Existential Psychotherapy (Irvin Yalom)
OVERVIEW
The Freudian perspective on psychodynamics is that humans come pre-programmed, “governed by instinctual forces that are innate.” The non-Freudian perspective counters that we are instead shaped by cultural forces… that we are programmed by our social environment/cultural framework. In Existential Psychotherapy, Irvin Yalom argues for a third perspective: that we are governed mainly by our “confrontation with the givens of existence.” While the Freudian approach to therapy argues that it’s our drives/urges that create anxiety, and the non-Freudian approach that it’s our cultural conditioning, the existential approach argues that anxiety stems from an awareness of four “ultimate concerns,” which are embedded in the ontological bedrock of our being. These ultimate concerns are: 1) that we are going to die, 2) that there is no inherent design in the universe by which to structure our lives, 3) that we are fundamentally alone, and 4) that life has no ultimate meaning.
In short, all anxiety is generated from our confrontation with death, freedom, isolation, and meaninglessness – the tension between what we would like to be true about existence and what we fear is actually true about existence.
DEATH
We yearn for immortality, for limitlessness, but we are finite and destined for death. One day your conscious experience will end, and you will be obliterated for all eternity. There are many ways that death anxiety might manifest – maybe as a fear of the dark, deep water, heights, snakes, spiders, germs, tight spaces, or even social rejection (the fear of exile). Yalom contends that these overt fears represent a displacement of our true anxiety, which is less about fear (of some-thing) and more about dread (the anxiety of no-thing). At its core, raw death terror is a terror of no-thing-ness… the anxiety of ceasing to be. We may tether our dread to something tangible (like spiders, snakes, or germs) – turn the anxiety of nothingness into a somethingness that is manageable, overcome-able, avoidable – but true death terror is a primal anxiety that rumbles around in the deepest layers of our psyche. We may bury our terror of nothingness deep in our subconscious, but it never stays there.
How do we cope with this dread? Children adopt the belief that death is temporary or reversible, that they are invincible, that they will be protected by some “ultimate rescuer” (a parent/guardian), or that they can outrun/outwit death; they are also consoled by their caregivers that only very old people die. By adulthood, we settle on two main defenses: the belief in our own specialness/inviolability (e.g., that our impact will outlast us, that we are immortal, that we are cosmically important), and/or the belief in an ultimate rescuer that takes the form of a “personal omnipotent intercessor” or “magical helper” (e.g., God, some supernatural consciousness). When these defenses are ineffective, we experience psychopathology. We enter therapy with unexplained phobias, with hypochondria, with OCD, with generalized anxiety. Maybe we are overcome with the feeling that time is running out, that we’re not doing enough, accomplishing or achieving enough. Dig down, and you’ll find that many neuroses have death at their core.
FREEDOM
Our hominid brains yearn for authority and structure, something bigger than us to guide and direct our lives, but we exist in a universe with no inherent design. There is no externally imposed structure, no supernatural author, no rules or prescribed roles. We generally think of freedom as positive, but this is a terrifying freedom – to be entirely responsible for every choice, with no “absolute external referents.” This is an anxiety of groundlessness… the responsibility of crafting our existence out of nothingness. Additionally, we must will ourselves into existence… but with every choice, every decision, we limit our possibilities (possibilities that will never come again). What if we make the wrong choice? What if we close the wrong door? And to truly accept that we are free? That’s to accept that there is no God, no ultimate authority, no grand design. Every failure could have been avoided, every regret is your fault, every suffering is self-created. You are also responsible for your own attention and where you direct it, and so if you choose not to attend to issues like homelessness or mass starvation or species extinction, then, in a way, you are responsible for them. This is the anxiety of freedom and existential responsibility.
How do we cope? Maybe we avoid situations that would make us aware of our responsibility – we avoid making irreversible decisions, or we blame others for our circumstances (we assure ourselves, “this is out of my control”). More commonly, we outsource our freedom to institutions and authorities… we seek out the structure. We abdicate choice to our religious texts, popular gurus, or political leaders. In other words, we externalize the locus of control. Many will pretend there is a grand design (which is to pretend that the choices have already been made for us, and therefore we are not entirely responsible). When these pretenses fail, we ask our therapists, “what choice should I make? Can’t you just tell me what to do?” “The patient complains of “something missing” from life, of being cut off from feelings, of emptiness, of zestlessness, or of a sense of being cast adrift.” This all stems from the anxiety of freedom.
ISOLATION
Two types of isolation we are most familiar with: interpersonal isolation (feeling lonely, disconnected from others) and intrapersonal isolation (feeling disconnected from your self). Existential isolation is different, it’s the “unbridgeable gulf” between yourself and others, or yourself and the world. It’s the anxiety that no one really knows you and can never know you… that you are alone in your experience of the world and always will be. You are fundamentally isolated. It’s this “basic separateness” we are confronted with.
