Death anxiety is anxiety caused by thoughts of one's own death, and is also known as thanatophobia (fear of death). This anxiety can significantly impact various aspects of a person's life. Death anxiety is different from necrophobia, which refers to an irrational or disproportionate fear of dead bodies or of anything associated with death. Death anxiety has been found to affect people of differing Demography groups as well, such as men versus women, and married versus non-married. The sociological and psychological consensus is that death anxiety is universally present across all societies, but different cultures manifest aspects of death anxiety in differing ways and degrees.
Death anxiety is particularly prevalent in individuals who experience terminal illnesses without a medical curable treatment, such as advanced cancer.
Researchers have linked death anxiety with several mental health conditions, as it often acts as a fundamental fear that underlies many mental health disorders. Common therapies that have been used to treat death anxiety include cognitive behavioral therapy, meaning-centered therapies, and mindfulness-based approaches.
Human beings are the only living things that are truly aware of their own mortality and spend time pondering the meaning of life and death. Awareness of human mortality arose some 150,000 years ago. In that relatively short span of evolutionary time, humans have fashioned a single basic mechanism through which they deal with the existential death anxieties this awareness has evoked: denial. Denial is affected through a wide range of mental mechanisms and physical actions, many of which go unrecognized. While denial can be adaptive in limited use, excessive use is more common and is emotionally costly. Denial is the root of such diverse actions as breaking rules, violating frames and boundaries, manic celebrations, directing violence against others, attempting to gain extraordinary wealth and power, and more. These pursuits are often activated by a death-related trauma, and while they may lead to constructive actions, more often than not they lead to actions that are damaging to self and others.
The Lester attitude death scale was developed in 1966 but not published until 1991 when its validity was established. By measuring the general attitude towards death and also the inconsistencies with death attitudes, participants are scaled to their favorable value towards death.
The Death Anxiety Scale (DAS) was created in 1970 by Templer, and it is one of the most widely used tools to assess death anxiety today. The scale itself is a self-report questionnaire that contains 15 true or false items, and it is used to assess an individual's fear and anxiety related to death. It was one of the first standardized assessment tools created specifically for measuring death anxiety, and it has been used in both clinical and nonclinical populations. Although the DAS has played a big role in shaping the empirical understanding of death anxiety, it is important to note that its design reflects a more Western conceptualization of death anxiety. Thus, its cultural sensitivity and generalizability across diverse populations should be taken into account when assessing the scale's validity and reliability.
One systematic review of 21 self-report death anxiety measures found that many measures have problematic psychometric properties.
Through the evolutionary period, a basic method was created to deal with death anxiety and also as a means of dealing with bereavement. Denial is used when memories or feelings are too painful to accept and are often rejected. By maintaining that the event never happened, rather than accepting it, allows an individual more time to work through the inevitable pain. When a loved one dies in a family, denial is often implemented as a means to come to grips with the reality that the person is gone. Closer families often deal with death better than when coping individually. As society and families drift apart so does the time spent bereaving those who have died, which in turn leads to negative emotion and negativity towards death. Mothers hold greater concerns about death due to their caring role within the family. It is this common role of women that leads to greater death anxiety as it emphasize the 'importance to live' for her offspring. Although it is common knowledge that all living creatures die, many people do not accept their own mortality, preferring not to accept that death is inevitable, and that they will one day die.
According to a study of elderly men and women in a care facility, many were not as worried about what happens to their soul beyond death, but more, what challenges they would face in relation to their personal health deterioration and self esteem. It was also observed that women seem to be more concerned with others they will be leaving behind and the loss of those around them, in many cases even moreso than themselves.
Another study which compared black and white men and women over the age of 65 found that race and sex are not the greatest determiner of death anxiety in elderly age. The age of the individuals ended up being a greater predictor of death anxiety than the other two variables previously mentioned. Age was the greatest predictor in how much death anxiety women had, but not in men. This study also found that this difference in death anxiety between sexes may be caused due to the different ways men and women communicate with other people specifically about death.
