The concerns that make us human (not mentally ill)
We will all ultimately die — ourselves and those we like and love.
We are ultimately alone.
We have the freedom of choice.
Life is ultimately meaningless.
These powerful statements are from existential psychology, called the Four Concerns — a concept coined by psychiatrist, professor, and writer Irvin D. Yalom.
He believed therapy is, at its core, the work of people wrestling with these realities — mortality, isolation, freedom, and meaning — and figuring out how to respond to and reconcile them within ourselves and our lives.
Why These Concerns Matter
Most of us don’t consciously think about these truths every day. But our autopilot brain is always aware of them in the background, scanning for danger, trying to keep us safe, and sometimes creating patterns that leave us anxious, restless, or stuck.
When we slow down and shift into our thinking brain, we can notice these deeper currents and respond with more wisdom and choice.
1. Mortality — facing the reality of death
Our autopilot brain doesn’t like uncertainty — and death is the ultimate uncertainty. This often shows up as:
Feeling anxious or panicked when thinking about aging, illness, or death.
Avoiding conversations about aging, death or loss.
Over-controlling health, safety, or routines in an effort to prevent harm.
Swinging between intense fear and numbness when tragedy strikes.
Feeling a sense of urgency to “make life count,” sometimes in a pressured or restless way, like “life is slipping by.”
When we can notice these patterns and step into our thinking brain, we can let the truth of mortality guide us toward living with intention, instead of letting fear keep us stuck.
2. Isolation — the unavoidable aloneness
Even in our closest relationships, a part of us is ultimately separate. Our autopilot brain can turn that into fear — pushing us to cling, withdraw, or numb out. This might look like:
Feeling lonely even when surrounded by people in a crowded room.
A fear that no one truly understands you, or a genuine feeling that no one does, no matter how hard they try.
Struggling to form deep connections or pushing others away out of fear of rejection.
Feeling detached or disconnected from yourself or others.
Over-relying on others to escape the discomfort of being alone.
Struggling to let people truly know us.
Our thinking brain can help us recognize that while we are separate, we’re also wired for connection — and we can build relationships that are more authentic and fulfilling.
3. Freedom — the weight of choice
Choice sounds empowering, but our autopilot brain often experiences it as pressure: “What if I mess this up?” or “What if I pick wrong?” This can lead to:
Feeling paralyzed by decisions, big or small, because of the weight of responsibility.
Obsessing over making the “right” choice in the future.
Procrastinating making decisions.
Rejecting all of your options when faced with choice.
Struggling with guilt or shame when things don’t go as hoped, believing “this is all my fault.”
Avoiding decisions and letting others take the lead or handing choices over to others to avoid the weight of responsibility.
Feeling restless, like life is slipping by without your input.
Regret and rumination over past decisions that didn’t turn out the way you wanted.
Our thinking brain helps us slow down, connect with our values, and take action — even when we can’t be certain of the outcome.
4. Meaning — making sense of it all
When our autopilot brain can’t find an obvious purpose, it often jumps to despair or endless searching. That can look like:
Asking questions like, “What’s the point?” during stress or loss.
Feeling like your work, relationships, or routines lack purpose.
Jumping from project to project, relationship to relationship, or belief system to belief system searching for fulfillment.
Experiencing a sense of emptiness or hollowness, even when things look “good” on the outside.
Struggling to align your daily actions with your deeper values or sense of identity.
Feeling empty or disconnected.
Drifting through routines without a sense of “why.”
Chasing the next achievement, relationship, or distraction to feel fulfilled.
With our thinking brain online, we can begin to notice what truly matters to us and make choices that create meaning in our daily lives — even in a world without guarantees.
How do I know if I need to work on one of these?
All of us are usually somewhere on a spectrum in terms of how we are relating to these powerful existential questions and concerns.
It can help to locate where you might be at, to assess how that approach is working for you, and to consider making a shift if that makes sense for you.
Consider this exercise:
1. Pause and notice
Choose one concern — mortality, isolation, freedom, or meaning.
Read through the list below and choose the statement(s) that feel closest to your current experience.
Notice if you are judging yourself and try to surf the urge without acting on it or believing those thoughts too intensely (if that’s hard, consider this). This is about increasing awareness of where you are honestly at. Sometimes when we get critical, it is our autopilot brain trying to help us avoid something important (more about that here).
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What is your current practice or stance towards the reality that you and everyone you like and love will die:
Denying the reality of death, avoiding all conversations about aging or illness, numbing with work, worry, substances, or distractions.
Feeling terrified of death and in the face of its inevitability being paralyzed, giving up, making choices that are harmful, or obsessively controlling health or safety.
Acknowledging death in theory but trying not to think too much about it.
Allowing yourself to experience the existential terror of death and the anticipatory loss it activates, and then integrating its reality into daily life or choices.
