Psychological Death: An Adaptive Response to Life-Threatening Illness

A 50-year-old man with documented multiple myeloma of two years duration was admitted to a psychiatric ward with the complaint of “being dead.” Discussion of the development of his complaints illustrates important issues, an understanding of which may be helpful in providing optimal care of any patient with a life-threatening illness. “Being dead” had significant individual symbolic meanings which developed from the patient's past and current conflicts and from his perceptions of changes in his body image resulting from the disease process. “Being dead” furthermore was a statement of the reflected appraisal of environmental neglect and in this context was closely related to “voodoo death.” Psychological “self-destruction” through “being dead” served to communicate anger and evoke guilt in the interpersonal environment while at the same time adaptively evoking reassurance, increased interpersonal contact, concern and amelioration of loneliness and alienation. Psychological “death” and “rebirth” also represented a quest for immortality; and complaints, through their potential to evoke humor, seemed an ironic mockery of death. In the context of a life-threatening illness, recognition and appreciation of many psychological phenomena as adaptive are necessary in order to aid both the patient and the care-giving environment to achieve a reasonable level of adaptation in the face of death.