was going wrong through dreaming of symbiosis with
the analyst, of needing to sustain him, showing him that she was having to
fulfill his “narcissistic and sexual” needs. Eventually, the analyst was able to
grasp his patient’s ambivalence when they hugged at the end of sessions suffi-
ciently to be able to modify his overinvolvement with her, so as, he thought,
to be able to help her change. There is no report of his having analyzed his
difficulties in himself nor of his having been able to address his boundary
violations with his patient.
A Thought in Closing
I have just read Thomas Mann’s “The Black Swan” (“Die Beitrogene,” which
should translate as “The Deceived”), Mann’s last written work. In contrast to
“Doctor Faustus,” which preceded this and which is much less easily accessi-
ble to the reader, here aging and youth, life and death, desire—forbidden and
otherwise—and its constriction, love and destruction flow freely. The reader
can imagine Mann, ill near the end of his life, turning these difficult themes
into evocative fiction, re-creating “Death in Venice” now with an older
woman craving a younger man, the narrator seeming to enjoy his rendering
of desire for a man. What courage it would take for an author to address these
looming issues within himself creatively! What satisfaction it could provide
an author to be able to do so successfully! Psychoanalysts too need courage
and fortitude to be able to face serious illness and death creatively in them-
selves and in their patients. The wisdom, satisfactions, and love in having
lived a long, full life may make it a bit easier to deal with the ultimate horror
of death with ourselves, our patients, our families, and our friends.
CHAPTER EIGHT
Living to Die and Dying to Live

Normal and Pathological
Considerations of Death Anxiety
Calvin A. Colarusso, MD
My rather complicated title deserves some explanation. The first phrase,

living to die, is a reference to the clinical material I will present from the
analyses of two middle-aged men whose engagement of the middle adult-
hood developmental task of confronting time limitation and personal death,
coupled with past experience, led to the formation of significant symptoms
and inhibitions. The second phrase, dying to live, is a colloquial reference
to the tremendous stimulus to normal development that occurs when the
healthy adult fully integrates the notion of a personal end of life.
This contribution will unfold as follows: a brief discussion of the seminal
ideas and thinkers who have shaped my thoughts on death will be followed
by the presentation of a developmental line of death awareness. After a
discussion of the relationship between death awareness and separation-indi-
viduation processes in middle and late adulthood, material from two midlife
analyses will be presented. The chapter will conclude with a presentation of
what I consider to be one of the most mature, poignant expressions of the
acceptance of old age and approaching death that I have ever heard.
What Constitutes Development?

I have found Rene Spitz’s definition most useful because it considers the
effect on psychic development of the continuous lifelong interplay among
107
108 Calvin A. Colarusso
biological forces, the external environment and the intrapsychic world. Spitz
(1965) defined development as “the emergence of forms, of function and of
behavior which are the outcome of exchanges between the organism on the
one hand, the inner and outer environment on the other” (p. 5).
Like myself, Erikson (1963), Emde (1985), and Pollock (1998) see devel-
opment as a lifelong experience. Erikson extended the concept of develop-
ment throughout adulthood with his Eight States of Man. Later Emde wrote:
“First and foremost, we must realize that the developmental thrust is not over
in adolescence—far from it. There is a continuous dynamic process, and the
adult personality continues to undergo structural changes” (p. 109). Pollock
added, “Development, obviously, is not the same as growth and can include
progression, regression, new constructions, remodeling, and in some ways,
decline” (p. 44).
The work of Margaret Mahler and her colleagues (1975) has had a ma-
jor impact on my thinking about development throughout the life cycle
and stimulated me to publish a series of three papers (1990, 1997, 2000)
on separation-individuation phenomena in adulthood which extended the
developmental line of separation-individuation originated by Mahler and
continued into adolescence by Peter Blos (1962) through Young, Middle,
and Late Adulthood by introducing the terms Third, Fourth, and Fifth Indi-
viduations. I will make frequent reference to these papers because the themes
of separation and loss are highly relevant to our discussion of the effect of
death awareness on development in adulthood.
Freud’s Thoughts on Transience and Uncertainty

In his paper “On Transience” (1916 [1915]), written during the First World
War, Freud’s thoughts were drawn toward loss and impermanence. Speaking
of a poet friend, he noted:
The poet admired the beauty of the scene around us but felt no joy in it. He
was disturbed by the thought that all this beauty was fated to extinction, that
it would vanish when winter came, like all human beauty and all the beauty
and splendour that men have created or may create. All that he would oth-
erwise have loved and admired seemed to him to be shorn of its worth by the
transience which was its doom. (p. 305)
This eloquent statement contains the essence of the mid- and late-life
struggle with the developmental task of the acceptance of time limitation
and personal death. Interestingly, Freud was fifty-nine years of age when he
wrote this paper.
Living to Die and Dying to Live 109
Freud’s use of the concept of transience, directly or indirectly, stimulated

psychoanalysts to use other words in their attempts to elaborate. Jacques
(1965), in his seminal paper “Death and the Midlife Crisis,” used the term
constructive resignation, without reference to Freud’s paper on transience.
Kernberg (1980) spoke of change in the perspective of time and Robert
Nemiroff and myself (1981) defined the developmental task of the accep-
tance of time limitation and eventual personal death.
In his paper “The Uncanny” (1919), Freud comments on the human
struggle to avoid and rationalize the idea of a personal end.
Two things account for our conservatism: the strength of our original emo-
tional reaction to death and the insufficiency of our scientific knowledge about
it. Biology has not yet been able to decide whether death is the inevitable fate
of every living being or whether it is only a regular but yet perhaps avoidable
event in life. No human being really grasps it (the idea that all men are mor-
tal), and our unconscious has as little use now as it ever had for the idea of its
own mortality. (pp. 242–243)
A Developmental Line of Death Awareness

The human struggle to accept personal mortality culminates in midlife in
a poignant, painful, monumental conflict between irrationality and reason;
one that more than any other defines the mature adult and the essence of
the human condition.
Childhood is characterized by a relative inability to understand the inevi-
tability of a personal end because of cognitive immaturity and the forward
thrust of maturation. There is little in the anabolic thrust of the development
process to indicate a personal end.
In late adolescence because of the loosening of intrapsychic ties to the
parents, a sense of history emerges which includes the realization that a part
of the self and an entire epoch of life, childhood, is in the past and irretriev-
ably lost. But this dawning recognition is quickly defended against by the
optimism and idealization of youth, a semi-successful attempt, according to
Jacques (1965) to deny “the two fundamental features of human life—the
inevitability of eventual death, and the existence of hate and destructive
impulses inside each person” (p. 505). Gradually a “more contemplative
pessimism” (p. 504) replaces the youthful belief that the power of stasis,
the status quo, and catabolism can be overcome. With youth behind them,
normal midlife adults are forced to confront their finiteness as the defenses
against the acceptance of time limitation and personal death crumble before
the power of new physical, psychological, and environmental experiences.
The Relationship between Death Awareness

and Separation-Individuation Processes in Midlife
A critical difference exists between the separation-individuation processes in
young adulthood and those in midlife. The need for a deep, lasting attach-
ment to another and the drive to replicate the self through the creation of
children are at the core of young adult experience. For most, by the time they
reach their forties and fifties their lives are emotionally anchored by relation-
ships with family members, friends, and colleagues. However, intrapsychic
reality changes significantly in midlife. Stimulated by the aging process in
the body, the death of parents, the growth of children into adulthood, grand-
parenthood, and the approach of retirement; during the Fourth Individua-
tion all midlife individuals come face to face with their mortality and struggle
to accept the painful, unavoidable recognition that the future is limited and
that they will die, leaving all that is known behind. The preoccupation with
the awareness of a limited time left to live is an extremely powerful psychic
organizer that forces a significant examination of all aspects of one’s experi-
ence and powerfully influences separation-individuation processes.
The ironic awareness that one will die and be deprived of involvement
with loved ones occurs at the very time that a mature understanding of the
importance of others for one’s health, happiness, and security is at its peak.
As Jacques (1965) expressed it, “The achievement of mature and indepen-
dent adulthood presents itself as the main psychological task. The paradox
is that of entering the prime of life, the stage of fulfillment, but at the same
time the prime and fulfillment are dated. Death lies beyond” (p. 506).
This paradox is particularly poignant in middle adulthood because fulfill-
ment is based in no small measure on the incredible richness of involvements
that occur then. Unlike the young adult years, when in the midst of the Third
Individuation after leaving the family of origin and not yet creating a family
of procreation, those in their twenties and thirties experience what I called
“the loneliness of young adulthood” (Colarusso, 1990); midlife men and
women are immersed in relationships with spouse, children, elderly parents,
in-laws, friends, and colleagues, and are forging ties with new individuals of
great personal importance, namely grandchildren. At no other point in life
is the potential for attachment—and loss—so great. The acceptance of this
juxtaposition of interdependence with others and the inevitability of total
separation is a central developmental task of middle adulthood that must be
engaged and mastered if developmental progression is to continue.
The acceptance of time limitation and personal death engenders a
need to understand two contradictory trends in human experience: (1)
the inevitable predictability of the linear temporal progression from the

present to the future, and (2) the unpredictability of loss and change in
human experience. The common element in both trends is loss. The ma-
ture individual in the midst of the Fourth and Fifth Individuations uses
this understanding and integration to value and seek out intimacy while at
the same time recognizing the time-limited nature of all human ties. This
bittersweet mature insight leads the older individual to a most exquisite
understanding of relationships and the human condition. Although sepa-
ration-individuation theory is only one of many complementary theoreti-
cal frameworks available to psychoanalysts, it is particularly well suited
to understanding mid- and late-life development because it sheds light
on the near-constant attempt to reconcile the incomparable pleasures of
wisdom and mature loving and living with the incomprehensible aware-
ness of personal death.
Robert Lifton (1979) recognized the growth-promoting, phase-specific
power of the midlife confrontation with death. He said, “There is a spe-
cial quality of life-power available only to those seasoned by struggles of
four or more decades. That seasoning includes extensive cultivation of
images and forms having to do with love and caring, with teaching and
mentorship, with work combinations and professional creativity, with
responses to intellectual and artistic images around one, and above all
with humor and a sense of the absurd. The seasoned psychic forms are
by no means devoid of death imagery. Rather they are characterized by
ingenious combinations of death equivalents and immediate affirmations,
or melancholic recognition of the fragmentation and threat surrounding
all ultimate involvements, along with dogged insistence upon one’s own
connections beyond the self—one’s own relationships to collective modes
of symbolic immortality. Like the despair, the life-power of this stage can
be especially profound (p. 5).
As previously noted, Freud spoke of the uncertainly of living in his ar-
ticle “The Uncanny” (1919), noting that uncertainty was tied to the fear
of death. During midlife, the connection between uncertainty, imperma-
nence, and the fear of death is reworked. As the concept of a personal end
is gradually integrated, uncertainty takes on a less ominous, even some-
times enjoyable meaning, because of the awareness that, at least for now,
in the vigorous midlife present, the challenges of uncertainty can not only
be met but mastered. Those who are unable to master the developmental
task of the acceptance of time limitation and personal death will continue
to have “uncanny” experiences, viewing the unexpected as a threat rather
than a challenge.
The Effect of Death Awareness and

Anticipation on Late-Life Development
In “Adulthood” (1978), Erikson noted the ubiquitous resistance to a detailed
understanding of adulthood because it is based on
the truly “dread-ful” human dilemma of having to reconcile a heightened

need for generational renewal in a “real” Here and Now with the certainty
of individual death. One must begin with such fundamentals if one wishes to
understand the necessity for adults to arrive at some formulation of adulthood
and to gain some objective perspective on its precursors. (pp. 21–22)
As they move from childhood into adulthood, individuals develop a con-

cept of an expectable life cycle and, as Neugarten (1979) put it, “a mental
clock telling them where they are and whether they are on time or off time”
(p. 888). In late adulthood, the subjectively perceived distance from death is
for many a more important organizer of subjective time sense than chrono-
logical age (Lieberman and Caplan, 1960). I would suggest that this shift
begins in midlife, the resultant of the engagement of the developmental task
of accepting time limitation and personal death (Colarusso and Nemiroff,
1979). The intense, normative midlife preoccupation with, and eventual
acceptance of, time limitation and personal death is a developmental prereq-
uisite for the benign acceptance of death in old age. When these are engaged
and mastered in midlife, the acceptance of death as a natural consequence
of aging occurs without shattering the continuity of the intrapsychically
perceived life cycle or the integrity of the ego. Thus, in late adulthood, it is
not the inevitability of death that is the issue but rather the timing of death.
To quote Neugarten (1979), “Even death is a normal and expectable event
for the old. Death is tragic only when it occurs at too young an age. Even the
death of one’s spouse, if it occurs on time, does not create a psychiatric crisis
for most men or women” (p. 889).
Attitudes toward the end of personal time are highly individual, influ-
enced by factors such as life experience, psychological and physical intact-
ness, and religious belief. When one’s life is viewed with a sense of integrity
rather than despair (Erikson, 1963), death is greeted with a measure of equa-
nimity because of one or more of the following considerations:
1. The realization that life has been long and fulfilling but that because
of physical or psychological limitations already present, a meaningful
quality of life can no longer be maintained.
2. Awareness that one’s knowledge, experience, and expertise are more

relevant to the past than to the present and the future, that one has
neither the time nor the capability to contribute significantly to the
evolution of society.
3. The desire to avoid a loss of dignity through mental or physical incom-
petence at some point in the future.
4. The wish to avoid becoming a burden on loved ones and rob them of
the freedom to use precious midlife time and energy as they choose.
5. The belief in an afterlife. Death becomes more acceptable if one ex-
pects to be united with a creator and with loved ones who have passed
on. Through the belief in an afterlife, the notion that personal time
ends is openly disavowed. For example, a central tenet of Christian
doctrine is that Christ rose from the dead and that there will be resur-
rection of the body and life everlasting.
Awareness, acceptance, and integration of these concepts are essential

aspects of late-life maturity. Whether viewed as an inevitable consequence
of God’s grand plan or as an unsolvable mystery, personal death is part of a
grander, incomprehensible scheme since all animate and inanimate structure
and organization—be it individual human beings, civilizations, planets, stars,
or galaxies—exist in an unalterable time-space framework that inevitably
moves from birth through maturation to decline and death. The mature late-
life human being must live—and die—with this unsatisfying relationship and
disquieting ignorance.
Living to Die but Dying to Live:

The Story of Two Midlife Analyses
Mr. T.
A full case report of the clinical vignette I am about to present from the
analysis of a fifty-three-year-old man may be found in Volume 54, Number 3
(2006) of the Journal of the American Psychoanalytic Association. The material
presented will be circumscribed to focus on the topic of death awareness. A
highly successful, very intelligent businessman, Mr. T. was married and the
father of three adolescent children. He entered analysis because of growing,
perplexing feelings of anxiety and depression. The four-year analysis was con-
ducted in classical fashion without parameters. He had been in good physical
health throughout his life. The most significant event in his childhood was a
parental divorce that occurred in late latency which was followed by maternal
decompensation and paternal abandonment that had a profound effect on his

adolescent and adult development.
Opening Phase
Six months into the analysis Mr. T. turned fifty-four. “What will I do with the
rest of my life?” he mused. This was the first reference to aging and the future.
Gradually his fears of aging and premature death began to emerge. Although I
thought that his fears were related to his father’s death at age fifty-eight, I had
no clinical data to support my hypothesis at this point in the analysis.
As Mr. T. approached the end of the first year in analysis body monitoring
became an increasingly prominent theme. After developing a sore back, he
remarked, “I’m getting old.” He had avoided exercise and medical checkups
and resisted my inquiring into these subjects. Mr. T. had a growing sense
that there was no “safe haven in life.” He should be happy because he had
everything a man his age could want—a great career, family, money, and
friends. He didn’t include health on his list, despite the fact that there was
no evidence of any significant disease.
A few months into the second year of the analysis, Mr. T.’s associations
turned to thoughts of retiring. He had no plans and the subject made him un-
comfortable. If he stopped working he might as well be dead. The increase in
anxiety as he spoke was palpable. Death, as an emotionally charged subject,
entered the analysis for the first time. In the next session his associations led
him to the theme of his parents’ death. With a sense of sudden awareness and
mild shock, Mr. T. recognized that he was just a few years younger than his
dad was when he died. This train of associations was a major turning point in
the analysis, though the significance was not clear to either of us at the time.
His depression had disappeared months ago but was now being replaced by a
growing concern about health and dying.
Approximately eighteen months into the analysis Mr. T. finally went for
a routine medical checkup. Although he was found to be in good health, lab
results indicated a slightly elevated PSA and mildly decreased bone density.
To his great relief a prostate biopsy was negative, but he remarked, “I dodged
a bullet. There will be more to come.” These findings, coupled with the re-
cent removal of a precancerous facial lesion, filled Mr. T. with anxiety. “It
looks like it’s going to be my face, my prostate, and my bones!” The irrational
idea that he might die “soon” was “crushing.”
Middle Phase
Two years into the analysis, just before he turned fifty-five, as he contin-
ued to focus on his unsuccessful attempts to exercise, I repeated an interpre-
tation that had had little effect in the past. “Your resistance to exercise is
part of a pattern of avoidance of powerful thoughts and feelings about fears of
illness and death.” His emotional response, which seemed to erupt from deep
inside, took both of us by surprise. “Why should I take care of myself?” he
shouted angrily, “I’m going to die in a couple of years, just like my father and
grandfather!” This response was the first indication of what became a central
theme in the analysis—a powerful but highly conflicted identification with
a father who had abandoned him in childhood. The need to regain the lost
object, albeit with feelings of intense rage, was so great that not even death,
at the same age his father died, was too high a price to pay.
During the third year of the analysis the issue of midlife aging was finally
approached after much resistance. “I was looking at my body in the mirror. I
didn’t do that before. I didn’t want to see what I looked like. Like it or not,
I’m fifty-five.”
The working-through process regarding his expectation of a premature
death continued as we approached the end of the third year of analysis. “My
father died at fifty-eight, my mother at fifty-six, my grandfather at fifty-eight.
What chance do I have? I’m right in the middle of the death zone.” Repeated
interpretations that his fear of dying prematurely was based on conflicted
feelings about his father and not the reality of his actual health seemed to be
having an effect. “Death and time have been in my life every day since my
parents died. But something is different. Am I starting to believe that I’m
going to live beyond fifty-eight?”
Clear evidence of engagement and beginning mastery of the midlife de-
velopmental task of confronting aging and mortality began to appear. Mr. T.
discussed how he wanted to die. “I want to go to the end and have used up
everything.” Later he said, “I want to be happy every day. Time is precious.”
A month later he added, “What if I live till I’m eighty? What am I going
to do with all that time?” The prospect of a long future began to be a pleas-
ant one of years filled with freedom and choice, not dread and intellectual
emptiness.
Mr. T. began to approach the idea of dying more philosophically. Religion
had played little role in his life during childhood and agnosticism became a
comfortable, rational concept that grew out of his scientific thinking and
evolutionary awareness. Thus, for Mr. T. the idea that death may be a means
of salvation and reunion with lost loved ones had little value. He raised
the issue of whether his creative works were a form of immortality. “Dead
is dead,” he said. Others may be thinking about him, but the idea provided
little comfort in view of his expectation of total nonexistence after death.
The same sort of thinking applied to the “genetic immortality” provided by
the idea of living on through children and grandchildren. “The idea of im-
mortality is comforting to the living, but I don’t think it does much for the
dead.”
After focusing on the idea of his death Mr. T. began, hesitantly at first, to
approach the idea of my demise. Mr. T. had looked me up on the Internet
and determined that I must be about ten years older than he. He was correct.
He asked many questions about my personal history. Why hadn’t I retired?
Did I believe in an afterlife? As we analyzed his thoughts it became clear
that I was the good, strong father protecting him from danger and death,
leading the way into the unknown, unafraid. But he was also afraid of my
power and potential aggression. If he crossed me, I might abandon him as his
father had. This work, which was concentrated over a few months, obviously
building on earlier efforts on these themes, resulted in a significant change
in attitude about living and the future. Mr. T. was now able to think about
the future without fear. In a subsequent session he happily spoke of how
good his life was in the present and how much he looked forward to eventual
retirement.
Termination Phase
Mr. T. began to plan in detail for his sixties and seventies. At this point, as
he again focused on my age and attitude toward dying, I confirmed that I was
sixty-eight years old. Because of the insight gained into his oedipal conflict
with his father and its midlife ramifications, Mr. T. was able to identify with
me as a father figure with much less ambivalence. If I could be healthy, ac-
tive, and mentally alert at sixty-eight, so could he. In fact, he could picture
me full of life at seventy-five or eighty. Then, he added, so could he. In the
final months of analysis further evidence of resolution was apparent. “I’m not
afraid of death anymore. I was afraid of living. You’re not really alive unless
you accept the fact that you’re going to die.”
As the analysis came to an end, Mr. T. attended the funeral of his paternal
uncle. He described the experience with a sense of calm and maturity. “It re-
ally was two funerals in one. I buried my Dad at the same time.”
Mr. B.
A further elaboration of the clinical material to follow my be found in the
Psychoanalytic Study of the Child, Volume 62, 2007, in a paper entitled “Tran-
sience During Midlife as an Adult Psychic Organizer,” by Dr. Guillermo Julio
Montero and myself.
Mr. B. began analysis at the age of thirty-seven. The focus of the nearly
two-year analysis was a desire to increase the degree of intimacy in his
long-standing, successful marriage; and curiosity about a sense of free-float-

