Tuesday, April 27, 2010

We're All Going To Die

I heard Irvin Yalom speak today. He's a psychiatrist/writer/ very famous shrink at Stanford, and he was at Johns Hopkins today to give the Jerome Frank lecture. The title of his talk was "Staring at The Sun: Overcoming the Terror of Death." It's also the title of his latest book. The auditorium was packed---no surprise here. When I heard Dr. Yalom was coming, maybe a month ago, I made a point to block off the time to be there-- I've never heard him speak and I was looking forward to this. Please let me share the experience with you.

Dr. Yalom is a gifted writer. He writes about his work in colorful and accessible ways, and he speaks about it this way as well. He lectures an audience of hundreds as though he is talking to a single friend. No notes, no hesitation, and he seems so at ease as he talks openly about work that is quite intimate. His specialties are group psychotherapy and existential psychotherapy, and he classifies the existential issues as death, isolation, freedom (as in freedom to make decisions and to steer the course of one's life, not political freedom), and meaning. "We are unfortunately meaning-seeking creatures heralded into a universe that has no meaning." Now he tells me!

Dr. Yalom started by talking about Dr. Jerome Frank (for whom the lecture is titled)--one of his mentors --and talked about a poignant visit with him near the end of Dr. Frank's life. Dr. Frank was also one of my psychotherapy supervisors, perhaps at a time in my training when I took such things for granted and had no true appreciation of what an amazing gift it was to be his student. Dr. Yalom talked about his memories, and I revisited my own.

Dr. Yalom talked about his own psychotherapy experiences: his three years in psychoanalysis in Baltimore "There was so much attention to the distant past and so little to the future and our death." Later in life, in California, he spent two years in therapy with Rollo May.

Death anxiety, Yalom contends, is an issue for many people--one patients won't necessarily bring up on their own, one they avoid if they sense the therapist is uncomfortable, one that, indeed, makes therapists uneasy as they, too, have their own death anxiety to face. Perhaps it's easier to avoid the topic; after all, there's nothing to do about it. We're all going to die. The therapist, he says, has a role in discussing death, and therapy can diminish the anxiety.

He talked a little about his work with cancer patients and how facing death can have a transforming effect; people get a better sense of priorities. "What a pity I had to wait until now to learn how to live," one dying patient told Dr. Yalom.

By far, the most interesting parts of the talk were when Yalom talked about specific examples of his own work with patients and the interactions that transpired. He talked about a patient--a psychotherapist--- who asked him about his own death anxiety (he responded) and who talked about his concerns about how Dr. Yalom might judge him. One nice thing about being Irvin Yalom is that you can get up in front of an audience of hundreds and talk openly about your work, boundary violations and all. He ended with the statement, "To become wise, you must listen to the wild dogs barking in your cellar." --a version of a quote by Nietzsche. I'm still thinking about that one.

It's been a while since I've heard a lecture like this. We've become so focused on psychiatry as the treatment of illnesses, of which drug at what dose, for how long, or which type of psychotherapy, and certainly we assume that what goes on in therapy includes talking about issues that having meaning to patients--including things that evoke anxiety, and the nuances of life that include meaning. We know we talk about these things behind closed doors--but we don't often talk about the process of such transactions.


FunPsych said...

I just finished reading another one of Dr. Yalom's books, Momma and the Meaning of Life, which includes several cases of patients dealing with grief and death. And honestly, his stories are just so touching, they really define for me the meaning of being a psychiatrist. It's so much more than just asking about symptoms and prescribing meds.


Lockup Doc said...


Thanks for sharing this. People like Dr. Yalom make psychiatry interesting. (And I share in your frustration that our field has become so disease-focused.) Cheers.

Maggie said...

Thank you for writing this. You are so lucky to hear Dr Yalom speak. I read Staring at the Sun shortly after starting bereavement counselling following my parents' deaths. It's a fantastic book, very accessible, and I'm very glad I read it. Looking forward to reading his other books when I get time (we're currently trying to tame a wild garden and get a house renovated and extended).

The Girl said...

Thanks for the post. I'll have to read his books - they sound fascinating.

SteveBMD said...

Blah blah blah. Get to the point, Dr Yalom: which atypical antipsychotic do you prescribe for death anxiety???

tracy said...

Wow. Lucky you! i love Dr. Yalom's work, especially his short stories, based on work with his patients. i loved the title story from "Momma and the Meaning of Life" in which he analyzed his own dream...brillant!

Sunny CA said...

This gives me some hope that psychiatry is not yet dead (and left to the pill pushers).

pj1280: very clever.

Mindful said...

Great post about a great doc. Thought provoking.

Anonymous said...

It's been a few years since I've read his books (i read two of them), and I came away thinking wow he's arrogant. Not exactly my idea of great MHP, but I will say the books were interesting.

I can't remember why exactly I thought he sounded arrogant, but then I don't remember much about the books. I sold my copies on Half.com, and they sold quickly. Maybe, I'm just missing something and should give it another shot.

SteveBMD said...


The way I see it, it's hard not to sound arrogant when writing the kind of prose Yalom writes-- and infuse it with psychodynamic relevance, no less.

That said, I've had the same impression of Yalom's books (and the few times I've seen him speak). He does carry something of a pretentious or self-righteous air about him.

tracy said...

i kind of felt the same "aggorance" from Chaim Potok (rest in peace) the times i heard him speak. i chalked it up to the fact that his intelligence was soooo far above mine, that i found it hard to "relate" to his presence. (But not his characters).

Hee, pj1280

Catherine said...

I really enjoyed reading his books and the fact that he was willing to face head-on such a squiffy topic for most people.

The other thing I enjoyed about his book is the feeling that I got of him as a person and how his boundaries were a lot more flexible than most people's. Granted, I have never met him in person, but that would be the guy I would want to talk to, someone who is not afraid to *really* talk, to talk about *anything*.

Anonymous said...

strange. i had to read most of yalom's books as part of coursework in undergrad and grad school (psychology). i was never impressed by his arrogance and self-styled aggrandizement. never really understood why he was somewhat of a cult figure amongst mental health professionals...to me, his books always lacked substance and seemed to basically "toot his own horn" in a boring, formulaic kind of way.

Pete said...

Interesting, Dinah. I've heard a number of people comment on Yalom's arrogance, his narcissism. But the fact that he's aware of it and talks about it is part of a reflexive style which makes him so accessible. I think he's added a lot to the MH field.