Thanatophobia is not only death anxiety but can mean intense fear and feelings of overall dread in relation to one's thinking about death. Usually it relates to one's personal death, especially those with terminal illnesses who have the right to demand a humane treatment for themselves. Death anxiety can mean fear of death, fear of dying, fear of being alone, fear of the dying process, etc. Different people experience these fears in differing ways. There continues to be confusion on whether death anxiety is a fear of death itself or a fear of the process of dying.
Those who are moving towards death will undergo a series of stages. In Kubhler-Ross's book On Death and Dying (1969), she describes these stages thus: 1) denial that death is soon to come, 2) resentful feelings towards those who will yet live, 3) bargaining with the idea of dying, 4) feeling depressed due to inescapable death, and 5) acceptance.
In a study performed in 2020, researchers tested to see if psychological need-based experiences affect their death attitudes and to see if ego integrity and despair greatly play a role in these death attitudes. The need-based experiences in this research study are the feelings of autonomy, relatedness, and competence. The researchers found that if the participants' needs were satisfied, they would have higher ego integrity in relation to their attitude towards death. This allowed the participants to have an easier time accepting death. If the participants struggled to have their needs met, then they would experience higher despair in relation to death anxiety. This meant that they had more death anxiety overall.
The psychological theory can also be seen by peoples' need for survival as human beings. There are several meaning-related MMT propositions that can see how we try to meet our basic needs for survival and happiness.
The American philosopher Sidney Hook criticized Heidegger's view of death anxiety in his review of Heidegger's book Being and Time when it was translated into English in 1962. Hook noted that for Heidegger, death anxiety "is a primordial anxiety, not something that waxes and wanes with changes in nature, history or society", and the anxiety is about "the possibility that one's existence may at any moment become finally impossible". Hook argued that Heidegger's claims were wrong:
In 2017, a literature review found that in the United States, both the very religious and the not-at-all religious enjoy a lower level of death anxiety and that a reduction is common with old age.
In 2019, a study further examined the aspect of religiosity and how it relates to death and existential anxiety through the application of supernatural agency. According to this particular study, existential anxiety relates to death anxiety through a mild level of preoccupation that is experienced concerning the impact of one's own life or existence in relation to its unforeseen end. It is mentioned how supernatural agency exists independently on a different dimensional plane than the individual and, as a result, is seen as something that cannot be directly controlled. Oftentimes, supernatural agency is equated with the desires of a higher power such as God or other major cosmic forces. The inability for one to control supernatural agency triggers various psychological aspects that induce intense periods of experienced death or existential anxiety. One of the psychological effects of supernatural agency that is triggered is an increased likelihood to attribute supernatural agency toward causality when dealing with natural phenomena. Seeing how people have their own innate form of agency, the attribution of supernatural agency to human actions and decisions can be difficult. However, when it comes to natural causes and consequences where no other form of agency exists, it becomes much easier to make a supernatural attribution of causality.
A study conducted among pilgrims at the Kumbh Mela in India discovered a link between strong religious beliefs, particularly in reincarnation, and reduced death anxiety among elderly Hindus. The research found that while certain religious practices, like the Ganga snan (ritualistic bathing in the river Ganges), did not significantly affect death anxiety, a firm belief in life after death and finding meaning in life did.
His theory suggests that as an individual develops mortality salience, or becomes more aware of the inevitability of death, they will instinctively try to suppress this thought out of fear. This behavior may range from simply thinking about death to the development of severe phobias and desperate behavior. According to terror management theory, this heightened awareness of mortality can lead individuals to cling more strongly to their cultural worldviews and self-esteem as a way to defend against existential anxiety, helping them maintain their sense of meaning and value. However, studies have also found that maladaptive behaviors resulting from TMT may also be connected to other mental health conditions. Disorders such as panic disorder, obsessive-compulsive disorder, and post traumatic-stress disorder also may contribute to feelings of death anxiety.
