Never have I reviewed a book from so many perspectives: as a cancer survivor, an existential psychotherapist, a researcher in thanatology, the organizer of a recent international conference on dying well, and a mourner who has recently lost both of his older brothers. When Staring at the Sun: Overcoming the Terror of Death arrived at my desk, I was literally buried in death-related issues at both personal and professional levels. To the extent that death attitude is a highly personal matter, my review of this book necessarily reflects an insider’s perspective.
Since his 1980 publication of Existential Psychotherapy, Yalom has written several therapeutic stories, addressing the fundamental existential issue of death anxiety. I thought that he had exhausted the topic. But I was wrong. In his latest book, Yalom elevates death to center stage and provides a comprehensive guide to death acceptance based on his existential orientation.
In spite of my admiration for Yalom, I find myself wrestling with some of the ideas advocated in this book. My questioning reflects an existential perspective shaped by a very different set of past experiences. For example, Yalom’s preoccupation with death anxiety is clearly related to his past. Looking back, he discovers “the persistence and clarity of so many memories associated with death” (p. 198). In contrast, the narrative of my past revolves mainly around the endless struggle to overcome obstacles and adversities with only a passing concern about personal death.
The Terror of Death and the Passion for Life
Staring at the Sun begins with a description of the ubiquitous terror of death. There are numerous reasons for our instinctual aversion toward death—the spoiler of all the things we hold dear and the terminator of all our dreams and aspirations. The dying process is often associated with the dark nights of the soul. In addition to pain and fear, we also experience the most terrible kind of loneliness and alienation when we find ourselves separated from all our loved ones by a widening, unbridgeable gulf.
Our unique human capacity to reflect on our existence, anticipate our own demise, and imagine the horrible details of dying inevitably creates a sense of terror. Death awareness, no matter how vague, poses a constant threat and makes us uncomfortable because we can never escape from the long shadow of death. Both cultures and individuals have developed elaborate mechanisms of death denials, such as religious beliefs and personal ambitions for success and happiness. The problem with these death-denying efforts is that no matter how hard we try to conceal and repress death, anxiety about our demise can still manifest itself in a variety of symptoms, such as worries, depression, stresses, and conflicts. Yalom discusses various ways of recognizing covert death anxiety with clinical case histories. Another problem with death denial is that it is doomed to fail. Sooner or later, various events in life, such as terminal illness or the death of a loved one, will thrust us right in front of the stark reality of death. Yalom focuses on ministering to our despair and overcoming the terror of death.
In spite of the predominance of death in human existence, it is helpful to recognize that there is deep within us a reservoir of passion for life, a longing for meaning and happiness, no matter how dreadful the circumstances. This positive existential given is stronger than the negative given of death anxiety in normal circumstances. Just watch how children play—how they pour themselves into play activities with total abandon. They are so caught up with the sheer excitement of the moment that nothing else matters. Also look at teens and marvel at how they can be totally engrossed in video gaming or skateboarding; they, too, can be totally consumed by the challenges and exhilaration of the flow of the moment.
Adults have a longer time frame—they can be so preoccupied with pursuing their dreams of happiness and success that the idea of death seldom crosses their minds. Zest for life is also evident in all their heroic struggles to endure and overcome adversities. Even when the horizon of our world narrows and darkens, the basic human propensity for survival and hope still persists. In Hemingway’s (1952/1981) The Old Man and the Sea, the protagonist tells himself that he could be destroyed but not defeated; such a defiant human spirit can persist until one’s last breath. Positive existential psychology focuses on the daily human drama of passion for living in the face of death. This positive orientation has different implications for existential therapy.
Positive Existential Therapy
Yalom recognizes the coexistence of fear of death and love of life. “Everyone is destined to experience both the exhilaration of life and the fear of mortality” (p. 273). However, the main objective of his existential therapy is to reduce death anxiety by confronting death, which may result in a positive life change. In contrast, positive existential therapy is more concerned with what makes life worth living in spite of death anxiety. Kahlil Gibran (1923/ 1994) expressed this idea well: “It is life in quest of life in bodies that fear the grave” (p. 104). From this positive orientation, the human quest for meaning and spirituality occupies the center stage, while death anxiety recedes to the background. Positive existential therapy ministers to both human aspirations and anxieties. Its main objective is to awaken the sense of meaning and responsibility, because such awakening will embolden and enrich our lives, no matter what.