ing anxiety. During the course of the analysis it became clear that he was
a highly successful, neurotically organized individual who was raised in an
intact, loving family. His early development was uneventful until the death
of his father when Mr. B. was twelve. This traumatic experience became a
powerful organizing factor in his mental and emotional life and became a
major focus of his subsequent need for additional treatment.
During the analysis Mr. B. experienced anxiety whenever he thought of his
father. “I’m fearful tragedy will strike again. Like when my father died when
I was twelve.” At other points the anxiety was expressed through statements
such as, “I don’t know where I’m going in ten years.” Transference issues during
the analysis were focused, not surprisingly, on strong longings for me to think
of Mr. B. as a good son. Desires to be praised for professional and personal ac-
complishments (which were many) were frequently expressed, as was the fear
that I would abandon him, as his father had through death, if he expressed any
criticism of me. Although interpretations connected these transference themes
to the patient’s loss of his father, they did not have nearly the impact that they
did when the patient returned to treatment as he approached fifty.
Countertransference themes toward this very likable, somewhat needy
man revolved around wishes to take care of him and to replace the good
father that he had lost. I was also aware of a desire to compete with the dead
father for first place in the “son’s” affections. These wishes were expressed
through a tendency to give advice and praise, rather than maintain neutral-
ity and analyze.
When the patient returned to treatment at ages forty-five and forty-nine it
became apparent that the analysis should have lasted longer than it did. My
failure to strongly confront the patient’s desire to stop after approximately
two years was the result of a transference-counter-transference collusion,
i.e., the successful son and the accommodating, loving father. However, Mr.
B.’s decisions to leave each sequence of analysis and therapy was interpreted
repeatedly as a resistance. With the advantage of hindsight, I understood
the urgency to leave as a means of avoiding the great anxiety and fear that
would have been generated by the emergence of murderous oedipal wishes
toward the father that were unconsciously considered to be the cause of his
death. Only after Mr. B. escaped retribution, i.e., outlived his father, could
the subject be approached.
Age Forty-five
Mr. B. returned to therapy for six sessions at age forty-five. Six years had
passed since the end of the analysis. During that time he had become even
more successful professionally and was in a very secure financial condition. He

reported that the analysis had been extremely helpful, “but I feel more vulner-
able than ever.” Despite having “everything that would make anyone my age
happy,” Mr. B. still had that vague, uncomfortable feeling about the future.
Shortly before returning to treatment, Mr. B.’s mother’s second husband
had died. Mr. B. did not relate his vulnerable feeling about the future or his
return to treatment to his stepfather’s death but quickly became less anxious
when the connection was interpreted. His mother had managed the death
with appropriate mourning and grace and continued to live a fully indepen-
dent life. Feeling, once again, in control of his thoughts and emotions, Mr.
B. decided to stop therapy, despite my suggestions to the contrary.
Age Forty-nine
The clinical material from this third course of therapy will be presented in
greater detail. Mr. B. returned to treatment three months before his fiftieth
birthday. This course of treatment consisted of twelve therapy sessions over
an interval of nine months. Eight were concentrated during the first four
months, usually on a biweekly basis.
First session: With a somber, depressed affect, Mr. B. related that his en-
docrinologist had discovered evidence of beginning osteoporosis and a sig-
nificantly low testosterone level. Further, the physician felt that Mr. B. was
depressed, hence the return to therapy. The endocrinologist suggested that
the depression may have caused the low testosterone level or vice versa. He
started Mr. B. on an antidepressant.
When asked to elaborate on his concerns Mr. B. mentioned money and
turning fifty. Financially he was in superb shape but was berating himself for
not selling his stocks at their peak. He felt a “driven need to save.” Mr. B.
was “obsessed” with turning fifty. His father died at fifty, he unnecessarily
reminded me. Father didn’t take care of himself, but Mr. B. worked out, had
a low cholesterol level, and was careful about what he ate. “I think of myself
as forty, not fifty.”
Mr. B.’s associations linked his two concerns. He feared losing his money
despite having a solid business, no debt and enough funds in savings to com-
fortably retire. He lived “way below my means, but if I spend money I feel on
the edge. There is no middle ground.” He might die soon, just as his father
did at his age. The money was a “magical fortress” protecting him and his
family against danger. His wife wanted to arrange a grand fiftieth birthday
party for him, but he didn’t want to “tempt fate.”
In our second session Mr. B. immediately began talking about money. He
wanted to avoid doing to his family what his father had done to him. After
father died he and his mother were “very poor.” Mr. B. felt intense feelings
of embarrassment when relatives provided money and clothing. He went to
work at age fourteen and later put himself through college. History would
not repeat itself, he would “bullet proof” his family. When I interpreted that
the intensity of his feelings about money and dying were related to his ap-
proaching the age at which his father died, Mr. B. sighed, volunteered that
he knew he was being irrational and thought maybe he should spend more
money on a vacation.
In session three Mr. B. began to contrast my ability to talk calmly about
his fear of dying with his own intense anxiety. My equanimity and the posi-
tive transference relationship in the past and present allowed many semi-
conscious and unconscious thoughts and feelings to burst into awareness.
Without his saying so, it was clear that within the therapeutic alliance Mr.
B. felt safe enough to explore his thoughts.
The events of 9/11 had been a “horrible experience” for him. I commented
that it was a sudden, unexpected trauma for which he was unprepared—just
like his father’s death. “What if I don’t want to die?” he said defiantly, strug-
gling against the now fully conscious awareness of the effect of the childhood
trauma. However, it was clear that he was not yet aware of the powerful, pri-
marily oedipal, dynamics that were determining and perpetuating the belief
that he would die at the same age as his father. He then associated to the
film Contact in which the first human (portrayed by Jodie Foster in the film)
to travel to an alien civilization is addressed by them in the guise of her dead
father. With increasingly confident determination he repeated that he would
not do to his family what his father had done to him.
Racing with determination from association to association, Mr. B. noted
that his child was approximately the same age as he was when his father
died. He didn’t even know the exact date of his father’s birth and death. He
would find out. Excited by his ability to think about his dad, he blurted out,
“I’m my father. I’m just like him in the way I walk and talk.” Why didn’t his
father get better after his first heart attack? He remembered his mother ask-
ing the doctor why he couldn’t save her husband. Mr. B. thought his father
died in a hospital. Maybe there were records available. Then able to tap into
the depth of his feelings for the first time since adolescence, Mr. B. cried as
he related the last time he saw his father, sitting on the edge of the hospital
bed in his white gown. They had been alone for a few minutes and Mr. B.
was about to leave. Near the door he turned and looked at his dad. “He was
smiling from ear to ear and seemed so proud of me.” Mr. B. hadn’t thought of
that experience in many years and sobbed with sadness and love. He began
to remember details of the death and funeral. Mother told him that his father
had died and an uncle would take him to a scheduled doctor’s appointment.
He went to the funeral but not to the gravesite. A relative took him for Ital-
ian food instead. As he processed this information for the first time from the
vantage point of midlife, he was struck by the juxtaposition of the mundane
and the tragic.
Session Four: Mr. B. asked his mother exactly when his father died—ten
days before his fiftieth birthday. Mr. B. would surpass his father’s lifespan in
exactly forty-one days! He recalled the night of his father’s heart attack. His
mother’s screams awoke him. Mr. B. believes his father was wheeled out and
mother went to the hospital with him. Maybe there were two heart attacks?
Mr. B. missed his father during adolescence and became more of a loner,
distant from extended family, particularly when they “gave us charity.” He re-
called spending hours shooting baskets, by himself. The summer before he died,
his father had smiled knowingly when he saw Mr. B. cutting pictures of women
out of a magazine. He felt a deep sense of sadness and loss when he imagined
how supportive his father would have been of his adolescent sexuality.
Two months into this course of therapy Mr. B. decided to stop taking the
antidepressant prescribed by the endocrinologist. The depression had begun
to lift soon after we began to deal directly with the memories of his father’s
death. As his ability to think about his father’s death increased, Mr. B. began
to think about his progenitor from an adult rather than a child perspective.
Father had lived in a foreign country for three years in his late teens. He must
have been sexually active then. Increasingly free from the early adolescent
fixation point and outlook, Mr. B. said, “I’m beginning to think of him as a
man, not just my Dad.”
Although the subject of competitive feelings toward father and fear of
retaliation had been interpreted during the analysis, they had fallen on deaf
ears. The defenses against any emotional acceptance of oedipal strivings were
too strong, the day of retribution, too far away. Because of Mr. B.’s increased
ability to talk about his father with less anxiety and dread, I chose to rein-
terpret the infantile, oedipal wishes that father would die. After an initial
response of surprise and dismay, Mr. B. responded, “some victory, the years
after he died were the worst ones of my life.”
Mr. B. avoided further discussion of his angry wishes toward father until
the actual date of passing father in longevity. In our last several sessions he
was able to criticize father for leaving his wife and son in such a precarious
financial condition, and for not being there to guide his son through ado-
lescence.
Approximately a month later Mr. B. was feeling and sleeping much better.
He was thinking about buying a bigger house. “I closed everything down. I
expected to die at fifty.” In two weeks he would surpass his father’s longevity.
As he continued to discuss his abundant options for the future, the patho-
logical identification with his father diminished and Mr. B. began to indi-
viduate, increasingly recognizing that his options and life as he approached
fifty were profoundly different from his father’s at the same age. No longer
feeling depressed, he decided to meet less frequently.
The next session took place two weeks after Mr. B’s birthday. He chose
not to work the day after he surpassed his father in age. He had “an anxious
celebration,” as he put it. Then, proving that life is far more remarkable than
fiction, he sadly reported that his mother had died two days after his fiftieth
birthday. Becoming unconscious two days before death, “my mother ceased
to be a person on my fiftieth birthday.” Without prompting, he volunteered
that he was sad, not depressed. He had been able to work carefully and sensi-
tively with his family, arranging the funeral and dealing with the estate.
Mr. B.’s ability to deal with his mother’s death as a middle-aged adult ver-
sus his reaction to his father’s death as a vulnerable child was contrasted by
me. He agreed but added that he doubted he could have managed it so well
if he hadn’t been working through his feelings about his father. Two weeks
later, Mr. B. continued to mourn for his mother.
Mr. B.’s ability to begin to focus on the midlife developmental tasks of
transience, time limitation, and personal death grew rapidly, unaccompanied
by the anxiety and symptoms that had surrounded his unresolved develop-
mental fixation related to his father’s death. Now that Mr. B. had survived
fifty, he was able to consider a future and exciting options. He proudly de-
clared that he had purchased a new car.
Six weeks later: He announced with amazement that his testosterone levels
were back to normal!
Mr. B. returned three times over the next six months but made only oc-
casional references to his parents and focused instead on his future. “I have
it all—a profession, my health back, a family, and money. I’m beginning to
realize that I can admit it, and it won’t go away.”
Mr. B. asked to come in about five months later. He had some “interesting”
information to share. He had been able to acquire his father’s medical records
from nearly forty years ago. He learned that his father had been in heart fail-
ure for two years after his heart attack. He died of heart failure, not a heart
attack. As he discussed this, and recognized that he had never manifested
any signs of heart disease, and was aware of the major advances in the medi-
cal and surgical treatment of heart disease that had occurred since his father’s
day, Mr. B. continued to feel “liberated,” certain that his father’s experience
was not his own. His future at fifty was bright, and long!
Discussion: The traumatic and developmental effects of Mr. B.’s father’s

death affected every phase of development from adolescence through young
adulthood and into midlife, primarily in the form of unrecognized inhibitions
and overdetermined behavior. Mr. B. was driven to become highly successful
financially so as to build a “fire wall” around himself and his family so they
would not end up poor and dependent as he and his mother had been as a
result of father’s death. However, he was unable to use money in a rational
manner and lived far beneath his means, unconsciously expecting financial
disaster at any moment.
But it was not until approximately a year before he approached the age
at which his father died that Mr. B. became depressed and experienced the
significant drop in testosterone level. With little insight into the dynamics
behind his behavior, he began to “close everything down” as he approached
the age when he, unconsciously, expected to die. He had been living to die
but he wanted to be dying to live.
As the therapeutic work took place during the months leading up to the
anniversary of father’s death and his fiftieth birthday, Mr. B. began to count
the days and hours until he surpassed his father in longevity, hanging on to the
magical, but guilt-ridden, hope that once he got past the fateful day he would
be safe. The oedipal underpinnings of the fear of dying, and the hormonal cas-
tration in the form of depleted testosterone levels, were clearly related to the
infantile wish to kill father off and take his place, along with mother.
Significant is the fact that the depression—and the lowered testosterone
levels—responded to an analytic exploration of the genetic and dynamic
factors that had produced both the physical and psychological responses in
the first place. Many nonanalytically trained psychiatrists would likely have
relied on antidepressant medication and testosterone replacement to treat
the symptoms, never understanding or analyzing the psychological factors
and conflicts that were the true determinants of the symptoms.
A Mature Integration of Death Awareness

I’d like to close with the same material that I presented in 1996, namely
the poignant words of psychoanalyst Martin Grotjahn (1985) as he contem-
plated his approaching death:
“When I was born, the old and wise woman from the neighborhood came
to foretell my future. She listened to the screams of my rage and said: ‘He
will love the yellow of eggs, but he will learn nothing.’ My mother loved the
poetry of these words, and I have heard them often.
I did not do badly in the almost 80 years of my life. I even learned how to
live a little from the people who did not know and came to me to learn. But
now I am stuck again. I am not ready to die, not ready to say goodbye to this
life. I am not ready to say goodbye to myself. That seems to be the worst: to
say goodbye to myself. Through all the years, I have built myself, and in that
way I am a self-made man or a ‘self-found’ one.
I know dying is unpleasant, for to be dead is Nothing. I like that even
less. Sure, I am a narcissist. Who in our profession is not? I think of all the
investment I have made in myself: the analysis, endless training, the contin-
ued self-analysis, the drive to understand, to give insight, and the wealth of
knowledge accumulated in a lifetime. All this I should give up?
Fifty-five years of marriage were built with care, study, insight, learning,
and patience, and grew to ever deepening love. I am a most impatient person
of genuine bad temper, but I worked on myself: I tried to deepen my insight,
to become a better therapist and a better person. And finally, all should turn
to ashes? Just because my heart does not want to do its part anymore? One
does not need to be a narcissist to find that unacceptable. To say goodbye to
myself and vanish into nothingness? Well, it shall be done. Nobody claimed
it would be easy.
I would not want to live my life all over again. I would not want to go to
a Prussian school again—to worry about being loved—or not. I am equally
certain that I would only accept the offer to live a much longer life, in rela-
tive health. I would so much like to see ‘who wins’ or what happens next.
When I came home from the hospital, I had become old. Etelka smiled
at me and said: ‘I have adopted you.’ It is this kind of tender love I needed
and to which I tried to respond in kind. To have that kind of love makes us
both happy. Life becomes worth living all over again when such tenderness
is the final renewal.
My story would be incomplete if I did not mention my son, who has be-
come my friend in these times of sickness. He saw me when I was closer to
death than to life in the intensive care unit. It seems that to feel the nearness
of death washes away all aspects of ambivalence in old and in young. With a
different intensity, this is also true in my feelings to my friend who was with
me and still is.
I hope when my time comes to say goodbye to this world and to myself
and when I sink into nothingness, I will have enough presence of mind left
to say my last words. I would like to say once more and for the last time to
my wife: ‘I love you.’”
CHAPTER NINE
Facing Death
Intrapsychic Conflict and
Intergenerational Passage
Ruth Garfield, MD
I want to thank Dr. Calvin Colarusso for a very elegant and moving paper.
He has made my job difficult because I think this is both an important paper
and review of his work. I will try to flesh out some of his points and add some
critique from my side. Allow me to begin by saying that I am often aware of
how demanding and rewarding our clinical work is. As I get older, one of the
paradoxes I struggle with is the therapeutic attempt to enrich an individual’s
life, to lessen conflict and personal suffering when what we are ultimately
heading for is our death. In our work each day we most often deal with ques-
tions of life. So I find the question—can analysis or psychotherapy really help
one deal with their impending death or mortality—compelling and part of
my angst and struggle about my work.
The paradox presents in many clinical iterations. For example, at one mo-
ment the work with Mr. A focuses on his wish to find happiness in a loving
relationship and with Ms. B to face her fears about the rage she holds inside.
Both are in their late thirties. They want their lives to be better, as do I. I
realize that time is fleeting, and they do not seem to. I must stay with them
in their developmental sensibilities about time, yet maintain awareness of
my foreshortened sense of temporality. When a patient is older, in midlife
or beyond, or perhaps terminally ill, the feelings and thoughts about death
and limited time are more accessible; yet questions still pertain about how to
125
126 Ruth Garfield
deal with mortality issues and simultaneously help one live a rich full life in
the time that is left.
The Tasks of Mid- and Late Adulthood

Today I want to keep in mind the question of whether psychotherapy or
psychoanalysis can help with these issues. Clearly Dr. Colarusso believes
that they can. In his earlier work, Dr. Colarusso (1990, 2006) has written
at length about middle adulthood as a particular developmental phase (from
about forty to sixty years). Psychologically he has defined this phase as the
moment in every individual’s life when the transient nature of personal
existence becomes a defining issue in the intra-psychic and real worlds. He
believes, and I agree, that whenever this moment occurs chronologically, it
serves as a “psychic organizer” (Spitz, 1957, 1965), forcing a significant re-
examination of all aspects of life that have been lived in the past: its present
positive and negative aspects, particularly in regard to marriage, family, and
work; and a reassessment of how to use the time that is left.
By setting forth the tasks of midlife and late adulthood, he urges us
as clinicians to keep them in mind, just as we would the developmental
tasks of a fearful preschooler, or an anxious adolescent struggling with age-
appropriate separation issues. In the same way that neither a small child nor
a teenager is likely to come in and directly present underlying concerns, an
adult, especially at midlife or late life, is often not yet aware of how end of
life issues impinge upon their presenting complaints. In their recent paper in
the Psychoanalytic Study of the Child, Dr. Colarusso and Dr. Montero (2007)
suggest that there is a continuum from midlife acceptance of “transience of
life” to midlife crisis. They define midlife crisis as a radical, unconsciously
driven, unreasoned overthrow of vital life structure and relationships, such
as work and family, often at the same time.
They describe two ways of negotiating the midlife transition continuum.
In their first, more healthy way, there is gradual, positive acceptance of life’s
temporal limits, as one engages consciously in this developmental coming
to terms. In the second, instead of mourning for the youthful past and inte-
grating the midlife task of transience, some individuals fly toward their lost
past in a desperate attempt to recover it. As the authors note, this may take
the mode of crisis or some more benign course, such as dressing like one’s
adolescent child, or as a newly fifty-year-old patient did—cruising Facebook
for old girlfriends.
Drs. Colarusso and Montero also review the contextual ways the thera-
pist may hear about these mortality-related issues from our patients in mid-
Facing Death 127
or late life. Even when issues discussed seem understandable from a familiar
psychological perspective, there may be significant components related to
mortality concerns. For example, content about body or sexual concerns
may also be existentially derived. One patient, in her eighties, who had
been in good health, had to stop use of daily estrogen. A few weeks later
she came in after experiencing a panic attack and continued anxiety. She
had been plagued throughout her life with excessive anxiety, for which an
analysis in her seventies had been very helpful. One of the consequences of
discontinuation of the estrogen was nightly incontinence. This was truly a
bodily concern and stirred feelings of shame; it also deeply shook her sense
of herself as strong and able. She felt frightened about the possibility of
viewing herself as frail as she ages. Another patient, a man in his late for-
ties, hesitatingly began to discuss a decrease in his libido and trouble with
sexual performance. In addition to his concerns about his masculine sense
of self, he worried about the state of his body. For the first time he found
himself worrying about the state of his aging body, whether he was systemi-
cally ill, and about time running out.
Dr. Colarusso definitively establishes peaceful acceptance as the positive
outcome of this developmental task. Yet a less peaceful approach to one’s
mortality is understandable given the conflicts surrounding aging and death.
At some point peaceful acceptance may merge with resignation. It is not
an easy task to come to terms with the predictable frailty of one’s body and
mind, if one lives long enough. In a well-known poem (Do Not Go Gentle into
That Good Night) written while confronting his elderly father’s frailty, Dylan
Thomas (1914–1953) advised against such a peaceful coming to terms.
I too question this positive standard of mastery, the benign acceptance
of one’s mortality in Dr. Colarusso’s paper. He cites Erikson’s (1950, 1959)
work on developmental stages throughout the life cycle; Erikson’s tasks in
middle adulthood are generativity versus self-absorption or stagnation, and
in late adulthood integrity versus despair. Irwin Hoffman (1979) points out
that for Erikson, the ultimate outcome involves an either-or solution. He
quotes Erikson who writes that the accomplishment of the state of integrity is
“the acceptance of one’s own and only life-cycle and of the people who have
become significant to it as something that had to be . . .”; on the opposite
side, “the lack or loss of this accrued ego integration is signified by despair
and an often unconscious fear of death: the one and only life cycle is not ac-
cepted as the ultimate of life” (Hoffman p. 251). Dr. Colarusso’s tasks have a
similar binary ring. He writes, “The intense, normative, mid-life preoccupa-
tion with, and eventual acceptance of time limitation and personal death is a
developmental prerequisite for the benign acceptance of death in old age.”
128 Ruth Garfield
An Existential View of the Tasks of Late Adulthood