Making these decisions and sharing them with people you trust (taken from Honoring Choices MN): What do I value most in my day-to-day life and what would I not want to live without? If I am ill and/or nearing death, what ritual, prayers, music, companionship, etc., would support me?
Deciding my beliefs about: When would I feel that my life had reached its end? When would I feel that the burdens of continued treatment(s) would outweigh the benefits? What are my thoughts about what it would mean to live well at the end of life? What are my thoughts and feelings about how and where I would like to die and what a good death would look like?
Using the reality of death to clarify values and priorities, practicing gratitude for ordinary moments, making intentional time for relationships and experiences that matter.
Accepting death as a teacher - using it to live more fully, approach others with compassion, and release perfectionism about how life “should” go.
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Where do you find yourself when it comes to allowing yourself to feel the reality that we are ultimately alone, only we can ultimately understand ourselves:
Avoiding relationships out of fear of rejection, or over-clinging to others to escape loneliness.
Seeing loneliness as a character flaw or sign that you’ve done something bad socially.
Seeking constant validation or overloading your calendar to avoid being alone.
Recognizing loneliness but feeling stuck about what to do with it.
Learning how to validate yourself when others struggle to understand or validate you (including learning how to experience that as satisfying-enough).
Building safe-enough, authentic connections, and practicing self-compassion during lonely times.
Learning to tolerate solitude and nurturing a relationship with yourself.
Seeing connection as a gift you and others can offer each other rather than demand from one another.
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Where do you find yourself when it comes to wrestling with the reality that we each can make choices:
Avoiding decisions, entirely, letting others choose for you, or blaming circumstances to avoid responsibility.
Refusing to choose because the options are less than ideal.
Making impulsive choices to relieve anxiety or endlessly second-guessing yourself.
Making practical choices without reflecting on alignment with values.
Considering your values when making decisions, practicing self-forgiveness for past choices.
Embracing freedom as an opportunity to build a life of meaning, practicing mindful decision-making, and seeing mistakes as information rather than proof of failure.
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Looking at the list below, where would you say you are in the pursuit of wrestling with meaninglessness and the need to use our freedom to bring meaning into our lives:
Resigning yourself to hopelessness or constantly numbing with distractions.
Chasing temporary fulfillment - overworking, overbuying, addictive behaviors, seeking external to fill the void.
Accepting a sense of meaninglessness but without exploring deeper values or purpose.
Clarifying what brings you a sense of purpose and weaving those things into daily life, even in small ways.
Actively creating meaning through values-driven choice, action, connection, and reflection - choosing to live in ways that align with who you want to be, regardless of uncertainty.
2. Assess the impact
Ask yourself:
“How is this way of relating working for me? What are the benefits I get from it? What might I be missing out on if I continue to stay this way”
“Is it helping me feel more grounded, connected, or at peace — or is it keeping me stuck or suffering? How so?”
Write down what you notice, even if it’s just a few words or phrases.
3. Clarify your direction
Look at the other options in the list.
Reflect:
“What would it look like to move slightly closer to another option that might be more helpful to me?”
“What small experiment could I try to explore that?”
You can also read this excellent blog and try any of the tangible exercises below the concern you’re wanting to work on (you’ll need to click the side arrow > under each concern to open the dropdown menu of exercises).
Examples:
Mortality – Telling someone you trust that you feel afraid of death and don’t know how to talk about it.
Isolation – Practicing self-validation the next time loneliness arises.
Freedom – Naming one choice you do have in a situation where you feel stuck, even if it isn’t an ideal choice.
Meaning – Set aside some time to articulate what really matters to you (great guides here and here). Or if you already know that, identify one step you can take to act according to your values.
4. Engage your thinking brain
As you take a next step, you might notice fear, shame, or resistance coming up. If that happens, try to remind yourself that this is your autopilot brain trying to protect you. You can always choose to act on its protection! And, there are costs and benefits either way. Consider asking yourself, “Why might it be worth trying something new here?”
5. Reflect and adjust
At the end of the experiment, take a moment to reflect:
“What did I notice about myself?”
“Did this step feel supportive or helpful?”
“What might I want to try next?”
“Who would I want to learn from regarding this?”
If you are able, try to practice gentleness and patience with yourself. These are huge questions, and the process of answering the questions can often be as important as the answer itself.
Welcome to the human club
Struggling with these four concerns doesn’t mean you’re broken, weak, or even that you’re depressed, anxious, or traumatized. It simply means you are fully human. These questions — about life, death, aloneness, choice, and meaning — are built into the experience of being alive.
Learning to recognize where you are with each concern, and taking small, intentional steps toward greater acceptance and alignment, isn’t about “fixing” yourself. It’s about meeting your life with more honesty, kindness, and agency — so you can create a life that you’re proud of even in the face of pain and suffering.