The difference between these two existential orientations is more than just a matter of emphasis because there are different therapeutic implications for these two orientations. For instance, positive existential therapy is more likely to see symptoms of depression and anxiety as caused by the harsh realities of daily living rather than by death anxiety. For many of my clients, life is a living hell worse than death, and the challenge is to awaken their defiant human spirit to living courageously and hopefully in the midst of horrific suffering.
From the perspective of positive existential therapy, we do not get drunk with life and all its distractions in order to reduce death anxiety. Instead, we drink from the wellspring of life in order to pour our lives for others. To live is to become what one is meant to be in spite of failures and death anxiety. To truly live is to give oneself fully to something bigger and higher. In sum, neither denial of death nor zest for life provides a satisfactory solution to the problem of death anxiety. Positive existential therapy integrates both positive and negative existential givens to inspire meaningful living within the context of suffering and death.
Stages of Death Acceptance
The title of this book is rich in meaning and symbolism. On the surface, it seems odd that the sun, generally considered the source of life and energy, is used as a metaphor of death. However, upon reflection, the title nicely sums up the three essential stages of death acceptance:
- Staring at the sun: The stage of initial awakening. Death acceptance necessarily begins with confrontation. This initial stage includes both confrontation with the terrorizing finality and the realization of the awesome responsibility of living meaningfully in spite of our finitude. “Death awareness may serve as an awakening experience, a profoundly useful catalyst for major life changes” (p. 30). Awakening may be a sudden or gradual realization that there is more to life than just all the everyday busyness, that there is a deeper meaning and a higher purpose for our existence. Awakening is essential for priming people to make significant changes. Awakening is becoming aware of the need to know how to “construct an authentic life of engagement, connectivity, meaning, and self-fulfillment” (p. 34).
- Walking toward the sun: The second stage of pursuing an ideal. The pursuit of a dream involves exploration of various pathways of meaningful living. Walking toward the sun also means that we put the shadow of death behind us and remind ourselves that we must do all we can while it is daytime because when the night comes, no one can work. This is the most important stage of death acceptance: living on purpose in the light of death. Awareness of our finitude gives us a sense of urgency and a sharper focus on what really matters.
- Gazing into the sunset: The last stage of getting ready for the final exit. Having accomplished the first two stages of death acceptance, we can now stare death in the face without regret and fear. We can now enjoy every moment of the glorious sunset before the dark night takes over. One of Yalom’s clients, Mark, said, “As I grow older, gazing at death has some positive results: I feel more poignancy, more vitality, in my more life; death makes me live more in each moment—valuing and appreciating the sheer pleasure of awareness, of being alive” (p. 209).
Pathways to Meaningful Living and Death Acceptance
A long time ago, Edward M. Forster (1910/2002, p. 171), a British author, wrote: “Death destroys a man, but the idea of Death saves him.” Yalom paraphrased his statement as “though the physicality of death destroys us, the idea of death saves us” (1980, p. 7). Yalom particularly favors Epicurus’s idea that where I am, death is not, and where death is, I am not; therefore, “Why fear death when we can never perceive it?” (2008, p. 81). Personally, I have difficulty finding any comfort in such cold logic. Even assuming that our conscious being no longer exists after physical death, we can still be conscious and fearful of the process of dying. He also advocates the stoic ideas of accepting the reality and finality of death. In spite of his emphasis on death-tolerance ideas, he also recognizes the importance of ideas about what makes life meaningful. “The insights of many great thinkers and writers through the centuries help us quell roiling thoughts about death and discover meaningful paths through life” (p. 77).
Yalom’s main therapeutic strategy is the synergy between ideas and connection. Meaningful relationship is emphasized as a powerful therapeutic tool for two reasons. First, focus on the here-and-now dynamics in a session can serve as a critical moment for therapy. Second, recognition of the rippling effect of one’s own existence can help enhance one’s sense of meaning and reduce death anxiety. Interestingly, several cases presented by Yalom move beyond the simple notion of synergy between ideas and connection and explicitly focus on what makes life meaningful. With respect to Susan, who was excessively worried about the incarceration of her adult son, George, Yalom redirected her attention to life’s meaning:
It seems to me that at a deep level you must be considering some important questions: What will you do with the remainder of your life? What will provide meaning, especially now when you realize that George is not going to fill that job? (p. 27)
Considering the above, it may be more appropriate to characterize existential therapy as explorations of pathways to meaningful living.
