Ирвин Д. Ялом

Разговор о бессмысленности возвращает меня в ту точку круга, к тому определению, с которого я начал: экзистенциальная терапия — это динамический подход, в центре внимания которого находятся факторы, составляющие неотъемлемую часть человеческого существования. Каждый из нас жаждет неразрушимости, почвы, общности и структуры, и тем не менее мы все должны переживать неизбежную смерть, отсутствие почвы, изоляцию и бессмысленность. Экзистенциальная терапия основана на модели психопатологии, согласно которой тревога и ее дезадаптивные последствия представляют собой реакцию на эти четыре конечных фактора.

Хотя необходимо было обсудить каждый из конечных факторов отдельно, in vivo они сложным образом переплетены, и их взаимодействие неизменно определяет подтекст терапии. В диалоге между пациентом и терапевтом они являются и содержанием, и процессом. Конфронтация пациента со смертью, свободой, изоляцией и бессмысленностью поставляет терапевту эксплицитный интерпретируемый материал. Даже когда эти темы не возникают в терапии открыто, они все равно обусловливают modus operandi. Такие психические феномены, как воля, принятие ответственности, отношение к терапевту и вовлеченность в жизнь, являются ключевыми процессами терапевтического изменения. Именно эти решающие виды активности во многих терапевтических системах слишком часто считаются несущественными “вбрасываниями”.

Притягательная сила экзистенциальной терапии обусловлена тем, что она твердо укоренена в онтологическом фундаменте, в глубочайших структурах человеческого существования. Она привлекает и тем, что имеет гуманистическую основу и, единственная среди терапевтических парадигм, полностью вмещает интенсивно личностную природу терапевтического предприятия. Кроме того, пространство экзистенциальной парадигмы является очень широким: оно принимает в себя и ассимилирует инсайты многих философов, художников и терапевтов, касающиеся мучительных и целительных последствий конфронтации с конечными факторами.

Однако это не более чем парадигма, то есть психологический конструкт, оправдываемый в конечном счете только своей клинической полезностью. Как и любой другой конструкт, он в конце концов уступит место другим конструктам, обладающим большей объяснительной силой. Каждая клиническая парадигма, если только какой-нибудь официальный институт не высек ее на камне раньше, чем она созрела, органична: выдвигая новую точку зрения, она позволяет четко описать некоторые смутные прежде факты. В свою очередь, эти новые данные модифицируют исходную парадигму. Я рассматриваю данную экзистенциальную парадигму как раннюю теорию, основанную на клинических наблюдениях, вынужденно ограниченных в своем источнике, спектре и количестве. Я надеюсь, что эта парадигма окажется органичной, то есть что она не только будет полезна клиницистам в своей нынешней форме, но послужит стимулом для дискурса, необходимого для того, чтобы модифицировать и обогатить ее.

Примечания

К главе 1

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2. Ibid., p. 158.

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11. Ibid.

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24. Ibid., p. 99.

25. Personal communication, 1978.

1. A. Meyer, cited by J. Frank, oral communication, 1979.

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8. Ibid., passim.

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11. Ibid., p. 290.

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13. Montaigne, Complete Essays, p. 67.

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23. К. Weers, manuscript in preparation.

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34. Heidegger, Being and Time, p. 223.

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42. Ibid., J. Meyer, Death and Neurosis, p. 58; and A. Heveroch, cited in J. Meyer, Death and Neurosis, p. 58.

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44. R. Kastenbaum and R. Aisenberg, Psychology of Death.

45. D. Lester, “Experimental and Correlational Studies of Fear of Death”, Psychological Bulletin (1967) 64(1): 27—36; and D. Templer and C. Ruff, “Death Anxiety Scale Means, Standard Deviations, and Embedding”, Psychological Reports (1971) 29:173—174.

46. P. Livingston and C. Zimet, “Death Anxiety, Authoritarianism and Choice of Speciality in Medical Students”, Journal of Neurological and Mental Disorders (1965) 140:222—230.

47. W. Swenson, “Attitudes toward Death in an Aged Population”, Journal of Gerontology (1961) 16(l): 49—52; D. Martin and L. Wrightsman, “The Relationship between Religious Behavior and Concern about Death,” Journal of Social Psychology (1865) 65:317—23; and D. Templer, “Death Anxiety in Religiously Very Involved Persons”, Psychological Reports (1972) 31:361—367.

