On Deaths and Endings

Psychoanalysts' Reflections on Finality, Transformations and New Beginnings

Brent Willock, Lori C. Bohm, Rebecca C. Curtis, Brent Willock, Lori C. Bohm, Rebecca C. Curtis

• Publisher: Routledge
• Year: 2007
• ISBN:
  9781134154944
• Edition: 1
• Topic: Psychology
• Subtopic: Psychoanalysis
• Index: Psychology

Winner of the 2008 Gradiva Award!

Can something as negative as loss also be a positive, transformative experience?

Is it possible that not only individuals but also societies can be developmentally arrested by problematic mourning?

On Deaths and Endings brings together the work of psychoanalytic scholars and practitioners grappling with the manifold issues evoked by loss and finality.

The book covers the impact of endings throughout the life cycle, including effects on children, adolescents, adults, those near death and entire societies. New psychoanalytic perspectives on bereavement are offered based on clinical work, scholarly research and the authors' own, deeply personal experiences.The contributors present compelling, often moving, enquiries into subjects such as the reconfiguration of self-states subsequent to mourning, the role of ritual and memorials, the tragic impact of unmourned loss, modern conceptualisations of the death instinct, and terror-based losses.

In that much psychotherapy is conducted with people who have suffered some form of loss, this book will be an invaluable resource for all mental health professionals. The emphasis on the potential of working through the vicissitudes of these experiences will provide inspiration and hope both to those who have endured personal loss and to anyone working with grieving patients.

Part I
Overture to finality

Chapter 1
Thoughts for our times on transience and transformation

Brent Willock

To know death better is to put it back in its rightful place.
(Louis-Vincent Thomas, Anthropologie de la mort)

Prelude

Freud (1915) was writing in his finest form in the concluding portion of “Thoughts for the times on war and death.” Having discussed the depths of degradation that can be activated during international conflagration, he launched his penetrating, final, “Our attitude towards death,” with an arresting remark: “The second factor to which I attribute our present sense of estrangement in this once lovely and congenial world is the disturbance that has taken place in the attitude which we have hitherto adopted towards death” (p. 289). Deficiencies in our capacity to fully face finality, he believed, had serious, negative repercussions with respect to the overall quality of our lives.

Conventional cultural attitudes toward mortality were characterized by the founder of psychoanalysis as “the denial of death” (p. 295). (Years later, that phrase became the title of Ernest Becker’s (1973) Pulitzer Prize winning book.) While we routinely espouse the sensible view that death is natural, undeniable, unavoidable, we behave as if it were otherwise, Freud (1915) cogently observed. We prefer to marginalize the topic, “to eliminate it from life” (p. 289). Consequently, when cherished, unconscious illusions of immortality are confronted with actual death, we are deeply affected, “as though we were badly shaken in our expectations” (p. 290). At these uncomfortable moments, unwelcome reality has succeeded in painfully perforating our protective shield of denial. The resulting, disequilibrating experiences range from difficult to traumatic.

Before Freud put his mind to this problem, philosophers had contributed their insights to elucidating the phenomenon of finality. They believed that the intellectual enigma death presented to primeval man forced him to reflection, thereby serving as the starting point for all speculative thought. While Freud (1915) agreed with these philosophers with respect to the monumental significance of finality, he nonetheless chided them for thinking too philosophically. What released the human spirit of inquiry was not the intellectual enigma, and not every death, he asserted. The essential impetus emanated, rather, from conflictual feelings evoked or exacerbated by the decease of loved ones who are, at least sometimes, perhaps unconsciously, also experienced as alien and hated. His emphasis was on the conflagration of ambivalence precipitated by such loss. “Of this conflict of feeling psychology was the first offspring” (p. 293), he averred. If we lend some credence to both the philosophers and Freud, then we are in a position of pondering the imposing possibility that both philosophy and psychology arose out of early human beings’ confrontation with the ashes and bones of the departed.

