The company you're building can't give you what you want most from it: immortality. And confronting that jarring truth--before you're forced to--can yield surprising insights

I've been having a terrible dream," my patient F. began. I'd noticed that he looked tired when he entered my office. "I'm moving through an old mansion--dusty, with broken windowpanes, paper peeling from the walls, cobwebs gathering in corners. There is a Frankenstein monster chasing me. I hear it, sometimes see it. I turn and fight, beating, kicking, throwing it from the third-floor window. But it's unstoppable. It reappears instantly and comes after me each time."

"Tell me about this monster," I suggested when he paused.

"I know him," F. answered. "An old enemy. He came into my dreams when I was 10, the night after my father's funeral. He haunted me for months and then disappeared. Now, 50 years later, he's back."

"Any thoughts about the old house?" I asked.

"Sure. I've got a hundred thousand miles on me, too," he responded without hesitation.

The meaning of the dream seemed clear: the monster was a personification of death, the deteriorating house a symbol of his own hundred-thousand-mile-old body. He had recently learned that his wife's breast cancer had metastasized and was no longer treatable. Surely, her imminent death--like the death of his father, years before--had forced him to confront his own mortality.

Usually calm and collected, F. looked uncomfortable, shifting nervously in his seat. This was, I thought, a fine time to get down to work. Clearly, he was entering what psychotherapists call a "boundary experience," a jarring, unexpected encounter with the inevitability of his own death. One way or another, it happens to all of us: we're going about our everyday business when suddenly a wall comes tumbling down, and in stomps the specter of death, wielding its arsenal of anxiety and panic.

My eagerness to treat F. stems from a crucial, perhaps surprising, axiom of my therapeutic approach: Although disturbing, "boundary experiences" can serve as wake-up calls. What I saw in F.'s near panic was a chance for him to review the way he had been living, even to reprioritize the values that had guided his life.

Boundary experiences can in fact help us grow, assuming we use them to understand the intricate psychological defenses we've constructed to shield ourselves from death anxiety--and, perhaps, to recognize the price we've paid to protect ourselves. Without even noticing it, we've all spent great amounts of energy protecting ourselves from the terror of death since childhood, when we first became aware of things dying around us: a pet hamster, autumn leaves. Back then, adults conspired to quell our fears, promising us that Aunt Jane was away on a long trip or that we would someday hug our puppy again in an ultimate celestial reunion. We eventually managed to repress the anxiety, forcing it into our unconscious, where it remains, covered over but unvanquished. It makes its presence felt in many ways, the most spectacular of which are nightmares, bursting forth with all the strength of that original terror.

For adults there is no easy balm to apply when these fears resurface; nor is it simple to anticipate their arrival, since the catalyst that ignites them is not always readily apparent. Boundary experiences come cloaked in many guises, from the extreme--a near-death encounter--to such commonplace markers of time and change as realizing that the company you worked so hard to create now operates just fine without you, or having a longtime colleague leave the office. While the exact crystallizing event may differ for each of us, its effects are remarkably universal: stopped cold, we are forced to take the measure of an anxiety that may have last surfaced strongly during adolescence, when we openly mocked mortality through acts of recklessness.

After adolescence, death anxiety gets buried--conveniently--beneath the avalanche of adulthood's defining tasks: forging a career, finding a mate, perhaps building a nest and a family. We stop neither to smell the roses nor to ponder the nightmares.

Our work, in particular, becomes a central preoccupation, consuming enormous amounts of energy. That's true for a number of self-evident reasons--we must survive economically, provide stability for our families, make a positive impact in our world, and answer to myriad internal impulses such as our own ambition and hunger for control. But our massive investment in work also ensures that we have neither the time nor the inclination to face our deepest fears. Success at work may even combat those fears directly, making us feel less threatened by our finiteness. We build our enterprises bigger and bigger, as if building a bulwark against an unspoken enemy.

As we struggle away, the death anxiety remains, lurking. Once it finds its chance to erupt, it can prompt a reevaluation of the meaning of our existence, often labeled--sometimes trivialized--as the "midlife crisis." Suddenly, we see through the illusion and are left with the bare fact of our mortality. We then begin to panic--wondering why we've devoted ourselves to such evanescent projects.

I've had a number of such moments myself, including a haunting realization that struck me when I would least have expected it: during a relaxing Caribbean-resort vacation. I was reading one night, sipping a drink and occasionally glancing up at the bar boy, who wasn't doing anything other than staring languidly out to sea--much like a lizard sunning on a rock, I thought. The comparison I made between the two of us made me feel very smug--he was simply wasting time while I was being productive, learning, getting ahead. And then some internal imp spoke up: Getting ahead of what? And why? Terrible, unanswerable questions. Over the next days I began to see how I had lulled myself into a death-defeating delusion by continually projecting myself into the future, toward progress and success.

What then? How do we respond to these emerging crises? Many people try to combat aging by spending long hours at the gym, by finding new, generally younger mates. Men in particular may embrace medication to enhance potency or take to fathering children at advanced ages. Others buy products associated with youth and adventure--muscle cars, rock-and-roll albums, sea kayaks.

Others question, and perhaps change, their careers--selling their stake in their company or starting a new business. For many that is a wonderful choice, a genuine, fruitful step toward self-realization. For others it is a false step, taken because they mistakenly blame their jobs for their crisis, believing that if only they'd chosen another occupational path, they would not feel so empty at this point in their lives.

Some people can become so consumed with work that it takes on an exaggerated importance. Think, for example, of the CEO who makes a fortune by the age of 40. Why does he or she continue to work exhausting 60-hour weeks after banking the first $30 million? Certainly, there are some tangible, real-world rewards--to be seen as successful just feels good, and power can be enjoyable. But there are also elements of self-defense at play here, as if a bigger bankbook or a more impressive headquarters would overturn our sentence of finiteness. For many entrepreneurs, the drive to create lasting institutions is a sort of futile attempt at immortality.

There are costs to this death denial: if we are too fanatically one-sided in our attempts to deny mortality, we lose our sense of humor and wonder. As in my Caribbean experience, even taking time off can become a chore and a potential existential minefield.

So I saw in F.'s emerging anxiety an opportunity to confront the essential truth of his mortality. Together we would begin to explore his fear from a calm, reflective stance. We would attempt to learn from it, learn to understand it, and approach it by removing, rather than constructing, elaborate defenses. I didn't yet know exactly what our work would entail, but I hoped, above all, that it would mean embracing self-discovery, rather than the self-deception we all so easily perpetuate.

Irvin D. Yalom, M.D., the author of the novels Lying on the Couch and When Nietzsche Wept, is a professor of psychiatry at Stanford University. Ben Yalom, a San Francisco-based writer, is working on a book about remarkable individuals and their mentors.