48. N. Iammarino, “Relationship between Death Anxiety and Demographic Variables”, Psychological Reports (1975) 37:262.

49. Iammarino, “Death Anxiety and Demographic Variables”; Swenson, “Attitudes toward Death”; A. Christ, “Attitudes toward Death among a Group of Acute Geriatric Psychiatric Patients”, Journal of Gerontology (1961) 16(1)156—59; and P. Rhudick and A. Dibner, “Age, Personality, and Health Correlates of Death Concerns in Normal Aged Individuals”, Journal of Gerontology (1961) 16(l):44—49.

50. M. Lieberman and A. Coplan, “Distance from Death as a Variable in the Study of Aging”, Developmental Psychology (1970) 2:71—84.

51. M. Means, “Fears of One Thousand College Women”, Journal of Abnormal and Social Psychology (1936) 31:291—311.

52. W. Middleton, “Some Reactions toward Death among College Students”, Journal of Abnormal and Social Psychology (1936) 3:165—173.

53. Templer and Ruff, “Death Anxiety Scale Means”; Iammarino, “Death Anxiety and Demographic Variables”; and D. Templer, C. Ruff, and C. Franks, “Death Anxiety; Age, Sex, and Parental Resemblance in Disease Populations”, Developmental Psychology (1971) 4:108.

54. P. Thauberger, “The Avoidance of Ontological Confrontation”, unpublished Ph.D. dissertation. University of Saskatchewan, 1974.

55. C. Stacey and К. Markin, “The Attitudes of College Students and Penitentiary Inmates toward Death and a Future Life”, Psychiatric Quarterly, supplement (1952) 26:27—32.

56. D. Templer, “Death Anxiety as Related to Depression and Health of Retired Persons,” Journal of Gerontology, (1971) 26:521—523.

57. Swenson, “Attitudes toward Death”; J. Munnichs, Old Age and Finitude (Basel and New York: Karger, 1966); and S. Shrut, “Attitude toward Old Age to Death”, Mental Hygiene (1958) 42:259—263.

58. Munnichs, Old Age and Finitude; A. Christ, “Attitude toward Death among a Group of Acute Geriatric Psychiatric Patients”, Journal of Gerontology (1961) 16:56—59; and Kastenbaum and Aisenberg, Psychology of Death, p. 83.

59. Kastenbaum and Aisenberg, Psychology of Death, p. 107

60. C. Stacy and M. Reichers, “Attitudes toward Death and Future Life among Normal and Subnormal Adolescent Girls”, Exceptional Children (1959) 20:259—262.

61. A. Maurer, “Adolescent Attitudes toward Death”, Journal of Genetic Psychology (1964) 105:79—80.

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63. Feifel and Branscomb, “Who’s Afraid of Death?”

64. W. Meissner, “Affective Response to Psychoanalytic Death Symbols”, Journal of Abnormal and Social Psychology (1958) 56:295—299.

65. К.G. Magni, “Reactions to Death Stimuli among Theology Students”, Journal for the Scientific Study of Religion (Fall 1970) 9(3):247—48.

66. Kastenberg and Aisenberg, Psychology of Death, p. 95.

67. Rhudick and Dibner, “Age, Personality, and Health Correlates”.

68. Shrut, “Attitude toward Old Age”.

69. Swenson, “Attitudes toward Death”.

70. Templer, “Death Anxiety”.

71. N. Kogan and R. Shelton, “Beliefs about ‘Old People”, Journal of Genetic Psychology (1962) 100:93—111.

72. M. Kramer, С. Winget, and R. Whitman, “A City Dreams: A Survey Approach to Normative Dream Content”, American Journal of Psychiatry (1971) 127:86—92.

73. H. Cason, “The Nightmare Dream”, Psychology Monographs (1935) 209:46.

74. M. Feldman and M. Hersen, “Attitudes toward Death in Nightmare Subjects”, Journal of Abnormal Psychology (1967) 72:421—425; and D. Lester, “The Fear of Death of Those Who Have Nightmares”, Journal of Psychology (1968) 69:245—47.

75. P. Handal and J. Rychlak, “Curvilinearity between Dream Content and Death Anxiety and the Relationship of Death Anxiety to Repression-Sensitivity”, Journal of Abnormal Psychology (1971) 77:11—16.

76. W. Bromberg and P. Schilder, “The Attitudes of Psychoneurotics toward Death”, Psychoanalyltic Review (1936) 23:1—28.

77. С. Parks, “The First Year of Bereavement,” Psychiatry (1970) 33:444—67.

78. The Gilgamesh Epic and Old Testament Parallels, trans. A. Heidel (Chicago: University of Chicago Press, 1946), pp. 63, 64.

