Book Review: Staring at the Sun: Overcoming the Dread of Death

Readers will be disappointed if they buy this book in the belief that, according to the jacket, they will read wisdom on how to cope with death anxiety. They will be even more disappointed if they believe the preface which states, '...this is a deeply personal book stemming from my confrontation with death.'

Better titles would be, 'Overcoming the Dread of Revealing' or possibly 'Overcoming the Dread of Feeling Fear', or even 'Overcoming the Dread of Feeling Emotions of any Kind.'

Dr. Yalom's much hyped book came into my hands via a Greek-American friend who was at my home taking a break from caring for her mother and mother-in-law who are dying at home—my friend's home. After a few chapters, she put it down. Curious, I picked it up and drew this conclusion from the first chapters: Dr. Yalom follows the usual American self-help book formula—a facile thesis [We all dread death] followed by skating around variations on the theme, illustrated by case histories that seem to me to be more grief/loss issues than death anxiety issues, and which, incidentally, are all written in the exact style of Dr. Yalom. And it's all sprinkled with the sayings of wise men speaking on the subject, sort of.

I then passed the book to a British friend who had held her husband's hand as he died, having passed long years caring for him at home. My friend had used Dr. Yalom's, The Theory and Practice of Group Psychotherapy for a course on group psychotherapy. Eagerly borrowing the book, she returned it after reading a few chapters, saying that it lacks the quality of his previous work. Pressed, she commented that the first chapters felt 'breathless' with their many sub-heads separating short case histories enlivened with quick comments. She also did not like being talked down to, and she concluded that Dr. Yalom does not in fact reveal himself, despite repeatedly assuring us that he does.

So I handed the book to two British Existential Psychotherapists who practice in the UK. One glanced at it and put it down and the other read it through and commented that Dr. Yalom dreads not death but isolation.

I began to wonder what the hype was all about. Perhaps, I thought, Dr. Yalom's fans are Americans who need advice that European readers do not. So, as an American, I opened the book again and, after many puttings down and pickings up, I reached the end. (OK, I merely glanced at the final self-help workbook questions.)

The problem is authenticity. The voice feels strained and artificial, not a deeply personal opening of a great man's heart. I found it hard to believe these are words of wisdom. The book is Dr. Yalom's detached observations of himself counselling others about their death anxiety. It's a professionally staged monologue which could be entitled, 'Relating the Confessions of the Patients of a Venerable Professor Who Also Dreads Death Despite Years of Therapy with the Best.' Dr. Yalom seems to have spent many of his therapeutic hours fitting the utterings of his loosely disguised patients into his death thesis, thus belying any oath of confidentiality, although he claims he got permission from his grateful patients.

As far as what dread of death is, Dr. Yalom does not really define it except to interchange 'dread' with 'fear', 'terror', or 'death anxiety', and he uses these terms for both self and others.

The core of my distrust comes from his failure to reveal a real Dr. Yalom, a human being as shaky on his anxiety legs as the rest of us reaching his age. I felt he revealed only what is appropriate for me to know, a conclusion confirmed when I read Chapter 7 where, as if prompted by his alert editor who said, 'Doctor, aren't you supposed to be revealing yourself?' he says, 'Reveal only when the revelation will be of value to the patient' (p 240). I instantly knew that I had not read any soul-searching. What I had been shown was a cheery, hearty, humorous Dr. Yalom who has many grateful and patients who talk about anxiety. In another spot, as if hounded by this relentless editor, he tries to prove how revealing he is by listing, one after the other, his experiences with death, all of which he leaves unexamined and unexplored. The most painful of these was his mother shrieking, when he was a rebellious fourteen-year-old, that he had caused the death of his father. This did hit my heart and caused me to murmur. 'Oh, you poor man, carrying that inside you all these years.'

Perhaps my problem is that I am not immersed in Existentialism, having read only the basic Existential writers when I was in college many decades ago, and having led a life in which one experience led to another. So, searching in the book for meaning about how Existential Analysis deals with death dread, I gleaned that there are five principles why this Existential psychoanalyst thinks people are anxious about death. In order, they are:

• 'Anxiety about nothing is really anxiety about death' (p 22);
• 'The more unlived your life, the greater your death anxiety' (p 45);
• 'Adults who are racked with death anxiety encountered too much death at an early age, failed to experience a centre of love, caring, and safety, were isolated individuals who never share intimate concerns',
• 'or were hypersensitive, particularly self-aware individuals who have rejected death-denying religious myths' (p 117).
• And lastly, 'Death anxiety is simply that every living creature wishes to persist in its own being. Our hard wiring will zap us from time to time' (p 128).

Since we all fit into one of those categories, particularly the last, it appears that we are doomed to feel death anxiety. Dr. Yalom has a solution for us. '...the most effective approach to death anxiety is the existential one' (p 118). Searching the text to find what this is, I learned he has derived this from a form of Epicureanism, '... the state of non-existence is not terrifying because we won't know we are not existing.' (page 128).

This does not do much for many of his patients, Dr. Yalom admits, and it does not do anything for me, either. I even get the feeling that it is not working for Dr. Yalom, although I can't really put my finger on why I feel this. Possibly it is because the philosophy is so intellectual and it comes crashing up against some short but powerful bursts of sadness about leaving this life, such as at the conclusion of Chapter 6 which is the end of the book for lay readers. Chapter 7 is for his fellow practitioners. Why the sadness? Would an Epicurean not rejoice at a life well lived, a potential fully reached, as he describes himself? Would not an Epicurean revel in the moment? Dr. Yalom needs to look backwards to feel happy.

