‘At the root of all anxiety is the dread of death. Discuss.’ Regrettably, Yalom does not dissect this proposition but presents it as a certainty, although he does cite sources for ‘the ubiquity of death anxiety’. Even if we set aside specific anxieties such as agoraphobia and social phobia, which Yalom presumably excludes from his theory, I remain sceptical: what dynamic contortions would be required to trace the anxiety of a 16-year-old facing a school examination to a dread of death? There are two likely reasons for Yalom's overstatement of his case – his personal experience (‘I've been astounded to see that death has shadowed me my entire life’) and his renown at dealing with his specialty, which inevitably leads to his practice being flooded with clients who are dominated by death anxiety.
Having aired this grouse, I can move on to Yalom's expertise as a therapist, which is clearly evidenced in the numerous case illustrations he presents, although he is commendably honest in detailing at least one of his therapeutic failures. Yalom defines himself as an existential psychotherapist, recognising like minds in philosophers such as Epicurus, Nietzsche and Schopenhauer. From a psychodynamic viewpoint he is an unconventional therapist, making physical contact with his clients, revealing to them details of his private life, getting up during a session to retrieve notes of a previous session, and encouraging his clients to address him as Irv. The spur to this approach is clearly identifiable – he writes that he remembers none of the ‘thoughtful, dense and carefully worded interpretations’ of his ultra-orthodox Freudian psychoanalyst, but cherishes ‘an unusual momentary burst of tenderness’ when he reports his mother's blaming him for his father's heart attack. He recounts that he gained more from studying philosophy than from the psychoanalytic literature. As a consequence, he often adopts the role of a teacher to his clients: ‘In every hour of work, I am able to pass along parts of myself, parts of what I have learned about life’. However, his philosophy-inspired teaching does not invariably achieve the desired effect. He quotes one client as saying, ‘Even though I get something from discussing all those great thinkers pondering the same question, sometimes these ideas don't really soothe the terror’.
It is not clear for whom Yalom intends this book. The case illustrations are educational for colleagues and are sufficiently jargon-free to be appreciated also by lay readers. There is a chapter headed ‘Advice for therapists’, and a curious section at the end entitled ‘A reader's guide’ which appears to be written by an editor and comprises sets of questions about each chapter which read like a test of comprehension for students, for instance, ‘Has Dr Yalom persuaded you that the Greek philosopher Epicurus has something more valuable to teach us all, and if so, what is it?’ There are nuggets of gold in this book, particularly in the case examples, but a fair amount of irritating material has to be sluiced away to reveal them.
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