79. A. Witt, personal communication, September 1978.

80. Personal communication from a friend.

81. Freud, “Thoughts for the Times”, vol. XIV, Standard Edition, p. 298.

82. J. Breuer and S. Freud, Studies on Hysteria, vol. II in Standard Edition (London: Hogarth Press, 1955; originally published in 1895).

83. Ibid., p. 9.

84. Ibid., p. 7.

85. Ibid., p. xxxi.

86. Ibid., p. 14.

87. Ibid., p. 34.

88. Ibid., p. 117.

89. Ibid., p. 63.

90. Ibid., p. 131.

91. Ibid., p. 137.

92. Ibid., p. 157.

93. S. Freud, Origins of Psychoanalysis, ed. by M. Bonaparte, A. Freud, and E. Kris (New York: Basic Books, 1954).

94. S. Freud, “Inhibitions, Symptoms and Anxiety”, vol. XX, Standard Edition, p. 166.

95. A. Compton, “Psychoanalytic Theories of Anxiety,” Journal of American Psychoanalytic Association (1972) 20(2):341—94.

96. S. Freud, Studies on Hysteria, vol. II, in Standard Edition, (London: Hogarth Press, 1955; originally published 1895), p. 33.

97. Ibid., p. 40.

98. Freud, “Inhibitions, Symptoms and Anxiety”, vol. XX, Standard Edition, p. 130.

99. M. Klein, “A Contribution of the Theory of Anxiety and Guilt”, International Journal of Psychoanalysis (1948) 29:114—23.

100. O. Fenichel, The Psychoanalytic Theory of the Psychoneuroses (New York: Norton, 1945).

101. R. Waelder, Basic Theory of Psychoanalysis (New York: International Universities Press, 1960).

102. R. Greenson, The Technique and Practice of Psychoanalysis (New York: International Universities Press, 1967).

103. S. Freud, The Ego and the Id. vol. XIX, Standard Edition (London: Hogarth Press, 1961; originally published in 1923), p. 57.

104. Ibid., p. 58ff.

105. S. Freud, Beyond the Pleasure Principle, vol. XVIII in Standard Edition (London: Hogarth Press, 1955; originally published 1920), pp. 1—64.

106. Freud, “Thoughts for the Times”, vol. XIV, Standard Edition, p. 299.

107. E. Jones, The Life and Work of Sigmund Freud, vol. I (New York: Basic Books, 1953), p. 40.

108. Ibid., p. 41.

109. Ibid., p. 45.

110. N. Brown, Life Against Death (New York: Vintage Books, 1959).

111. S. Freud, “Thoughts for the Times”, vol. XIV in Standard Edition, pp. 273—300.

112. S. Freud, “The Theme of Three Caskets”, vol. XII in Standard Edition (London: Hogarth Press, 1966; originally published 1913), pp. 289—302.

113. E. Jones, The Life and Work of Sigmund Freud, vols. I, II, III (New York: Basic Books, 1953,1955,1957).

114. I. Stone, Passions of the Mind (New York: Doubleday, 1971).

115. For example, J. Wortis, Fragments of an Analysis with Freud (New York: Simon & Schuster, 1954).

116. For example, S. Freud, Origins of Psychoanalysis, eds. M. Bonaparte, A. Freud, and E. Kris (New York: Basic Books, 1954); H. Abraham and E. Freud, eds., A Psycho-Analytic Dialogue: The Letters of Sigmund Freud and Karl Abraham 1907—1926, trans. B. Marsa and C. Abraham (New York: Basic Books; London: Hogarth Press and Institute of Psycho-Analysis, 1965); E. Freud and H. Meng, eds., Psycho-Analysis and Faith: The Letters of Sigmund Freud and Oskar Pfister, trans. E. Mosbacher (New York: Basic Books; London: Hogarth Press and Institute of Psycho-Analysis, 1963); and E. Pfeiffer, ed., Sigmund Freud and Lou Andreas-Salome: Letters, trans. William and Elaine Robson-Scott (New York: Harcourt Brace Jovanovich; London: Hogarth Press and Institute of Psycho-Analysis, 1972.)

