Few of my readers will fail to wonder whether, at 75, I’m coping with my own death anxiety through the writing of Staring at the Sun*. I need to be more transparent. I often ask patients the question, ‘What is it in particular that most frightens you about death?’ I’ll pose that question to myself. The first thing that comes to me is the anguish of leaving my wife, my soul mate since we were both 15. An image enters my mind: I see her getting into her car and driving off alone. Let me explain. Every week I drive to see patients in San Francisco on Thursdays, and she takes the train Fridays to join me for the weekend. We then drive back together to Palo Alto, where I drop her off to retrieve her car at the train station parking lot. I always wait, watching through my rearview mirror to make certain she gets her car started, and only then do I drive away.

The image of her getting into the car alone after my death, without my watching, without my protecting her, floods me with inexpressible pain. Of course, you might say, that is pain about her pain. What about pain for myself? My answer is that there will be no ‘me’ to feel pain. I am in accord with Epicurus’s conclusion: ‘Where death is, I am not.’ There won’t be any me there to feel terror, sadness, grief, deprivation. My consciousness will be extinguished, the switch flicked off. Lights out. I also find comfort in Epicurus’s symmetry argument: after death I will be in the same state of nonbeing as before birth.

But I can’t deny that writing a book about death is of value to me personally. I believe that it acts to desensitise me: I guess we can get used to anything, even death. Yet my primary purpose in writing Staring at the Sun is not to work through my own death anxiety. I believe I write primarily as a teacher. I’ve learned a great deal about tempering death anxiety and wish to transmit what I can to others while I’m still alive, still intellectually intact. Thus the enterprise of writing is intimately associated with rippling. I find great satisfaction in passing something of myself into the future. But as I say throughout the book, I don’t expect that ‘I’, my image, my persona, will persist, but rather that some idea of mine, something that provides guidance and comfort, will: that some virtuous, caring act or piece of wisdom or constructive way of dealing with terror will persist and spread out in wavelets in unpredictable ways among people I can ever know.

Episcurus and his ageless wisdom
Ideas have power. The insights of many great thinkers and writers through the centuries help us quell roiling thoughts about death and discover meaningful paths through life. Here I discuss those ideas that have proved most useful in my therapy with patients haunted by death anxiety.

Epicurus believed that the proper mission of philosophy is to relieve human misery. And the root cause of human misery? Epicurus had no doubt about the answer to that question: it is our omnipresent fear of death. The frightening thought of inevitable death, Epicurus insisted, interferes with our enjoyment of life and leaves no pleasure undisturbed. Because no activity can satisfy our craving for eternal life, all activities are intrinsically unrewarding. He wrote that many individuals develop a hatred of life – even, ironically, to the point of suicide; others engage in frenetic and aimless activity that has no point other than the avoidance of the pain inherent in the human condition.

Epicurus addressed the unending and unsatisfying search for novel activities by urging that we store and recall deeply etched memories of pleasant experiences. If we can learn to draw on such memories again and again, he suggested, we will have no need for endless hedonistic pursuit. Legend has it that he followed his own advice, and on his deathbed (of complications following kidney stones), Epicurus retained equanimity despite searing pain by recalling pleasurable conversations with his circle of friends and students.

It is part of Epicurus’s genius to have anticipated the contemporary view of the unconscious: he emphasised that death concerns are not conscious to most individuals but must be inferred by disguised manifestations: for example, excessive religiosity, an all-consuming accumulation of wealth, and blind grasping for power and honours, all of which offer a counterfeit version of immortality. How did Epicurus attempt to alleviate death anxiety? He formulated a series of well-constructed arguments, which his students memorised like a catechism. Many of these arguments have been debated over the past 2,300 years and are still germane to overcoming the fear of death. I will discuss three of his best-known arguments, which I’ve found valuable in my work with many patients and to me personally in relieving my own death anxiety: the mortality of the soul; the ultimate nothingness of death; and the argument of symmetry.

The mortality of the soul
Epicurus taught that the soul is mortal and perishes with the body, a conclusion diametrically opposite to that of Socrates, who, shortly before his execution 100 years earlier, had found comfort in his belief in the immortality of the soul and in the expectation that it would thereafter enjoy the eternal community of like-minded people sharing his search for wisdom. Much of Socrates’ position – fully described in the Platonic dialogue the Phaedo – was adopted and preserved by the Neo-Platonists and ultimately was to exert considerable influence on the Christian structure of the afterlife.