Most prefer to conceal their existential isolation to thwart anxiety. We “flail toward” others in the hopes that they – spouse, child, friend, divine entity, etc. – will save us from drowning in our aloneness. We turn to the interpersonal mode, seeking “the presence of others to affirm [our] existence.” We long “to be swallowed by others” or “seek to alleviate [our] sense of lonely helplessness by swallowing others.” In doing this, we are not actually caring for/loving the other person… we are using them as a tool to alleviate our discomfort. Accordingly, these “relationships” do not satisfy for long because the safety-seeker needs constant affirmation. Some people choose to sacrifice their self-hood, seeking immersion into some greater cause or pursuit (humanitarian, political, religious, etc.); they attempt to dissolve their ego boundaries to combat their isolation. If done without first accepting the reality of existential isolation, these attempts, too, are doomed to failure. Our therapists may note that we cannot stand to be alone, that we don’t have a stable self-identity, that the people we’re in close relationships with are driven away by our insecurity and “clingy-ness,” or that we constantly use and discard people. What we’re trying to do in every instance is assuage the terror of our fundamental aloneness.
MEANINGLESSNESS
Humans are always “patterning” incoming stimuli/data, fitting them into existing frameworks; we also need to know the purpose, aim, or intention of things. Both are required to make sense of our environment and give us a feeling of coherence. This coherence is what we call “meaning” (or “purpose,” which Yalom uses interchangeably). Without meaning, without a coherent, discernable pattern/structure, we experience “dysphoria in the face of an indifferent, unpatterned world” – we experience helplessness. This is meaninglessness, and meaninglessness is most poignant when it stems from our awareness of the lack of any cosmic meaning… the lack of any God-given meaning. Secular societies provide “terrestrial” meaning schemas, but these can feel contrived and insubstantial. Without cosmic meaning, life feels directionless or pointless. Struggling with a lack of meaning is struggling with questions like “Why am I here?” or “Why is there something rather than nothing?” (notice how these questions are trying to elucidate a pattern). But meaning also gives birth to values, and helps us answer questions like “How should I live? How ought I to live?” (which, rather than getting at a pattern, is attempting to illuminate a set of guidelines or principles to live by… a “blueprint for personal action”). Without meaning, without shared belief systems that are legitimized by their perceived (cosmic) authority, our lives seem to lack purpose and value. What contributes to the increase in perceived meaninglessness in modern society? Yalom underscores that, in part: “We have time, too much time, to ask disturbing questions.”
We respond to this sense of meaninglessness in one of four ways: 1) we seek out (and believe we have found) grand meaning (religion, crusadism), 2) we angrily denounce the “meaning” that others seem to have found (nihilism), 3) we simply sink “into a severe state of aimlessness and apathy” (vegetativeness), or 4) we engage in frenetic activity in an attempt to outrun our anxiety (distraction).
Meaningless is tricky, too, because it so closely overlaps with the other three ultimate concerns.
· Freedom/meaning – to live meaningfully requires ideals and guidelines to live by… but freedom makes us aware that there are no absolute ideals or guidelines. The anxiety of creating meaning in a meaningless universe therefore combines meaning (needing guidance) with freedom (there being no guidance). Sometimes fear of freedom masquerades as fear of meaninglessness (the fear of there being no grand design that assigns us a role is really a fear of groundlessness). Modern society also gives us plenty of free time (which thrusts us into freedom), often revealing that there isn’t anything we really want to do, which makes it even harder to answer the question “How ought I to live?”
· Death/meaning – many will lament, “How can life have any meaning if we all die anyway?” This is not purely lamenting a lack of meaning, but rather a lack of meaning that can overcome transience and death. Meaning is also something we seek to escape death – to count, to matter. So, transience and death increase perceived feelings of meaninglessness, and meaninglessness makes death anxiety worse. Double trouble.
· Isolation/meaning – fear of isolation can propel us to find something or some group to dedicate ourselves to, which provides an effective way to deny our isolation. Fear of meaninglessness does the same thing… compelling us to search for some grander (supernatural) meaning schema to merge into. Unfortunately, coming into awareness of either our existential isolation or our cosmic meaninglessness brings down the whole house of cards: there is no cosmic meaning, and we are alone… there is no universal meaning schema that can save us from isolation or from meaninglessness.
WHAT NOW? (actions for mortal atheists)
Well, that’s all very depressing. Is that all that’s available to us? Denial or the anxious acceptance of the truth?
What to do about death
Because death is part of life, anxiety of death will always be part of life. The goal is to get the anxiety to a comfortable level so that it can be worked through and used as a catalyst. First, confront your feelings and anxiety about death: try writing your epitaph or obituary, imagining your death and funeral in detail, spending a day living like a dying person, imagining that you are dead, buried, and forgotten. Or, take a life-centered approach. Yalom says, “death anxiety is inversely proportional to life satisfaction.” So, focus on increasing your life satisfaction. The two are, in practice, complementary. Death anxiety can wake us up to living fully, and living fully decreases death anxiety. “. . . although the physicality of death destroys man, the idea of death saves him.”
