Yalom's Four Ultimate Concerns

Irwin D. Yalom, in his 1980 book "Existential Psychotherapy", argued that the root of all psychological stress is induced by one or more of four ultimate concerns: death, freedom, isolation, and meaninglessness. The individual's confrontation with each one of these concerns constitutes the content of their existential dynamic conflict, and the resolution (or lack thereof) of these concerns will dictate how satisfied a person is in life.

  1. Death.

This is the most obvious and the most easily apprehended ultimate concern. We exist now, but one day we won’t. It is a truth we so often respond to with mortal terror, and that is where our first core existential conflict manifests: the tension between the keen awareness of the inevitability of death and the ongoing wish to survive longer.

  1. Freedom.

This is a far less accessible concern. Ordinarily, we think of freedom as an unequivocally positive concept. Throughout recorded history, human beings have both yearned and striven for freedom more than any other thing. It is far and beyond the most celebrated part of life. Yet freedom viewed from the perspective of ultimate ground is riveted to dread. In its existential sense, freedom refers to the absence of external structure. Contrary to everyday experience, the human being does not enter and leave a well-structured universe that has an inherent design. Rather, the individual is entirely responsible for their own world, life design, choices, and actions. In this sense, freedom has a terrifying implication: it means that beneath us there is nothing but a void. A key existential dynamic, then, is the clash between our confrontation with the abyss and our wish for ground and structure.

  1. Isolation.

This concern does not refer to interpersonal isolation with its attendant loneliness, or intrapersonal isolation (from parts of oneself), but rather to fundamental isolation from both creatures and from the world. No matter how close each of us becomes to another, there remains a final, unbridgeable gap; each of us enters existence alone and must depart from it alone. The existential conflict is thus the tension between the awareness of our absolute isolation and our wish for intimacy, contact, protection, and community. How can we become part of a larger whole?

  1. Meaninglessness.

This concern encapsulates its predecessors and subsequently asks: “So then what’s the point?” If we must die, if we constitute our own world if each is ultimately alone in an indifferent universe, then what meaning does life have? Why do we live? How shall we live? If life is not predetermined, and we each do contain within us a free will, then each of us must construct and assign our own meanings to life. Yet can a "meaning" of one's own creation be sturdy enough to bear one's life? This existential dynamic conflict stems from the dilemma of a meaning-seeking creature who is thrown into a universe that has no meaning. It’s paradoxical, it’s frustrating, and it’s perhaps the most important question one can ask themselves.

Thus, "Existential psychodynamics" refers to these four givens and, subsequently, to both the conscious/unconscious fears and motives created by each of them. The dynamic existential approach retains the basic dynamic structure outlined by Freud but radically alters the content. The old formula of DRIVE → ANXIETY → DEFENSE MECHANISM replaces "DRIVE" with "AWARENESS OF ULTIMATE CONCERN", suggesting that this acute awareness is the source of all motivation, anxiety, and behavior in our lives.

What do you think? Are we driven by the awareness of Yalom's ultimate concerns? Are there concerns that exist outside Yalom's four? Can we go deeper and explore what else lies within each ultimate concern? And lastly, how does each concern manifest in the daily anxieties we experience in today's fast-paced world?


  1. Yalom, Irvin D. (1980). Existential Psychotherapy. United States: Basic Books.