Projecting himself far back in the cultural evolution of our species, Freud imagined our ancestors tasting the bitter pain of loss of (ambivalently) loved ones. Unable to keep personal death at a safe distance, our forebears were, nonetheless, unwilling to fully acknowledge its power and significance. It was impossible for them (and us) to conceive of themselves as nonexistent, Freud believed. In these stressful circumstances, humans crafted a cunning compromise.

Bowing once more to the imperious actuality of the reality principle, our predecessors conceded that they, too, would die. Nonetheless, they denied this inevitability the significance of annihilation. Beside the deceased body of the beloved, they invented spirits; not the kind to drown our sorrows but, rather, phantoms to elevate elan vital, that is, spirits to raise spirits.

Postmortem physical changes in the dead gave rise to the conception of an individual composed of a body and a separable soul (originally several souls, prefiguring contemporary interest in multiple selves). The persisting memory of the deceased provided a basis for assuming other forms of existence, specifically the powerful notion of life continuing after apparent cessation.

Over time, religions succeeded in representing this afterlife as the more desirable, valid, important one. They managed to reduce the finite existence that had transpired to a mere preparatory phase for the truly significant, eternal, life hereafter. From there, it was relatively easy to extend conceptions of life in the opposite direction, yielding ideas of earlier existences, transmigration of souls, and reincarnation. These potent concepts were skillfully designed and promoted to deprive death of its more incomprehensible, frightening meaning as the total termination of life.

The far-reaching success of this vital human project to rob death of its significance led to unfortunate, unanticipated side-effects. One particularly disturbing sequella was that life became “impoverished, it loses interest. . . It becomes shallow and empty” (p. 290), Freud believed. This affective barrenness consequent to eliminating the full meaning and impact of death from life provided fertile soil for various remedies for our alienation to spring up. One of the more dangerous of these antidotes, Freud thought, was the exhilaration furnished by international conflagration. “War is bound to sweep away this conventional treatment of death” (p. 291). With the outbreak of hostilities, mortality returns to center stage. Marginalization is reversed. Denial is undone. “Life has, indeed, become interesting again; it has recovered its full content” (p. 291). Assuming Freud’s perturbing analysis to have some validity, one can only conclude that we pay a high price, often the supreme one, for underestimating finality.

Nearly a century after Freud shared his disquieting thoughts, Jed Sekoff (1999) noted that psychoanalysis, itself, has a history of beckoning death into its reach, only to push it away. (This ambivalence illustrates what Lewy (1941) referred to as the “return of the repression,” that is, defensive disciplinary inattention and regression subsequent to the achievement of insight.) Death hardly sits with sex, attachment, or self at the centre of recent analytic discourse, Sekoff observed. Attempts to think about the subject, such as Green’s (1986) or Ogden’s (1995) descriptions of deadness as a fundamental psychic entity, have drawn criticism for manifesting an unnecessarily grim vocabulary.

With the advent of the modern era, Sekoff (1999) noted, death receded from the front parlor or bedroom to the funeral home or hospital suite. So, too, has death disappeared from psychoanalytic discourse, abandoned excessively to new age prophets and self-help programs, he observed. The thoughtful contributions in the book you are holding may help bring death back toward the center of the analytic, and broader cultural dialogue.

Sekoff’s perspective, like that of so many of our authors, proved personally evocative. It prompted me to recall my own grandfather, who had been a blacksmith in Glengarry County, Canada. His innate strength, reinforced by his daily labor, made him a natural athlete. His prowess at the caber (beam) toss was renowned as far away as Montreal and New York. I, however, remember him more as lying paralyzed for several years in a bed beside his wooden, roll-top desk, a few feet away from the huge, woodburning stove in the kitchen, the warm heart of the home he had built so many years before. Right to the end he was close by the people who meant the most to him. This was a different dying compared to how his daughter, my mother, expired in the company of strangers in a modern, long-term care facility during the time I was editing this book.

