On Existentialism

Core Existential Dilemmas

In existential psychotherapy, psychiatrist Irvin D. Yalom identified four "ultimate concerns". Inescapable truths of the human condition that, when confronted, evoke deep anxiety but also offer the potential for growth. These dilemmas are rooted in the work of existential philosophers such as Heidegger, Kierkegaard, Sartre, Camus, Frankl, and others who grappled with what it means to be human in an uncertain, often absurd world.

1. Death

The awareness of our mortality and the fact that life is finite creates a foundational tension. As Heidegger put it, we are “beings-toward-death,” and to live authentically means confronting that reality. Kierkegaard saw death anxiety as part of becoming a self. In therapy, this fear often emerges as avoidance, urgency, or an underlying sense of dread.

2. Meaninglessness

If the universe offers no inherent meaning, how do we create purpose? Sartre and Camus explored this existential void, with Camus famously calling life absurd. Viktor Frankl responded to this by emphasizing the human capacity to create meaning, even amidst profound suffering. In therapy, this concern may appear as depression, apathy, or spiritual questioning.

3. Isolation

Existential isolation refers not just to being alone, but to the unbridgeable gap between self and other. Rollo May and Martin Buber spoke to this tension between the desire for connection and the fundamental aloneness of the human experience. In the clinical space, this might show up as relational struggles, chronic loneliness, or difficulty feeling understood.

4. Freedom (and Responsibility)

To be free is to bear the burden of choice. Sartre called this “condemned to be free,” meaning we can’t escape the responsibility of shaping our lives. Freedom brings possibility, but also anxiety, regret, and self-doubt. This may show up in therapy around indecision, avoidance, or fear of change.