The one solution Dr. Yalom does give us for death anxiety is his advice to therapists, 'It is the synergy between ideas and intimate connection with other people that is most effective both in diminishing death anxiety and in harnessing the awakening experience to effect personal change' Page 119. This sounds right but I do not see any intimacy in this book, despite his telling us that his patients hug him.

I have to confess that what really set me against the book was the description of his fifteen-year leaderless support group with ten other psycho-therapists. Dr. Yalom relates that one of the members is dying of cancer and during one session turned the discussion to death by saying that conventional therapy is no longer relevant. He wished

to talk about spiritual things, areas in which therapists do not tread. "What do you mean by spiritual areas?" we asked him. After a long pause, he said, "Well, what is death? How do you go about dying? No therapist talks about that."

What an extraordinary meeting, I mused. In the history of humankind, has any group ever held such a discussion? Nothing withheld, nothing unspoken'

(p. 182)

Does Dr. Yalom truly believe that his is the only group in the history of humankind speaking frankly about death where nothing is unspoken? He refers briefly to his association with Hospices in the US. Has he never attended any of the weekly sessions about death and grieving led by the hundreds of Hospice counsellors and chaplains across the US? Did he never sit at the bedside of a dying person and hear a Hospice chaplain help a family open their hearts to grief?

A revealing sentence is Dr. Yalom considering his own death. He says that his greatest concern about dying is that his wife will not being able to see him any more. I wonder if he's talking about grief, rather than anxiety, and he's stepping back from feeling it by imagining how she will feel.

'Staring at the sun' is an odd metaphor. It is a maxim of François de La Rochefoucauld, we are told, one of Dr. Yalom's wise men, and it is translated for us as, 'You cannot stare straight into the face of the sun, or death.' Like many of the wise quotes tossed into the mix, it does not seem to fit. We cannot stare at the sun, true, but no one dreads the sun. It is impossible to look at full strength, but tennis and baseball players can pick a ball out of it, and all of us gaze sentimentally at the red globe on the dusky horizon. So if we do not dread the sun, even though we are not supposed to look at it, does that mean we're not supposed to dread death? Yes! We aren't! At the end, Dr. Yalom tells us that this quote means that even though we are NOT supposed to stare at the sun, we ARE supposed to look Death in the face.

Which brings me to the other wise quotes. I am told that a hallmark of Dr. Yalom's writings is sprinkling in quick quotes from people whom he feels are wiser than we. I wonder why these are necessary. Wise quotes are no replacement for thoughtful conclusions drawn from one's own life's experiences, and certainly no replacement for emotional reactions drawn from the heart regarding personal contacts with death. These wise-men quotes are distracting. They drew my thoughts to their authors as I struggled to connect their writings to Dr. Yalom's purpose. Also distracting were his introductions to these wise men, such as (regarding Schopenhauer's essays) 'For anyone philosophically inclined, they're written in clear, accessible language.'

Chapter 7, "Advice for Therapists", is the longest chapter and the only place where a voice rings true, detracted a bit by Dr. Yalom's statement that he has attempted to write it in a jargon-free manner so that any reader can understand. He did a good job of making it simple. One case history follows another, spiced with counselling tips and advice such as, therapists who don't face their own mortality will be overwhelmed with anxieties about their own death.

As I closed the book for the last time, I wondered if Dr. Yalom wrote this because his publishers told him he could get a best seller out quickly if he threw together some death-related case histories and linked them with wise sayings. His publishers told him they could market it to us, the huge ageing audience with death on our minds because by now we have stood at more than one graveside, and we know someone in a Hospice, and because war death stares us in the face every morning, and because, well, the publishers and Dr. Yalom think we lack the ability to deal with more serious works about death.

Whimsically, I decided that this book could be an even better seller, as well as more compelling and enjoyable, if the word "death" were replaced throughout with the word "sex", or even "plants" or "spiders". These words, as I discovered via some entertaining experimentation, fit easily into the simple grammar and syntax of this mass-market hardback and would convert this book into an engaging, provocative, and even elucidating Existential Psychological endeavour.

On the other hand, perhaps we would be better to leave revelations and reflections about death to the novelists, poets, and playwrights.

The Therapeutic Potential of Creative Writing, Writing Myself

Gillie Bolton. (2005). Jessica Kingsley. £17.95.

Do you feel emotionally or creatively blocked? Do you want to develop new approaches to life? Have some fresh insights? Perhaps you need to come to terms with loss or illness? Or are suffering from old wounds caused by past events? Then why not try the powerful and therapeutic aspects of creative writing? We can all write. But sometimes we lack confidence, don't know where to start, or have a voice that has been silenced. Gillie Bolton can help.

I was interested in hearing more about the therapeutic potential of creative writing from Gillie Bolton as she is extremely well qualified on the subject. She is Literature and Medicine Editor of the Journal of Medical Ethics Humanities, Arts and Health Editor to Progress in Palliative Care, and Associate Editor of the Journal of Poetry Therapy. Not only has she trained healthcare professionals to offer therapeutic writing to their patients, she is also a researcher, and an award winning poet.

Writing Myself is a practical handbook of exercises which form the basis of a non-confrontational and sensitively designed approach to therapeutic writing. These exercises are intended to promote emotional healing, physical well-being, and boost personal development. In the foreword to the book, Sir Kenneth Calman (a former Chief Medical Officer of Health), is advocating the use of creative writing as a new initiative that will increase the well-being of patients and practitioners alike.

There is a lot in this book, with useful contact addresses of creative writing organizations and therapists, as well as a detailed bibliography and subject index. Bolton says it is suitable for both healthcare professionals who wish to implement therapeutic writing with their patients, and those wishing to start writing creatively in order to help themselves. If you fancy trying this for yourself, she recommends chucking writing out of the

Jan McGiffin