Epicurus was vehement in his condemnation of contemporary religious leaders who, in an effort to increase their own power, increased the death anxiety of their followers by warning of the punishments that would be meted out after death to those who failed to heed particular rules and regulations. (In the centuries to follow, the religious iconography of medieval Christianity depicting the punishments of Hell – as in the 15th-century Last Judgment scenes painted by Hieronymus Bosch – added a gory visual dimension to death anxiety.)

If we are mortal and the soul does not survive, Epicurus insisted, then we have nothing to fear in an afterlife. We will have no consciousness, no regrets for the life that was lost, nor anything to fear from the gods. Epicurus did not deny the existence of gods (that argument would had been perilous, Socrates having been executed on the charge of heresy less than a century before), but he did claim that the gods were oblivious to human life and only useful to us as models of tranquillity and bliss toward which we should aspire.

The ultimate nothingness of death
In his second argument, Epicurus posits that death is nothing to us, because the soul is mortal and is dispersed at death. What is dispersed does not perceive, and anything not perceived is nothing to us. In other words: where I am, death is not; where death is, I am not. Therefore, Epicurus held, ‘Why fear death when we can never perceive it?’

Epicurus’s position is the ultimate counter to Woody Allen’s quip, ‘I’m not afraid of death, I just don’t want to be there when it happens.’ Epicurus is saying that indeed we won’t be there, that we won’t know when it happens because death and ‘I’ can never coexist. Because we are dead, we don’t know that we are dead, and, in that case, what is there to fear?

The argument of symmetry
Epicurus’s third argument holds that our state of nonbeing after death is the same state we were in before our birth. Despite many philosophical disputes about this ancient argument, I believe that it still retains the power to provide comfort to the dying. Of the many who have restated this argument over the centuries, none has done so more beautifully than Vladimir Nabokov, the great Russian novelist, in his autobiography, Speak, Memory, which begins with these lines: ‘The cradle rocks above an abyss, and common sense tells us that our existence is but a brief crack of light between two eternities of darkness. Although the two are identical twins, man, as a rule, views the prenatal abyss with more calm than the one he is heading for (at some 4,500 heartbeats an hour)¹.’

I have personally found it comforting on many occasions to think that the two states of nonbeing – the time before our birth and the time after death – are identical and that we have so much fear about the second pool of darkness and so little concern about the first. An email from a reader contains relevant sentiments: ‘At this time I am more or less comfortable with the idea of oblivion. It seems the only logical conclusion. Ever since I was a small child I thought that after death one must logically return to the state before birth. Ideas of afterlife seemed incongruous and convoluted compared with the simplicity of that conclusion. I could not console myself with the idea of an afterlife because the idea of unending existence, whether pleasant or unpleasant, is far more terrifying to me than that of a finite existence.’

Generally I introduce the ideas of Epicurus early in my work with patients suffering from death terror. They serve both to introduce a patient to the ideational work of therapy and convey my willingness to relate to him or her – namely, that I am willing to enter that person’s inner chambers of fear and have some aids to ease our journey. Although some patients find Epicurus’s ideas irrelevant and insubstantial, many find in them comfort and help – perhaps because they remind them of the universality of their concerns and that great souls like Epicurus grappled with the same issue.

Rippling
Of all the ideas that have emerged from my years of practice to counter a person’s death anxiety and distress at the transience of life, I have found the idea of ‘rippling’ singularly powerful. Rippling refers to the fact that each of us creates – often without our conscious intent or knowledge – concentric circles of influence that may affect others for years, even for generations. That is, the effect we have on other people is in turn passed on to others, much as the ripples in a pond go on and on until they’re no longer visible but continuing at a nano level. The idea that we can leave something of ourselves, even beyond our knowing, offers a potent answer to those who claim that meaninglessness inevitably flows from one’s finiteness and transiency.

Rippling does not necessarily mean leaving behind your image or your name. Many of us learned the futility of that strategy long ago in our school  curriculum when we read these lines from Shelley’s poem about a huge shattered antique statue in a now barren land: ‘My name is Ozymandias, king of kings: Look on my works, ye mighty, and despair.’ Attempts to preserve personal identity are always futile. Transiency  is forever. Rippling, as I use it, refers instead to leaving behind something from your life experience; some trait; some piece of wisdom, guidance, virtue, comfort that passes on to others, known or unknown. The story of Barbara is illustrative.