The Role of Religion in Death Acceptance
My main criticism of the book has to do with Yalom’s dismissive treatment of religious faith. His uncompromising certitude about his own materialist worldview and his unflinching defense of his beliefs seem out of character with his willingness to be open-minded and neutral about religious beliefs. Simply witness his heated debate with an Orthodox rabbi and his misinformed view of Christianity on the basis of Nietzsche. His harsh judgmental attitude toward religion in these incidents seems inconsistent with his previously kinder and gentler view. In fact, his relationship with Paula, a cancer survivor and a very religious person, as recorded in Yalom (1999) was tender and moving. He even confessed his willingness to trade “a small corner of my skepticism for a closer snuggle with Paula’s grace. At times, I even heard myself mouthing little phrases such as: Who knows? Where, after all, does certainty lie? Can we ever really know?” (p. 25). Has Yalom’s soft agnosticism hardened over the years?
At the intellectual level, Yalom has always recognized the adaptive value of religious beliefs, especially for those who feel isolated and helpless in facing the monstrosity of a painful death: “God, as formulated transculturally, not only softens the pain of mortality through some vision of everlasting life but also palliates fearful isolation by offering an eternal presence, and provides a clear blueprint for living a meaningful life” (p. 5).
Research has clearly supported Yalom’s positive assessment of religion (Tomer, Eliason, & Wong, 2008). I have often said that there are no atheists on deathbeds. Recently, cancer claimed my two older brothers: one, a professor in chemical physics; another, a writer. Both were once self-assured, hard-line materialists like Yalom. However, during the last stage in their futile fight against terminal cancer, they wondered about what would happen after death, and eventually they embraced the religious faith of their family. In those dying hours, it was religious faith that gave them comfort and hope.
Here is a little mental experiment: During lonely and terrifying days, if cancer’s destructive work on your body is advancing unopposed, how would you feel if there is no hope at the end of the dark tunnel? Now, imagine that during those dark nights of the soul, when you are lying alone on your deathbed with tubes in your nose and mouth, and your body and the physical world are quickly fading away, faith opens a window to a transcendental reality and a strange moment of calm acceptance and relief descends upon you. As you enter the spiritual realm, light and joy wash over you like a beautiful, soothing symphony from Heaven. Is there any better way to exit this world?
In the final analysis, religious beliefs are not incompatible with reason because we all adopt some prepositions and beliefs that are impervious to scientific proof or disproof. There are always some areas of human experience and some psychological phenomena that are inexplicable, given the current state of science. Such mystical experiences can enrich our lives and give us a sense of awe toward both life and death. Positive existential therapy would gladly include religious faith as one of the royal roads to meaning and death acceptance (Wong, 1998).
In this book, once again Yalom demonstrates his clinical skill of cutting through layers of psychological problems with the precision of a neurosurgeon. As always, he is able to engage his audience with the ease and grace of a master storyteller, even when he recounts a disturbing case. The genuine humaneness in his tone of voice also makes this a compelling book on a very sensitive subject.
In many ways, this is “a deeply personal book stemming from my confrontation with death. I share the fear of death with every human being: it is our dark shadow from which we are never severed” (vii). Given the confessional nature of this book, we can understand its scant references to theories and research on the psychology of death.
Overall, the book contains a great deal of wisdom for both psychotherapists and laypeople struggling with the issue of personal mortality. However, some of his statements about religion in this book may limit its appeal to individuals with strong religious convictions.
- Forster, E. M. (2002). Howard’s end. Mineola, NY: Dover. (Original work published 1910)
- Gibran, K. (1994). The prophet. London, UK: Senate Press. (Original work published 1923)
- Hemingway, E. (1981). The old man and the sea. New York, NY: Simon & Schuster. (Original work published 1952)
- Tomer, A., Eliason, G. T., & Wong, P. T. P. (2008). Existential and spiritual issues in death attitudes. New York, NY: Taylor & Francis.
- Wong, P. T. P. (1998). Implicit theories of meaningful life and the development of the Personal Meaning Profile (PMP). In P. T. P. Wong, & P. Fry (Eds.), The human quest for meaning: A handbook of psychological research and clinical applications (pp. 111-140). Mahwah, NJ: Erlbaum.
- Yalom, I. D. (1980). Existential psychotherapy. New York, NY: Basic Books.
- Yalom, I. D. (1999). Momma and the meaning of life: Tales of psychotherapy. New York, NY: Basic Books.