PSYCHOANALYTICAL PERSPECTIVES ON DEATH AND DYING: IDEAS FOR THEORY AND PRACTICE

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1 PSYCHOANALYTICAL PERSPECTIVES ON DEATH AND DYING: IDEAS FOR THEORY AND PRACTICE Draft paper Barış Özgen Şensoy İstanbul Bilgi University, Lunar Psychotherapy Center Introduction Psychoanalytical thinking is (in)famous for its emphasis on childhood sexuality: Freud suggested that neurotics are human beings who are suffering from the pressure of being stuck between instinctual desires and social norms. This idea was revolutionary in terms of science because by positing that Freud stated most of the mental life is out of awareness and therefore it can be studied in a structured way that he founded. It should be also taken into account that the idea was also humanitarian: Instead of blaming the hysterical (woman) as a liar, psychoanalysis recreated the subject as a vulnerable being prone to psychic pain caused by its constitution and environment. Drawing upon this Freud viewed most of the mental life and psychopathology is strongly related to childhood sexuality. The infant finds pleasure in the caretaker s body, later he or she is preoccupied with the primal scene. Then, pleasure becomes related to anal zones as well as a form of autoeroticism takes place. The child is also destined to fall in love with the mother and deal with the loss of mother to the father. Surviving all of these, the present life of the adult is a form of repetition of these stories with new subjects. As Freud developed concepts of repression, narcissism, nachtraglich, Oedipal conflict among others, and improved his ideas on sadomasochism, obsessions and compulsions, he emphasized the importance of childhood sexuality. Even though these formulations became popular and were labeled as the trademark of psychoanalysis, another Freud existed in psychoanalysis, maybe a little bit silently. However, this Freud was as essential as the Freud who talked about childhood sexuality and even the last version of Freud s conceptualization of mental life supports this. This Freud started writing about death as early as 1900, about the capacity to think about death and mortality in Thoughts on War and Death in 1914 and published another masterpiece in 1916 called Mourning and Melancholia. Freud also coined a new term to conceptualize the operations of the psyche in 1920, which is death instinct. This concept resulted in a lot of controversy in the psychoanalytical community and it is still discussed in regard to the origins of aggression. As new generations of psychoanalysts contributed to psychoanalytical thinking, new approaches regarding the relationship between human beings and death emerge. In this regard, Heinz Kohut s views on the nature of psychopathology point a new epistemology in psychoanalysis. Kohut regarded that narcissistic wounds, that is, the pain of not being understood and supported, lie at the heart of psychological problems and psychoanalytical encounter is both a place for the repetition of such history and the possibility to overcome the infantile trauma. Once the emphasis is directed to fundamental relationships, instead of drive and norms conflict, Kohut s version of psychoanalysis developed into a new understanding, and even a movement, in psychoanalysis. Kohut basically suggested that narcissism, and frustration regarding narcissism, has a line of development throughout the life course. Kohut re-examined Freudian concepts such as auto-

2 eroticism, Oedipal conflict and aggression and offered new perspectives. These reconceptualizations, referred to discussions of human nature and resulted in different technical interventions in terms of psychoanalytical practice. In this regard, Kohut (1966) argued that human beings have to reconfigure and transform their narcissism when they met their mortality. One of the most important contributions by Kohut is to open a new path for psychoanalysis to think on death and mortality. These suggestions, even though accepted or rejected by later psychoanalysts, influenced the psychoanalytical community to further study aggression, mortality and methods to work or improve work with groups such as the elder, the dying, the AIDS patient, end-of-life decisions, the caretaker and the patient relationship, the suicidal among others. Freud s views on death Freud s views on death, dying and mortality have different focuses: a) about the mind s capacity to imagine death and the results of this (lack of) capacity b) the unconscious meaning of death anxiety c) unconscious mental life regarding loss d) the concept of death instinct (for a similar categorization, see Hoffman, 1979). However, it should be taken into account that in various writings, thoughts on death can be found in Freud s work in an unsystematic way. Freud was preoccupied with his death, he guessed the age he would die three times; but failed in all of these. He was deeply influenced by the loss of his father and himself lost one of his daughters; and suffered both the First World War and the rise of Nazis. It is meaningful to see his preoccupation in his personal life and work. As early as 1900, in Interpretations of Dreams where he formulated his suggestion of unconscious as the fundamental basic element of psychic life, Freud wrote that the fear of death is alien to the child. Even though this is a nearly metaphysical argument regarding the mind, because in a sense Freud suggested that there is not an organic relationship between the mind and the idea of death, he did not develop this. However, in 1915 Freud returned to this issue. He was clear that time and suggested that no human being can imagine their own death and psychoanalytic approach should take it given in the study of the mind. Freud made several conclusions from this point of view. First of all, he suggested that brave behavior is a form of instinctual satisfaction as human beings unconsciously believe that they are immortal. Freud (1923), in his book The Ego and the Id also argued that death is a negative concept with abstract content, therefore it can have a place in unconscious. Even though this statement has many underlying tenets regarding the ontology of mind, Freud did not draw upon it. Freud at the same time made use of the concept of negation, in the sense that the attempt to negate something is a form of defensive maneuver; but he did not discuss the relationship between representation and negation. The way a certain form of inexistence refers to a form of existence drew interest later theorists from various areas, such as anthropology, structuralism and linguistics. The suggestion that the idea of death has no place in unconscious is also related to Freud s understanding of fear of death. As death is unthinkable, fear of death should be a symbol of something else and Freud suggested that it is a form of fear of castration. This formulation found echo in later generation of psychoanalyst. Some other later psychoanalysts argued that fear of death could be related to a traumatic separation.