In his paper, Dr. Colarusso mentions Freud’s paper, “The Uncanny” (1919),
and his elegant statement about the human struggle to avoid and rationalize
the idea of personal end. Freud writes,
Two things account for our conservatism: the strength of our original emo-
tional reaction to death and the insufficiency of our scientific knowledge about
it. Biology has not yet been able to decide whether death is the inevitable fate
of every living being or whether it is only a regular but yet perhaps avoidable
event in life . . . no human being really grasps it (the idea that all men are
mortal), and our unconscious has as little use now as it ever had for the idea of
its own mortality.” (1919, p. 242)
Many other writers, however, have criticized Freud for derailing the idea
that our mortality is at the root of much of our anxiety. He locates this fear
only in our unconscious mind and even questions whether death is avoidable.
Other writers, such as Robert Lifton (1996), credit Freud both with facing
his own death heroically and acknowledging that death must not be denied.
Lifton, however, also asserts that in his theory, Freud neglected the question of
death, and relegated fear of death to a derivative of the fear of castration.
I am drawn to the more existentially based perspective and nonbinary
model proposed by Irwin Hoffman (1979) in his important paper, “Death
Anxiety and Adaptation to Mortality in Psychoanalytic Theory” and then
slightly revised (1998) in his book Ritual and Spontaneity in the Psychoanalytic
Process. His model suggests that greater psychological development late in
life is associated not with benign acceptance of one’s mortality, but with
increased conflict and complexity, like that which is familiar to us in facing
conflicts which are reawakened at every life stage. Resolution and/or mastery
are aspirations, but basically are oversimplifications or fictions. Hopefully
we achieve greater peace as we approach the end of life, but also we have
times of death anxiety or existential dread. Hoffman (1979) writes about an
advanced level of development associated with a tolerance of an ambivalent
relation to death—one which includes existential “dread” and anticipatory
mourning as well as self-affirmation.
Hoffman refutes the idea that death anxiety is a sign of developmental
weakness or failure. He continues, “It may be that ultimate wisdom lies not
with a ‘cosmic narcissism’” (Kohut, 1966) which results in a calm accep-
tance of mortality but with an ability to maintain in awareness both sides
Facing Death 129
of the paradox posed by the prospect of death, namely that death renders
life meaningful and meaningless, precious and valueless at the same time”
(p. 255). He is critical of both Erikson and Kohut when he writes that emo-
tional maturity includes real and anticipatory grief or even depression along
with self-affirmation.
Hoffman believes that an existential model shares a complex perspective
with a psychoanalytic model. Each person is both ultimately responsible for
her life and aware of her death. The anxiety about death both contributes to
one’s sense of utter helplessness and buttresses one’s need to take responsibil-
ity for the time she has. He writes, “The dread or anxiety associated with the
anticipation of the loss of the self and the exhilaration associated with the
sense of ownership of one’s life are inseparable aspects of the same experi-
ence” (p. 256).
Although Dr. Colarusso presents the tasks of mid and late adulthood on a
continuum, in his model, there seems to be a healthy, positive outcome and
one less salutary. His schema is more conceptually neat than Dr Hoffman’s
or other existential psychologists. It is interesting to note, however, that Dr.
Grotjahn’s (1965) essay, with which he concludes and, in fact, entitles “A
Mature Integration of Death Awareness,” contains both notes of acceptance
and of existential angst.
Clinical Material
I’d like to turn now to a few comments about the clinical material presented
in the paper by Dr. Colarusso. The full case reports capture the depth and
sensitivity of his work. If it is not clear from his summarized case versions,
it is abundantly clear in the full case reports that Dr. Colarusso is extremely
attuned to these patients. He provides a safe, noncritical atmosphere, and is
sensitive to their transferential needs for him and his feelings for them.
In the case of Mr. T., one has the sense, from the outset, that Dr. Co-
larusso is not only interpreting Mr. T.’s resistance to free association as he
claims, but that he is relating to him in the gentle, holding way that he needs
at this early stage. His fears surfaced early about his health, and the probabil-
ity, even certainty that he would die in his late fifties as had his parents. Dr.
Colarusso provides a brief holding environment until such time that Mr. T.
is able to explore past relationships and current feelings in a more interpre-
tive climate.
130 Ruth Garfield
Dr. Colarusso’s emotional constancy and availability are significant be-

cause Mr. T. has suffered broken relationships with parents and siblings,
and at the outset has limited connections with his children. Through the
treatment he remembers that at age eleven, he lost both parents, after their
divorce because of their emotional or physical unavailability. A time of
great emotional pain and upheaval ensued. His early response was to turn
to school, then work and to a frenetic but largely unsatisfying social sexual
life in young adulthood. Eventually he established a more settled life, with
great professional accomplishments and marriage to a stable woman. Largely,
however, he tried to bury his pain through his work and through his attempt
to maintain a rose-colored view of the world.
At a relatively early stage in the analysis, Mr. T.’s fears about his health
and the probability that he would die prematurely surfaced. Dr. Colarusso
recognized the specific genetic contributions to this man’s anxiety but also
saw that he was grappling with appropriate developmental tasks of facing
limited time and mortality.
Mr. T. longed for a father figure in Dr. C., someone who could help him
repair his fractured identification with his father. He aggressively questioned
Dr. Colarusso about his age, his views of an afterlife, his publications, his sex
life. I think that this treatment was successful, in part, because Dr. Colarusso
valued the relational aspect of the treatment, allowing himself to be “used”
in a Winnicottian way. He writes that through interpretation and identifica-
tion Mr. T. gradually internalized his analytic attitude, as well as his insights
and knowledge regarding mid- and late-life development, and became a
loving “father” to both himself and his children. He refers to T.’s insight
into his oedipal conflict with his father and its midlife ramifications which
allowed this. I believe, however, that a broader, more progressive, view of
oedipal conflict may be more relevant in understanding the benefit of such
interpretations, which I will elaborate later.
With the next case report, that of Mr. B., it is again possible to discern
Dr. Colarusso’s sensitivity and attunement to his patient who lost his father
through premature death when he was twelve. Dr. Colarusso understands
Mr. B.’s neediness and search for someone “to replace the good father that
he had lost.” After Mr. B. returns to treatment at age forty-five following a
two-year analysis from ages thirty-seven to thirty-nine, Dr. C. acknowledges
that he provided a safe therapeutic milieu for Mr. B. to explore his fears about
dying. Mr. B. contrasted Dr. Colarusso’s “ability to talk calmly about his fear
of dying with his own anxiety.”
Dr. Colarusso again also appends a more traditional oedipal explana-
tion, that “only in hindsight, [after Mr. B. left analysis] I understood the
Facing Death 131
urgency to leave as a means of avoiding the great anxiety . . . generated by

the emergence of murderous Oedipal wishes toward the father that were
unconsciously considered to be the cause of his death.” I also question later
oedipal interpretive comments he makes which are related to sexual and ag-
gressive drive elements, because they seem forced and of questionable use.
I imagine that Mr. B. gained at least as much from interpretive comments
about oedipal wishes to kill his father as he did from Dr. Colarusso’s help in
containment of his anxiety and in his provision of a model of a wise father
figure who faces death and who will talk with him about it.
A More Progressive View of the Oedipus Complex

Hans Loewald (1979) suggested a more progressive understanding and usage
of the Oedipus complex in his paper, “The Waning of the Oedipus Com-
plex.” Thomas Ogden’s (2006) paper, “Reading Loewald: Oedipus Recon-
ceived,” develops this further. Both papers relate to the psychological impact
of awareness of mortality. When Loewald wrote “The Waning of the Oedi-
pus Complex,” he told a colleague that he could not have written it before
he became a grandfather. Ogden writes, “At the heart of Loewald’s (1979)
reconceptualization of the Oedipus complex is the idea that it is the task of
each new generation to make use of, destroy and reinvent the creations of
the previous generation” (p. 651). He strongly makes the case that Loewald
viewed the Oedipus conflict as much less—perhaps not at all—driven by
sexual and aggressive impulses than by the urge for independence and in-
dividuation. Children, boys and girls, thus must have fantasized parricidal
designs on their parents, “not as an end in itself,” but as “collateral damage”
so that the baton can be passed from one generation to the next. The parents
must die so the children can advance to the next generation.
In such a reading, Laius and Jocasta fear their death and try to destroy the
child who will form the next generation and replace them. In this process
the child atones for the psychic murder by internalizing his or her experience
of the parents; however, this internalized version is a “transmuted” version
which allows the child to both be like her parents and, at the same time, to
be him or herself. Ogden (2006) writes:
To the extent that the parents have been transformed in the internalization
process, the parents have contributed to the creation of a child who is capable
of being and becoming unlike them—that is, capable of becoming a person
who is in certain respects, more than the people who the parents have been
capable of being and becoming. What more meaningful atonement can there
be for killing one’s parents? (p. 660)
132 Ruth Garfield
Let me present a very brief clinical vignette. A patient whom I’d treated
in analysis for eight years beginning when he was in his late thirties called to
begin weekly psychotherapy. He is now in his early fifties. Originally he came
into treatment because of generalized and obsessive anxiety which interfered
greatly with the flow and enjoyment of his life. He was dissatisfied with work
and worried greatly about his relationships with his sons, following divorce
from their mother. The analysis was very helpful with his anxiety and he
has been a wonderful, involved father to his sons. He returned to treatment
to continue to work on his job dissatisfaction. His father was in the same
general field, well known and respected, though recently retired, while my
patient’s work, though successful, was on a less grand scale. Through the
years of analysis, we spent much time understanding the impact of his pretty
uninvolved father. He longed for a stronger connection to him but perceived
him as an irresponsible child who needed protection.
His father, in his eighties, now had cancer. After several months, my
patient began to discuss, with difficulty, newly arisen physical problems, and
worries about the decline of his body. His boys were doing extremely well,
one about to graduate from professional school and the other about to go off
on a prestigious graduate fellowship. He had the following dream,
I get a package in the mail. When I unwrap it, there is a plate which says my
son will be expelled from the local school system. I know that he does not go
there, but I get extremely anxious and worry that he will lose his fellowship.
We had spent much time in the analysis, fifteen years ago, trying to un-
derstand his work inhibitions and related them to, among other things, his
relationship with his father along traditional oedipal lines. With this dream,
we related it to his recently revealed concerns about life and death, and the
passage of time. In addition to his pride, he could acknowledge some jealousy
of his son and wished he’d been as diligent a student. I reminded him that
he had provided the kind of fathering to his son, the encouragement and
support that he had longed for. He tearfully agreed. His sons will, I think
feel freer to supplant their father and his generation in the progression of life
without guilt. I believe they view him as an adult who has experienced some
of life’s rewards (satisfying marriage, relationships with his sons) and disap-
pointments. The sons may very well internalize large aspects of him and then
“transmute” these images and go further than he was able to.
Thus I believe that Dr. Colarusso is using the Oedipus story more as a
narrative about sex and aggression (which I see as really the back story), and
less about the natural progression of life, that one generation guides the next,
Facing Death 133
its guidance is used and transformed and then the old generation dies off.
This version is especially relevant to mid- and late-life conflicts. With this
reconceptualization in mind, there is yet more impetus for hearing the death
anxiety in our patients’ material when we might have been inclined to hear
about lust and murder. Ogden (1996) writes:
Not to diminish one’s children (and one’s patients) involves not a passive
resignation to aging and death, but an actively loving gesture repeated time
and again in which one gives over one’s place in the present generation to
take one’s place sadly and proudly among those in the process of becoming
ancestors. (p. 657)
Final Comments
Plato suggested that we practice dying. By recognizing our feelings about
death, not only those of mastery, but also fear and depression, we are much
more apt to know our patients’ existential struggles. The knowledge of our
death is the ultimate boundary. A limit is set allowing us to make the most
of our time here and to value whom we have in our lives and what we do
with our lives. Hoffman writes ironically about what if that boundary were
not there.
We are so accustomed to appreciating the way in which the anticipation of

death, of endless nonbeing, undermines our sense of meaningful selfhood, that
we fail, perhaps, to sense that the prospect of endlessness itself is anxiety pro-
voking, whether we imagine ourselves forever alive or forever dead. (p. 18)
Often later in life, people find new generativity, make new friends, and con-
tinue to work on their inner lives. The eighty-two-year-old patient who had re-
cently completed an analysis is but one example. An eighty-six-year-old friend
“reassured” me that her conflicts continue and that she works on them daily.
In her book, The Last Gift of Time (1997), Carolyn Heilbrun wrote at age
seventy about the surprising changes she was able to make in her life after
turning sixty. She had earlier planned to end her life at age seventy but after
a decade of continued good health and productivity, she delayed this plan.
She continued her writing, made new important friends, and found renewed
pleasure in relationships with her adult children. She writes,
In my sixties, I found that death adds the intensity that used, I imagine, to
come with the parting of friends and lovers in the days before direct com-
munication over distances was possible, when even mail took many weeks to
134 Ruth Garfield
wend its way across oceans and continents. Those of whatever age who have
been near death tell us that life, when they returned to it, was never again the
same. I think that that same intensity, that constant awareness of newness and
brightness, is also possible in one’s sixties and after; it certainly has been in
mine. Perhaps only when we know on our pulses (another phrase of Keats’s)
that our time is limited do we properly treasure it. (p. 207)
Finally I want to return to the question about whether psychotherapy or

psychoanalysis can be useful in helping to face mortality and cope with death
anxiety. Dr. Colarusso’s paper today and his body of work suggest how our
work can help. I will summarize:
1. Anxiety about aging and death is often imbedded in other presenting

complaints, especially (but not exclusively) in patients over forty. It is
essential to bear in mind that patients need the therapist to provide
emotional constancy, holding environment until they are able to use
the relationship to tolerate frightening feelings. These feelings can
then be explored in a more interpretive climate.
2. Dr. Colarusso has made a significant contribution to our understanding
of the ongoing developmental tasks of adulthood. He further explains
that we must be aware of these tasks and the varied issues and conflicts
which express them. He writes, “In patients who do not present the
major developmental themes and conflicts spontaneously—and in my
clinical experience this rarely, if ever occurs—the analyst should raise
them, always in relation to the patient’s unique life experience.”
3. Sensitivity to our own personal process in facing mortality, our fears,
our countertransference, and enactments in the therapeutic relation-
ship are instrumental to helping patients with these life tasks. The
analyst’s ability to approach such frightening topics as aging, illness,
retirement, and death without fear or avoidance provides a basis for the
patient to identify with the analyst and further confront and struggle
with these issues.
There is obviously no absolute answer to the question I pose. The best I

can do is to quote Irwin Hoffman when he writes, “We can think of psycho-
analysis as an institution that has just that underlying purpose; finding that
means within consciousness for confronting and ‘going beyond’ mortality,
that is the means for investing in the particulars of living in the context—
even through—awareness of negation” (p. 47).
CHAPTER TEN
Eastern Intersubjectivity
Relational Homes for Frailty and Death
Tooraj Moradi, PhD
In the Name of God, the Beneficent, the Merciful1
How do you feel? Chilled a little?

Were you taken aback by how this chapter began with God? Did you feel
a visceral withdrawal from me or this chapter?
Did you imagine me to be a fundamentalist to be avoided? One with an
authoritarian mind and God embedded in dogma, inflexibility and closed-
mindedness as his organizing principle? One who may defend against the
fear of death by anti-phobic martyrdom and clinging to the promise of going
to heaven?
I and generally most of us here in Iran feel warm with God. We die nor-
mally. But we die together and on a daily basis.
Without undermining or exploring your experience, I would like to in-
vite you as the reader to wait: in order to understand us; to momentarily
suspend your beliefs and disbeliefs, to take my hand and meet me. Let me
show you another field, another lifeworld (Orange, 2008), another world
horizon (Stolorow, Atwood, and Orange, 2001), another world of experience
(Stolorow, Atwood, and Orange, 2002), another intersubjectivity between
man and his fellowman, society, and God—one that is soft, sad, and creatively
playful. This may enrich both of us to gain a little edge, triumphantly, not de-
fensively, over the issue of our mortality—perhaps a spiritual “now moment” to
135
136 Tooraj Moradi
have “a moment of meeting” (Stern, 1998). I am suggesting that you tempo-

rarily abandon your self- and other-centered listening perspectives (Fosshage,
1997) and (sub)merge with me into Rumi’s grass:
Out beyond ideas of wrongdoing and right-doing, there is a field.

I will meet you there. When the soul lies down in that grass, the
world is too full to talk about.
Ideas, language, even the phrase “each other”
doesn’t make sense.2 (Sorter and Gotthold, 2007)
Introductory Remarks
Listen to this flute as it has a story to tell,
One about its complaints and pains of separations.3
—Rumi (in Masnavi)
My most immediate reaction to the idea of exploring death and dying was
that I was at a loss. To explore death and dying placed me in an existential
loss for words. I thought that perhaps we are asking what it is like to have
death in mind and what it is like to be going to be dead. Such experiential
states of mind, as I organized myself, would involve our expectations, thoughts,
beliefs, feelings, and religiosities. Most universal of the factors involved, matur-
ing this experience, seem to be those of the epigenetic level (Erikson, 1950),
the level of object constancy (Akhtar, 1994) and the particular relation to
material things (Akhtar, 2003) that we have succeeded to achieve in our life
cycles. The more we have succeeded to attain an inner sense of fulfillment
on our psychosocial tasks, of a deep and post-ambivalent worldview, and of a
balance between greed and asceticism, the more peacefully we will approach
death. I was feeling better by this time.
The other factors are culture-specific which vary with traditions, as well
as, what I am proposing here, with the existence of supportive selfobject
matrices available for containing (cushioning) the notion (including fear)
of death.
Later, I understood my earlier loss of words to indicate that death can
be understood only by implication and metaphor. I also realized that I had
become blocked because I had put the question of facing death in the first-
person singular which has a very different feel than in any other voice. As
explicated by De Masi (2004) (reviewed by Brearley, 2005): “my death is or
seems to be unthinkable.” Further, aside from losing everything including my
self, I expected the terror of the dismemberment, disintegration, and decay
Eastern Intersubjectivity 137
of the body after death—inevitabilities I was wishing to triumph over (Got-

tlieb, 2007) by blocking.
Givens
I am drawing extensively in what follows from conclusions reached by Stolo-
row in his book, Trauma and Human Existence (2007), and from Heidegger’s
book, Being and Time (1927).
1. Death is the last breath of the narcissistic wish for omnipotence and we
are injured to the degree that we are omnipotent.
2. Death can be experienced as the loss of self-other tensions.
3. Anticipation of death exists in all of us. We live with the “possibility
of the impossibility of any existence at all” and an “authentic Being-
toward-death” (Heidegger, 1927, p. 39). Death always impends as a
constant threat—it is constantly possible.
4. Anticipation of death can annihilate “any actualizable Potentiality-
for-Being that might stably anchor everyday significance” (Stolorow,
2007, p. 38).
5. Being absorbed in everydayness and worldly concerns provides “a con-
stant tranquillization about death” (Heidegger, 1927, pp. 297–298).
6. Death and dying most significantly involve an isolated self, over-
whelmed and alone.
7. “Culture can provide ready-made ‘container(s)’ (Bion, 1967). Pain and
culture thus come to exist as loving cousins who often have significant
things to offer each other” (Akhtar, 2000, p. 240).
8. We have a common finitude: The fact that we will all die gives a com-
forting twinship experience, one of “a kinship-in-the-same-darkness.”
This provides for a “relational home,” so beautifully named by Stolo-
row (2007), wherein sharing of the experiences associated with death
by “someone else who is like me” becomes most rewarding.
9. What we cannot see does not necessarily mean it does not exist.
Our Relational Homes

How we live determines how we die.
The degree to which our parents, the society we live in, and the dominant
culture we daily breathe in provide for creation and maintenance of rela-
tional homes for our worst fears will determine how we deal with our mor-
tality. The less relational homes we have to live in, the more difficult and
138 Tooraj Moradi
defensive our attitudes about death and dying will be. The more we have
such relational homes, I am proposing, the stronger our selves, more whole-
some our relation to life, and less likely it is for us to fall into the grips of an
addictive disavowal of mortality.
I am assuming that the Iranian cultural relational homes are partly repre-
sentative, more or less, of the Islamic cultural geography of the East which
extends from Indonesia in its eastern frontier to Morocco in the west and
from Kazakhstan in the north to Somalia of Africa in the south, with more
than a billion people altogether.
I am extending Dr. Stolorow’s (2007) concept of relational homes to
include both external object relations and internal object relations as the
wellsprings and pillars for such homes which are to hold, ameliorate, soothe,
soften and contain the present “trauma” about the expected future trauma
of death.
Exposure to Frailty (a societal twinship relational home)

Frailty serves as a metaphor for death, if allowed and not defended against.
As Shabad (2006) proposes: “the degree to which we are open or are closed
off to our vulnerabilities has a profound effect on whether we address
the ultimate frailty of human suffering with compassion or ruthlessness”;
then recommends “an ethic of mutuality based on the interdependent
acknowledgement of human frailties and the wish to be of compassionate
help to one another” as opposed to “the fear-based morality of survival”
(p. 413).
Seeing and feeling frailty in others and societal norms allowing one to
show one’s own frailty to others, on a daily basis, creates a comfortable re-
lational home in which one doesn’t feel alone with one’s own frailty, aging,
and deterioration. I personally have had such a selfobject experience. Many
a time after work, about to leave my office building to go home, I have come
across the building doorman, Agha Mustafa. He is the same age as me and
from Afghanistan, with deep dark and kind eyes. He is a wise man. He of-
fers me a cup of tea, without exception with each encounter. I hug him first,
thank him, and then we sit down in his corner of the lobby, have tea together
and talk. This relational home begins from my hug as he feels my needing
it, sees it, and then I see it. Thereafter, I feel assuaged from, for example, a
hard patient I had, some pressures with my wife, and/or from the ongoing
fears, fragilities, and uncertainties associated with the establishment of our
psychoanalytic institute, first time in Iran. This occurs every week. And with
no shame for me.
You may see a Turk and a Hindu talk the same language,
but then two Turks may be alien to each other
Co-heartedness4 is more pleasant than being co-lingual,
co-heartedness is another language of its own.
Turkish and Arabic are all one and the same.

—Hafez
Recite the tale of love in whatever language you sing or know.

