Salman Akhtar, MD, was born in India and completed his medical and psychiatric education there. Upon arriving in the USA in 1973, he repeated his psychiatric training at the University of Virginia School of Medicine, and then obtained psychoanalytic training from the Philadelphia Psychoanalytic Institute. Currently, he is Professor of Psychiatry at Jefferson Medical College and a training and supervising analyst at the Psychoanalytic Center of Philadelphia. He has authored, edited, or co-edited more than 300 publications including books on psychiatry, psychoanalysis, and several collections of poetry. He is also a Scholar-in-Residence at the Inter-Act Theatre Company in Philadelphia. Salman Akhtar received the Sigourney Award in 2012.

What is the general overview of your journey with death and meaning making?

I was born in India, in 1946. India was still a British colony. It became independent in 1947 when I was 13 months old. But the effect of the colonization remained very strong for a long time and therefore, that generation of people who were born around that time were vulnerable to immigration. Follow the white master, so to speak, that’s what the great novelist Salman Rushdie said. So, people born around that time were under the hangover of British colonialism and vulnerable to immigration. By the time I was 10 years old, I had encountered the death of four different people. It sensitized me prematurely to death, to funerals, to graves, to dying, to fantasies about what happens after death, and so on and so forth, as a little child, pre-college, pre-medical school pre-psychiatry, pre-psychoanalysis. So, these thoughts were in my head from the beginning because I was exposed to four very beloved people’s deaths.

A serendipitous incident happened, which led me to find psychiatry, and I realized in psychiatry, I can realize both my interests: I could realize my medical desire to save all the dying people in the family, and I could become a writer like my mother and father. Psychiatry is, essentially, with minor exceptions, a field of stories, a medical field of stories.

How is religion viewed in the context of psychoanalysis? Does it serve to help with death anxiety in your view? Or is it another way to deny death?

In psychoanalysis, the situation was very messed up. What happened was that Freud claimed to be a vocal, vehement atheist, and wrote an important book, a small book, 59 pages, called The Future of an Illusion, suggesting that the need to believe in God was a neurotic need of human beings to find a parent-like figure who’s omniscient and omnipotent. That was his official public position. But in his private letters to friends and to everybody he’s writing, “Due to the mercy of Lord, I’ve gotten admitted in medical school.” “Due to the divine intervention, Martha has fallen in love with me,” instantly thanking God for every little thing. The reason this mess up happened was the following. Freud was born in a Jewish family. But when he was a little boy, his mother gave birth to six other children, and his care was relegated to a Catholic nursemaid who would take him to the church every day. The Catholic nurse was fired later, and the Catholic nurse went and with that went the memory of religion and music. So, Freud started hitting two things, music and religion. For an extremely cultured and widely read man, and sophisticated man, this disgust for music was shocking. Music and religion went away. Why? Because they were reminiscent of the loss of his beloved nursemaid.

So, for a while, people became lock, stock, and barrel identified with Freud and started thinking anybody who believes in your religion is neurotic, and religion is bullsh*t. And everybody who believes in God is neurotic, that position remained for 50-60 years. Now, cracks are showing in that. Why? Because Christian people came into the field, because Muslim people came into the field, because Hindu people came into the field. And the Jewish hegemony of psychoanalysis broke. With that, people in Japan, China, Korea, are writing and reading psychoanalysis. I think a bunch of them still believe that being religious is neurotic, and religion is crazy. I think that depending upon what function religion is serving, if it is making you humble, kind, generous, contemplative, helpful to people, respectful, accepting, and forgiving, then it’s a mentally healthy thing. If it is making you feel that your religion is better than everybody else’s religion, and other people’s religions are bad and they should be killed, then it’s a sick religion.

I will hear a knock on the door. I’m waiting for that knock…And somebody who has come to take me and that I promised to meet is not an intruder, but it is an integral part of my daily schedule, my life schedule.

Do you think that religion itself is irrelevant, and what matters the most is the ability to accept death?

The problem with Freud’s psychoanalytic view of death is that death began to be seen as a trauma, as a bad thing, as an intruder upon life, as something alien, foreign, and something undesirable. And therefore, if it’s a foreign and undesirable and intrusive and disruptive thing, then of course, we should be nervous. If you and I are talking and somebody started banging on my door or your door you will be annoyed. We are not expecting anybody. So, if you’re not expecting anybody, if you consider death an intruder, an outsider alien force that is disrupting your life, of course, you must be annoyed, and hurt and angry and frightened. On the other hand, if your view is that, 12 years from now, I will hear a knock on the door and I’m waiting for that knock, then I’m expecting it as a welcome guest. And somebody who has come to take me and that I promised to meet is not an intruder, but it is an integral part of my daily schedule, my life schedule.

Of course, I think anybody who has loved, been loved, or done some very good piece of work that they have enjoyed, then they’re never afraid of death. There’s no reason to be afraid of death. That is not apart from life. It is a part of life. Not apart.

There are two lines in Urdu you don’t know but I’ll recite it and translate and you will see the beauty of it. The first means the warmth of the sun has a didactic value for the dewdrop because the sun teaches the dewdrop how to disappear. Second line: I do exist, till a kind glance will fall upon me like dew disappears from sun. The warmth of the sun has a didactic value towards a dewdrop in the art of disappearance, and I too exist till a kind glance will fall upon me.

Are you religious yourself?

No, no, no. And yes. Do you see? I believe that the question “does God exist?” or “does God not exist?” is a wrong question. The issue is not what is the right answer? The question is wrong, because it makes it appear as if God is like this pen – does this pen exist or does this pen not exist, we can prove it. The question does God exist or does God not exist is not in this register of reality. We cannot prove God exists. We cannot prove God doesn’t exist. It is not a matter of proof. It’s a matter of faith.

What would you say to someone who is not religious but struggling with a lot of death anxiety?

I would say that one has to distinguish between fear of death versus fear of disease and infirmity. Most people when they describe fear of death, they’re talking actually of infirmity. That they will not be able to walk, talk, move, blah, blah, right? That’s infirmity that’s not death that’s life. Be afraid of life. Life is more scary than death. Second, death when? 27 is lamentable, and very sad. Very upsetting.

It shouldn’t happen that way. But at 89?

There’s also confusion in psychoanalytic literature of mature death versus premature death. That must be delinked. Dealing with premature death versus mature death. Thirdly, death in the setting of an unsatisfied life, and death in the setting of a satisfied life. You go to a restaurant, you’re eating food. The waiter takes your plate away while you’re eating. You’ll be upset. But you go to the restaurant, you eat food and there comes a time you say to the waiter, “take the plate.” And the waiter takes the plate.