‘Look for her among her friends’: Barbara
Barbara, who had been plagued by death anxiety for many years, reported two events that markedly reduced her anxiety. The first event occurred at a school reunion, when, for the first time in 30 years, she saw Allison, a close, slightly younger friend from early adolescence, who ran up to her, smothered her with embraces and kisses, and thanked her for the vast amount of guidance she had provided when they were teens together.

Barbara had long before intuited the general concept of rippling. As a schoolteacher, she had taken it for granted that she influenced her students in ways entirely divorced from their memory of her. But her encounter with her forgotten childhood friend made rippling far more real to her. She was pleased and a bit surprised to learn that so much of her advice and guidance persisted in the memory of a childhood friend, but she was truly shocked the following day when she met Allison’s 13-year-old daughter, who was visibly thrilled to meet her mother’s legendary friend.

While reflecting on the plane home about the reunion, Barbara had an epiphany that permitted her a new perspective on death. Perhaps death was not quite the annihilation she had thought. Perhaps it was not so essential that her person or even memories of her person survived. Perhaps the important thing was that her ripples persist, ripples of some act or idea that would help others attain joy and virtue in life, ripples that would fill her with pride and act to counter the immorality, horror, and violence monopolising the mass media and the outside world.

These thoughts were reinforced by the second event, two months later, when her mother died and she delivered a short talk for the funeral service. One of her mother’s favourite phrases came to mind: ‘Look for her among her friends.’ This phrase had power: she knew that her mother’s caring, gentleness, and love of life lived inside her, her only child. As she delivered the talk and scanned the funeral assemblage, she could physically feel aspects of her mother that had rippled into her friends, who in turn would pass the ripples on to their children and children’s children.

Since childhood, nothing had terrified Barbara more than the thought of nothingness. The Epicurean arguments I offered were ineffective. She was, for example, not relieved when I pointed out that she would never experience the horror of nothingness because her awareness would not exist after death. But the idea of rippling – of continued existence through the acts of caring and help and love she passed on to others – greatly attenuated her fear.

‘Look for her among her friends’ – what comfort, what a powerful framework of life meaning, resided in that idea. I believe that the secular message of Everyman, the medieval religious drama, is that good deeds accompany one to death and will ripple on to succeeding generations. Barbara returned to the cemetery a year later for the unveiling of her mother’s tombstone and experienced a variant of rippling. Rather than being depressed by the sight of her mother’s and father’s graves situated amidst those of a large number of relatives, she experienced an extraordinary sense of relief and lightening of her spirits. Why? She found it hard to put into words: the closest she could come to it was, ‘If they can do it, then so can I.’ Even in death her forbears passed something on to her.

Other examples of rippling
Examples of rippling are legion and well known. Who has not experienced a glow upon learning that one has been, directly or indirectly, important to another? My desire to be of value to others is largely what keeps me pecking away at my keyboard long past the standard time for retirement.

In The Gift of Therapy², I describe an incident where a patient who had lost her hair because of radiotherapy had felt extreme discomfort about her appearance and was fearful that someone would see her without her wig. When she took a risk by removing her wig in my office, I responded by gently running my fingers through her few remaining wisps of hair. Years later, I saw her again for a brief course of therapy, and she told me that she had recently reread the passage about her in my book and felt joy that I had recorded this piece of her and passed it on to other therapists and patients. It gave her pleasure, she said, to learn that her experience might in some way benefit others, even those unknown to her.

Rippling is cousin to many strategies that share the heart-wrenching longing to project oneself into the future. Most apparent is the desire to project oneself biologically through children transmitting our genes, or through organ donation, in which our heart beats for another and our corneas permit vision. About 20 years ago, I had corneal replacements in each eye, and though I do not know the identity of the dead donor, I often experience a wave of gratitude to that unknown person.

Other rippling effects include: a rise to prominence through political, artistic, or financial achievement; leaving one’s name on buildings, institutes, foundations, and scholarships; making a contribution to basic science, on which other scientists will build; rejoining nature through one’s scattered molecules, which may serve as building blocks for future life.

Rippling and transiency
Many individuals report that they rarely think of their own death but are obsessed with the idea, and the terror, of transiency. Every pleasant moment is corroded by the background thought that everything now experienced is evanescent and will end shortly. An enjoyable walk with a friend is undermined by the thought that everything is slated to vanish – the friend will die, this forest will be transformed by creeping urban development. What’s the point in anything if everything will turn to dust?

