Coronavirus Anxiety: An Exploration of the Fear of Dying

“The primitive dread of death resides in the unconscious –a dread that is part of the fabric of being, that is formed early in life at a time before the development of precise conceptual formulation, a dread that is chilling, uncanny and inchoate, a dread that exists prior to and outside of language and image.” — Melanie Klein

A recurring theme in the psychotherapeutic clinic is death and dying. Usually it appears in the form of grief or loss when we are affected by the deaths of others. Occasionally, it appears in the form of death anxiety, thanatophobia, when individuals fear for their own mortality. In some cases the anxiety is of such proportions it invades consciousness at all opportunities, its effects readily apparent.

Most of the time, however, death anxiety remains hidden, buried deep in our psyches. Psychoanalytic theory holds that we live in a culture which successfully represses our fear of dying. For most individuals it resurfaces only in times of crisis; the passing of a loved one, a brush with death, a terminal diagnosis.

At a societal level mass arousal of death anxiety would require an extraordinary event. The arrival of Covid-19 appears to be such an event.

Psychiatrist Robert Langs names two forms of death anxiety; predatory and existential. Whereas first is instinctual — the fight-flight response — the second is characterised largely by our capacity for its denial. Both have been prevalent in the last number of weeks. And, with the consequences of Covid-19 increasingly impossible to ignore, repression of existential death anxiety has become less of an option.

Bion’s Container-Contained

Psychoanalyst Wilfred Bion’s metaphor of the ‘container and the contained’ is grimly apt for the current moment. He believed our first encounter with death anxiety occurs the moment we are born. Life in the womb offers relative security and comfort. Over nine months we float blissfully, in constant temperature, never having to consider our next meal. Abandoning the womb is to enter an alien universe. We are bombarded with strange sensations — light, sound, cold, touch, colic, and strange new emotions. Not long after birth we will — for the first time in our existence — experience hunger. According to Bion, this singular moment brings with it — at some level — the realisation that life is no longer assured. Though life for the infant is interspersed with moments of bliss, the above realisation brings terror.

Fortunately the mother soothes the infant’s anxiety, receiving and taming it in the feeding relationship. She becomes the ‘container’, the fear of dying the ‘contained’. But, unfortunately, not all anxiety is containable all of the time. When — for whatever reason — the infant’s fear is uncontained, he is left with what Bion refers to as a ‘nameless dread’. The vast majority of us will have had ‘good-enough’ mothers and we will have received sufficient containment. But, because no mother is perfect, we will all carry some measure of this nameless dread within us. For some it lies closer to the surface. For most it remains dormant, erupting only when something occurs to unearth that which has been buried.

The unfolding of the last couple of weeks has been that event for many.

An Alien Universe

Scenes last week from Ireland’s national sports stadium, Croke Park, of people in hazmat suits directing traffic through tunnels, as people arrived for testing, resembled a Hollywood disaster movie. Panic-buying saw Gardai (Irish Police) patrolling supermarkets to restore order. Schools, pubs, and restaurants have all closed their doors. Business has ground to a halt. Internationally flights have been grounded and borders closed. The contracting of the global economy is fuels angst.

An international lockdown on this scale — especially for those living in the West — is unprecedented. The rapidity with which everyday life has dissolved has been, for many, overwhelming. The emergence of novel coronavirus has exposed the fragility not just of life, but of the very fabric of society. Like Bion’s newborn we have entered an alien world. The constancy of our previous existence evaporated, we too feel bombarded.

As national borders close, so too our personal boundaries are tightening. ‘Social distancing’ and ‘self-isolation’ have entered the lexicon. Never before have we been more aware of our personal space. One of the most discomforting aspects of the whole experience for me is people wariness of one another. Though the level of suspicion is discomforting, it is necessary. We are assured that isolation is key to containment. However — though it may slow the spread of the virus — isolation will do little to contain anxiety.

The Neuroscience of Containment

Bion’s theories were a forerunner of modern attachment theory. While formulations on the thoughts and feelings of a newborn can only be speculative, the science of containment stands on steadier ground. The work of developmental neuropsychoanalyst Allan Schore, for example, explores emotional regulation in infancy by the mother. This regulation takes place largely unconsciously. The infant, lacking language skills, communicates via body language, eye-gaze, tone of voice, facial expression and so on. The mother reciprocates. Schore’s neuroimaging studies shows this communication taking place between the right hemispheres of the brains of both mother and infant. Similar studies show the same right-brain to right-brain communication between therapist and client. When it comes to emotional communication, we all communicate this way, right-brain t0 right-brain.