Given our tendency to shun this morbid topic or, as Freud put it, “to hush it up” (p. 289), some might question the wisdom of creating a whole book devoted to this theme. Wouldn’t a single article suffice? Could such a dreary or terrifying volume ever be an attractive object to its intended audience? Would its very title spell the death of desire? When our colleague, Dr. Art Caspary, proposed a symposium on this subject, some feared it would not fly. It might, instead, go over like the proverbial lead balloon, taking on the dead weight of inanimacy inherent in the topic, rather than providing a more buoyant vehicle suitable for soaring, imaginative, intellectual/clinical adventure. Despite some initial concerns of this nature, it proved fairly easy to achieve unanimity about the importance of promoting scholarly exploration in this area. Consequently, colleagues from the psychoanalytic societies of the William Alanson White Psychoanalytic Institute, New York University’s Postdoctoral Program in Psychotherapy and Psychoanalysis, Adelphi University’s Postdoctoral Program in Psychoanalysis and Psychotherapy, the Toronto Institute for Contemporary Psychoanalysis, and the Irish Forum for Psychoanalytic Psychotherapy assembled at Trinity College Dublin for a conference on Deaths and Endings in the summer of 2002.

Death, we learned, can be a most engaging, lively topic. War is by no means the only way to transcend the stultifying limitations of traditional attitudes toward this difficult topic. Indeed, the Trinity discussions proved remarkably congenial despite the diverse psychoanalytic viewpoints in attendance that, in some other situations, might have been more inclined to make war rather than love(ly discourse). Nonetheless, war may have played some role in the vitality of this assembly. Our call for papers was circulated shortly before Al Qaeda’s attack on Manhattan’s World Trade Center. That assault had a powerful impact on the subject matter chosen by several authors and, indeed, on the sense of importance and timeliness many perceived in responding to the call.

Quite apart from the unanticipated influence of September 11, there was something inherently special about a symposium devoted to finality. I was reminded of this unique quality at a meeting of the Toronto Society for Contemporary Psychoanalysis where Dr. Gary Rodin, head of psychosocial oncology and palliative care at the University of Toronto, presented his paper, “Psychoanalytic reflections on mortality.” During the discussion, analysts not only engaged with the theoretical points he was making, but also shared their own, very personal experiences pertaining to the death of loved ones. Others, I am sure, were thinking similar thoughts, even if they did not express them. An unusual degree of closeness was established.

This awesome topic seems to promote a certain intimacy. We crave both the theoretical insights our discipline affords and the personal stories we are moved to share when we engage this topic. There is a particular wisdom contained in the stories we exchange at these moments. No doubt from time immemorial, we have sensed the importance of such sharing. When these narratives are integrated with the treasures of theoretical formulation we have been forging during the past century, a powerful, moving literature results. The ensuing chapters provide a rich immersion in this special place, the confluence of personal and theoretical wisdom.

So moving and stimulating were the discussions in Dublin that the spirit propelled us to create this volume. We viewed our mandate as updating and extending an already noble tradition in this area of psychoanalytic investigation. The literature to which we would be contributing includes such classics as Eissler’s (1955) The Psychiatrist and the Dying Patient. That book, over fifty years old, fruitfully combined theoretical perspectives on thanatology, extensive case illustrations, and thoughtful consideration of the arts. Our work draws on a similarly diverse, but even broader range of viewpoints. We are the beneficiaries of numerous advances in theoretical formulation and clinical practice. The impact of these new ideas is richly reflected throughout the following chapters.

Our authors’ chapters cover an impressive array of interrelated topics. Building upon one another, their contributions combine to create a comprehensive view of our complex subject. Immersing oneself in this rich flow of ideas will, I believe, eventuate in a sense that one has not only encountered, but also come to grips with many, if not all, facets of this crucial, challenging topic.

