Staring at the Sun: Overcoming the Terror of Death

Staring at the Sun: Overcoming the Terror of Death

by Irvin D. Yalom, MD. Jossey-Bass, San Francisco, CA, 2008, 306 pages, $24.95.

In this excellent book, Irvin Yalom is most ambitious: he clarifies "death anxiety," develops the underlying theory, and shows how it and other existential concerns are managed clinically. Yalom discusses his own experience of death anxiety, which is often associated with significant losses, and describes his therapy with Rollo May. The book is beautifully written with numerous presentations of philosophical and literary existential thought as well as detailed clinical vignettes.

Existential psychotherapists provide a genuine, authentic relationship for patients focusing on the here and now and offer appropriate self-disclosure. The rippling effect (the impact our good works have on people after we die), the importance of connecting with others, and the fulfillment of one’s potential are also emphasized in this therapy. This has been dramatically presented in Yalom’s previous work with patients who are dying of breast cancer. What is not considered is the hope for an afterlife. The Greek philosopher Epicurus offers a major foundation for Yalom’s thought and practice. Unlike Plato and Christian writers, Epicurus did not believe in an ongoing existence of the soul. Epicurus suggests that there is nothing to fear after death, as it is similar to antenatal "nothingness." He urges direct confrontation with the reality of death rather than remaining in denial, masking death with "excessive religiosity," or the accumulation of wealth, honor, and power. Like Paul Tillich, Yalom focuses on ultimate concerns of death, isolation, meaning in life, and freedom.

Yalom provides instruction for therapists in his last chapter. Although he addresses existential psychotherapeutic practice, he emphasizes commonalities among all therapies as does his mentor Jerome Frank. His techniques may be useful for dynamically, cognitively and pharmacologically oriented therapists—not as a school of thought, but as a "sensibility for existential issues." These principles could be helpful in 20-minute sessions with patients, for those fearing death and dying, and, ironically, even for some patients who are suicidal. Yalom makes the case that existential therapy often complements the needs of religious patients and of those who ascribe to the ideas of Christian thinkers such as Kierkegaard and Maritain.

The argument of this book is clearly based on philosophy and anecdotes rather than on scientific evidence, but it contains much clinical experience to stimulate our thought and practice. Staring at the Sun is the teaching of a master psychotherapist, and I highly recommend it to all psychiatrists and other mental health professionals.

Arthur M. Freeman III, MD

[email protected]

Author affiliations: University of Tennessee College of Medicine, Memphis, and University of Alabama School of Medicine, Birmingham. Financial disclosure: Dr Freeman is a member of the speakers board for Shire.

doi:10.4088/JCP.09bk05370

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