—Hafez5
There is an interesting paradox in our intersubjectivity here: although

we have a serious interpersonal distrust toward each other when it comes
to believing each other’s honesty (Naraghi, 2001), we usually connect quite
easily. For example, I interviewed a couple of taxi drivers and I was able to
ask them right off the bat when I sat in their cars: “What do you think about
death?” This did not create a personal boundary violation as without hesita-
tion they began talking and reciting poems. One, after I started counting,
touched me by tapping me on my knee forty-nine times in a twenty-minute
ride, while making his point. We men sit in the front seat here in Iran, next
to the driver, as passengers. The other talked about the enormous pressures of
life and joked, “man is created by pressure from the beginning to the end.”
Having significant problems or to suffer in life is not shameful in Iran.
Getting old and the fact of dying, while feared, are not disavowed. Co-aware-
ness of frailty and death contains and detoxifies horror of death. This painful
reality is worked through as people see frailty, together, in funerals, poverty,
veterans on wheelchairs, eroding buildings and cars, needy cats and dogs in
the streets, and in people who are mostly average in height, build, clothing,
demeanor (with no need to be smiling all the time), and life expectancy.
People also easily talk about death with each other: in everyday regular
conversations, we use the word death for our oaths (“I swear to my/your/my
mother’s/my child’s death that . . .”), or to show special closeness upon an
encounter with someone (“Hello. I am yours to be devoted/to be sacrificed/to
die. So how are you today?” or “Hello, no, you got the wrong number. I am
yours to be sacrificed. Keep alive. Bye.”)
Such societal attitudes create a very different intersubjectivity among peo-
ple than the “life is great” or the “I am on top of it all” display. The latter leaves
little space for integration of frailty, sadness, irrationality, incompressibility,
140 Tooraj Moradi
fluidity, and unpredictability of life and its emotional experiences (Coburn,

2007)—which are the stuff of death and dying as well. Therefore, people of dif-
ferent cultures approach death differently based on how they have negotiated
this facing of death together as a group.
Death of each man, oh boy, is the same color as he is,

as Clear Mirror will certainly reflect that color.
Lack of integration of frailty into group psyche is a sign that a split has
succeeded, where death is disavowed by the “official” intersubjectivity of that
group. However, does death then loom around even more intensely for that
group from the beneath? Will such a group then inadvertently invite outsid-
ers to help undo its split?
Shared Sadness (a societal and interpersonal relational home)

Our culture is replete with sad occasions. Most of our popular songs have a
sad content. We have more than a dozen national days yearly for mourning.
We are frequently attending funerals and the third, seventh, and fortieth
day post-death funeral services—for a large circle of known people ex-
tending from very close to far acquaintances. When we are not in funeral
services of those we may know in any conceivable way, we see the pictures
of the deceased loved ones of others all over, in building lobbies, on the
walls in the streets, and on the rear windshields of cars—with notices in-
viting us for their funeral services. Recently, some companies have been
established which rent “criers” for funeral services. It is a regular religious
event in local mosques6 where there is a religious eulogist whose job is to
sing sad religious themes; the one who makes more people cry is considered
a better eulogist. Thursday nights, when the souls of dead are believed to be
free, the family of the deceased serves dates or food—usually the deceased’s
favorite food—to the people in the street “for the sake of the happiness of
the souls of the dead.”
During the burial, it is common to show physical and emotional outpour-
ing of affect. Iranian women of Azari background, for example, hit on their
own feet and heads and loudly sing sad poems called “kelme” expressing to
others their pain and the story of how they lost their loved ones. After the
burial, the extended family stays with the mourning family for the first seven
days and nights. After the seventh day, they are not left alone abruptly as the
separation from the friends and extended family takes place gradually lasting
until the fortieth day following loss.
Further, we constantly share how the times are hard whenever we get
together. We discuss poverty, illness, and death frequently. We believe that
suffering is a natural part of life. The content of our lullabies mostly deal with
pain—mothers’ pains. The mother sings the lullaby melancholically to her
infant/child as if she is seeking his or her empathy and companionship:
If I don’t sing my lullaby, I will die

If I don’t suffer for you, I will die
My mom is far away
If I don’t say “mom,” I will die.
Or,
Cry less my child

Cry in autumn, cry in spring
Take a pen
I will tell you about my pain, for you to write and to cry.
—M. Barforoosh
Creative Playfulness with Authority Figures (a transitional

relational home)
Dodging Authority
We dance to our sad songs.
Aside from mourning days, we have plenty of happy holidays—for ex-
ample, our whole system is practically closed for a month for the Persian
New Year. Officially the off days are two weeks but a week before and a week
after is in the blurry zone—one for playing around with an authority figure
called: Work!
While we traditionally don’t run away from mourning, we are also vibrantly
alive and value life’s present moments very much, while aware of death:
Let us rejoice the night we now have,

Perhaps, my dear love, there won’t be a tomorrow.
—Omar Khayyam7
Poetry, the Language of Metaphor, Ambiguity, Satire, and Love

Poetry marries authority. Poetry serves as a vehicle to soften harsh realities
we are usually alone with by taking us to the transitional land of the poet who
we assume knows a bigger and softer truth. It is an escape route to go from the
father to the mother, from the paternal culture of sobriety to the maternal
142 Tooraj Moradi
culture of “valuing affirmation, soothing, relatedness and psychic consolida-

tion” (Akhtar, 2000, p. 240). In other words, if the culture we live in allows us,
without shaming us, and freely, i.e., not in a pre-designed time-compartmen-
talized fashion, to live in a transitional space (Winnicott, 1953) where reality
and fantasy are intermingled, like in poetry, we will have a private edge over
our fears. Another aspect of this culture-specific space is toleration of ambigu-
ity. Iranian poets/people value and use vagueness and being equivocal as it is
equaled to being wise.8 This comes easier to a people with a long tradition of
having poetry in their collective consciousness and is to be differentiated from
dishonesty. As death can be understood to be one final authority figure to be
dealt with, we frequently use the reciting of different poems about death.
Poetry serves as an important arbiter for people, lending relief from the
unknown and the uncertain aspects of life. And many people know poetry
by heart. We have a national pastime called “poetry contest”9 when two or
more people test each other’s extent of ability to recite: one begins with one
line of poetry; the other is then supposed to say another line of poetry which
has to begin with the last letter of how the line of the previous contender
ended, and it goes on.
Having a culture of reciting poetry tends to scaffold and bridge the lonely
parts of our psyche. Poetry is a relational home located in the transitional
space—one that allows merger with the one who recites, the poet, and his or
her message about life or death:
This vase, like me, has someday been a weeping lover,

chained by the hair of a pretty woman
The handle you see around its neck,
is the arm that was once around a lover’s neck.
—Omar Khayyam
Or,
Went to the vase-maker’s shop last night,

saw two thousand talking and mute vases
Suddenly one of the vases began to scream,
where are the vase-maker, the vase-buyer, and the vase-seller?
Wise Suffering (a “shared optimal frustration/suffering that makes one

stronger” relational home)
We give up some comfort and incur some suffering in exchange for goodwill.
Rumi, in Fie Mafie says, “It is pain which leads man,” and uses the metaphor
of pain of delivery being necessary for the birth of potentials. He recounts the
story of “the butterfly and the candle” as metaphors for wisdom and truth,
respectively. He tells us that a butterfly will rotate around the candle for a
lifetime in pursuit of the truth, all along knowing that getting too close is
fatal.
This story speaks to one aspect of the relationship between Iranians and
the authority figures in their lives—those on whose selfobject functioning
they are dependent. This relationship is characterized by respect, caution,
and playfulness. It does have master-slave connotations and can feel bitter
to a Westerner’s taste. Yet, the “felt” intersubjectivity for us, i.e., between us
and our God, Prophet and Disciples, parents, bosses, and between us and our
destiny, i.e., death, is one of negotiation. A give and take, so to speak: “I will
abide by keeping you in mind and by suffering a little through serving you,
you will protect and enlighten me, and we will be intimately connected.”
Actually such a selfobject must not be misunderstood to be a terrifying,
ruthless dictator demanding to be placated. There is a fine bent here. The
selfobject itself is known to have its own selfobject needs for mirroring and
connectedness, as, for God, for example, we are his departed children. We
are his “noblest creature”10 and “God’s Representative”11 on earth.
Rumi, in Fie Mafie, recounts another story:
God says: “Oh my creature, I speedily

granted you what you wished when you were
praying and moaning. The melody of your
moaning is pleasant to me. Any delay in
gratifying you was to have you moan more as
your song of moaning is so pleasant to me.”
We Live and Die Philosophically (a cognitive, mirroring, idealizing and/

or transitional relational home)
Here in Iran, almost anyone you speak to about any topic, whether it is about
politics, environment, art, literature, marriage, architecture, or death, has a
rather well-formed and ingrained opinion. This rather grandiose position
(Moradi, 1987; Naraghi, 2001) allows a certain feeling of mastery over the
unpredictable realities of life—one feels in control and also clever. We de-
rive strength from our own individual minds. When asked about death, most
of the people I interviewed became philosophical and responded profusely.
There was little “I don’t know” or “I am not God, how would I know?!” Most
referred to poetry to validate their belief systems. One of my interviewees
responded this way: “I am not scared of death at all (I am more scared of
144 Tooraj Moradi
injections!), because I have read as much as a regular person could read in six
hundred years, and I have also traveled a lot. Further, my sons have achieved
what I wished they would.” He continues, “I love life and don’t welcome
death. And I don’t eat salad and olive oil at nights either.”
Philosophy Based on Our Religion

It is said that for the man of God there are three sources for enlightenment
regarding how to live: The Holy Koran, religious stories, and one’s intellect.
There is a story12 told by Prophet Mohammad about two people walking to-
gether at the bottom of a hill. They suddenly see a rock rolling down toward
them. One of them just continues on and walks away unscathed. The other
stops, calls onto God and says: “I am resigned to your will,”13 “help me.” The
rock hits this man’s leg. The Prophet and his companions see this event. The
companions ask the Prophet why the man mentioning the name of God was
hurt and the other who didn’t was not. Prophet replies that one had God
within his mind all the time and the other thought of God only when he
was in danger. So Iranians live with and by God and attribute events in their
daily lives to Him. Their philosophy of life and why things happen the way
they do is mostly based on believing in God’s will.
Moreover, we often hear this phrase repeated in our funeral services that
“he or she was very innocent.” Our feelings about death are intermingled with
dying innocently and out of oppression. Aside from the political origins (Rafi-
poor, 1997) of this state of mind pertaining to the persecution suffered by 2,500
years of oppression by kings and also by the numerous times that we have been
ruthlessly attacked and conquered by foreigners such as Chengiz Khan, there is
a religious factor involved, too. There is a “live” affective memory of “innocent”
death that repeatedly presents itself through our exposure to the story of Imam
Hossein.14 The memory serves to soothe us by identification and self-pity as we
imagine ourselves and our loved ones dying innocently. There are many people
who have a special regard for Imam Hossein. They listen to the story of his mar-
tyrdom recited melancholically by professional eulogists in mosques or at their
homes, and then they cry profusely. His memory evokes boastful feelings about
his bravery and/or spontaneous feelings of sadness and being choked with tears,
remembering15 his having been innocent and subject to cruelty.
There is a deep religious background to our notions about death which
is frequently believed to be “the last word” on the subject. Here are some
examples:
The Prophet is known to have said: “One who accepts death will have removed
rust from his heart16 and will have a clear heart.”
The Holy Koran: “The learned who does not do is like a four-legged carrying a
book on his back”17—thus advising action over preaching.
Or again in Holy Koran: “There is no god except God”18—thus advising to
abandon material dependencies in favor of God, for God will provide far be-
yond, making a common proverb apropos: “if you have a hundred, then you
already have ninety.”
“Resigning to God’s will” and “if God so wishes”19 are two of the most
common phrases used by Iranian people (religious or not) almost every
time something is about to occur that one wishes for or fears.
Imam Reza,20 while in exile, goes to a public bath where the bath masseur was
very kind to him and served him well. Imam Reza asks him if he needs any-
thing. The masseur says nothing. Imam turns a piece of stone into gold and
offers it to him. The masseur does not accept it but instead asks Imam to be
next to him when the time for his death arrives so it won’t be hard for him.
Philosophy Based on Poetry

Many life lessons present in our live memory have to do with poetry. Po-
ets represent our benevolent idealized object—ones from whom advice and
direction is comfortably integrated without the need to rebel against them,
which stands opposite to current objects.
About life:
No one has found a way to the secret of existence,

each of us carries a myth with ourselves.
—Unknown poet
Or,
O’ heart, you are ignorant in this world,

day and night you are looking for money and gold
Your assets in this world will amount to a shroud,
and that too, I am not sure whether you will take or not.
Hey friend, don’t upset over the world unreasonably

Unreasonably don’t upset over this worn out world
What was, is gone and what was not was not
Be happy and don’t upset over what was and was not.
—Khayyam (in Robayeeaat)
146 Tooraj Moradi
And,
Hey friend let’s not upset over tomorrow

let’s make the most of this one breath which sure exists
Tomorrow when we pass from this ancient convent,21
we will be head to head with the seventy-thousand-year-olds.
The world becomes fixed by medicine and treatment,
as illness and death do not depopulate the earth
Grey hair is a message from death,
why are you so hopeful to last?
Loneliness is worse than death,
whoever is alone is inept.
—Ferdosi22 (in Shahnameh)
Whoever became distanced from own roots,

will look for the days of connectedness again.
—Rumi (Masnavi)
Rumi, in his Divane Shams, talks about life, motion, and love while brim-
ming over in ecstasy:
Hey you: my heart’s desires, come, come, come, come

Hey you: my wish and gain, come, come, come, come
Don’t talk about the way or the home, don’t anymore, don’t anymore
Hey you: my home, come, come, come, come.
Life is a pleasant ritual
Life has wings as vast as death
Has a leap with the height of love
Life is not a thing to be forgotten by me and you, like a habit placed on a shelf
Life is the attraction of a hand which picks
Life is the strange feeling of an immigrant bird
is touching the loneliness of the moon, the thought of smelling a flower in another
planet
Life is washing a dish
Life is mirror “squared”
Life is flower to the power of infinity
Life is the multiplication of earth by our heart rate
Life is the uniform and simple geometry of breaths
Wherever I be, so be it
The sky is mine
The window, thought, air, love, earth are mine

What does it matter
If sometimes
Mushrooms of nostalgia grow?
—Sohrab Sepehri23
About death
I am not one to fear my going,

as the other half is more pleasant than this half for me,
This life is one loaned to me by God,
I will surrender it when time to surrender arrives.
—Omar Khayyam
I am at the edge of the sea of finitude, o’ one who bestows wine,

it’s an opportunity as short as from lips to mouth.
—Hafez
Whether you live to be 200 or 300,000,

they will take you out of this old house
Whether you are a king or the beggar of bazaar,
you will be worth the same at the end.
—Unknown poet
And let us not fear death

Death is not the end of the pigeon
Death is not a chirp turned upside down
Death flows in the mind of acacia
Death is seated in the pleasant climate of ideas
Death speaks of the morning at the height of darkness in a village
Death comes by a cluster of grapes into the mouth
Death is sung by the throat of a bird
Death is responsible for the beauty of the wing of the butterfly
Death sometimes picks basil
Death sometimes drinks vodka
Death sometimes is sitting in the shadow and looking at us
And we all know,
the lungs of joy are filled with the oxygen of death.
—Sohrab Sepehri
148 Tooraj Moradi
Philosophy Based on Storytelling

The Iranian verbal culture is permeated by meaningful tales, parables,
proverbs, and jokes. Iranians are not only exhaustive storytellers in their
regular day-to-day conversations when they want to make a point, but are
traditionally voluminous story writers. An example is what one of the people
I interviewed told me which he presented as “the result of a scientific discus-
sion somewhere”: “Happiness means being in the right place which is being where
you used to belong to” and then added that an “Irwin Segal” in his book “How
Man Became a Monster” has found that “we need to live in the 500-meter
(one third of a mile) radius of where we were born to feel alright.” As an
Iranian, I liked both what he said and what “Mr. Segal” has found out in spite
of the fact that I could not find any reference for either one and could not cross-
validate any such assertions. I am not saying that I will base my whole life on
these statements or that the content has any particular weight for me. What
mattered was that we both met. While he was saying what he was saying, our
lonely intuitions that “there truly is something right about living where we
are living” in spite of our lonely doubts to the contrary, were co-affirmed. It is
the intersubjectivity with a storyteller, the original and the present one, that
brings relief. There is somebody that has a belief to whom I can lean my loneliness.
What is life like without such people whose certainty and being opinionated
can be so reassuring? Doubtful selfobjects are poor selfobjects. When it comes
to death which is the most cardinal of vague and unknown experiences in
life, it really helps to have some people who have beliefs.
Here are some examples of other tales that are comforting:
“The more mature a tree, the more bent it is (by its fruits).” This speaks to the
virtue of modesty in life with respect for the old and frail.
Bayazid Bastami24 was once asked why he was walking a dog. He re-
sponded: “I don’t let him go, don’t torture him, I just walk by his side.” This is
an advice about our relation with our instinctual life—which “can take us to
hell, if not contained, causing us to sin.”
About individual subjectivity of each person, Rumi (in Masnavi) tells the
story of some people who were looking for the “truth.” They were each sent
to a dark room in which an elephant was kept and told that they will find
“truth” there. Each was then asked to describe what they found to be the
truth. Each reported a different part of the elephant they couldn’t see but
were able to touch—a large building, a tree branch, a fan, etc.—as the truth.
This lesson helps us appreciate different philosophies we hear about life after
death without loss of the main hope, i.e., life after death (the elephant).
Ferdosi, the poet of one of the most important Iranian mythologies
called Shahnameh (which took him thirty years to write), recounts the
story of our hero, Rostam, who fights and defeats his strongest foe, White
Evil. We find this victory as an inspiring one for confrontation with any
foe, including death. Another culturally significant event in this mythol-
ogy is the one to one war between Rostam and his son Sohrab. Rostam,
who is our hero, is older and weaker and is about to be killed by Sohrab.
He resorts to trickery, dodges death, and finally becomes able to kill his
son—both father and son were unaware of their relationship. This tragedy
lends some weight to the particular Iranian subjectivity we are discussing:
the idea of frailty is again presented and accepted. Our hero is accepted to
be frail. The new does not replace the old. The old survives. Death is not
the end of everything.
Toward a Spiritual Intersubjectivity: The Third Handwriting (a merging

relational home)
(As another reminder to the reader, who was urged to suspend “objective
thinking” while reading this manuscript, Hafez is remembered: “The tale
of love is not to be found in the books.”) A spiritual intersubjectivity is yet
another state of mind, whether pursued or achieved, for an Iranian to attach
his or her death thoughts for containment.
We know from the Holy Koran that God breathed His soul into man25
and that “Indeed we are from God and indeed we return to Him”26 and from
Zoroastrian religion, Iranians’ religion before Islam, that Ahooramazda (God
of benevolence) gave each newborn a faravahar (soul, psyche) which will be
separated from man upon death and will join Ahooramazda. However, Su-
fism aims to achieve this union before death. All of the previously mentioned
relational homes may be regarded by a Sufi to be the preliminary steps for be-
ginning and engaging a joyous spiritual journey whose goal is to “to become
nothing” in order to become one with God.
Such soul journeys are described by numerous Iranian Sufi poets, a few of
the most famous of whom are Rumi, Attar, Shams, Hafez, and Shabestari,
who are known as founders of the “Love Spirituality.” The Islamic stages
of the road to spirituality27 (also called “travel and behavior”28) involve
Attar’s29 “Seven Cities of Love” (in Manteghol Teyr): Intense Desire, Love,
Knowledge, Self-Sufficiency, Monotheism, Awe, Poverty and Annihilation.
“Del,” which stands for heart and soul, is the vehicle for this journey and is
the container of the “secrets of God” (Shabestari, 1266–1299 AD).
Rumi (in Masnavi):
Be the slave of del to become the ruler,

the master over intellect and to make your life worthy.
150 Tooraj Moradi
And,
I traveled from my intellect toward del,

I did not see any empty space between the two places.
This del is like an interpreter,
between the spiritualist30 and the knowledge to be known.31
Death before death:
Between the lover32 and the loved,33 there is no screen34

You are your own veil, Hafez, rise out of your center.
—Hafez
It is the goal of this spiritual route to be emptied of your “I,” your “selfish
whims,” before you can join with your loved one (God) which leads to only
experiencing love, i.e., ones becomes self35-less and “dies” while alive, if you
will. It is said that when Hafez ascended to a particular spiritual level, he
burned all his writings and poems. His present book of Robayeeaat is the col-
lection of his poems by others who knew them by heart.
There are contemporary Sufis who Thursday nights go to their previ-
ously purchased graves, lie down in them all night long, and recite religious
prayers.36
There is the story (Zarinkoob, 1994) of Rumi and his spiritual teacher,37
Shams, who tests Rumi in various ways to see if he is ready to abandon his
earthly self before he accepts him as his devotee.38 Shams first asks Rumi who
is in love with Shams to make his wife and son available for his sexual whims.
Rumi complies but Shams doesn’t take advantage of them and asks for some-
thing else. He tells Rumi that he should go and buy wine from the Jewish
quarter. This would amount to a total loss of face for Rumi, as he was the
grand clergyman of the town and could not be seen drinking wine, let alone
buying it. He passes this test too. Last, Shams asks him to go in the middle
of the town and dance. Rumi goes there and begins his dance39—dancing to
the beat of the goldsmiths at work.
I died as an inanimate and became vegetation,

and died as vegetation and showed up as animal
Died of animal nature and became human,
so why fear? When did I ever become less with death?
I will die again—from humanity,
to become an angel with wings
And again I will leap from angels,
and become what cannot be fathomed

Thus I will become non-existence, non-existence like the farthest star,
will tell me “you will return to God.”
Die, die, die in this love,

once you die in this love, you will be all a soul
Die, die and don’t fear this death,
because you will emerge from this earth and capture the skies
Die, die and cut off from this breath,
because this breath is like a chain and you are like a captive
Get an axe and work with it inside the prison ditch,
once you break free of the prison you will be king and prince
Die, die in the presence of a beautiful king,40
once you die of this king you will be all king and famous
Die, die and emerge from this cloud,
once you emerge from this cloud you will be all a full moon
You are silent,41 silent; silence borders death,
it’s being alive that can cause you to escape silence.
—Rumi (in Divane Shams)
After triumphing over one’s narcissistic self, it is time to let go of the

teacher as well, i.e., the very idealizing selfobject who guided you is to be
outgrown. There, it’s promised, there will finally be a total silence, silence in
the mind—where self and other are overcome and you are left in the bliss of
a loving intersubjectivity with God.
I have eyes filled with the face of Friend42

I am pleased with what I see as long as Friend is in it
Can’t differentiate between sight and Friend
Either He is sight or sight is him.
—Safi Ali Shah43
Attar says this final tale about, what seems to be, the extinction of nar-
cissistic internal and external object relations in such a journey: “two der-
vishes44 were sitting in silence. One says, ‘God,’45 the other responds, ‘you
atheist!’”
The Third Handwriting

The fact that we can’t see something does not mean that that thing does not
exist. Perhaps a special lens is necessary. For example, the fact of “implicit
152 Tooraj Moradi
relational learning” (Stern et al., 1998) had always existed during the time
that psychoanalysis was not aware of it, till rather recently following new in-
fant research (Stern, 1985; Beebe and Lachmann, 2002, 2003; Lichtenberg,
1983). Sufis are known to pick and choose with whom they will share such
a lens. Rumi: “we are listening, watching, and aware but are silent with you
non-confidants.”
Shams (in Maghaalaate Shams) mentions the lens this way:

The Calligraphist46 wrote in three different handwritings,
The first handwriting was to be read by the subject but not the object
The second handwriting was to be read by both the subject and the object
The third handwriting is read by neither the subject nor the object
That third handwriting is me.
Concluding Remarks
God is great! Greater than what can be fathomed. And We are undiscovered
too.
In Iran people help each other intersubjectively, practically, poetically, re-

ligiously, and by telling many stories full of lessons and cushions, to assuage
and help with the vulnerabilities, frailties, and natural limitations any one
person has.
People of different cultures can learn about each other’s particular in-
tersubjective lessons. What each one of them has accumulated in different
areas of living can be shared. But can the lessons learned in one culture be
implemented in another culture?
Life issues such as how to rear our children’s/patients’ selves so they will
have cohesive and happy selves, how to promote their healthy dependence
and independence, how to help them to be good selfobjects for others so that
they can form families, and how to approach suffering, frailty, and finally
death are among the most key issues that we, as parents and therapists of the
psyche, are confronted with. The author was attempting to take a glance at
an intersubjectivity that seems to him to offer some peace with the issue of
death. He argued that Iranian culture as part of a greater Eastern and Sufi
culture is characterized by a certain everydayness which provides “relational
homes” for conceptualizing death and containing its associated feelings.
Such relational homes lead to less anxiety and helplessness.
However, is there anything and to any degree that the West can learn and
integrate from us? Can it integrate another intersubjectivity—in view of its ev-
erydayness? How? These are questions to be pursued by all of us as analysts and

souls scattered all around the world, perhaps with an eye to another realm.
Life is not empty:
There is kindness, there is apple, there is faith
Yes,
As long as there is flower,47 we must live.
—Sohrab Sepehri
Notes
The author is deeply indebted to Mahmoud Delphi (a play director), Naser Shojayee
(a poetry lover), Hassan Naraghi (a sociologist), Manochehr Dezavare (a painter,
poet, and satirist), Farhad Mehrbina (an injured war veteran), Yasaman Ekrami (a
psychologist), and a couple of taxi drivers who were all interviewed and made valu-
able contributions to the preparation of this chapter, and to Ms. Mahboobe Abbasi
for her helpful Internet search.
1. Sooreh Alfatehe, Verse 1 in Holy Koran (trans. M. H. Shakir. Qum: Ansarian

Publications).
2. Rumi is perhaps the most significant and influential spiritual poet and Sufi
of Iran who lived some eight hundred years ago (1183–1251). Sufi means somebody
who wears “suf” which means “wool.” Sufis wore woolen clothing to disavow their
bodily comforts.
3. The translations of the poems are mine which have thus incurred an unfortu-
nate loss of beauty and rhyme.
4. Empathy.
5. Or Hafiz, one of the most famous Iranian poets who lived some seven hundred
years ago (1305–1370) with “Robayeeaat” as his main work.
6. Moslem temples.
7. Poet (1018–1096 AD).
8. “To rend” in Farsi.
9. Called “moshaaere” in Farsi.
10. Interpreted from Sooreye Osara, Verse 70, by Ayatollah Mesbah Yazdi.
11. Sooreh Baghare, Verse 30.
12. “Hadis” in Farsi and Arabic.
13. “Tavakkol be khoda” in Farsi, which literally means “giving power of attorney
to God.”
14. The third Disciple of Shiite Moslems.
15. He and his seventy comrades were martyred 1,400 years ago in an uneven
battle with Yazid’s large army.
16. “Heart” is the literal translation of “del” in Farsi literature, which is used to
convey one’s “feeling” psyche.
154 Tooraj Moradi
17. Sooreye Jomeh, Verse 5.

18. Said in both “azan” (the call for daily prayer) and “namaz” (daily prayer done
five times a day).
19. “Ensha Allah” in Farsi and Arabic.
20. The eighth Disciple of Shiite Moslems.
21. Meaning “this worldly life.”
22. Poet (908–995 AD).
23. A contemporary poet (1928–1980).
24. A Sufi (710–813 AD) cited in Attar’s Tazkaratol Olia.
25. Sooreh Sajdeh, Verse 9.
26. Sooreh Baghare, Verse 156.
27. “Erfan” in Farsi.
28. “Seir va solook” in Farsi.
29. A Sufi (1119–1205).
30. “Aref” in Farsi.
31. “Maroof” in Farsi.
32. Meaning “the spiritual traveler.”
33. Meaning “God.”
34. “Haael” in Farsi is also used for the “retaining wall” which interestingly
enough, for our objective minds, can be interpreted to represent our self structure
without which we can disintegrate into psychosis, let alone this being accompanied
by the proposed regression to a symbiotic oneness. So how are we to differentiate the
spiritual state we are being invited to from psychosis? It seems to me that what is be-
ing purported, in an intersubjectivity of intimacy, is not loss of the self and object world,
but rather growing (de-centering) out of them. Further let us remember that what
is being proposed is another dimension of man which is his soul or “spirit”—thus
spirituality—to be differentiated from “psyche.”
35. “Nafs” in Farsi.
36. “Zekr” in Farsi.
37. “Morad” in Farsi, which also means “desire.”
38. “Moreed” in Farsi.
39. “Sama” is a circular dance aimed to take the dancer into a trance.
41. Meaning “to take a passive attitude toward spiritual growth.”
43. A contemporary Sufi (1830–1895).
44. A person who pursues spirituality and is known for his extreme modesty.
45. “Hoo” in Sufi terminology.
47. “Shaghaayegh” (corn-poppy): a beautiful wild flower which self-grows in the
desert.
CHAPTER ELEVEN
Demise and Illusion

M. Hossein Etezady, MD
Dr. Tooraj Moradi’s depiction of “the East,” as exemplified by the Persian

culture and life in today’s Iran, necessitates the introduction of moral and
religious principles dating back to prehistoric and ancient Zoroastrian as
well as latter-day Shiite-Eslamic tenets. Persian ancient belief in spiritual
purity, achieved through vigilant maintenance of: (1) good deeds, (2) good
words, and (3) good thoughts, in obedience of the Deity, Ahura Mazda,
extends seamlessly into Eslamic values of faith, loyalty, and selflessness.
The following discussion will examine these spiritual and sociocultural
tenets as instruments of interpersonal relations and elements of intersub-
jective experience. Matters of personal privacy as opposed to the standards
of public behavior and socially sanctioned conduct will be differentiated.
Fatalistic surrender to one’s fate as a predetermined unfolding of events and
resignation to the humility entailed in the existential vulnerability of man,
as presented in Dr. Moradi’s observation, appear at odds with the Western
model of individualistic self-sufficiency and independence. The Eastern
perspective sees this only as fostering ruthless materialism in mindless pur-
suit of greed. Faith, spirituality, and human relations, in the context of an
Eastern culture, will be considered, in a developmental and psychoanalytic
perspective.
155
156 M. Hossein Etezady
The Shrinking Globe and the Fellowship of Man

Dr. Moradi deserves credit for presenting an intriguing, broad, and intimate
picture of the Eastern view of mortality. He begins with an Eslamic1 custom
of announcing his own belief in the existence of a benevolent and merciful
Creator. He then, self-consciously, pauses to ask us to contain our horror
and prejudice, derived from our fright of “Eslamic terrorism” so that we can
listen to what he is trying to explicate. He proceeds to present sociological,
cultural, linguistic, and attitudinal constellations that an Eastern perspec-
tive and life experience, as might be encountered in the present-day Iranian
culture, would implicate. He sets up this examination in contrast to the
ethnocentric perspective commonly held in our Western culture.
Globalization has favored the loosening of boundaries and erosion of lines
of separation between nations and cultures, leading to intensification of the
universal impact of science, commerce, and technology and to progressive
homogenization or, what some have called, creolization of culture. This affects
essential components of day-to-day life, ranging from art and industry to food,
dress, and child rearing, to name but a few. Increasingly more of the people
of other nations seem to be adopting values and aspirations of our American
culture as we are surely and insidiously adopting and integrating more and
more of the ways and choices of foreign or erstwhile exotic groups and nations
across the globe. This notwithstanding, each culture contains its own amalgam
of evolving alterations and progression, as well as inalterable instruments of
stability and permanence, comprised of the native elements of tradition and
historical identity. It is this combination of change and continuity that gives a
culture and society its manifest identity and cohesive integrity.
Group Identity and Stereotypes

Dr. Moradi depicts such a distinguishing characteristic in today’s Persian
culture and presents an essential element, namely the particular quality of in-
tersubjectivity within the Persian culture, which I find intriguingly thought-
provoking. We cannot draw general conclusions or reach reliable insight
into the lives of individuals based on the manifest content of their culture,
customs, and group behavior. Such an effort would inevitably be susceptible
to the vagaries of misperception, misinterpretation, or false assumptions re-
garding the observable surface of the mass phenomenon. Looking from the
outside we may miss the unique context of each person’s individual experi-
ence. Psychoanalysis has long convinced us of the centrality of the unique-
ness of each person’s subjectivity, as opposed to the apparent similarities we
Demise and Illusion 157
might assume from the surface of group behavior. Observational assessments

and conclusions derived from the manifest content, such as we might en-
counter through anthropological observations of societies and masses, or
statistics on populations, take no account of individual subjectivity. Group
behavior and communal reaction have their own course and quality, some-
times at odds or in contradiction to the tendencies of the individual members
of the group or community. Often a person’s own personal world is in conflict
with their manifest and socially acceptable behavior. Conclusions based on
generalizations derived from mass phenomena can easily result in prejudicial
stereotypes that may violate the sanctity of the individual’s integrity and
personal subjectivity.
We tend to form stereotypes that comfort and supposedly guide us in
facing the unfamiliar and the exotic. If new things and other people are
taken to be all the same, they would appear to be easier to comprehend and
control. Using stereotypes reduces ambiguity and alleviates the dilemma of
uncertainty as it comforts us to see the numerous and unwieldy unfamiliar
others as reassuringly and simply all the same. This allows us to label them
clearly, objectify and thereby confidently put them all in their predetermined
and “proper place.” We have such stereotypes for children, teenagers, par-
ents, grandparents, in-laws, men, women, artists, politicians, doctors, nurses,
members of minorities and other races, creeds or nations. All prejudicial cat-
egories of stereotypes allow us to bypass a need for intimate familiarity with
each individual member of a group, especially when such familiarity is either
not possible or sometimes not in our self-interest. Difference, unfamiliarity,
and strangeness are the most common blocks to empathy.
Familiarity and the Context

Dr. Moradi’s characterization of a Persian is no less subject to the vicissitudes
of prejudicial stereotyping than others, with the significant exception that
his observations and impressions are from within the culture, with firsthand
personal knowledge and extensive exposure. This renders his judgment in a
cast of solid comprehension and the authenticity of an intimate and empath-
ically garnered attunement. He invites us to suspend our prejudicial notions
of the dangerous Moslem terrorists and to open our minds receptively to his
depiction of the mind of the Eastern man, as particularized by the members
of the Iranian culture, and specifically in reference to coping with the doom
of transience and mortality. Moslems, no need to point out, also come in
different sizes and shapes, looks, nationalities and local customs. Dr. Moradi,
a Persian himself, speaks as a psychoanalyst about his observations with re-

gards to the worldview of Persian-speaking people. For those who may not be
aware, it should be mentioned that nearly all Persians belong to the Shiite
sect, unlike the Turks, Afghans, Indonesians, most Arabs and other Moslems
who are, almost all, members of various sects of the Sunni religion.
Persians stand apart from all other Moslem nations by virtue of their
cultural distinction, namely their ancient ancestry, their poetry, art, linguis-
tic-literary heritage, and the Shiite denomination of Eslam. Another major
distinction is the nation’s historical resilience and the continuity of national
and cultural heritage, from prehistorical epochs to the present day. Sweeping
and devastating assault on the land, first by Alexander the Great and then
the Arab invasion, and still later, the reign of the Mongols, not only failed
to eclipse the native culture and its expansive reach, they were themselves
absorbed and metabolized within the surviving heritage of Persian identity
and national traditions. This created a more vital and progressive legacy that
continues to thrive and accommodate in order to embrace modernity, as it
in turn influences and permeates other cultures and societies.2
Creating Relief and the Depressive Position

During long periods of triumph or adversity the nation’s heart and mind
seems to have taken refuge in creativity, arts, poetry, industry, and phi-
losophy. Vestiges of influence from venturesome foreign invaders over many
centuries can easily be identified in today’s Iran. Therefore, the uniformity of
the cultural milieu is amply punctuated by diversity, in ethnic and geographi-
cal differences in various regions, tribes, territories, and social strata. In this
kaleidoscope of diverse origins, customs, and ethnic affiliations, Dr. Moradi’s
citation of texts of faith and poetry identifies salient features relevant to our
topic and sheds light on questions regarding the Eastern posture of fatalism
toward life, which is readily noticeable as a prevailing feature of this world-
view. This fatalistic attitude centralizes death and personal demise as undeni-
able, unavoidable, and a point of final destination in the finite journey of life.
In this respect it might be regarded as a truly “depressive position” (Klein,
1940), par excellence, as it endures, accepts, and accommodates to loss and
deficit, as it turns the pain into gain and growth.
Dr. Moradi’s observation of cultural elements influencing the individual’s
reaction to fear of death are astutely isolated and disarmingly presented as
a particular quality in the intersubjectivity which he describes as empathic,
open, and down to earth. He notes that Iranians are at home with their
own vulnerability and tend to wear their humility and selflessness on their
sleeves. Being in the presence of an other, when there is engagement in a

state of relatedness to a benevolent and compassionate selfobject, can foster
security, provide satisfaction, and create solace and relief. It promotes self-
cohesion and amplifies ego strength, needed for adaptive functioning.
Here, reliance on others, as well as one’s own moral obligation to those in
need, is culturally reinforced and broadly manifested during all stages of the
life cycle. This makes parent/child relations more intensely symbiotic, with
varying degrees of boundary overlap in identity formation. More than being
one’s own self, one’s identity, generally, is regarded as an aspect of the per-
sonhood of others, who are closely or significantly connected. Throughout
the life cycle, individuals’ identities are inseparable from those of parents,
siblings, relatives, communal affiliates, tribal, regional, and national ties.
These cross identifications evolve, mature and increase in strength, rather
than diminish, over time. One is expected to put the welfare of others ahead
of his own. The individual’s honor and personal value is judged first by the
care and regard displayed for others and sacrifices one makes for those who
are dependent and in need, and not as much for personal abilities or other
individual attributes. Selflessness and the need to put others’ needs before
one’s own is the first and foremost condition framing the holding environ-
ment that family, friendships, community, and the larger society represent.
Persian folklore, idiom, slang, and poetry are replete with evidence of this
imperative in the reality of present-day events, as well as in historical narra-
tives. On any given day or during any casual encounter one can find, read or
hear others, or one’s own self expressing flat-out willingness, or indeed the
urgent desire, to give one’s life for one’s child, parent, sibling, relative, friends
or other loved one. This pervasive attitude is expressed as a matter of formal
courtesy even in encounters that are completely impersonal, such as in the
course of a casual phone conversation with a veritable stranger, a cab driver,
or the official agent behind the service counter. The outside observer might
find incongruent the literal terms of self-sacrifice and altruistic surrender,
which saturate the common daily dialogue, casual greetings, or inconsequen-
tial encounters.
Labor of Love or Love of Labor

I would like to present an explanatory statement pertaining to this cultural
peculiarity which from the Western ethnocentric prospective might appear
bizarrely out of context. To provide this explanatory frame I wish to draw a
contrast between the Western Christian view of man as a child, protected
and loved by “our Father,” boundlessly loving, benevolent, easily appeased
and generously gratifying, on one hand, and on the other hand the Eslamic
notion of man, having been created in His image, of course, but not as the
privileged child of a doting father, but as a laborer and worshiper, serving
an omnipotent Lord and Creator who placed man on earth to obey and
worship Him, in submission to His will. Like a slave, the servant is at the
mercy of the Lord Creator who is the provider of life and its bounty, and
is omnipresent, merciful, and beneficent. This master-servant form of rela-
tionship, reminiscent of a sadomasochistic bond, may be a derivative based
on control and power-play of the anal mode of relatedness, or in contrast, it
may emanate from enthusiastic and loving surrender to the unwavering will
and infinite power of an omnipotent creator, whose boundless beneficence
is sought through selfless obedience and devotion. Whether a person main-
tains a sadomasochistic mode of forcibly submitting to the insurmountable
power of a demanding master, or by contrast, engages in loving surrender to
the welcome sanctions and provisions of a benevolent protector, may be a
matter of having achieved the developmental tasks of basic trust, libidinal
object constancy, capacity for mutuality, and individual autonomy. Love
and labor are inseparable companions; where you find one, the other is not
far away.
The interpersonal dimensions of this willing submission and self-denial
may be extended into one’s relationship to figures of authority and those
whom one regards in position of respectful superiority. For instance, in the
course of such a dialogue the selfless speaker refers to himself in third per-
son, not as an equal peer but rather as a servant or slave, while addressing
the listener as his lord and master who determines the fate and destiny of
the speaker/“slave.” Of course not the speaker, the listener or any bystander
would take this format of interlocution as anything other than a quaintly
formal manner of etiquette and a ritualistic game, intended to neutralize
surreptitious aggression, rivalrous competition, and territorial contention.
The literal translation of such an interchange might, for example, sound
something like the following: “This insignificant slave is present and at the
service of your Excellency,” (i.e., I am here and/or ready). The second person
then responds, “it is the highest honor for this sincere slave to be assigned
to the service of your exalted door step” (meaning, “Alright, me too!”). It
is as if one needs a mask of seductive formality to woo others into a peace-
ful encounter, where no defensive or preemptive attack needs take place,
in the face of abject and complete surrender of the first person, taking the
stage. This ritualistic formality or the beguiling mask of social propriety and
gamesmanship by no means eliminates the imperative impetus of one’s own
personal and concealed private agenda.
In this respect, one needs to be mindful of various means and formal

boundaries that are erected, both on an individual as well as sociocultural
level, in order to separate the public display of socially expected behavior
from the personal “true self” of the individual’s elaborately guarded internal
world. While the outer appearance is for social compliance and affiliated
homogeneity, the inner world of one’s subjectivity is grounded in self-
preservation and concealment of conscious and unconscious internal needs
and tensions, in order to maintain a background of safety.
Being Close
As a young immigrant to this country, what I noticed soon after my full im-
mersion in my host culture, was the intriguing discrepancy in the placement
of boundaries and lines of demarcation, in the two cultures, separating public
from private. Not only certain elements of private life in one cultural milieu
were displayed publicly in one or the other of these two communities, mat-
ters of intimacy and optimal distance were often established at glaring odds
in one culture as compared to the other. For example, physical proximity,
such as in the case of multi-generational or extended family cohabitation,
was well tolerated, sought, or even craved for in my earlier environment, yet
it seemed to create self-protective boundaries in the form of guile, disguise,
and emotional distancing. By contrast, in my new environment where people
lived in one room or space per person, sharing physical space was poorly
tolerated, they seemed more at ease in sharing emotional space, and many
aspects of their private life seemed to be more easily accessible and open to
outsiders. They appeared to be more self-expressive and not as elaborately
guarded against emotional exposure or display of their personal lives and
private experiences. In my early environment physical proximity and sharing
close quarters seemed to engender defensive protection of one’s true subjec-
tive and personal sphere of experience. In the Western environment, on the
other hand, where single individuals consumed ample quantities of space and
perishable resources, with relatively little sharing, overlap or cohabitation,
people seemed less guarded, more open with regards to their private lives,
and more spontaneous in self-expression and emotional exposure.
While in my early upbringing I was used to the enriching luxury of being
at all times in the same single space with a number of intimate others, and
while this number happily swelled several fold during holidays, celebrations,
and other special occasions, in my new environment one additional person
in the room, or one extra couple in a large house, or more than two or three
people in a spacious vehicle would represent overcrowding, at times resulting
in tension and even disturbing distress. “Optimal distance” seemed to be

established differently in each culture. Where unlimited physical proximity
was sought or imposed by circumstances, emotional intimacy seemed to be
limited and psychological privacy carefully curtailed. Americans, compared
to my Persian compatriots, were more open, less mysterious and seemed to
utilize relatively little guile or ritual formality. What became apparent to
me, after I had been able to adjust sufficiently to the novelties of my new
surroundings, was the realization of the effects of ethnocentricity in forming
stereotypical impressions of one culture by another.
I had always been leery of subscribing to the well-accepted impression,
held by my fellow countrymen, of a typical citizen of the United States.
This stereotype was expressed in incontrovertible conviction that portrayed
Americans as lacking manners, being void of compassion and being fix-
ated on materialistic goals, to the exclusion of spirituality or humanitarian
values. While this robust composite picture of the crude, heartless, and
single-minded cowboy or gangster has been well substantiated by depiction
of the American life and character through movies, literature, and television
stories, it dissolves and vanishes in the context of individuals in one-on-one
and person-to-person contact, where the reality of one’s native character
and actual inclinations may be experienced firsthand. Once a personal con-
nection, friendship, courtship, or marital connection is established, each
particular individual, it turns out, will fail to fit the mold. From fellow coun-
trymen close to me, I heard repeatedly and often that Jill, Susan, Bob, or
Gabe was “really” not at all like other Americans. Rather, they were “really”
very considerate, displayed gracious manners and held admirable moral and
humanitarian standards, “just like us.” This recognition provided relief from
the anxiety and suspicion that is inherent in our xenophobic tendency to
construct stereotypes when faced with ambiguity or the unfamiliar.
In forming our prejudicial stereotypes, we will be able to place all those
individuals and their uniquely unpredictable intentions and behavior into
neatly predetermined categories that conveniently eliminate their indi-
viduality and the unpredictability of their unique subjective stance. When,
in this manner, we presume that we “know” those people, based on our
prejudicial stereotypes, we can group them all together and address, attack,
dismiss, or treat them all as one and the same entity, thereby robbing them
of their humanity, individual dignity, and unique subjectivity. Even more
disturbingly destructive is the fact that we tend to externalize or project the
unacceptable and poorly tolerated aspects of our own negative attributes and
our own bad internal part-objects, onto others whom we use as containers for
elements we could not tolerate or contain within the sphere of our own self
experience. This prejudicial distortion will inevitably mislead and ironically

confirm and compound our distorted and misplaced judgment, which in turn
widens the xenophobic gap we use in self-protective defense.
As a member of the native Persian community now naturalized as a
U.S. citizen, I have experienced numerous instances of blind xenophobic
attributions and prejudicial assumptions, nearly all of them easily dispelled
whenever an opportunity existed for establishing a one-on-one and person-
to-person relationship. I have had to repeatedly reassure my relatives from
far away, regarding the dangerously venomous ire sometimes stored in the
consciousness of the American laity against Iran. Iran’s formerly dignified
historical image of civility and endurance has all but been lost and made
into a distorted image of terror and destructive doom, propagated by invested
interests of opportunistic political mischief and sensationalist journalism.
Those Americans that I know personally respect and value my individuality
and go the extra mile in extending to me courteous consideration and gener-
osity, in compassionate and genuine concern. Far from animosity or mistreat-
ment, I have been showered with tender regard and heartfelt concern for my
well-being and safety.
Mixed Signals
Innocent misunderstandings and false interpretations may also originate
from the discrepancy in the covert meaning versus the latent content of
signs, symbols, and body language within one cultural context as compared
to another. For example, some hand signals or bodily gestures may convey
a particular meaning or intent in one culture and another, perhaps dia-
metrically opposed, in another culture. For instance, “thumbs up,” meaning
affirmation and approval in our midst, is taken in Iran as the obscene gesture
of giving someone” the finger.”
Six months after my arrival to the United States and into my internship in
a hospital in Chicago, a fellow countryman was accepted for internship and
began training in the same hospital. During his orientation period he seemed
confused and often irritated. When I asked about his distress, he expressed
serious consternation at the cafeteria personnel in some detail. It turned out
that the maternally solicitous woman behind the counter was concerned
about the newcomer’s lack of familiarity with the food. Each time he showed
up across the counter, she would attentively accost him, point to each food
item and then would place on his plate generous portions she thought he
was asking for. He, on the other hand, could not understand how incor-
rigibly dimwitted the lady was, as each time she piled up on his plate huger
and huger portions of food he detested and did not want. I felt quite smugly
like a triumphant hero, when I solved the problem by carefully explaining to
him that each time he thought he was adamantly and energetically signal-
ing, nonverbally by lifting his head, indicating “no” of course in Persian, the
woman thought he was emphatically signaling “yes, yes, yes.” I also explained
to him that to indicate “no” in English, the correct gesture would be shaking
the head sideways and not upward, unless he means to indicate “yes.”
This mismatch of signs and signals, it may be pointed out, is at least a
partial explanation for the false and distorted stereotype image that my com-
patriots often maintain regarding U.S. citizens. For this reason, becoming
“Americanized,” in their view, is regarded as irreparable degradation into
becoming crudely self-focused, mechanically heartless, and driven by materi-
alistic greed. That is the crude and tough cowboy/gangster/ CEO, recklessly
romping and stomping, grabbing and yanking in all directions, voraciously!
Beyond the Self