3 Freud s suggestion regarding fear of death also provided a simple but strong difference from existentialism and Heideggerian thought. Existentialists believed that awareness of mortality is both constitutive of experience and psychopathology. Heidegger focused that being a mortal being in the world is the determinant how the affective experience emerges. Another issue that Freud tried to deal with was mourning and its difference from melancholia. Freud stated that mourning was a process at the end of which the lost object can be identified with and new relationships can be formed. However, in melancholia the inner world becomes empty. Freud, in this piece, tried to develop his answer to the questions he asked in Totem and Taboo. Freud tried to understand how human beings can suffer from the loss of the other, as the other is always alien to the ego and most of the time, an enemy. Freud s observation was that even though human beings lived in a difficult environment, they had to capacity to develop moral law, love and mourning. Freud got surprised in the capacity of human beings to mourn even for the enemy. He attempted to find out the importance of significant relationships via the question of mourning. Freud also suggested a new term to explain human beings tendency to repeat their mistakes and aggression. Death instinct means to return to less complex forms. Freud suggested that such a tendency exists because the basic form of matter is inorganic and all living beings are likely to reach such form. The idea that all living forms are trying to return to a less complex state is one Freud worked on since 1895, he wrote it in Project for a scientific psychology. As he had difficulty to explain why his patients are going through the same problems, both in life and in psychoanalytic situation, Freud suggested that there might be another principle in addition to the pleasure and reality principle, which was death instinct. Freud became convinced with the existence of death instinct by time. In 1938, when he wrote a summary of psychoanalysis, he said that all daily behaviors are a combination of life and death instincts. Eating is both about destruction and reproduction of life, as well as sex and the existence of muscles. Freud referred to death instinct to explain aggression and sadism. Freud s suggestion on the nature of human beings created controversy in the psychoanalytic community. Even his closest colleagues doubt it. Still, schools of psychoanalysis differ from each other regarding their approach to death instinct and aggression. In this sense, Melanie Klein placed death instinct in the core of mental life of the infant, whereas Heinz Kohut suggested that aggression is a frustration-tolerated response. Today, some psychoanalysts still believe that human beings have a tendency to destroy what is accomplished whereas some other argue that aggressive elements in mental life are responses to various forms of anxiety. Heinz Kohut s views on death Once vice-president of International Psychoanalytical Association, Heinz Kohut founded a new metapsychology for psychoanalysis and a new movement in the psychoanalytical community, known as self psychology. Basically, Kohut believed that at the heart of human suffering lie narcissistic wounds, that is, not being understood or supported by a significant other. Within this framework, he redefined the instinctual theory, Oedipal complex and aggression. Instincts were pressing the human being for Freud, but for Kohut they contributed to self assertion. Freud s Oedipus was destined to fall in love his mother and kill his father, Kohut said Oedipus was disappointed because of the prophecy, and that resulted in rage and murder of an old man. Freud thought aggression was inherent in