One consequence of isolation, therefore, is the lack of our normal mode of emotional regulation. Schore’s work highlights the differences between the emotional right-brain and the linguistic left-brain. Left-brain communication typically involves the processing of language and information. So much of the communication we do today, especially in a time of mandatory lock-down, involves text messaging, email, or social media. Because these are informational media, they achieve little in terms of emotional regulation.

At the moment there is a lot of anxiety around. Whether death anxiety or not, isolation ensures, bereft of human contact, we are denied any container for it.

The Denial of Death

Ernest Becker won the 1974 Pulitzer Prize for his non-fiction book The Denial of Death. The award ceremony took place two months after he himself passed away. According to Becker, such is our discomfort with the thought that we and our loved ones will one day die, we developed a culture whose main function is repression. Civilisation, in his view, acts as an elaborate defense mechanism, distracting us from any knowledge of our future demise.

One disadvantage of having an ego is that we know we will someday die. However, the same ego allows us to evade that knowledge. We create, think, dream, and aspire. Or, we invent religions and belief-systems that hold the promise of an afterlife. Some choose to numb the ego, others engage in the creation of what Becker calls ‘immortality projects’. For some that project is children, for others the perpetuation of their name beyond the time of their passing. Striving for excellence in the fields or characteristics most prized by our culture are simultaneously a distraction, and — in ensuring we are remembered — a way of living on.

According to Becker, these projects are — given their arbitrary nature — a form of fiction. He divides these fictions into four categories; personal, social, secular, and cosmic. The demise in the 20th century of the fourth, argues Becker, leaves Western society engaging mostly with the first three. This has implications with the arrival of covid-19. The last couple of weeks has seen the disintegration of our social and secular realms. This means the personal, our sense of selves, has taken a battering. This stripping away of our fictions has meant the removal of our repressive mechanisms. And this has aroused in many of us the greatest anxiety of all.

Staring at the Sun

Irvin Yalom, a contemporary psychotherapist, writes extensively on death and the terror of dying. For Yalom, death anxiety begins — around the age of three — with the first conscious realisation of death. Around this age — perhaps because of the death of a pet or relative — the child becomes able to conceptualise non-existence. This thought is terrifying. According to Yalom these anxieties are then soothed by an ‘ultimate rescuer’; one or both parents.

“When we are young, we deny death with the help of parental reassurances and secular and religious myths; later, we personify it by transforming it into an entity, a monster, a sandman, a demon. After all, if death is some pursuing entity, then one may yet find a way to elude it; … frightening as a death-bearing monster may be, it is less frightening than the truth — that one carries within the spores of one’s own death.”

Death becomes the bogeyman or the monster under the bed that the parent chases away. This according to Yalom is how we repress death. The death later, in adulthood, of our ‘ultimate rescuer’ reignites for many those childhood terrors.

Yalom sees our confrontation with death anxiety as presenting the core existential conflict. A tension exists between our awareness of the death’s inevitability and our wish to continue living. When we die — not only our participation in — but the meaning we give to the world dies with us. With this thought, Yalom argues, we are truly confronted with nothingness. For him, the ultimate symbol of a meaningless death is a lonely death.

In this context then, there have been no starker images than those from Italy of funerals with no-one in attendance. Or images of coffins loaded on army trucks for transport to crematoria. At the conscious level we understand the need for this, the health risk. However, at the unconscious level these images stoke our greatest existential fear; that we will die alone and unremembered.

That it all truly has been for nothing.

Death as an Opportunity

Though the current situation is undoubtedly a strain, it presents an opportunity. In the course of time Covid-19 will pass and we will be free to resume our chosen fictions. The depth of the current crisis is so profound many are beginning to evaluate which ‘fictions’ are most important. This potential for change exists not just at the individual but also at the societal level. The immense power of nature has exposed not just our own fragility, but the fragility of the systems we inhabit. The long-term effects of the Covid-19 crisis will be profound and will reverberate for some time. The months and years ahead will reveal what those societal effects will be and will be the topic of much discourse for some time to come.