Religiosity can play a role in death anxiety through the concept of fear. There are two major claims concerning the interplay of fear and religion: that fear motivates religious belief, and that religious belief mitigates fear. From these, Ernest Becker developed what is called "terror management theory". According to terror management theory, humans are aware of their own mortality which, in turn, produces intense existential anxiety. To cope with and ease the produced existential anxiety, humans will pursue either literal or symbolic immortality. Religion often falls under the category of literal immortality, but at times, depending on the religion, can also provide both forms of immortality. It is theorised that those who are either very low or very high in religiosity experience much lower levels of death anxiety, whereas those with a very moderate amount of religiosity experience the highest levels of death anxiety. One of the major reasons that religiosity plays such a large role in terror management theory, as well as in similar theories, is the increase in existential death anxiety that people experience. Existential death anxiety is the belief that everything ceases after death; nothing continues on in any sense. Seeing how people deeply fear such an absolute elimination of the self, they begin to gravitate toward religion which offers an escape from such a fate. In one specific meta-analysis study that was performed in 2016, it was shown that lower rates of death anxiety and general fear about dying were experienced by those who went day-to-day living their religion and abiding by its practices, compared to those who merely label themselves as members of a given religion, without living according to its doctrines and prescribed practices.
A 2009 study with 135 participants on death anxiety in the context of religion showed that Christians scored lower for death anxiety than non-religious individuals, which supports the main tenets of terror management theory, that people pursue religion to avoid anxiety about death by finding comfort in the ideas about afterlife and immortality. Interestingly, the study also found that Muslims scored much higher than Christians and non-religious individuals for death anxiety. This finding is however not significant, because only 18 of the participants identified as Muslim. These findings do not support terror management theory, as the belief in an afterlife caused more anxiety for the Muslim participants than those with no belief in an afterlife. There is a need for further examination into TMT in the context of different religions/sects as well as the impact of varying beliefs about the afterlife on levels of death anxiety.
People who are exposed to those who are near death or who have already died seem to have a paradigm shift in their way of thinking about death.
A more recent longitudinal study asked cancer patients at different stages to fill out different questionnaires in order to rate their levels of death acceptance, general Anxiety disorder, demoralization, etc. The same surveys administered to the same people one year later showed that higher levels of death acceptance could predict lower levels of death anxiety in the participants.
Attitudes towards life and death have been shown to impact cancer patient's understanding of death anxiety. For example, higher spiritual well-being has been found to help reduce death anxiety. Research has found five key themes surrounding perceptions of life and death in cancer patients: despair, making sense of death, how to live the rest of life, special feelings for loved ones, and fluctuation. These themes impact how these patients grapple with death on their own terms. The first theme, despair, concerned the patient's fear of death. For making sense of death, this involved the various interpretations patients had for death such as death as liberation or their own responsibility. The third theme on how to live coincided with what it means to the patient to have a dignified death. Special feelings for loved ones involved patient reports that they were questioning their worth to their families. The last theme, fluctuation, was found in patient reports that they felt contradictory feelings about their life and potential death.
Studies have found that end-of-life stage cancer patients highly valued their dignity in relation to both life and death. However, many patients also expressed that they worried that they were a burden to their families. These patients consider a dignified death to be one that allows them full autonomy (if possible) and respect. Cancer patients in Eastern and Western countries both saw their ability to give something of importance to others as an essential part of living a dignified life.
Death anxiety has been correlated with anxiety disorders, specifically through mortality salience. Mortality salience is the awareness of one's death being inevitable, and it has been found to have an effect on anxiety levels, which suggests that an individual's anxiety may increase when they are reminded of their mortality. Reminders of death have also been found to have a medium to large effect on anxiety levels, revealing how death anxiety may play a role in intensifying existing anxiety symptoms, and developing new ones as well. Further, individuals with panic disorder have been shown to exhibit higher death anxiety compared to those with depression or other anxiety disorders, because it can be particularly pronounced during panic attacks.