Freud states the argument (and the counterargument) beautifully in an incidental short essay, ‘On Transience’³, that recounts a summer walk he took with two companions, a poet and an analytic colleague. The poet lamented that all beauty is destined to fade into nothingness and that all he loved was shorn of its value by its ultimate disappearance. Freud disputed the poet’s gloomy conclusion and vigorously denied that transiency negates value or meaning.

‘On the contrary,’ he exclaimed. ‘An increase! Limitation in the possibility of an enjoyment raises the value of the enjoyment.’ Then he offered a powerful counterargument to the idea that meaninglessness is inherent in transiency: ‘It was incomprehensible, I declared, that the thought of the transience of beauty should interfere with our joy in it. As regards the beauty of Nature, each time it is destroyed by winter it comes again next year, so that in relation to the length of our lives it can in fact be regarded as eternal. The beauty of the human form and face vanish for ever in the course of our own lives, but their evanescence only lends them a fresh charm. A flower that blossoms only for a single night does not seem to us in that account less lovely. Nor can I understand any better why the beauty and perfection of a work of art or of an intellectual achievement should lose its worth because of its temporal limitation. A time may indeed come when the pictures and statues which we admire today will crumble to dust, or a race of men may follow us who no longer understand the works of our poets and thinkers, or a geological epoch may even arrive when all animate life upon the earth ceases; but since the value of all this beauty and perfection is determined only by its significance for our own emotional lives, it has no need to survive us and is therefore independent of absolute duration.’

Thus Freud attempts to soften death’s terror by separating human esthetics and values from death’s grasp and positing that transiency has no claim on what is vitally significant for an individual’s emotional life.

Many traditions try to gather power over transiency by stressing the importance of living in the moment and focusing on immediate experience. Buddhist practice, for example, includes a series of meditations on anicca (impermanence) in which one focuses on the desiccation and disappearance of leaves from a tree and then on the future impermanence of the tree itself and, indeed, of one’s own body. One might think of this practice as a ‘deconditioning’, or a type of exposure therapy whereby one habituates to the fear by pointedly immersing oneself in it. Perhaps reading Staring at the Sun will have a similar effect on some readers. Rippling tempers the pain of transiency by reminding us that something of each us persists even though it may be unknown or imperceptible to us.

Religion
In this book about fear of death, I have avoided writing extensively about religious consolation because of a cumbersome personal dilemma. On the one hand, because I believe that many of the ideas expressed in these pages will be of value even to readers with strong religious beliefs, I’ve avoided any phraseology that might prompt them to turn away. I respect persons of faith even if I do not share their views. On the other hand, my work is rooted in a secular, existential world-view that rejects supernatural beliefs.

My approach assumes that life (including human life) has arisen from random events; that we are finite creatures; and that, however much we desire it, we can count on nothing beside ourselves to protect us, to evaluate our behaviour, to offer a meaningful life schema. We have no predestined fate, and each of us must decide how to live as fully, happily, and meaningfully as possible. However stark such a view may seem to some people, I do not find it so. If, as Aristotle holds, the premise that the faculty that makes us uniquely human is our rational mind, then we should perfect this faculty. Hence, orthodox religious views based on irrational ideas, such as miracles, have always perplexed me. I am personally incapable of believing in something that defies the laws of nature.

My personal coping with death
A final word on writing about death. It is natural for a self-reflective 75-year-old to wonder about death and transiency. The everyday data are too powerful to ignore: my generation is passing, my friends and colleagues grow ill and die, my vision fades, and I receive ever more frequent distress signals from various somatic outposts – knees, shoulders, back, neck. In my youth, I heard my parents’ friends and relatives say that all the Yalom men were gentle – and that they all died young. I believed in that early death scenario for a long time.

Yet here I am at 75. I’ve outlived my father by many years, and I know I live on borrowed time. Isn’t the creative act in itself entwined with concern about finiteness? Such was the belief of Rollo May, a fine writer and painter, whose lovely cubistic painting of Mont St Michel hangs in my office. Persuaded that the act of creation permits us to transcend our fear of death, he continued writing almost to the very end. Faulkner expressed the same belief: ‘The aim of every artist is to arrest motion, which is life, by artificial means and hold it fixed so that a hundred years later, when a stranger looks at it, it moves again⁴.’ And Paul Theroux said that death was so painful to contemplate that it causes us ‘to love life and value it with such passion that it may be the ultimate cause of all joy and all art⁵.’