At the personal level, in terms of the existential question, both Becker and Yalom offer direction. Though their remedies differ, they converge on the same axis; that of meaning.

Cosmic Heroism

Becker referred to the four fictions — personal, social, secular, and cosmic — also as a type of heroism. Some forms of heroism, he argued, are emptier than others, fulfilling no role other than repression. For Becker the most meaningful is the fourth; cosmic-heroism. The decline of religion has robbed us of an important illusion, the comforting thought of an afterlife. Becker argued that some form of return to the fourth fiction, however we define it for ourselves, has the potential for providing the most meaning. Tending to the spiritual, cosmic-heroism transcends the other mortal ‘fictions’. Striving for something beyond the mundane represents, for Becker, the ultimate freedom.

Of cosmic-heroism he said the following: “If we put this whole progression in terms of our discussion of the possibilities of heroism, it goes like this: Man breaks through the bounds of merely cultural heroism; he destroys the character lie that had him perform as a hero in the everyday social scheme of things; and by doing so he opens himself up to infinity, to the possibility of cosmic heroism … His life thereby acquires ultimate value in place of merely social and cultural, historical value. He links his secret inner self, his authentic talent, his deepest feelings of uniqueness, his inner yearning for absolute significance, to the very ground of creation.

Out of the ruins of the broken cultural self there remains the mystery of the private, invisible, inner self which yearned for ultimate significance, for cosmic heroism. This invisible mystery at the heart of every creature now attains cosmic significance by affirming its connection with the invisible mystery at the heart of creation.”

Though he sketched something of a road-map, Becker doesn’t fully define what cosmic-heroism is. That we must discover for ourselves.

A Death with or without Meaning

Yalom, an avowed atheist, offers a different remedy.

In his 2008 Staring at the Sun: Overcoming the Terror of Death Yalom encourages us to face death anxiety head on. By continually reminding ourselves of our inevitable passing, we bring sharper focus to living our best lives. Contemplation of death, rather than sentence us to terror or pessimism, can spur us into getting the most out of our lives. Paradoxically the integration of death, when it encourages us to live more authentically, becomes a recipe for fulfillment. In confronting death we become calmer, more centered, more able to focus on what is truly important.

Yalom offers several reasons why we fear death. We are concerned for those who will survive us; the pain they will feel, the struggle they will face. Or we fear not knowing how the plots of our various fictions play out. Mostly, he says, we fear missing out on those parts of life we haven’t yet achieved. He says, “The death anxiety of many people is fueled … by disappointment at never having fulfilled their potential. Many people are in despair because their dreams didn’t come true, and they despair even more that they did not make them come true. A focus on this deep dissatisfaction is often the starting point in overcoming death anxiety.”

Our fear isn’t of death itself, but of a death without meaning.

Yalom has been very generous in writing about his own death anxiety. He has written also on what brings meaning to his life. “Intimate connections help me overcome the fear of death. I treasure my relationships with my family — my wife, my four children, my grandchildren, my sister — and with my network of close friends, many stretching back for decades. I’m tenacious about maintaining and nurturing old friendships; you cannot make new old friends.”

For Yalom the true meaning of life is found in the poignancy of relationship; love.

A Final Reflection

Contemplation of death, or of any subject matter, requires think capacity to think. In the immediacy of the Covid-19 crisis, stalked as we are by predatory anxiety, thinking may not always be possible. In that context Yalom’s striving for relationship has added benefit.

Let’s double back for a moment to Schore’s right-brain containment. In modern society the default mode of communication for many is text, email, or messaging apps. As explored above, these left-brain — linguistic, informational — modes of communication are ineffective at containing our emotion. Similarly, constantly searching for updates from mainstream or social media will not contain. In fact, some of the misinformation will only fuel anxiety. While it’s convenient to text, and wise to be informed, , there needs to be balance with human contact.

Just a day or so before I write these words the Irish government announced mandatory ‘stay at home’ legislation, reinforcing isolation. Some people may thrive by being alone, but for most it is proving a strain.

To that end — to derive as much right-brain containment as possible — it is better to hear someone’s voice or see their face. If you can, phone rather than text, or FaceTime or Zoom rather than Whatsapp. Whatever medium you choose, try to make the contact as human as possible. It may only be a small thing, but, in the extraordinary times we find ourselves, a little goes a long way.

In the meantime, stay safe!