Death anxiety has also been researched within the context of Suicide. Individuals with high death anxiety have been found to fear death while also engaging in suicidal behavior, which has been described as a paradoxical effect. This effect has been linked to a lower suicide intent when death anxiety is high.
These findings highlight the need for specialized fields such as psycho-oncology, in order to understand how death anxiety should be treated in association with distress and symptoms alongside other mental illnesses and medical issues. This way, a more comprehensive approach can be offered so that individuals struggling with death anxiety can receive care that addresses the full scope of their psychological health concerns.
In individuals with advanced cancer in which there is often no curable medical treatment, care for death anxiety also involves a combination of therapeutic approaches in order to address both the psychological and existential distress associated with dying. For instance, dignity therapy focuses on helping terminally ill patients find a sense of purpose and meaning in their lives, by enhancing their sense of self-worth and dignity as they approach the end of life. This intervention can alleviate existential suffering by allowing patients to reflect on their lives, highlight their important memories, tell life stories to their loved ones. Meaning-Centered Group Psychotherapy is another treatment option for terminally ill patients, and it focuses on spiritually searching for meaning within death. Additionally, Cancer and Living Meaningfully psychotherapy, a brief and individualized intervention, allows patients to feel a sense of control over the idea of death which can reduce distress. All of these interventions offer ways to help patients with terminal illnesses come to terms with the complex idea of death, and find peace as they near the end of life. However, it is important to note that patients' cultures should also be taken into account when being treated, as their death anxiety type may vary based on their cultural background.
In a review of international law, there have been arguments made that support the idea of death row being a violation of human rights. In the past, executions have occurred hours or days after a sentence to death was received. However, in the United States, it can take up to, or more than, 10 years for a prisoner to see their day of execution. This time is spent in an area of a prison known as death row, where inmates are typically in their cells for up to 23 hours each day and have limited interaction with others. This, combined with the extensive time they wait for their day of execution, might correlate with the symptoms of psychological and physical deterioration increasing among those imprisoned on death row.
According to the attachment theory, people exhibit different attachment patterns. Several studies have found that individuals who are more anxious about death tend to have less secure attachment styles. Insecure attachment styles are characterized by a fear of abandonment and a lack of trust in others, which can make it difficult for individuals to form close, supportive relationships. These individuals may also have difficulty coping with the idea of death, as they may feel a lack of support and security in their relationships.
On the other hand, individuals who have more secure attachment styles tend to have lower levels of death anxiety. This may be because they feel more supported and connected to others, which can provide a sense of comfort and security when dealing with the idea of death.Beggs, J. R. The relationship between adult attachment style and death anxiety as related to a romantic partner. Dissertation Abstracts International: Section B: The Sciences and Engineering, 5231.
There is evidence that suggests increasing one's social curiosity, which plays a role in interpersonal relations, can reduce and subdue death anxiety. In the context of particular study, social curiosity and its tendency to foster social connection and relatedness with others acts as a form of symbolic immortality. Symbolic immortality is a conceptual model that can help reduce the fear of death.
A study of 90 children, aged 4–8, done by Virginia Slaughter and Maya Griffiths showed that a more mature understanding of the biological concept of death was correlated to a decreased fear of death. This may suggest that it is helpful to teach children about death (in a biological sense), in order to alleviate the fear.
Measuring death anxiety
Sex
Age and sex
Personal meanings of death
Psychological theories
Thanatophobia
Wisdom: ego integrity vs. despair
Meaning-management theory
Philosophical theories
Heidegger's being-for-death
Existential theories
Other theories
Death anxiety and culture
Religiosity and death anxiety
Terror management theory and religion
Health and death anxiety
Death acceptance and death anxiety
Death anxiety experienced by cancer patients
Death anxiety and mental illness symptoms
Death anxiety amongst patient caregivers
Death anxiety and COVID-19
Treatment
Death row phenomenon
Relationship to adult attachment
Children
See also
Bibliography
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