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by Irvin D. Yalom
HarperCollins , 1989
Review by James Sage on May 15th 2002

Love's Executioner

What do you want?

This simple question generates some of the most intimate answers, even between perfect strangers. 

I want my to see my dead mother again.  I want to be loved.  I want to live forever.  I want to know, Dad, that you are proud of me.  I want to be young again.  I want the childhood I never had...

And between patient and psychotherapist, answers reflect a deeper anxiety, a fear, a restless longing, that Yalom terms "existence anxiety" or "existence pain".  Existence pain is the kind of pain that is "always there, whirring continuously just beneath the membrane of life. Pain that is all too easily accessible" (p. 3).  Existence pain is the organizing principle behind Yalom's approach to existential psychotherapy, and typifies what he calls the "givens" of existence. Yalom identifies these four "givens" as follows.

First, there is the anxiety that is generated by the inevitability of death (for each of us as well as for those we love).  The reality of death haunts many; most of us avoid the topic altogether (we do so by inventing convenient myths and comforting euphemisms).  Existential psychotherapy aims to penetrate, identify, and re-assess these layers of concealment and these multiple defenses that attempt to shut out the reality and finality of death that are so often destructive and unhelpful.

Second, existence pain occurs when we realize the ultimate freedom with which we live our lives.  The realization that we are free to choose how our lives will unfold leads many to deny this responsibility.  Ultimately, accepting responsibility for our lives and our ways of relating to others will empower us and put us in control.

Third, great effort is often spent to avoid the pain of being alone.  The fear of failing to achieve close and personal relationships often sabotages the very attempt to connect with others.  Coupled with the nagging sense that each of us will face death alone, aloneness generates so much grief that many people, paradoxically, fail generate significant relationships. Identifying these self-defeating tendencies is the first step at removing the obstacles that hinder the generation of significant relationships.

Finally, existence pain occurs when we come to realize that life is devoid of any obvious meaning.  Our attempt to cling to artificial meaning structures (leading to behaviors such as collecting dolls and stamps in ritualistic fashion), ultimately unravels our ability to cope with a world of existence and death. 

Each of these sources of existence pain (death, freedom, aloneness, meaninglessness) have a synergistic effect with each other: often we employ arguably unhealthy strategies to avoid one source of pain, which then exacerbates the pain and anxiety experienced in other areas. 

For example, people often fear the finality of death that ultimately awaits a loved one.  This leads us to place distance between ourselves and others (as a kind of defense mechanism to avoid the pain of loss).  But in so doing, we place barriers between ourselves and others, thereby undermining our ability to relate to each other authentically.  This, in turn, reinforces the anxiety that, ultimately, each of us is alone and will die alone.  Avoiding the pain of death places us directly in the path of existence pain that results from being alone.  And the diversity of examples are as endless as there are people in the world.

 For a more detailed and scholarly examination of this existential approach to psychotherapy, see Yalom's Existential Psychotherapy, New York: Basic Books, 1980.

Love's Executioner is the story of ten patients who turned to psychotherapy to deal with existence pain. 

 There is the woman who yearns for her dead daughter, visiting her grave daily, while at the same time neglecting her two living sons. 

 There is the 60-year-old woman who clings to a fantasy relationship with a man 35 years younger, all in the attempt to avoid the uncomfortable reality of aging and death.

There is the man who has the mentality of a sexual predator, even though lymphatic cancer is slowly eating away his body. 

Still another man who, in an attempt to deny his own mortality, cannot throw away love letters three decades old. 

 And then there's the "Fat Lady" who manages to lose 100 pounds, despite longing to understand her father's death. 

All in all, Yalom presents an excellent account of how psychotherapy might unfold for both patient and clinician.  Yalom provides an uncharacteristically personal account of the therapist's own challenges and illuminates some of the fundamental challenges associated with providing therapy.  After all, the therapist, too, is dealing with existence pain just as much as the patient.  This proves to make therapy sessions particularly intriguing, and Yalom pulls no punches when providing introspective accounts of his own frailty.

Yalom's prose is both accessible and penetrating as he leads the reader into the depths of the human condition in ten unique accounts of existentialist psychotherapy.  I highly recommend this book (as well as others by Yalom) to anyone, on either side of the couch, who is remotely interested in psychotherapy.  Yalom is a delight to read, and offers penetrating insights that apply to each of us who is caught, inescapably and firmly, in the grips of the human condition.



© 2002 James Sage


James Sage is a Ph.D. candidate in philosophy at the University of Utah. His interests include the evolution of mind and rationality, philosophy of science, and naturalized theories of knowledge.

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