Bereavement

Following this “Overture to finality,” the second part of this book (Grief and mourning) commences where all philosophy and psychology may have begun, namely with the emotional tasks, challenges, and opportunities presented by the death of a loved one. In the first of that group of chapters, Dr. Anna Aragno, an accomplished psychoanalytic writer, surveys the vast psychoanalytic literature on mourning. Her division of the relevant research according to themes focused on during various epochs helps organize what can otherwise seem like an overwhelmingly large field of inquiry. Through her work, Dr. Aragno reveals important transformations that have occurred, and continue to evolve in our understanding of bereavement. Like several of our authors, she is unusually self-revelatory, adding authenticity and vitality to her delineation of theory.

In Chapter 3, Dr. Vamik D. Volkan, an eminent contributor to this field, discusses his belief that not only individuals, but also large groups, even entire societies, can have significant problems with bereavement. Nations, like persons, can become stuck in a problematic position of perennial mourning. Differentiating creative from pathological mourning, Dr. Volkan emphasizes the importance of what he calls linking objects and linking phenomena. His interest and expertise in both bereavement and international conflict is strikingly congruent with Freud’s seminal thoughts on these conjoined topics.

In Chapter 4, Dr. Judith Lingle Ryan reflects on the sudden, tragic loss of her son as she delves into important theoretical matters pertaining to bereavement. Like Dr. Aragno, she is sensitive to the limitations of our earliest models of mourning. She does, however, find herself resonating with Melanie Klein’s ideas about the potentially supportive role of internal object relations. (Klein, herself, lost her own son in strikingly similar circumstances. That tragic event no doubt impacted her own writing on this topic.) Dr. Ryan also found the ring of truth in some contemporary contributions. Philip Bromberg’s beliefs about the protective value of dissociative mechanisms and Stuart Pizer’s cogitations concerning the importance of living with paradox were especially helpful to her.

In Chapter 5, Dr. J. Gail White shares moving work with a patient struggling with feelings of absence and aloneness. This case concerns psychic loss of a parent, even though there was no “actual” loss. Failure to mourn such absences can leave one encapsulated in early dynamics, with little or no room for future, intimate, adult relationships. The troubled, driven condition of her analysand strongly supports Freud’s view, cited earlier, that failure to face finality impoverishes our lives, making them “shallow and empty.” On a hopeful note, Dr. White’s analysis reveals the reverse to also be true. Finding a way to work through such matters – giving up illusions and defensive denial – enriches one’s life enormously.

In the final chapter of this part, the well-known psychoanalytic author, Joyce Slochower, voyages beyond the consulting room to explore the importance of sociocultural support, ritual, and memorialization in facilitating mourning. Like some other authors in Part II, she stresses processes of internalization and integration that do not end a year or two after loss, but continue throughout the lifetime of the mourner in an ongoing, transformative process. While keenly aware of the importance of psychoanalytic treatment for some patients suffering from arrested, pathological mourning, she is equally attuned to the fact that for many people, including our patients, much of the crucial therapeutic action occurs with other people, in other places, by other means.

Childhood and adolescence

The third part of this book deals with issues pertaining primarily to losses experienced early in life. In the first chapter of this group – a courageously personal one – Dr. Michael O’Loughlin struggles to understand the reverberating impact of very early developmental loss and trauma throughout the life cycle. In particular, he is interested in the origins and manifestations of unsymbolized, free-floating forms of primitive dread and emptiness. In his investigation of disquieting experiences likely deriving from the presymbolic period of development, he found the work of Searles, Klein, Kristeva, and Green especially informative. He illustrates the importance of analysts being willing and able to connect their own split-off states of deadness and associated agonies in order to effectively empathize, connect to, and help patients.

In Chapter 8, Dr. Anita Weinreb Kat...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Contributors
• Acknowledgments
• Part I Overture to finality
• Part II Grief and mourning
• Part III Childhood and adolescence
• Part IV Violence and terror
• Part V Death instinct?
• Part VI Working with dying patients
• Part VII Insights from (and to) literature
• Part VIII Termination
• Part IX Conclusion