4 human beings, whereas Kohut stated human beings feel rage as long as they are psychologically frustrated. Kohut suggested that human beings need satisfying and important relationships, which he called selfobjects, to feel coherent. At the face of death, this need increases and therefore selfobjects become a very important figure for the dying. Getting old, receiving treatment for a terminal disease or expecting death impose new psychological pressures both on the individual and the selfobject. Kohut stated that nurturing relationships, which are reminiscent of early days of life, are vital for the dying but it is also difficult for the caregiver part. Kohut also stated that human beings have to transform their narcissism throughout the life course, as each phase of life come up with new limitations, responsibilities and possibilities. As human beings approach death, one has to deal with the sense of finitude. Humor and acceptance can show mastery over the sense of finitude, whereas denial and grandiosity can be other forms of relating with mortality. Kohut stated that appreciating the idea of being one with a higher being by dying is a transformation of narcissism and called it cosmic narcissism. As it can be seen, narcissism does not connote a negative meaning for Kohut. It is mostly related to self esteem and self affirmation, and in this sense cosmic narcissism is an answer to deal with mortality and to value oneself. Kohut also differed from Freud in his understanding of death anxiety. Kohut stated that what human beings feared was not dying as such, but instead, they were afraid of losing the emphatic environment that surrounded them. Kohut gave the example of the astronauts who were to decide whether to delay death by floating in space meaninglessly or returning to Earth to die. The astronauts decided to return to Earth and die, as their spacecraft is bound to burn when they enter the atmosphere. Kohut commented that this example shows how important it is for human beings to have an environment where they feel they belong to. These astronauts decided to be close to their emphatic environment, even though it meant a shorter life. Discussion Why could the differences of these two names be important, in terms of death studies, psychoanalysis and application? First of all, Kohutian and Freudian metapsychology differed in terms of their approach to aggression and rage. Basically, they have two different suggestions for human nature. The curious reader might be tempted to accept one of these suggestions. However, these differences could also form the basis for further discussion and production of knowledge. First of all, Freud s understanding of human being takes place in an evolutionary anthropological context. He tries to see how psychological life came into existence in a competing environment. On the other hand, Kohut tried to understand human beings in a relational context. He tried to understand how the mind finds its own pathway in early relationships. In this regard, Freud s study of the mind focused on intrapsychic processes, whereas Kohut paid attention to interpsychic phenomena. Freud related aggression to death instinct and stated that aggression is a form of death instinct that is projected to outer world. Kohut insisted that it is a response which emerges when an idealized selfobject frustrates one. Kohut did not go into details on the nature of aggression and the capacity of human beings to respond with aggression. On the other hand, Freud did not go into details of the

5 operations of aggression. It can be said that aggression, as a culture of death instinct, is sort of self explanatory. In a sense, it is the burden of human beings, which can be tamed but can not be totally transformed. There are different positions on aggression and it is studied heavily. Those who work on aggression should ask themselves whether they are trying to end the discussion and have an ultimate answer. As a result of controversiesi today many psychoanalysts and other researchers have a framework to evaluate data from various areas, such as primatology, developmental psychology, qualitative studies and more. Freud s work on death leads those who are interested to a discussion of methodology. Still, from a Freudian position, it is possible to criticize contemporary psychological science; because Freud asked questions regarding the mind s capacity to think itself. Instead of doing it in a rationalist philosophical manner, Freud tried to bring together evolution, anthropology, psychology and philosophy. Freud s assertion that human beings are incapable of imagining death and they believe in their immortality still point a basic question to the study of the mind: What is the limit in studying mind? On the other hand, Kohut s position provided very daily questions and answers regarding those who are approaching death. Kohut s insights are valuable for those who are working with the elder or caregivers. In this regard, Kohut s question is related to the issue of identifying death. It can be asked whether there is a relationship between a sense of self and expecting death. Kohut s ideas provide framework not only to study the individual and their mortality, but also the dying and the one who is accompanying the dying. In this sense, Kohut s approach created new potentials to work with deathrelated groups. It is understandable that those who are trying to come up with knowledge want to get certain answers and specific models that could overcome controversies. However, psychoanalysis is more alive than any other time with these differing views. Not only different arguments can be explanatory for different contexts, but also they contribute to the never ending attempt to gain more knowledge, come up with models which are more powerful to understand our world and life and potential technical procedures to work better with people or to work with larger communities.