Existential Psychotherapy

"Yes, Irvin Yalom, 1980. He is aware of Becker’s ideas, he’s very fond of them, and he is richly steeped in existentialism from a philosophical point of view. He is known, along with Rollo May, as one of the foremost practitioners of existential psychotherapy. What he purports to do in the book is see what we can do with these ideas to enhance psychological wellbeing. If you look at the structure of the book there’s four big existential ideas — death, freedom and choice, isolation and meaninglessness. For each of these notions, he muses about their implications in a therapeutic context. He says that death is the motherlode. What he adds to the corpus of knowledge is a wonderful chapter on childhood and death, where he presents, in my opinion, very compelling evidence that children are aware of, and concerned about, death much earlier than most of us remember or than parents report. Children as young as two, and certainly by 5 or 6, are often very much aware of death. That is correct. It may seem like a simple point, but Yalom says that it is a testament to our own death denial as adults that we tend to think that our kids are not all that worried about it. Then he demonstrates how children deploy some of the same defenses in rudimentary form as we do as adults, to ward off death anxiety. There’s another great chapter on death and psychopathology. He’s not arguing that death anxiety causes all forms of psychopathology, but that existential concerns pervade them and amplify them. We’ve done a considerable amount of research that we report in our book , which shows that, for example, when arachnophobes are reminded of death, they become more afraid of spiders. Obsessive compulsive people, when reminded of death, wash their hands longer — and so on and so forth. Some people do come in and say, “I’m concerned about my mortality.” Sometimes you address it directly. As Albert Camus said, ‘Come to terms with death, thereafter anything is possible.’ My wife is a bereavement counselor in our local hospice, and there are ways of working with people. You’re certainly not going to talk them out of being anxious about death, but hopefully you can enable them to recognize that it’s not an evil atrocity so much as the inevitable culmination of all finite forms of life. I like how some of the ancient Romans put it: if you’re reading a book, you’d be disappointed if it never ended and surely a great feast would be aggravating if you never finished and got to leave the table? I think it was Lucretius who asked, ‘Can’t we get to the point where we can depart from life as satiated and satisfied as a guest at the end of a glorious banquet?’ I love that. I’m not there yet. Yalom also says that sometimes people may be concerned about death, and while you might know that as a therapist, addressing it directly may not be the way to go… If you asked a therapist, ‘Do you have an existential take?’ a lot would say, ‘No, I don’t do that.’ But if you actually look at what they’re doing, I see a lot of elements that overlap. I think a lot of good therapists just say, ‘I’m eclectic, I’ll use anything that works.’ Students that I teach who become therapists that don’t define themselves as working in an existential tradition, still find it helpful. Yalom then goes on to another problem, which is that we often feel isolated. As Elizabeth Cady Stanton says in The Solitude of Self , we come into the world by ourselves, whenever there’s difficulties you’re in it by yourself, nobody jumps in your coffin with you when you die. One of the poignant ironies of being a person and a member of a highly social species is that we still have no direct connection with our fellow humans. We communicate with words, which work pretty well. But there’s still times, when you’re talking to people and they don’t understand a word you’re saying. What the existentialists say is that it is inevitable that we will sometimes feel isolated, and alone, even in the middle of London or Paris. This is where they then prescribe healthy relationships with our fellow human beings (making a distinction between genuine love and morbid dependency, as Karen Horney puts it). The idea here is that love really does conquer death. In fact, in our experiments, when we ask people to reflect on their significant others, for people that are in healthy relationships, it literally eradicates death anxiety. Finally there’s the meaninglessness piece. The point is — how do you make sense of the world around you in which you will not reside in perpetuity? It sure seems like life is meaningless, given that I’m not going to be around forever. What the existentialists say is that just because life doesn’t have any intrinsic meaning it doesn’t follow that it’s meaningless. No, because, they say — and this may seem like semantic gymnastics — that you have the sublime privilege of being able to fashion your own meanings. You get to choose, based on your culture and your historical traditions and complemented by your own personal experiences. While that’s a perpetual challenge, it’s also a potentially uplifting and liberating privilege. Again, on my better days I see that. Other times, I’m not so sure… In a sense, depression is a luxury. For most of human history, you didn’t have time to be depressed. We lack the connection of extended families. And, in addition to that, we live in a world that values things that can’t be realistically attained. We value being rich and famous. Women are subjected to impossible standards of youth and beauty. It’s a toxic combination of unfortunate factors. But there’s no doubt that levels of depression are historically high."