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Paediatricians have less work with acute and life-threatening situations but they see an ever increasing number of patients suffering from psychosomatic disturbances and from adjustment and behaviour problems. Physicians have more people in their waiting rooms with emotional problems than they have ever had before, but they also have more elderly patients who not only try to live with their decreased physical abilities and their limitations but who also face loneliness and isolation with all its pains and anguish. The majority of these people are not seen by a psychiatrist. Their needs have to be elicited and gratified by other professional people, for instance, chaplains and social workers. It is for them that I am trying to outline the changes that have taken place in the last few decades, changes that are ultimately responsible for an increased fear of death through unfamiliarity, the rising number of emotional problems, and the greater need for understanding of and coping with the problems of death and dying. When we look back in time and study former cultures and peoples, we are impressed that death has always been distasteful to man and will probably always be. To a psychiatrist this is very understandable and can perhaps best be explained in terms of our understanding of the unconscious parts of the self; to the unconscious mind, death is never possible in regard to ourselves. It is inconceivable for our unconscious to imagine an actual ending of our own life here on earth, and if this life of ours has to end, the ending is always attributed to a malicious intervention from the outside by someone else. In simple terms, in our unconscious mind we can only be killed; it is inconceivable to die of 1 a natural cause or of old age. Therefore death in itself is associated with a bad act, a frightening happening, something that in itself calls for retribution and punishment. One is wise to remember these fundamental facts because they are essential in understanding some of the most important, but otherwise unintelligible, communications of our patients. The second fact that we have to comprehend is that in our unconscious mind we cannot distinguish between a wish and a deed. We can all recall illogical dreams in which two completely opposite statements occur side by side-very acceptable in our dreams but unthinkable in our waking state.

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