117. Jones, vol. I, p. 4.

118. Ibid., p. 20.

119. Ibid.

120. Ibid., p. xii.

121. Ibid., p. 78.

122. Freud, Origins of Psychoanalysis, p. 217.

123. Ibid., p. 129.

1. S. Anthony, The Discovery of Death in Childhood and After (New York: Basic Books, 1972).

2. E. Becker, The Denial of Death (New York: Free Press, 1973), p. 36.

3. Anthony, Discovery of Death, p. 155.

4. Ibid., pp. 155—56.

5. Ibid., p. 157.

6. F. Moellenkoff, “Ideas of Children about Death”, Bulletin of the Menninger Clinic (1939)3:148—56.

7. E. Erikson, Childhood and Society (New York: W. W. Norton, 1963).

8. Anthony, Discovery of Death, pp. 78ff.

9. R. Kastenbaum & R. Aisenberg, Psychology of Death (New York: Springer, 1972), p. 9.

10. S. Freud, The Interpretation of Dreams, vol. IV in Standard Edition (London: Hogarth Press, 1964; originally published 1900), pp. 254—55.

11. R. Lapouse and M. Monk, “Fears and Worries in a Representative Sample of Children”, American Journal of Orthopsychiatry (1959) 29:803—18.

12. S. Harrison, С. Davenport, and J. McDermott, “Children’s Reactions to Bereavement,” Archives of General Psychiatry (1967) 17:593—97.

13. Anthony, Discovery of Death: M. Nagy, “The Child’s View of Death”, Journal of Genetic Psychology, (1948) 73:3—27; P. Schilder & D. Wechsler, “The Attitudes of Children toward Death,” Journal of Genetic Psychology (1934) 45:406—51; G. Koocher, “Talking with Children about Death”, American Journal of Orthopsychiatry (1974) 44:404—11; M. Macintire, C. Angle, and L. Struempler, “The Concept of Death in Mid-Western Children and Youth”, American Journal of Disease of Children (1972) 123:527—32.

14. Nagy, “Child’s View of Death”.

15. Anthony, Discovery of Death, p. 47—77.

16. Schilder and Wechsler, “Attitudes of Children”.

17. Anthony, Discovery of Death, p. 158.

18. E. Furman, A Child’s Parent Dies (New Haven, Conn.: Yale University Press, 1994), p. 5.

19. Anthony, Discovery of Death, p. 255.

20. J. Sully, cited in Anthony, Discovery of Death, p. 269.

21. J. Piaget, cited in Anthony, Discovery of Death, p. 56.

22. Anthony, Discovery of Death, p. 59.

23. Kastenbaum and Aisenberg, Psychology of Death, p. 9.

24. Kastenbaum and Aisenberg, Psychology of Death, p. 12f.

25. S. Brant, cited in Kastenbaum and Aisenberg, Psychology of Death, p. 14.

26. Kastenbaum and Aisenberg, Psychology of Death, p. 14.

27. G. Rochlin., Griefs and Discontents: The Focus of Change (Boston: Little, Brown, 1965), p. 67.

28. G. Rochlin, “How Younger Children View Death and Themselves”, in Explaining Death to Children”, ed. E. Grollman (New York: Beacon Press, 1967).

29. M. Scheler, cited in J. Choron, Death and Western Thought (New York: Collier Books, 1963), p. 17.

30. Rochlin, “How Younger Children”, p. 56.

31. Ibid., pp. 84—85.

32. M. Klein, “A Contribution to the Theory of Anxiety and Guilt”, International Journal of Psychoanalysis (1948) 29:114—23.

33. К. Eissler, The Psychiatrist and the Dying Patient (New York: International Universities Press, 1959), pp. 57—58.

34. A. Freud, “Discussion of John Bowlby’s Paper”, Psychoanalytic Study of the Child (1960) 15:53—62.

35. Furman, A Child’s Parent Dies, p. 51.

36. Anthony, Discovery of Death, p. 139.

37. Ibid., pp. 157—58.

38. A. Maurer, “Maturation of Concepts of Death”, British Journal of Medical Psychology (1964) 39:35—41.

39. M. Stern, “Pavor Nocturnis,” International Journal of Psychoanalysis (1951) 32:302.

40. R. White, “Motivation Reconsidered: The Concept of Competence”, Psychological Review (1959) 66:297—333.

41. Maurer, “Maturation”.

42. Kastenbaum and Aisenberg, Psychology of Death, p. 29.

43. Maurer, “Maturation”.

44. MacIntire, Angle, and Struempler, “The Concept of Death”.

45. I. Alexander and A. Adierstein, “Affective Responses to the Concept of Death in a Population of Children and Early Adolescents”, Journal of Genetic Psychology (1958) 93:167—77.

46. Nagy, “Child’s View of Death”.

47. S. Hostler, “The Development of the Child’s Concept of Death,” in The Child and Death, ed. O. J. Sahler (St. Louis, Mo.: C. V. Mosby, 1978), p. 9.