Wary of the potential for this variety of misperception, Dr. Moradi began
his paper by resorting to a currently routine practice of reciting the fragment
that is religiously used as the opening to any significant feat or intention.
This, we assume, he does deliberately yet playfully, to first catch us at our
reflex-like defensive response, as if confronted by a dangerous terrorist, as he
displays his vulnerability, comfortably on his sleeve, asking us to hold judg-
ment, to hear him out and not to judge the book by its cover, so to speak. He
opens up to us intimately and establishes a warm and inviting intersubjective
context, plays with us and with our concern about fear of death, and shows
how, in his native culture, people face life and its challenges by turning
to one another, and how, in order to ease the anxieties of life and death,
they turn to the use of illusion and creative playfulness, thus reducing the
enormity of the matter through sharing and playful, interactive regulation of
the intersubjective field. Exemplified by his daily encounter in the building
lobby, having tea with the Afghan doorman, he describes turning to others,
vulnerable, humble, and willing to indulge in the intimacy of cross-penetra-
tion of boundaries, surrendering to the uncertainty of the unforeseeable fate,
in confident expectation of merciful beneficence from the Creator. This
makes life and its existential dread more manageable.
To this we may prominently add the certainty, comfort, and the inner
strength that only faith in the deity can supply. Living one’s life in the
pursuit of timeless values of spirituality and eternal bliss, together with the
promising appeal of death as the beginning of a new and eternal utopian ex-
istence, enables the faithful to find joy in sacrifice and transcending beyond
the self-focused confines of physical reality, space, or time. From this perspec-
tive, the physical vessel is subject to transience, demise and loss, while the
spiritual realm of the soul extends beyond the boundaries of time and space
and lives past the transience of the physical vessel, into eternity. Free of the
physical confinements of time and space, the soul existed and will live be-
yond the limits of time and space, unaffected by the vagaries of transience or
corporal demise. Time in the physical world is limited but the life of the soul
is eternal. For the selfless faithful, denouncing the carnal cravings of physical
existence in the material universe is the path to the spiritual rewards of the
soul, in eternity, having returned back to the Creator, to be finally judged,
for deeds, obedience, and selflessness, in one’s earthly life.
Uncertainty and Trust

Uncertainty is a fact of life and a source of unending concern and anxiety,
but also an important organizer of our native potentials as well as acquired
resources that serve adaptation and emotional growth. We owe much of
our strength and resiliency to the ever present threat of the unknown and
the pending doom that may be lurking around each corner. Since the only
certain thing in life is regarded to be death, and since our unconscious is
not capable of coming to terms with the notion of inevitability of our own
demise, the uncertainty of when and how we might reach our demise is an
ironic source of relief. The prevailing denial of death which allows us to
submerge ourselves in the illusion of the timeless moment of the present is
widely strewn in every aspect of personal and communal life. As children
we believe that we do not die and those we need and love will not die or
be lost, or losses are recoverable and not permanent. Children’s peek-a-boo
games, for instance, play at this compelling urgency. We feel entitled to the
recovery of what has been lost, in whole, or in more perfect compensation.
We imagine an afterlife in which all that went wrong will be corrected and
righteous suffering will be amply rewarded. Our good deeds of charity, mercy,
and benevolence will determine the course and quality of our afterlife. We
reap what we sow.
From layers upon layers of disruption and repair in our dependent re-
lationships with our caregivers, we learn to be hopeful and optimistic,
expecting that good things will come to us by the mere dint of our trust. In
unending vulnerability, we learn to look to others for strength, soothing,
affirmation, empathic resonance, and fulfillment. We imbue the heavens
and eternity with the magical omnipotence of our symbiotic fantasies, as
prayerfully and longingly we wait for miracles or divine intervention. As we

outgrow our self-centered shell of magical thinking and relinquish infantile
omnipotence, we recognize the disillusioning limitations of our caregiv-
ers and protectors and begin to turn to the power of providence, and thus
entering into a relationship with the ever present mental representation
of the object of our faith. For many, religious faith is the most elemental
component of their subjective experience. For others it may not be the main
occupant in the center of their life, but figures prominently in the composi-
tion of their emotional and interpersonal disposition. For still others, noth-
ing that defies the boundaries of logic and objective validation would pass
muster and would, for the most part, be relegated to the realm of the exotic,
superstition, naiveté, or pathology.
To represent multitudes of exceptions and variations in this convenient
classification, I will here mention the story of two adamantly self-declared
atheists, each with subclinical phobia of flying, on a routine flight home from
a vacation, refusing to accept a generous offer of cash, on the condition that
they would pray for the airplane to crash. While they ostensibly denounced
faith, religious matters, and prayers altogether, they could not be persuaded
to risk the remote possibility that their prayers might be answered, resulting
in a crash!
In the Eslamic world view, as well as the Persian tradition of spirituality,
reality in its comprehensive totality encompasses the objectively physical,
as well as the intuitive and spiritual dimension of existence. Erfan, a Sufi-
derived philosophy, defined as reaching for the complete knowledge of the
ultimate truth, as opposed to the intellectual recognition of objectively
validated scientific facts, is grounded in faith and spirituality, derived from
emersion in the irreducible, super-ordinate unity that binds and energizes the
entirety of existence, from beginning to the end.
Faith as an Intersubjective Context of Relatedness

If we regard faith as a state of relatedness to an object whose dimensions ex-
ceed the reach of cognitive and affective grasp, we can apply our knowledge
of object relations, from a developmental perspective, to the understanding
of faith-related manifestations and their vicissitudes. Psychoanalytic theories
of development, attachment, object-relations, and separation-individuation
are biologically founded on drive expression and ego development. The
individual’s subjectivity is a product of the biological givens, including
chromosomal, male-female distinctions that predate the emerging self of the
neonate, and along with the primitive body ego contribute to differentiation
and the emergence of the intersubjective self. By the last quarter of the first
year of life, with the beginnings of ego boundaries and the rudimentary de-
marcation of self and object representations, a relatively coherent subjective
sense of the self begins to form. From this point onward recognition of the
subjective world of others and an intersubjective mode of relatedness become
possible.
The so-called intersubjective self maintains cohesion through interactive
regulation, aimed at libidinization of the experience. The “good-enough
mother” (Winnicott, 1960) naturally provides this libidinization at an op-
timal level in most, but not all events. The intersubjective self of the rap-
prochement subphase (Mahler et al., 1975) and senior toddlerhood maintains
equilibrium on the tightrope of a secure attachment, in small steps and guided
by mother’s empathic attunement. Early in this period the child learns how to
be in the presence of an other. Later, during rapprochement, mother’s libidi-
nizing of the experience neutralizes the rage at the bad object by establishing
a positively energized emotional space for working through the ambivalence,
healing the split between good and bad while separating self and object repre-
sentations. This is a prerequisite for object constancy. Optimally, through the
critical subphase of rapprochement, the intersubjective self is learning how to
be alone, in the presence of an other, in a new way, and as a separate center of
initiative and intention. By thirty-six months, having reached the beginnings
of object constancy, the libidinized internal representation of the object is
now stable enough to remain in place, relatively independent of the negative
or positive affective charge of the immediate state of relatedness. The toddler
years also establish the transitional object and phenomena, and thus bring in
creativity, beginning with the capacity to use illusion, in the service of self-
soothing, problem solving, play, and fantasy.
Ultimately, interactive regulation of object relations and the transition
of primary narcissism to secondary narcissism are based on the capacity to
appreciate and tolerate the subjective state of others, and being able to ob-
jectively consider and hold in mind, the mind of an other. By the fourth year,
this objectivity begins to become possible, as part-objects of primary narcis-
sistic era have coalesced into mental representations of whole objects, with
their own subjectivity and uniqueness of personal intent and initiative. The
intersubjective self of the toddler years coincides with the years of transition
from primary to secondary narcissism, primary process thinking to secondary
process, and from schizoid-paranoid position to the depressive position.
Freud’s theory (1900, 1924) of the dynamics of the Oedipus complex
concerns a triadic mode of relatedness. Freud’s one-person psychology iso-
lated drive development in lived experience of need-wish, instinctual drives,
conflict, and the three anxieties of childhood, in oral/monadic, followed by

anal-sadistic/dyadic and phallic-genital/triadic organizations. In two-person
psychology of relationships, intersubjectivity adds a pre-oedipal dimension to
the task of holding and containment in parent-child relations and in treat-
ment.
The subject of psychoanalysis is subjectivity itself, within a co-constructed
intersubjective field, governed by the dynamics of conflict in a triadic mode
of relatedness. When we consider faith as a state of relatedness to an object,
whose dimensions exceed the reach of cognitive and affective grasp, we can
appreciate the restorative value of choosing to creatively allow the illusory
presence of an omnipotent object to engage, in intersubjective reciprocity.
Faith in the deity needs no objective grounding, since the dimensions of the
object of faith exceed the reach of cognitive and affective grasp. Rather than
addressing the question of the objective existence of such an unfathomable
entity, the psychoanalyst can only focus on the intra-psychic representation
of such a state of relatedness and its effect on the subjective experience of the
individual. Faith is capable of seemingly impossible feats, including rendering
tolerable unbearable pain and loss, insurmountable hardship and inevitable
mortality, or converting a dreaded misfortune into a challenge of hope and
testing of the limits of human potential in overcoming adversity.
Quotations from Patients

In settling an argument: “Listen man . . . there is a God and He wants you to
obey Him and to please Him. You’re gonna deny Him and deny that there
is more than you, and more than you could figure? Deny your soul? Deny
yourself faith? Be my guest!”
From a ten-year-old boy: “You need more than sticks to move with and
brains to think with. You need faith.”
Thankful for her many accomplishments: “I always keep my faith very
strong. I don’t know how I would have survived without my faith. My faith
is all I have.”
A forty-year-old terminal victim of malignancy, anticipating death in a
few weeks: “I wish I had something to believe in. But I know that after I die
there will be nothing. . . . What a waste!”
Notes
1. With apology to those accustomed to seeing the Arabic pronunciation of
Eslamic terms, I will try to consistently use the correct Persian pronunciation of the
words, e.g., Eslam, rather than the unfamiliar-sounding “Islam.” The letter “E” as the
first sound in egg, end, elephant, and essential and not “I” as in India, ischemia, or
infant.
2. For an example, consider the fact that no one would think that the following
words, among hundreds of others, are Persian: e.g., paradise, jungle, khaki, kayak,
cummerbund, caravan, gourmet, mahi, caviar, and kebab. Of course, today’s Persian
language, called Farsi, is replete with foreign words borrowed heavily from Ara-
bic, the language of the Koran, and also from Turkish as well as French and other
Western languages. Today’s Persian language is a well-integrated system of multiple
sources adopted into the literature, communication systems, and dialect.
CHAPTER TWELVE
Is That All There Is?

A Concluding Commentary
on Psychoanalysis and Death
Ira Brenner, MD
To anyone who listened to us, we were, of course, prepared to maintain that

death was a necessary outcome of life; that everyone owed nature a death;
and we needed to expect to pay the debt—in short, that death was natural,
undeniable and expected. In reality, however, we were accustomed to behave
as if it were otherwise. We showed an unmistakable tendency to put death on
one side, to eliminate it from life. It is indeed impossible to imagine our own
death; . . . in the unconscious everyone is convinced of his own immortality.
(Freud, 1915)
A man in the throes of anxiety in the transference once told me that he

heard that the sign of being truly analyzed was the ability to stand in front
of a firing squad, facing imminent death, and remain perfectly calm. Ma-
turely accepting the inevitability of the end of life, he insisted that such a
“post-Oedipal” man, having worked through his castration and pre-Oedipal
anxieties, would have absolutely nothing to fear. Furthermore, the patient
was an avowed atheist who rejected the religious indoctrination of his child-
hood and had nothing but contempt for anyone who was so weak-minded
and infantile that he had to resort to such magical thinking. He asserted that
one not need fear an afterlife because there is none. Life simply ends sooner
or later. With this ego-ideal in mind, the patient ambitiously strived to attain
this elusive state of mind. Despite this stoic veneer, however, it eventually
171
172 Ira Brenner
came to light that he had a deeply repressed unconscious fantasy such that as
long as he was in analysis he would never die.
The developmental line pertaining to an understanding of death is
literally a lifelong process. Encompassing somatic, psychological, familial,
societal and cultural/religious dimensions, the human mind’s capacity
to grapple with this great “mystery” has been an inexhaustible source of
inspiration for creative expression in all realms of the arts and literature.
Belatedly, psychoanalysis has entered this sphere and the contributions
from the authors in the preceding chapters cover well-known areas as well
as extend our knowledge; necessarily we leave many unanswered and unad-
dressed questions.
As I was preparing the following summaries, I was reminded of my own
first confrontation with death which occurred at age five, when my great-
grandfather died. He was blind, weak, and about ninety years of age; I was
convinced that he was just about the oldest man in the world. He was a
quiet learned man who prayed all day long and was revered by the family.
I would see him every Friday afternoon when my mother would visit her
grandparents and pick up the weekly allotment of freshly made chicken soup,
that mysterious, delicious golden liquid that had been imbued with so many
magical qualities. As this would begin our weekly ritual of honoring the Sab-
bath with a family meal and lighting of candles, no such dinner would have
been complete without the soup, which, handed down through the genera-
tions, was the powerful link between the living women of three generations.
As important and sustaining to the family as mother’s milk to an infant, it
became a sign of my growing up when I became old enough to be entrusted
with carrying the glass jar out of the house and into our car. However, it was
always just a little bit slippery with a slight sheen of chicken fat from the
overflow, since it was filled to the brim. The challenge of holding it tightly
in my little grip added to the gravity of this part of the ritual, lest it fall to the
ground and smash into a thousand pieces, spilling the family life blood and
ruining our meal. I would feel the thrill and tension of having such a key role
in this ceremony. So, in the course of these weekly visits I would cautiously
walk over to my great-grandfather and sit next to him where he would greet
me in a friendly but austere way, interrupting his otherworldly devotional
activities to have a brief chat.
In anticipation of having an audience with him, since he was always talk-
ing to God, I felt I had to be prepared with an erudite question to justify his
attention. While I do not recall asking him specifically about death, I was
perplexed about the nature of a God who had always been there. The no-
tion of an eternal Almighty made no sense to me and I kept wondering how
Is That All There Is? 173
He got there in the first place. Where did He come from? Indeed where did
I come from and where was I before I was born? (Kestenberg and Brenner,
1996) At the time, that question vexed me more than the question about
what would happen to me after I were to die. My great-grandfather would
patiently listen to me and give me an answer consistent with my limited
comprehension of such matters. Little did I realize that my grown-up version
of the same big questions would continue to perplex me.
Then, I did not see him for several weeks because he had gotten sick
and I sensed my mother’s growing concern when I overheard conversations
about him possibly dying. I knew something must be very wrong but I was
essentially shielded from it and could not quite understand it all. When I
was finally told the bad news that he had indeed died, I could tell from my
mother’s sadness and tears that she was very upset, but I still could not appre-
ciate the finality of it all. All I knew was that I had not seen him in a while
and he was not there to explain it to me. I did suspect that I would not see
him for another long while, but that was all my young mind could compre-
hend at the time. What I recall next was that when I returned home I was
eager to look across the street to see if my neighbor was outside so I could go
talk with him. This neighbor, a friendly old retired policeman who had had
a stroke and had the stigmata of a hemiparetic arm and a spastic gait, walked
with a cane and would take his daily constitutionals to the end of the drive-
way. There he would stand for a while, survey the neighborhood and talk to
everyone who came by. I was one of his regular visitors and would listen to
his stories of yesteryear on a regular basis, and even though I was aware of
his tendencies to repeat himself, I would nevertheless listen respectfully and
try not to interrupt him. It was good preparation for my chosen field. When
I finally saw him at his designated spot that day I rushed across the street to
see him and continue our dialogue. This time however, instead of our usu-
ally pleasantries and his reminiscences, I blurted with a certain amount of
naive excitement, “My great-grandfather just died”! What followed is a bit
unclear to me but I was left with the distinct impression that he became very
solemn, a departure from his usual cheerfulness. This change in his affect
made a further impression upon me since it was not only my mother who
had gotten very upset over the news, but also the local elder, my grandfather
surrogate, who unbeknownst to my own young mind was not far from his own
demise. Therefore, it must truly be a serious matter even if I could not quite
understand the implications of the finality of death. Indeed, it is a lifelong
process.
The papers included in this volume, which I will briefly summarize, ad-
dress and elaborate upon the issues alluded to in these anecdotes.
174 Ira Brenner
Leon Hoffman et al.’s Chapter

Following a review of the literature on the developmental considerations
in the child’s acquisition of an appreciation of the significance of death, a
transcript of a videotaped “panel discussion” by three children is offered, fol-
lowed by an analysis of their comments. The fascinating interchange among
these three- and four-year-olds, facilitated by one of the co-authors, is lively,
spirited, contentious, heartwarming, humorous, and quite instructive. This
data, derived by direct observation, pose a challenge to Freud’s ideas that
children have little interest in death. In fact, the anxiety that is associated
with this subject is quite evident, as the children offer many varying views
and deal with the confrontations and challenges with each experience. As
though these youngsters were foreshadowing the issues that we all grapple
with throughout life, they represented everything from inevitability to om-
nipotent denial, and from wishes for reunion with a lost love object in the
afterlife to rudimentary fantasies of heaven and hell.
Given the immaturity and propensity for regression in the ego of children
at that age, it was interesting to see their fluctuations and variations of func-
tioning. One boy, for example, who had the advantage of his older brother’s
knowledge, was the proclaimed expert on the subject and it was more dif-
ficult for him to maintain his coherence under the pressure of another boy’s
vociferous denial of his own mortality. His omnipotence, developmentally
appropriate but something that we may see throughout life, illustrates the
problem that we have when contemplating our own mortality. Here we are
treated to an entertaining illustration of the research findings about how
difficult it is for youngsters with preoperational thinking to comprehend
the inevitability, irreversibility, and cessation of functioning associated with
death. I note here that despite the excellent review of cognitive development
and dynamic development, the authors left out a very important milestone
described by Spitz as occurring at about eight months of age, i.e., the ability
to distinguish between animate and inanimate. The acquisition, as in Spitz’s
own words:
My attention was drawn to this phenomenon [eight-month anxiety] for the

first time when I offered a 12-inch doll to infants who had never before seen
one and they reacted to it with anxiety. . . . It ranges from mild unwilling-
ness to touch the doll to screaming panic. . . . The phenomenon appeared to
be reinforced in children who had undergone separation but this is only an
impression. . . .
In the further course of my experiments, I discovered that though the doll
provokes the most spectacular negative responses such responses can only be
elicited by other inanimate objects at the same period though not necessarily
in the same children.
These observations led me to the conclusion that the second organizer of
the psyche marks the period at which the infant goes through a development
as the result of which, among other achievements, he becomes capable of
distinguishing not only the love object from the stranger but also the living
from the inanimate. . . . I believe this is the precursor to the inception of the
concept of “alive” of life . . . and distinguishing animate from inanimate is an
achievement of major importance and as such is fraught with conflict, some-
times manifested by anxiety. I suspect that in this conflict the aggressive drive
plays a significant role. . . . Ethologists have become alerted to these reactions
to the inanimate which appear to be rather spectacular in primates but have
been also observed in various other animal species. . . . They all consider the
phenomenon to be a reaction to strangeness but to strangeness of a particular
kind. . . . This is the response to the mutilated or dead of the same species.
(Spitz, 1963, pp. 159–161)
Here he is alluding to Freud’s work on the uncanny and the experience

that people have in wax museums (Freud, 1919). It is then that Spitz poses
the question, “Could it be that anxiety before the inanimate is related to the
child’s unrestricted discharge of all aggression on inanimate objects?” (1963,
p. 167). He then adds: “Without dialogue—and it is the dialogue through
which the animate is distinguished from the inanimate—maturation may
proceed but development will be arrested” (p. 174). It has then been pos-
tulated that disturbances in the acquisition of this capacity due to excessive
aggression in the toddler may have implications for the persistence of beliefs
in malevolent, supernatural creatures like vampires that come back to life
and even the paranoid beliefs of those with pernicious forms of prejudice who
believe that certain minorities are in league with satanic forces (Brenner,
2007). It may be that in the more mundane situations described here chil-
dren may in general acquire the capacity to distinguish between what is alive
and what it is not but one of the children has some confusion about toys.
Parenthetically, I wonder whether children growing up in the current era of
the Internet with lifelike video games, virtual reality, and other interactional
cyberexperiences will have any deleterious effects on their ultimate capacity
to distinguish between animate and inanimate.
Jaswant Guzder’s Chapter