For all my recommendations on addressing the fear of death, check out: The Mortal Atheist: A Secular Guide to Death and Meaning.
What to do about freedom
Accept that the locus of control is internal, not external. Whether you like it or not, you are responsible for your own self-constitution. Bring awareness to the omnipresence of decisions – even in deciding not to act (to procrastinate, to persuade another to decide for you), you are still deciding… evasion is also a choice (and a bad one). When you do have to make a decision, ask, “is it a small or big one?” If it’s a small one, try to see the smallness of it by placing it inside a larger perspective. If it’s a big decision, especially if it’s an irreversible decision, use your imagination. Imagine making the choice, then pay attention to the feelings in your body. If you’re stymied by multiple “what ifs?”, perform a systematic analysis of all possible outcomes. Again, pay attention to how imagining each outcome makes you feel. This can help guide and “unstuck” you. It can also help to uncover the meaning of your decision; is whether to sell your house and move really about money… or did your house belong to your late parents, and selling means letting them go? When you uncover the meaning of hard decisions, it’s easier to make them. The approach to freedom, then, is two-fold. First, you must take back the locus of control (which was always yours to begin with), and then you must will your life into existence… you must take responsibility.
What to do about isolation
Only once you confront your existential isolation can you be inspired to compassion for others… real compassion, real love, real caring. Then, you can “reach out” to others across the void, not merely “flail toward” them; isolation can only be transcended if it is first experienced. So, let the knowledge of your aloneness wash over you. “We are all lonely ships on a dark sea. We see the lights of other ships – ships that we cannot reach but whose presence and similar situation affords us much solace.” Yalom says that true compassion and empathy “cannot be constructed in panic.” We must confront and tolerate our isolation (like all other ultimate concerns, it can’t be “fixed”). Learn to be alone, and let that experience of loneliness inspire true relatedness, an ability to love without condition.
What to do about meaninglessness
First, ensure what you’re dealing with is the anxiety of meaninglessness (and not the anxieties of death, freedom, or isolation masquerading as meaninglessness). Second, discard the “cultural artifacts” that may be stymying meaning. For instance, do you take to be true that things must last to be meaningful? That meaning must be discovered (rather than constructed)? That things have to be meaningful from the cosmic perspective for them to be truly meaningful? That if life has no clear purpose, then it’s not worth living? We take these as absolute truths, but they are cultural artifacts… they are perspectives based on cultural or religious arbitrariness, and you are free to discard them. Third, approach meaninglessness in the right way. The approach to death, freedom, and isolation is one of confrontation… confronting the givens of existence so that anxiety can be tempered (though never eliminated). You must grapple with the questions of death, freedom, and isolation to move through them. The approach to meaninglessness in different. Here you do not “plunge in and through the problem of meaningless,” rather, you must “immerse [yourself] in the river of life and let the question drift away.” Meaning is not gained through confrontation… it’s a by-product of engagement – it’s created when you immerse yourself in life. Meaning, unlike the other ultimate concerns, is not something to be approached rationally, thought about, grappled with… it’s something that’s gained by living. Meaning is not “out there” as part of some outside design. That’s a supernatural stance. Meaning is what you create through engagement. What should you engage with? Self-transcendent purposes and values… those that are altruistic, creative, and bigger than you (though still, necessarily, terrestrial).
Here are three other points to consider: 1) To despair at the lack of meaning means that there is something that’s meaningful to you (namely, that life have meaning). Use this to pull yourself out of the nihilistic stance that “nothing matters” (clearly, there is plenty that matters to you). 2) Things don’t need meaning to matter; there may be a great many things that don’t serve any ultimate purpose or point but are still intrinsically valuable/worthwhile (i.e., that need no outside justification; like play and love). 3) One other cultural artifact to challenge is the belief that meaning lives in the future, that it comes from what could be and not what has already been. We treat meaning as something that lives in the potential of tomorrow, but you could choose to craft meaning out of the life you have already lived. Meaning doesn’t have to be about possibility, it can be about reality… crafted from the rich tapestry of experiences you have already lived through.
The four ultimate concerns are death, freedom, isolation, and meaninglessness. Much of our anxiety stems from attempting to deny our awareness of these “givens of existence.” Death, freedom, and isolation should be confronted, grappled with, moved through; in doing so, something positive is catalyzed from our acceptance. Anxiety can never be eliminated entirely, but it can be tempered. Meaninglessness, in contrast, is not something to be grappled with, but something we overcome by engaging with life. Meaningfulness is a by-product of living (not contemplating). All four ultimate concerns greatly shape our life, as do our conscious and unconscious defense/coping mechanisms. The main thrust of this book is that therapists should afford them their due importance.
IN SUM:
Is this book entirely secular? From the perspective of Yalom’s beliefs (and not including those of his patients)? Yes.
If I had to describe the book in one sentence? Why the existential concerns of death, freedom, isolation, and meaninglessness are undervalued in the realm of psychotherapy.
Who should read this (text)book? Anyone with a death blog.