The act of writing itself feels like renewal. I love the act of creation from the first glimmering of an idea to the final manuscript. I find the sheer mechanics to be a source of pleasure. I love the carpentry of the writing process: finding the perfect word, sanding and burnishing rough sentences, tinkering with the tick-tocks of phrase and sentence cadence. Some think that my immersion in death must be deadening. When I lecture on the subject, often a colleague will respond that I must be living a grim life to dwell so much on such dark issues. If you believe that, I say to them, then I haven’t done my job. I try again to convey that facing death dispels grimness.

Sometime I can best describe my inner state by using the metaphor of the ‘split screen’ technique. This hypnotic therapy technique helps patients detoxify some haunting, painful memory⁶. Here’s the procedure: the therapist asks hypnotized patients to close their eyes and split their visual horizon, or screen, into two horizontal parts: on half the screen, the patient places the dark or traumatic image; on the other half, a lovely scene, one providing pleasure and tranquillity (for example, a stroll on a favourite forest trail or tropical beach). The continued presence of the tranquil scene offsets and tempers the disturbing image.

One half of my conscious screen is sober and always aware of transience. The other half, however, offsets it by playing a different show, a scenario I can best describe by a metaphor suggested by the evolutionary biologist Richard Dawkins⁷, who asks us to imagine a laser-thin spotlight moving inexorably along the immense ruler of time. Everything that the beam has passed is lost in the darkness of the past; everything ahead of the spotlight is hidden in the darkness of the yet to be born. Only what is lit by the laser-thin spotlight lives.

This image dispels grimness and evokes in me the thought of how staggeringly lucky I am to be here, alive, and luxuriating in the pleasure of sheer being! And how tragically foolish it would be to diminish my brief time in the life-light by adopting life-negating schemes which proclaim that real life is to be found elsewhere in the utterly indifferent, immense darkness ahead of me.

Writing Staring at the Sun has been a journey, a poignant journey backward, back to my childhood and my parents. Events from long ago pull at me. I’ve been astonished to see that death has shadowed me my entire life, and astonished too by the persistence and clarity of so many memories associated with death.

The capriciousness of memory, too, strikes me with much force – for example, that my sister and I, once living in the same household, recall such different events.

As I age, I find the past ever more with me – as Dickens describes so beautifully, when he writes in A Tale of Two Cities: ‘For, as I draw closer and closer to the end, I travel in a circle nearer and nearer to the beginning. It seems to be one of the kind of smoothings and preparings of the way. My heart is touched now by many remembrances that have long fallen asleep.’

Perhaps I am doing as he suggests: completing the circle, smoothing out rough spots of my story, embracing all that has made me and all that I have become. When I revisit childhood sites and attend school reunions, I am more moved than I used to be. Perhaps I feel joy in finding that there is yet a ‘there’ there, that the past doesn’t truly vanish, that I can revisit it at will. If, as Kundera says⁸, death’s terror stems from the idea of the past vanishing, then reexperiencing the past is vital reassurance. Transiency is stayed – if only for a while.

Dr Irvin Yalom is professor Emeritus of Psychiatry at Stanford University. He has won two major awards from the American Psychiatric Association and is the author of Love’s Executioner, The Gift of Therapy and Momma and the Meaning of Life. He continues to run his clinical practice and lectures widely. This is an edited excerpt from Irvin Yalom’s new book, Staring at the Sun*: overcoming the dread of death, published in hardback in the UK by Piatkus. It is reproduced here with the kind permission of the publisher. therapy today readers can obtain a copy for £13.99 with free p&p by calling 01832 737525 and quoting ref PIA 019. This offer expires 30 June 2008.

1. Nabakov V. Speak, memory. New York: Putnam (originally published as Conclusive Evidence, 1951).
2. Yalom ID. The gift of therapy: an open letter to a new generation of therapists and their patients. New York: HarperCollins. 2001:187-194.
3. Freud S. On transcience. In J Strachey (ed and trans), Standard edition of the complete psychological works of Sigmund Freud. London: Hogarth Press. 1955; 14:304-7.
4. Quoted in Southall TW. Of time and place: William Evans and William Christenberry. San Francisco: Friends of Photography; 1990.
5. Theroux P. ‘D is for death’ in S Spender (ed), Hockney’s alphabet. New York: Random House; 1991.
6. Spiegel H, Spiegel D. Trance and treatment: clinical uses of hypnosis. Washington DC: American Psychiatric Publishing; 2004.
7. Dawkins R. The god delusion. Boston: Houghton Mifflin. 2006; 361.
8. Quoted in Roth P. Shop talk: a writer and his colleagues and their work. Boston: Houghton Mifflin; 2002.