Dr. Guzder offers us an ambitious paper which addresses the importance of
the cultural and religious matrix on the developing child’s conceptualization
176 Ira Brenner
of death. Such “symbolic methaphors of death” crystallize in the latency-

aged child’s mind which affects how he/she experiences death and mourn-
ing. Comparing and contrasting East and West in patients from Jewish and
Hindu backgrounds, the author offers clinical vignettes of three boys, nine
and ten years of age, whose fathers had died. Given their superficial similar-
ity it is perhaps implied that we can tease out the impact of the different
“mythic organizations” on their mental processes. However, these cases are
quite complex and it is not clear how intensive the therapy was with these
very disturbed boys.
The author emphasizes the importance of the “melting pot” phenomenon
of North America, citing the merging of the immigrant, indigenous (First
Nation) and Judeo-Christian influences. Adding to this variable mixture is
the clinical observation that about half of the nine-year-olds in a study she
cited saw death as a reversible process. Moreover, “families’ beliefs and reli-
gious orientation may become the strongest organizing factors . . . [but] the
cultural matrix of the life event and the ritual imagery of death may none-
theless vary with each family’s cultural life” (p. 4). To further complicate
matters, Dr. Guzder asserts that while in the West, science has been eroding
but not completely replacing religion, in the East, “a more clear bi-cultural
space remained . . . [allowing] . . . a pragmatic integration of scientific ap-
plications and knowledge” ( p. 5). For example, karma and a tendency to
retraumatization owing to the repetition compulsion may be overlapping
and compatible concepts in the East. Nevertheless, while Orthodox Judaism
and Hindu Brahmanism have maintained their traditions, the “creolization
of culture,” undoubtedly accelerated by the Internet, has resulted in a global
hybrid culture such that children can choose from traditional mythic heroes
to rock stars to comic superheroes to populate their transitional play spaces.
In the traditional Hindu family, she describes an intense, overstimulating
mother-son relationship which is culturally interfered with by the “thread
ceremony.” This pre-pubertal rite of passage, analogous to the Bar Mitzvah,
welcomes the boy to the world of men. Given the lifelong mother-son bond
that even his wife will have to pay homage to, it then follows that should he
lose his father at an early age then his individuation process will be adversely
affected. Furthermore, if the boy’s mother becomes a widow and she loses her
status, she will rely even more heavily upon her son and this oedipal victory
adds to his conflictual situation. Owing to such external and internal factors,
there may be a more fluid gender identity, problems with intimacy, fears of
engulfment, counter-phobic homosexual identities, and/or asceticism. These
outcomes are represented in Hindu mythology, as Dr. Guzder cites the ego-
ideal of Lord Shiva, whose two sons follow different pathways to masculin-
ity. Ganesh, who is very close to his mother, Parvati, is ascetic and spiritual,
whereas Kartikeya, the more phallic one, is a heroic warrior.
In an effort to contrast with Judaism, she briefly notes that the Jewish boy
is circumcised at birth and his “progression to masculine identity tends to
move towards nuclear family units within the collective setting though in-
tense maternal son bonding may remain operative” (p. 12). Perhaps the most
important point here is that there may be much variability in each case.
Three case reports presented illustrate this variability: Kumar, a Brahmin
boy who emigrated to Canada with his widowed mother, had a disintegrating
anxiety reaction on the first anniversary of his mentally ill father’s death, a
possible suicide. Too young to have actually ignited his father’s funeral pyre,
he nonetheless witnessed it and was possibly quite traumatized by it. And,
in keeping with tradition, he would have been involved in the 12 days of
mourning rituals afterward as well as the annual commemorations. Seen in
the emergency room, he suffered from phobias, nightmares, enuresis, suicid-
ality, tantrums, and school refusal, as well as blaming his mother for killing
his father. While wishing to join father but fearing his own sudden death, the
boy dis-identified with his Indian heritage but wanted to return to his home
country nevertheless. Immigration conflicts and the clash of cultures were
expressed in his fantasy play as he fluctuated between identifications with
Lord Shiva and Captain Picard of Star Trek. His rage at his mother was mul-
tiply determined and often turned against himself. The patient was treated
with individual and family therapy as well as antidepressants and eventually
improved. Ultimately the family returned to India where Kumar lived with
his maternal grandparents and avoided any reminder of his father.
In the second case, a ten-year-old multilingual Hindu boy, Anil, who pre-
sented with his schizophrenic mother, had little knowledge of his father. The
father left when the mother was pregnant; he reportedly died. Fearing he was
reliving this abandonment in treatment, his social worker who was retiring
was so concerned about the boy’s withdrawal that she was “handing over this
child” to Dr. Guzder for safekeeping. Actually Anil was rather resourceful,
having been part of a peer group organized around athletics for many years,
and having maintained an attachment with his maternal grandparents back in
Gujarat. Deeply religious, they adhered to their karmic beliefs and their devo-
tion to Guru Ramakrishna. At their behest, Anil became his disabled mother’s
caretaker and was further burdened by their demand that he become a success
in life so he could finance the grandparents’ eventual emigration to Canada.
The mother’s delusional jealousy of Dr. Guzder threatened the treatment
and the boy would lapse into a sleepy altered state to ward off rage and loneli-
ness. Therapy did continue for years and Anil did begin to identify with Dr.
178 Ira Brenner
Guzder as a mental-health caretaker. However he became overwhelmed by

the emergence of memories of molestation, and at age twenty-one after be-
ing disappointed by a girlfriend, he withdrew from the university and from
life. Fears of becoming psychotic like his mother became prominent and he
reaffirmed his promise to his grandparents that he would remain faithful to
Ramakrishna, regarded as either mystic or psychotic, and continue with his
daily prayer, or Puja, to heal his mother. A hoped-for cure through faith
was in the service of his denial of her schizophrenia, as Anil struggled with
“western views” of his mother’s affliction.
Eventually he institutionalized her and was able to acknowledge his mur-
derous wishes toward her. In addition, his longings for a father continued to
plague him and he returned to India when his grandfather died. His struggle
to integrate his worlds was manifested by the split maternal transference to
his Canadian therapist who displayed a picture of Vishnu and Shiva in her
office.
In the third case, ten-year-old Jacob, who was adopted by an Orthodox
Jewish family, saw his father die suddenly and was not able to grieve. Initially
referred because of his age, he continued treatment for more than a decade
for an “endless blankness.” Unable to sustain relationships throughout his
twenties he was plagued by homosexual and death anxieties. Losing his
father and furious with God, he renounced Judaism around his Bar Mitzvah
and identified instead with comic book heroes and characters from Russian
novels. At that time he was hospitalized for psychotic behavior and got re-
traumatized, before being rescued by Dr. Guzder. This experience apparently
reactivated his deep, inchoate psychic wound.
Idealization of the dead father as well as the non-engulfing “Asian mother”
therapist in the transference helped contain his aggression and deny interest
in finding his birth mother. Narcissistically fragile, he was terrified of anti-
semitism and was easily shattered by disappointments with women whom he
regarded with suspicion, and from whom he withdrew into Buddhist celibacy.
His ideal woman fantasy, a beautiful, inscrutable Chinese martial-arts expert
with deadly hands, was a phallic woman who did not need his protection.
He, himself, identified with the Batman character who witnessed his own
parents’ deaths and had a split, secret identity as a masked avenger.
In her discussion of these cases, Dr. Guzder points out the boys’ difficulties
in their differentiating from their mothers in the absence of a father, as well as
the long-term affects of unresolved grief over the loss of that same-sex parent.
In addition, “the loss of cultural rituals and supports also fell away with the
disorganization of the family system after the loss of the father, complicated
by migration, dislocation, psychotic parents and parental anxious responses”
(p. 30). In both Indian and Jewish traditions, rituals exist to help boys dif-
ferentiate from their mothers and join “the men.” But these customs broke
down when they were needed most, after the death of the father. Therapeu-
tic efforts aimed to help the child internalize the lost father through incor-
poration, introjection, and ultimately identification in an effort to stabilize
their masculine identities. Indeed, Jacob’s phallic woman fantasy may reflect
his confusion over the anatomical difference between the sexes. Dr. Guzder’s
knowledge, sensitivity, and immersion in her own cultural identity enabled
her to help these very troubled boys. This paper emphasized the problem of
early object loss from a multicultural perspective.
Calvin Colarusso’s Chapter

Dr. Colarusso’s life cycle perspective is highlighted in this paper which ad-
dresses the conflict over the acceptance of death in middle age. Applying
the Mahlerian model to young, middle, and later adulthood, he conceives
of a third, fourth, and fifth individuation, following Blos’s second individu-
ation of adolescence. He also reminds us of Freud’s insights related to the
temporariness of life which heightens our appreciation of it all. Bringing in
clinical material from the analyses of two men whose neurotic conflicts in-
terfered with a more developmentally appropriate appreciation of the human
condition, he demonstrates that one of the outcomes of a well-conducted
analysis is such an acceptance. In his extension of a developmental line of
death awareness, Dr. Colarusso states that, “with youth behind them, normal
midlife adults are forced to confront their finiteness as the defenses against
the acceptance of time limitation and personal death crumble before the
power of a new physical, psychological and environmental experience” (p.
3). In contrast to the “loneliness of young adulthood” in the third individua-
tion, the fourth individuation is characterized by the paradox of the progres-
sive awareness of the finiteness of loss coupled with the poignant realization
of “the importance of others for one’s health, happiness and security” (p. 3).
It is as though the process of aging helps prepare one for the inevitability of
death, like a well-timed interpretation. In contrast with this developmen-
tally informed interpretation, one way of thinking about why the precocious
exposure to death in childhood is traumatic is that it is so out of phase with
the normative life cycle; therefore it may be thought of as the antithesis of a
fixation (Kestenberg and Brenner, 1994).
In the first case, summarized from a previously published paper, Mr. T.
entered analysis at age fifty-three complaining of escalating anxiety and de-
pression. His father had died at age fifty-eight, and Dr. Colarusso theorized
180 Ira Brenner
that this issue might be relevant to the man’s progressive preoccupation

with aging, health, and dying. As the analysis progressed his unconscious
fear of prematurely dying came to the fore. His fatalism was confronted and
interpreted in light of his ambivalence toward his father which was eventu-
ally determined to indeed be the underlying issue. As opposed to a father
dying young, in the transference Mr. T. saw his analyst as a vigorous father
figure who could look forward to living a long and active life. His subsequent
identification with Dr. Colarusso enabled him to conclude, “I’m not afraid
of death any more. I was afraid of living. You’re not really alive unless you
accept the fact that you are going to die” (p. 8). When it became time to
terminate his analysis, the process required him to mourn his analyst which
in turn enabled him to further his mourning for his father. Significantly, the
death of his father’s brother appeared to be catalytic to his ending analysis.
The second case, also previously published, is of an analysis of a thirty-
four-year-old man whose father died when the patient was twenty. Mr. B.
suffered from the anxiety of waiting for another tragedy to occur and sought
help for this symptom. In addition, he expressed the wish to enhance his
capacity for intimacy. The first installment of his treatment lasted only two
years due to his difficulty with becoming close, which in this instance was
with the analyst. The patient was cautious in the transference; he sought
praise for his achievements and good qualities, but feared another devastat-
ing loss if he criticized the analyst. Dr. Colarusso realized that an unconscious
collusion had developed between them in their mutual admiration society,
allowing the patient to leave before murderous oedipal fantasies could be-
come conscious. Such unacceptable wishes, Mr. B. suspected, had caused his
father’s death and “only after Mr. B. escaped retribution, i.e., outlived his
father, could the subject be approached” (p. 9).
When the patient returned for his third installment of treatment as he
was turning fifty, he realized he was the same age as his father when he died.
Sadly, his mother had died two days after his birthday, but he was better able
to deal with this loss at this point in his analysis. Defensively, Mr. B. was ob-
sessed with warding off danger by protecting himself in his “magical fortress”
of money, having been triggered by the sudden, unexpected events of Sep-
tember 11 and the realization that his own child was the same age that he was
at the time of his father’s death. He had a deep catharsis and sobbed for a pe-
riod of time, which was therapeutic. (I wish to point out parenthetically that
despite all the exciting advances in technique, the role of catharsis in certain
cases, like those of traumatic loss, remains an important part of the analyst’s
therapeutic repertoire.) He was finally able to reconstruct the events around
his father’s heart attack, hospitalization, death and funeral. Having outlived
his father by forty-one days at the time was a huge accomplishment for Mr. B.
and he became able to further his mourning. His depressive symptoms then
improved. As Dr. Colarusso describes it, “the oedipal underpinnings of the
fear of dying and the hormonal castration in the depleted testosterone levels
were clearly related to the infantile wish to kill father off and take his place
along with mother” (p. 13). Giving new meaning to that mythical notion of
a fountain of youth, Dr. Colarusso illustrates how neurotic conflict and de-
velopmental anxiety, i.e., separation and castration anxieties heightened by
traumatic loss, may underlie the conscious fear of death and ironically keep
a person young, but only in a pathological way.
Ilany Kogan’s Chapter

Ilany Kogan’s contribution centers around a clinical case, also previously
published, of a woman using “manic defenses to run away from aging and
death by endlessly attempting to conceive and produce new life, thus holding
onto everlasting youth and usefulness” (p. 8). In her review of the literature
she cites Eissler, who noted that despite Freud’s positing a death instinct, or-
ganized psychoanalysis has not taken up the study of death as deeply as might
have been expected. Indeed, even in this special volume, there is very little
about “thanatos” itself. But as Freud has theorized, the death instinct does
not have a direct psychical expression, so whether the conscious fear of death
is a defense against developmental anxieties or indeed a fundamental fear in
and of itself, remains an arguable issue which is addressed by Ms. Kogan. She
reminds us that Kohut and Erikson, for example, equate wisdom with the
mature acceptance of the inevitability of death whereas Hoffman contends
that tolerating the paradox of the meaningfulness and the meaninglessness
of life is essential. With regard to the meaning of life in women, the loss of
the capacity to bear children is studied in depth here.
In the clinical material, Dina, a forty-one-year-old mother of two, had
a fantasy of having a baby without a man, which had reached the level of
psychotic proportion. Her analyst was rendered impotent as the patient was
unable to take in any of her interventions. As though Dina were warding
off anxiety over penetration of any type unless she herself was in control of
it, the patient set about to get pregnant through high-tech means without
a partner. Although this report does not go into detail about the absence of
her father, we are told that the patient’s bipolar mother bitterly complained
about being abandoned by her husband and fluctuated between being frankly
abusive and emotionally dead. Without a “father of individuation” or a
father to protect against the mother’s dangerousness, Dina evidently grew
182 Ira Brenner
up without a male presence and had to become self-contained. This mode

of adaptation was enacted in the transference and became a source of great
resistance to the treatment. In this challenging case, Ms. Kogan candidly
and honestly shares her countertransference as she at times came to wonder
if too much insight into the manic defense might promote a total disintegra-
tion of the patient’s psyche. In addition, Ms. Kogan’s own awareness of the
importance of the loss of her childbearing capacity resulted in an overiden-
tification. To her great credit, her self-analysis made her able to recognize
this pitfall and use her insights to better form her interventions and further
the analytic process which had been interrupted by the patient’s flight after
she became pregnant.
The analytic dyad got reinstated after the patient’s miscarriage but the
patient was not able to tolerate grief until many years later. Working through
a deeply ambivalent maternal transference required the analyst’s sensitivity
to the regressive pull of projective identification with the helpless child and
the dangerous mother.
Eventually the patient became pregnant again but interestingly only after
a diminution of her murderous rage. As in Dr. Colarusso’s case of Mr. B.,
we see powerful psychophysiologic issues involved as reproductive hormone
levels seem to be affected by the ameliorative effects of analysis. Dina’s
rage was projected onto the analyst who was perceived as a murderer of her
babies. She eventually acquired insight and began to realize that having
babies would not prevent, but “just postpone dealing with aging and death”
(p. 14). She continued in treatment until her new daughter was two years
old. Ms. Kogan thoughtfully considers the benefits of the analysis from the
standpoint of neutralizing her hatred of the mother and modulating her fear
of death but was concerned that the patient’s actualization of her fantasy
of making a baby without a man was an unconscious collusion that left the
treatment incomplete. Ms. Kogan thus asks, “Could she ever complete the
process of mourning necessary for accepting her mono-sexual identity and
the inevitability of her death, a process she began before the birth of this
child?” (p. 18).
Ms. Kogan’s doubts about the value of the treatment were allayed after a
fortuitous post-termination encounter with the patient on the street. Dina,
then fifty-four-years-old, was well dressed and looked quite feminine, in
contrast to her earlier appearance. She spontaneously told the analyst how
well she was doing with her family and her teaching career, the latter being
a reflection of her enhanced capacity for sublimation. Now she could better
tolerate her mood fluctuations and was accepting her age. Such a welcome
and unplanned follow-up reassured Ms. Kogan that indeed the analysis had
been successful. As in life itself, the role of chance seems to be very impor-
tant in our work, as we may be uncertain about the value of the direction
we have gone until much later, after certain unexpected encounters with
key people. The ongoing struggle to accept both the limitations of life and
the limitations of analysis requires us to tolerate uncertainty, imperfection,
and incompleteness which paradoxically may enhance the appreciation and
value of both.
Tooraj Moradi’s Chapter

Tooraj Moradi gives the Western reader an important opportunity to learn
about the experience of death from an Eastern perspective. He gets our atten-
tion immediately by trying to shock us by praising Allah through his quote
from the first verse from the Koran. But, since he uses the Judeo-Christian
term, God, instead, perhaps he hopes to build a bridge to the Western mind. I
believe he does. Drawing upon references to scripture, the monumental work
of Rumi, the exalted Sufi poet of the thirteenth century, along with other
notable writers, interviews, and his own subjectivity, Dr. Moradi invites us
to join him in his exploration of this topic. As the founder of the Tehran
Psychoanalytic Institute, he integrates the work of Stolorow and Heidegger
into his thinking. In reference to the former, he incorporates the notion of
a “relational home”: “The fact that we all die gives a comforting twinship
experience, . . . wherein sharing of the experience associated with death by
‘someone else who is like me’ becomes more rewarding” (p. 3).
Asserting that the only way we can comprehend death is through implica-
tion and metaphor, Dr. Moradi looks to the great poets of his Iranian Islamic
culture, which he states is representative of the larger regional population of
more than one billion people. In this context he puts forth six facets of his
expanded definition of a relational home which includes both external and
internal objects:
1. A societal twinship relational home in which one is exposed to frailty, a
metaphor for death. He points out that seeing it “in others and societal norms
allowing one to show one’s frailty to others on a daily basis, creates a com-
fortable relational home in which one doesn’t feel uncomfortable with one’s
own frailty, aging and deterioration” (p. 4). He tells us that in Iran people are
not ashamed to talk openly about such issues and that references to death are
regular features of daily conversation.
2. A societal and interpersonal home in which there is shared sadness. There
are more than twelve national mourning days, and people regularly attend
funerals as well as the traditional third, seventh, and fortieth post-burial day
184 Ira Brenner
services. In addition, every Thursday night, families of the lost loved ones
serve their favorite food in accordance with beliefs that their souls are free
at that time. Dr. Moradi also says that it is common in Iran to be very open
and demonstrative with emotion during funerals. However, in my own lim-
ited experience attending Muslim funerals of those from other countries, the
custom was to be quite restrained and controlled. While I realize that this
is just one discrepancy, I do wonder just how representative Dr. Moradi’s
description of Iran actually is of the overall “Islamic cultural geography of
the East” (p. 4).
3. A transitional relational home in which there is creative playfulness with
authority figures. There are also many happy holidays in Iran, such as the
Persian New Year where nearly everything is shut down for a month; he sees
this as a playful rebellion against the authority of “work.” There is a quality
of living for the here and now, knowing about the uncertainty of the future,
which he illustrates with poetry by the world-famous eleventh-century poet,
Omar Khayyam. The proud and ancient Persian culture has produced writ-
ers whose works have endured and formed the backbone of today’s culture.
The poet has an exalted status whose wisdom and lyricism are part of the
national ego ideal. It is “a vehicle to soften harsh realities [like death] we
are usual alone with by taking us to a transitional land . . . [to] a bigger and
softer truth” (p. 8).
4. A “shared optimal frustration/suffering that makes us stronger” relational
home in which there is wise suffering. This category appears to overlap with
the first category of “exposure to frailty” but here there is mutual selfobject
relatedness between man and the ultimate authority, i.e., God. To illustrate
this point, he refers to Rumi again who explains through a story that God’s
delay in answering prayers is due to the Almighty’s pleasure in hearing the
moaning associated with hearing the prayers.
5. A cognitive, mirroring, idealizing and/or transitional home in which Iranians
live and die philosophically. They have a narcissistic investment in being well
informed and have opinions about everything from politics to literature to
death. Their philosophy is heavily based on Koran, poetry, and storytelling.
As in other great religions, martyrdom is elevated and there is a prominent
identification with suffering. If one dies who was “very innocent,” he or she
would be rewarded in the afterlife. As has been previously described, there
is an overriding importance on poetry which, overlapping with religion, ad-
dresses the central issues of the human condition of life, love and death.
Iranians are “exhaustive story tellers” and “traditionally voluminous story
writers” (p. 16) who have tales, proverbs, and jokes for all occasions. Perhaps
one of the most famous of these stories, known to Westerners, is another one
by Rumi where people are in search of the “truth.” They were placed in a
dark room with an elephant and could only search by touch. Each described a
different part of the animal, which was that person’s own truth. Analogously,
there are different philosophies and “truths,” which tell us about life and
what is supposed to occur upon death.
6. Emerging relational home in which there is a spiritual intersubjectivity as char-
acterized by the story of the Third Handwriting. This often aspired to spiritual
state of mind may help a religious Iranian contain his anxieties about death
through a hoped for reunion of the soul with the creator. Being a sublime
ascendant state, “ . . . the previously mentioned relational homes may be
regarded by a Sufi to be the preliminary steps for beginning and enjoying a
joyous spiritual journey whose goal is to ‘become nothing’ in order to become
one with God” (p. 18). In this quest, the “Third Handwriting” from God is
not read by either the subject or the object. It is unknowable in the usual
sense of the word.
Conclusion
After this meditational experience with Dr. Moradi, he leaves us with a very
important question, i.e., “Is there anything and to any degree that the West
can learn and integrate from us?” (p. 22). In a larger sense, this question may
be applied to this whole volume. In other words, do such spiritual states of
mind and the thousands of years of reflection upon our fate simply repre-
sent a cleverly disguised regressive harkening back to the early states of the
maternal-infant dyad or are they an advanced human achievement which
point us in the direction of an as yet unknowable deeper truth? But, if this is
not the case and if indeed there is nothing more than life itself, then perhaps
we may be guided by the philosophy of a once famous song that proclaimed,
“if that’s all there is, then let’s go dancing.”