48. E. Jaques, “Death and the Mid-Life Crisis”, International Journal of Psychoanalysis (1968) 46:502—13.

49. J. Masserman, The Practice of Dynamic Psychiatry (Philadelphia and London: W. B. Saunders, 1955), p. 467.

50. V. Frankl, oral communication, 1974.

51. Anthony, Discovery of Death, p. 154.

52. Ibid., p. 155.

53. Schilder and Wechsler, “Attitudes of Children”.

54. Anthony, Discovery of Death, p. 155.

55. Ibid., p. 257.

56. Schilder and Wechsler, “Attitudes of Children”.

57. Nagy, “Child’s View of Death”.

58. Koocher, “Talking with Children”.

59. I. Opie, The Love and Language of School Children (Oxford: Clarendon Press, 1959).

60. Maurer, “Maturation”.

61. J. Bowlby, Attachment and Loss, vol. II: Separation (New York: Basic Books, 1973).

62. A. Jersild and F. Holmes, Children’s Fears (New York: Teachers College, Columbia University, 1935); and A. Jersild, “Studies of Children’s Fears,” in Child Behavior and Development, eds., R. Barker, J. Kounin, and H, Wright (New York, London: McGraw-Hill, 1943).

63. Bowlby, Attachment and Loss, pp. 105—18.

64. R. May, The Meaning of Anxiety (New York: W. W. Norton, 1977) pp. 105—9.

65. Ibid., pp. 107—8

66. Klein, “A Contribution”; and D. Winnicott, The Maturational Process and the Facilitating Environment (New Yolk: International Universities Press, 1965), p. 41.

67. A. Freud, “Discussion”.

68. Anthony, Discovery of Death, p. 161.

69. С. Wahl, “The Fear of Death”, in The Meaning of Death, ed. H. Feifel (New York: McGraw-Hill, 1959), pp. 214—23.

70. S. Freud, An Outline of Psycho-Analysis, vol. XXIII, in Standard Edition (London: Hogarth Press, 1964; originally published 1940), p. 185.

71. S. Rosenzweig, and D. Bray, “Sibling Death in Anamneses of Schizophrenic Patients,” Psychoanalytic Review (1942) 49:71—92; and S. Rosenzweig, “Sibling Death as a Psychological Experience with Special Reference to Schizophrenia,” Psychoanalytic Review (1943) 30:177—86.

72. Rosensweig, “Sibling Death”.

73. Ibid.

74. H. Searles, “Schizophrenia and the Inevitability of Death”, Psychiatric Quarterly (1961) 35:631—55.

75. J. Hilgard, M. Newman, and F. Fisk, “Strength of Adult Ego Following Childhood Bereavement”, American Journal of Orthopsychiatry (1960) 30:788—98.

76. Furman, A Child’s Parent Dies; Bowlby, Attachment and Loss; R. Furman, “Death and the Young Child”, Psychoanalytic Study of the Child (1964) 29:321—33; and R. Zeligs, Children’s Experience with Death (Springfield, III.: C. C. Thomas, 1974), pp. 1—49.

77. Maurer, “Maturation”.

78. Macintire, Angle, and Struempler, “The Concept of Death”; F. Brown, “Depression and Childhood Bereavement”, Journal of Mental Science (1961) 107:754—77; 1. Gregory, “Studies in Parental Deprivation in Psychiatric Patients”, American Journal of Psychiatry (1958) 115:432—42; G. Pollack, “Childhood Parent and Sibling Loss in Adult Patients”, Archives of General Psychiatry (October 1962) 7:295—305; and H. Barry and E. Lindeman, “Critical Ages for Maternal Bereavement in Psychoneuroses”, Psychosomatic Medicine (1960) 22:166—81.

79. J. Hilgard and M. Newman, “Evidence for Functional Genesis in Mental Illness: Schizophrenia, Depressive Psychoses and Psychoneurosis”, Journal of Nervous and Mental Disease (1961) 132:3—6.

80. M. Breckenridge and E. Vincent, Child Development, ed. W. B. Saunders, 4th ed. (Philadelphia, Pa.: W. B. Saunders 1960), p. 138.

81. E. Kubler-Ross, address at Stanford Medical School, May 1978.

82. S. Ferenezi, cited in Anthony, Discovery of Death, p. 157.

83. Anthony, Discovery of Death, p. 159.

84. J. Bruner, cited in H. Galen, “A Matter of Life and Death”, Young Children (August 1972) 27:351—56.

85. Galen, “A Matter of Life”.

86. Rochlin, “How Younger Children”, p. 63.