Death and the Self

Heinz Kohut lived his last decade in the shadow of death. In the summer of 1971, at 58 years of age, just after the huge triumph of the publication of The Analysis of the Self, his doctor discovered in a routine medical examination that he had an enlarged spleen. Kohut decided, somewhat fatalistically, to delay further diagnostic testing and take his vacation as usual that summer in Carmel, California, though he talked morosely at times about it as his last. When he returned to Chicago in September, he went in for tests and was diagnosed as having lymphoma (or lymphatic cancer), which is similar to, but not the same disease as, leukemia. ¹ The cancer never really went into remission but spread slowly and seemed largely under control until the middle of 1977. ² In those first six years of cancer, Kohut’s most serious complaint was it affected his immune system and he often got colds and flus. The worsening of his disease from 1977 on, however, ground him down in general and resulted in the need for more aggressive treatment. First, the doctors tried a round of chemotherapy in the summer of 1977, which gave him a sore throat, aching feelings, pain on the top of his eyeballs, and a mounting fever. Needless to say, the drugs were discontinued within two months. ³ A year later, in the fall of 1978, he received some radiation treatment for which he had to prepare by having weekly blood tests. ⁴ Then came a relentless series of shocks. On January 12, 1979, Kohut had double by-pass heart surgery, which was followed by serious complications (and more surgery) that spring from which he almost died. ⁵ Just as he was recovering, he developed inner ear trouble that was to recur periodically over the next year. ⁶ Meanwhile, his cancer spread relentlessly. It had not responded to the chemotherapy or radiation, nor had his heart surgery jolted it into remission, something that occasionally happens and which he had hoped would occur in his case. ⁷ In the late fall of 1980, within days of returning from the Boston Self Psychology conference, he again almost died from type 3 pneumonia in both lobes that required two full months of convalescence. ⁸ In the last couple of years, Kohut also got increasingly weak and began seriously to lose weight. By the summer of 1981 he was bone-thin and down from his customary 128 pounds to 100 pounds. He developed edema, or severe swelling throughout his body, for his heart was simply unable to push things around any more. When he died on October 8, 1981, some 20 percent of his weight was in the form of cancer tumors spread throughout his body. ⁹