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Index
acceptance of death: Akhtar on, 13; 79–96; and immortality, 16; stuck in
Colarusso on, 107–23; dialectic of, literal interpretations, 101–2
17 anxiety: and children’s understanding
adolescence, and fear of death, 84–85 of death, 34, 46–47, 49. See also fear
adult development: Akhtar on, 8. See of death
also aging; late-life development; appropriate death, definition of, 12
middle age Attar, 149, 151
afterlife, belief in, 1, 19n1, 113 authority figures, playfulness with,
aggressive instinct, 3 Iranian culture and, 141–42
aging: acceptance of, 95; and analyst,
104–6, 122–23, 125; and analytic Barforoosh, M., 141
couple, 93; anxiety over, 107–23; Bastami, Bayazid, 148
children’s anxiety over, 50; Heilbrun Batman, 64–67
on, 133–34; Madow on, 11–12; Being-toward-death, 137
struggle against, 89, 92 Billie, Susie, 51
Akhtar, Jan Nisar, 16 Blos, Peter, 108
Akhtar, Salman, 1–20, 99 boundaries: and gender identity, 57;
ambiguity, Iranian culture and, 142 Islamic culture and, 161–63; loss of,
analyst: aging, 104–6, 122–23, 125; fantasies on, 4
attitudes of, 99–100; and children’s Brahe, Tycho, 16
pain, 43–44; commentary on, Brenner, Ira, 171–85
97–106; and fear of death, 38, Buddhism, 3, 14, 54
199
200 Index
castration anxiety, versus fear of death, of, 112–13; mature integration of,
6, 23, 78, 84 122–23; and midlife tasks,
causation, of death, 26; children’s talk 110–11
on, 35 death instinct, 3–5; Freud and, 38
Chadwick, M., 84–85 death rituals, Iranian culture and,
change, fear of, 94, 103–4 140–41
Chased by Bears, Mato-Kuwapi, 51 death wishes, 7, 60
children and death: Colarusso on, 109; defenses, against fear of death, 19n4,
commentary on, 37–50, 71–78, 86–92; relinquishing, 95
172–73; Freud on, 5, 21, 37–38; del, 149–50, 153n16
Guzder on, 51–69; Hoffman et al. denial and death, 19n4; commentary
on, 21–36; literature on, 22–27, on, 165; dialectic of, 17, 127–29
37–42; transcript on, 27–33, 44–48 depression: fatalism and, 158; toleration
clinical immortality, 16 of, 44
Coen, Stanley J., 97–106 development: adult, Akhtar on, 8;
Colarusso, Calvin A., 107–23; nature of, 107–8. See also aging; late-
commentary on, 125–34, 179–81 life development; middle age
concrete operational stage, 25, 38 developmental sequence: culture and,
constructive resignation, 109. See also 55; and understanding of death,
acceptance of death 24–25, 38–39, 81–82, 172
continuous dying: Akhtar on, 13–17; dialectics, of denial and acceptance of
and analysis, 93; Colarusso on, death, 17, 127–29
107–23; Moradi on, 135–54; nature
of, 150–51; Plato on, 133 Eastern cultures, and death: children
Cooper, A. M., 95 and, 51–69; commentary on,
counterphobic actions, 20n4 155–69; Freud and, 3; Ghalib and,
countertransference: and fear of death, 9–13; Moradi on, 135–54
89, 92; and midlife issues, 117; ego, and death, Freud on, 7
termination and, 94–95 Eissler, Kurt, 12, 80–81
courage, for analysts, 106 Emde, R. N., 108
creolization of culture, 54–55, 76, 156 Epicurus, 79
culture: creolization of, 54–55, 76, 156; Erikson, E., 82, 108, 112, 127
and death imagery, 51–69, 137; as “Erlkonig” (Goethe), 73–75
dynamic influence, 53–54; mixed Eslamic culture. See Islamic culture
signals in, 163–64. See also Eastern Etezady, M. Hossein, 155–69
cultures, and death existential view, of tasks of late
adulthood, 128–29
death: mature understanding of, 23,
25–26, 34, 48, 93; poetry on, 147; faith, Islamic culture and, 164–68
questions on, 18; relational homes fantasy(ies): and coping with death,
for, 135–54; timing of, 112 46, 48; function of, 50n1; of loss of
death awareness: commentary on, boundaries, 4; of resurrection, 8
125–34; development of, 109; effect fatalism, 158
Index 201
father, death of: commentary on, 71–78; Ghalib, Mirza Asad-Ulla Khan, 1–20;
coping with, 67–69; culture and, 57; background of, 9–10
Hindu culture and, 56, 58–64; and ghost, term, 77
midlife issues, 115, 117 Gilgamesh, 79
Fayek, A., 7–8 Gill, Harwant, 67, 72
fear of death: Akhtar on, 1–20; globalization, and culture, 54–55, 156
Colarusso on, 107–23; commentary Goethe, Johann Wolfgang von, 73–75
on, 97–106, 125–34; coping great immortality, 16
mechanisms for, 80; Freud on, 5–9; Greek philosophy, 79
Kogan on, 79–96; literature on, Grinberg, L., 93, 96n1
80–83; making conscious, 23, 93, 96; Grotjahn, Martin, 122–23
origin of, 84–86; term, 19n3; versus group identity, 156–57
understanding, 48 guilt: analyst and, 89; death wishes and,
Fechner, Gustav, 3 7, 49–50; and fear of death, 84–85
Fenichel, O., 81 Guzder, Jaswant, 51–69; commentary
Ferdosi, 146, 148–49 on, 71–78, 175–79
fertility, as defense against fear of death,
86–91 Hafez, 139, 147, 149–50, 153n5
First Nations cultures, and death, 51–52 Heidegger, Martin, 80, 137
formal operational stage, 38–39 Heilbrun, Carolyn, 133–34
Foster, Michelle, 21–36; commentary Herzog, James, 73–75
on, 37–50, 174–75 Hinduism, 54; and children, 55–64
frailty: exposure to, Iranian culture Hoffman, Irwin, 25, 83, 128–29, 133–34
and, 138–40; relational homes for, Hoffman, Leon, 21–36; commentary on,
135–54 37–50, 174–75
Freud, Julius, 38, 48 hope, 15, 99
Freud, Sigmund: on children and Hossein, Imam, 144
death, 5, 21, 37–38; on conscious human nature, Islamic culture and,
understanding of death, 23, 93; 160–61
on fear of death, 1–20, 84; on
immortality, 81, 171; on Oedipus identification, 68
complex, 167–68; on transience identity, Iranian culture and, 158–59
and uncertainty, 108–9, 111; on “if only” fantasy, 4
uncanny, 128 immortality: Akhtar on, 1–20; Freud
Furman, Erna, 48 on, 23, 81, 93, 171; Pollock on, 11;
future, options for, 115, 121 types of, 16
incorporation, 68
Garfield, Ruth, 125–34 inevitability, of death, 25; children’s
gender identity: boundaries and, 57; talk on, 34
Hindu culture and, 55–56; and integrity, Erikson on, 82
origin of fear of death, 84–85 intersubjectivity: Eastern, 135–54; faith
genetic immortality, 16 and, 166–68; spiritual, 149–52
gestures, cultural variation and, 163–64 introjection, 68
202 Index
Iranian culture: and attitudes toward Madow, Leo, 11–12

death, 135–54; commentary on, Mahler, Margaret S., 108
155–69; language of, 169n2 Mann, Thomas, 106
irreversibility of death, 23–24, 26; menopause, and fear of death, 85–91;
children’s talk on, 34–35 commentary on, 97–106
Ishrat-e-Qatra (Ghalib), 9–13 merger fantasies, 4
Islamic culture: commentary on, metaphors: children and, 51–69; Iranian
155–69; Moradi on, 135–54 culture and, 136, 141–42; and
isolation, coping mechanisms for, 80 transference, 102
Metcalfe, Thomas, 10
Jacques, E., 109–10 middle age, developmental tasks of:
Johnson, Eileen, 21–36; commentary Colarusso on, 107; and death
on, 37–50, 174–75 awareness, 110–11; Garfield on,
Judaism: and children’s understanding 126–28
of death, 172–73; and death of migration, and cultural shifts, 68
father, 64–67; and gender identity, minor immortality, 16
57 miscarriage, 86
moksha, 57
Kakar, S., 55–57 money, attitudes toward, father loss
Kali, 63, 67 and, 118–19
Kaplan, Albert, 71–78 monstrification, 50; term, 50n4
karma, 54, 64 Montero, Guillermo Julio, 116, 126
Kartikeya, 57 Moradi, Tooraj, 135–54; commentary
Khayyam, Omar, 141–42, 145, 147 on, 155–69, 183–85
Klein, Melanie, 3–5 mortality. See death
Kogan, Ilany, 79–96; commentary on, mother: and death of father, 61–62; and
97–106, 181–83 fear of death, 90–91, 103; in Hindu
Kohut, Heinz, 82–83 culture, 55–57; in Jewish culture,
Kundera, Milan, 16 65–66
mourning: children and, 26–27, 42–44,
late-life development: death awareness 51–69, 71–78; growth and, 94,
and, 112–13; Garfield on, 103–4; Iranian culture and, 140–41;
126–29 miscarriage and, 86
Lerner, P. M., 26–27 Mustafa, Agha, 138
life: boundaries with death, 13–17; and
nature of death, 137–38; poetry on, Nagera, Humberto, 43
145–47 narcissism, primary, and blame for
Lifton, Robert, 111, 128 death, 49–50
linking objects, 16–17 narcissistic wound, death as: Akhtar
Loewald, Hans, 131–33 on, 2; Fayek on, 8; Freud on, 81, 84;
loss: children and, 26–27, 42–44; in Kaplan on, 78; Moradi on, 137
midlife, 111 Neugarten, B., 112
Low, Barbara, 3 Nirvana principle, 3
Index 203
non-functionality, and understanding relational homes, 137–52; for frailty and

of death, 23–24, 26; children’s talk death, 135–54; term, 137
on, 35 religion: and coping with death, 19n4,
61, 63–64, 80, 113, 185; Iranian
Obama, Barack, father loss and, 72–73 culture and, 144–45; Moradi on,
object constancy, and fear of death, 8 135–36
object loss, early, 26–27 resignation: versus acceptance, 127;
object relations, and faith, 166–68 constructive, 109
Oedipus complex: in children coping resurrection fantasies, 8
with death, 41–42; death of father ridiculous immortality, 16
and, 116–17; Indian culture and, Rolland, Romain, 3
56; progressive view of, 131–33; Rumi, 136, 139–40, 142–43, 146, 148–
relatedness and, 167–68 52, 153n2
Ogden, Thomas, 131–33 Russell, Ralph, 9
Orgel, Shelley, 105
sadism, in children coping with death,
41–42
Parens, Henri, 37–50 sadness: in children coping with death,
Parvati, 57 40; sharing, Iranian culture and,
Persia. See Iranian culture 140–41
philosophy, Iranian culture and, Schafer, R., 96
143–49 Schiller, J. C. F., 75
Piaget, Jean, 24–25, 38–39, 50n2 schizoid personality disorders: analyst
Picard, Jean Luc, 58–61 attitude and, 99–100; withdrawal
Plato, 133 in, 15
play, term, 77 school refusal, death of father and, 60
playfulness, with authority figures, Schubert, Franz, 74–75
Iranian culture and, 141–42 Schur, Max, 37–38
poetry, Iranian culture and, 141–42, sensori-motor stage, 38
145–47 separation anxiety, 46, 50n3
Pollock, G. C., 11, 108 separation-individuation processes, and
pregnancy, as defense against fear of death awareness, 110–11
death, 86–91 Sepehri, Sohrab, 147, 153
pre-operational stage, 24–25, 38 Shah, Safi Ali, 151
primary narcissism, and blame for death, Shams, 150, 152
49–50 Shiites, 158
psychic death, 14–15 Shiva, 57, 59
psychotherapy and death: commentary siblings, death of, 38, 48
on, 171–85; effectiveness of, 125–28, Siegel, B. L., 94–95
134; questions on, 18 Skanda, 57
Slater, Philip, 82
Ramakrishna, 61–64 someday fantasies, 4
rebirth, wish for, 8 spiritual intersubjectivity, 149–52
204 Index
Spitz, Rene, 107–8, 174–75 transience, Freud on, 108–9

Star Trek, 58–61 trust, commentary on, 165–66
stereotypes, 156–57; of Americans, 162,
164; formation of, 162 uncanny: Akhtar on, 15; Freud on, 111,
Stolorow, R., 137 128
Stone, Leo, 100 uncertainty: commentary on, 165–66;
storytelling, Iranian culture and, Freud on, 108–9, 111
148–49 universality, of death, 23–24, 26;
sublimation, and coping with death, children’s talk on, 34; as relational
47, 93 home, 137
submission, Islamic culture and, 160–61
suffering: Iranian culture and, 139; wise, vicarious reassurance, 19n4
Iranian culture and, 142–43
Sufism, 149–50, 152, 153n2 Weissman, A. D., 12, 81
symbolism, children and, 51–69 Western culture: and boundaries,
161–63; denial of frailty in, 139–40;
Taj Mahal, 17, 20n7 stereotypes of, 162, 164
termination: and fear of death, 16, Wheelis, Allen, 18–19
93–96; issues in, 96n1; and midlife Winnicott, Donald, 75
issues, 116 wisdom, 83; Iranian culture and, 142–43
thanatology, popularity of, 83 Wolff, Peter, 39
Thomas, Dylan, 127 World War I, 23
thread ceremony, 55–56 Wright, Josephine, 21–36; commentary
Ticho, E. E., 96n2 on, 37–50, 174–75
time sense, death as organizer of, 112
Todesangst. See fear of death Yalom, I., 79
transference: and fear of death, 88–90;
literal interpretation in, 101–2; and Zen Buddhism, 14
midlife issues, 117 Zoroastrianism, 149, 155

About the Editor and Contributors
Salman Akhtar, MD, Professor of Psychiatry, Jefferson Medical College;

Training and Supervising Analyst, Psychoanalytic Center of Philadelphia,
Philadelphia, PA.
Ira Brenner, MD, Clinical Professor of Psychiatry, Jefferson Medical Col-

lege; Training and Supervising Analyst, Psychoanalytic Center of Philadel-
phia, Philadelphia, PA.
Stanley J. Coen, MD, Clinical Professor of Psychiatry, College of Physicians

and Surgeons, Columbia University; Training and Supervising Analyst and
Senior Associate Director for Academic Affairs, Columbia University Cen-
ter for Psychoanalytic Training and Research, New York, NY.
Calvin A. Colarusso, MD, Clinical Professor of Psychiatry, University of

California at San Diego; Training and Supervising Analyst, San Diego Psy-
choanalytic Institute, San Diego, CA.
M. Hossein Etezady, MD, Clinical Director of Psychiatric Services, Paoli

Memorial Hospital; Faculty Member, Psychoanalytic Center of Philadelphia,
Philadelphia, PA.
205
206 About the Editor and Contributors
Michelle Foster, BA, Research Extern, Bernard Pacella Parent-Child Cen-

ter, New York, NY.
Ruth Garfield, MD, Faculty Member, Psychoanalytic Center of Philadel-

Jaswant Guzder, MD, Head, Department of Child Psychiatry, Sir Mortimer

Davis Jewish General Hospital, Montreal, Canada.
Leon Hoffman, MD, Director, Bernard Pacella Parent-Child Center; Train-

ing and Supervising Analyst, New York Psychoanalytic Society and Insti-
tute, New York, NY.
Eileen Johnson, MA, Director, Little Missionary’s Day Nursery, New York,
NY.
Albert Kaplan, MD, Faculty Member, Psychoanalytic Center of Philadel-

Ilany Kogan, MA, Member of the Advisory Board, Fritz Bauer Holocaust
Research Institute, Frankfurt, Germany; Training and Supervising Analyst,
Israel Psychoanalytic Society, Rehovot, Israel.
Tooraj Moradi, PhD, Founder, Dean, and Faculty Member, Tehran Psycho-
analytic Institute, Tehran, Iran.
Henri Parens, MD, Professor of Psychiatry, Jefferson Medical College;

Training and Supervising Analyst, Psychoanalytic Center of Philadelphia,
Philadelphia, PA.
Josephine Wright, MD, Faculty Member, Berkshire Psychoanalytic Institute,

Stockbridge, MA; Faculty Member, New York Psychoanalytic Society and
Institute, New York, NY.

(Margaret S. Mahler) Salman Akhtar, Ira Brenner, Stanley J. Coen, Calvin A. Colarusso , Hossein M. Etezady, Michelle Foster, Ruth Garfield, Jaswant Guzder, Leon Hoffman M.D., Eileen Johnson, Albert Ka.pdf

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(Margaret S. Mahler) Salman Akhtar, Ira Brenner, Stanley J. Coen, Calvin A. Colarusso , Hossein M. Etezady, Michelle Foster, Ruth Garfield, Jaswant Guzder, Leon Hoffman M.D., Eileen Johnson, Albert Ka.pdf

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The Wound of Mortality

Margaret S. Mahler Series

BOOKS BASED UPON THE MARGARET S. MAHLER SYMPOSIA

• The Trauma of Transgression (1991) • Does God Help? (2000)

Estover Road, Plymouth PL6 7PY, United Kingdom

Copyright © 2010 by Jason Aronson

British Library Cataloguing in Publication Information Available

Library of Congress Cataloging-in-Publication Data

⬁ ™ The paper used in this publication meets the minimum requirements of

Printed in the United States of America

with respect and affection

Chapter 7 The Dead Self Must Be Reborn 97

Freud’s Todesangst and

We have a complex relationship with death. To call our attitude toward

intrigued. Our epistemic instinct exhorts us and we concoct elaborate

The Death Instinct

is utilized largely to explain mental operations that seek to destroy sublime

a “death instinct” even before middle age. Such a formulation of “death

unconscious. Here I am referring to his notion of todesangst, translated as fear

narcissism and especially within the emergency of secondary narcissism from

Fayek (1981) emphasizes that the idea of death as a narcissistic wound

While these contributions underscore its object-relational context, they

to be a primary phenomenon and a subjective reverberation of the death

the customary romanticism and earthly preoccupations of the literature of his

Ghalib’s statements on various themes (e.g., religion, drinking, love) were

Ghum-e-hasti ka Asad kis se ho juz marg ilaaj

Partaw-e-khur se hai, shabnam ko fanaa ki taleem

• Death is recognized to be a natural and expectable event without which

The metaphors utilized by Ghalib (e.g., “drop-river merger,” “sunshine-

Weissman, in contrast, allows for the possibility of what he calls “appro-

one in which there is reduction of conflict, compatibility with the ego-ideal,

mal distinction between a premature, unexpected, and violent death and a

Yet Another Conundrum

The Zen exhortation is to live a life of detachment, including detach-

• The schizoid withdrawal is, at its core, an instinctive ego response to

To be sure, such scenarios of “death in life” have their counterparts in

cremated remains) is sad and disturbing. Our reaction to professional mimes

Jism-o-jaan ka yeh aarzi rishta

is actually present in the environment that is psychologically contaminated

does not fade as it does in uncomplicated mourning. Rather, it increasingly

A noticeable aspect of linking objects is that such objects can neither be

• Can one draw a “developmental line” (A. Freud, 1963) pertaining to

The list can be extended, to be sure. However, the point I am trying to

What Happens When You Die?

In The Interpretation of Dreams, Freud (1900) said, “Children know nothing

Review of the Literature

Irreversibility refers to “the understanding that once a living thing dies,

More recently, Slaughter and Griffiths (2007) have summarized an ex-

1. Inevitability—the acknowledgment that living things must die even-

2. Universality or applicability—the understanding that death must hap-

mitigating aspects of defense, the availability of substitute objects, and the

Children Talking about Death

David: No, I won’t.

David: In the sky.

Lily: Yeah, because I can’t hug her anymore.

Hmm. Why is he worried—

Robert: It doesn’t have wings.

Children’s Understanding of Death

Hoffman has selected an informative review of the literature on children’s

On Hoffman’s Review of the Literature

Schur (1972)—who also became a well-known psychoanalyst—Freud had a

and concerns about me. He was quite positively responsive to interpretation

Young Children’s Experience of Death, Loss, and Mourning

About Hoffman’s Sample of “Children Talking about Death”