Now that I'm more attuned to altruism and the deep object of death several instances of it appear very much on the surface of my patients.
In comparison, striving for perfection or feeling oneself to be perfect (high self-regard/low ego ideal) is also very much on the surface with egoists.
With altruists there is often death apparent in the absence of others or them "not being there" even when physically present. For example, a woman meets men who disappear on her. (Freud compared going on a journey to death in the Interpretation of Dreams). Many complain about having a boyfriend who treats them badly and who they ask about his feelings or about his future plans and he gives them no response (he isn't there). They are afraid to demand an answer.
In a previous post I shared a song about the opposite of this "the fade away" in which it is the altruist who disappears on the person they were with for fear of turning the person down. They just ignore phone calls and texts and "fade out of existence" for the person.
I've also written about victimization or spousal abuse as sometimes being traceable to the repetition of the primal scene in which one takes the place of the abused, injured, or humiliated mother.
In comparison to egoism, the death of the other becomes related to the death of oneself in the deutero stage just as perfection becomes part of oneself. In this case, the death or loss of one's consciousness becomes the central idea. Wanting to sleep all the time, over-eating and dimming consciousness this way, losing oneself in work or scattering oneself with several different projects and things to do or people to help, etc.
This is all still very rough, but something fell into place for me and I thought others might be interested to read it even though it is roughly patched together.