Anxiety About Death

• Introduction

The finality of death can be daunting for many people and often hampers conversations about death. While it is natural to be afraid of death and for individuals to take measures to avoid it, people might, at times, express an irrational fear of death, which borders on anxiety. The fear might be twofold: the fear of death itself or the fear of the dying process. Such fear can significantly lower a person’s quality of life, as they remain preoccupied with anxious feelings. Thanatophobia is a term that refers to the excessive fear of death and can even manifest in physical symptoms such as choking, hyperventilation, or nervous breakdowns (Gossman et al., 2017). People might fear dying themselves or have anxiety about someone else’s death, such as a loved one, close acquaintance, or someone they value. Understanding death anxiety causes is a crucial step in helping persons manage such irrational fears surrounding death.

Death anxiety is a fairly common phenomenon across various populations. However, its prevalence among some populations is worrying because of its ability to diminish a person’s quality of life. For instance, among older adults, death anxiety can prevent them from appreciating the time they still have, instead, choosing to fixate on their impending death. There is little literature on the widespread prevalence of death anxiety across different populations. Misler et al. (2012) report that 57% of older adults and 60% of persons with chronic illness, based on the results of a study with 122 participants. Although this is a small sample size, the results demonstrate a high prevalence of death anxiety among some groups of people. Due to its deleterious effects, there is a need for more research to determine the actual incidence of thanatophobia, its effects, and how best to manage it.

Causes of Death Anxiety

Religious beliefs often shape people’s attitudes surrounding death and are a possible target when minimizing death anxiety. Many people understand death from a spiritual perspective, with such concepts as the soul, spirit, heaven, afterlife, heaven, and hell is common among many different communities (Jong et al., 2017). Among people who profess prominent religions, the concept of an afterlife has a significant impact on their perception of death. People believe that their actions can determine their souls or spirits' fate after they die (Jackson et al., 2017). As such, religious beliefs can produce anxiety about death since people are worried that their actions might cause an unfortunate fate for their souls in the afterlife. On the other hand, some beliefs within these religions might cause people to experience decreased anxiety about death when they feel that they have lived a fulfilled life and are more accepting of the finality of death (Mehri Nejad et al., 2017). Nonetheless, highly religious people are more likely to be anxious about death than their less religious counterparts, although extreme religious beliefs can lead to unhealthy anticipation and desire for death (Jong et al., 2017). Religion and spirituality can either increase a person’s anxiety about death or help them develop a healthy appreciation for its finality.

Death anxiety tends to decline across the lifespan of individuals. It is easy to assume that young people might be less concerned about death than their older counterparts since they still have their whole lives ahead of them. However, numerous studies have demonstrated that younger people are more anxious about death than older people (Chopik, 2017). In young people, the understanding of death and the finality of death is usually diminished, as they are still learning more about what it means to pass and its impact on society. Additionally, young people tend to always be in denial about the aging process, failing to accept that they too will be old and eventually die (Zhang et al., 2017). It is also possible that death in young people would be more negatively impactful, with concerns about their offspring and a person’s welfare within their social circles (Chopik, 2017). On the other hand, older people usually have experienced more death over their lifetime than their younger counterparts, allowing them to amass more information about the dying process and death itself (Zhang et al., 2019). Also, older people tend to have a sense of limited time and become more present-oriented in their intentions and actions, unlike younger people who are more future-oriented.

Gender also plays a vital role in the development of death anxiety. Women tend to be more anxious about death than men. This disparity in thanatophobia is multifactorial for a wide range of reasons. First, women are more likely to express strong religious beliefs than men (Sinoff, 2017). As discussed earlier, religiosity directly correlates to anxiety about death, and since women are often more religious than men, they might be more anxious about death. From an evolutionary perspective, women’s increased fear of death is an adaptive response to ensure the species' survival. Female parents are more actively involved in raising their offspring than male parents, so a mother’s death would be more impactful for the child than that of a father, diminishing their survival chances (Sharma et al., 2019). As such, evolution selects this trait in women, causing them to express heightened anxiety and implement more robust measures to avoid death than their male counterparts. This difference likely explains why women are more rational and risk-averse than their male counterparts. It is also worth noting that anxiety disorders generally occur with more frequency among females than males. This statistical difference likely extends to anxiety surrounding death.

Health status and social support systems can also impact a person’s fear of death. Physically healthy people tend to express lower levels of anxiety than those who are ill. This difference is especially apparent in people with chronic illnesses such as cancer and neurodegenerative disorders. However, the fear of death fluctuates as chronic illnesses progress, with earlier stages producing more anxiety than later stages. In such circumstances, the critical determinants of achievement are accepting death’s finality and fear of the dying process (Grossman et al., 2017). It is natural to fear pain and to avoid all experiences which inflict pain. However, in chronic illnesses like cancer, patients are trapped with their pain and are usually unable to control it. Additionally, numerous medical procedures like surgeries to remove tumors, induce great pain in patients, and expose them to a greater risk of dying (Grossman et al., 2017). In such persons, death anxiety is usually initially elevated. However, as with any other loss, acceptance finally kicks in, and anxiety levels decline. Overall, people with poor health are more anxious about death than healthy people.

Measuring Death Anxiety

Researchers often employ a wide range of tools to measure death anxiety among research participants. These scales can also provide a clear picture of a person’s anxiety about either the process of dying or dying itself. Some of the most reliable scales are the Death Anxiety Scale and the unnamed scale designed by Nelson and Nelson (1975). The Death Anxiety Scale requires subjects to answer a series of questions in a questionnaire, whose answers are then used to determine their level of anxiety about death or the process of dying. Nelson and Nelson’s (1975) death anxiety scale majors on four factors: death avoidance, death denial, death fear, and reluctance to interact with those dying. Both of these scales can reliably determine a person’s anxiety surrounding death. However, these scales are modifiable to compensate for various variables that significantly contribute to people developing thanatophobia. For instance, the prevalence and patterns of death anxiety in the Middle East greatly differ from those of people in the United States, necessitating the creation of death anxiety scales suitable for each population.

Despite the wide variability and dynamicity of death anxiety scales, they all rely on the same fundamental principles and investigate similar entities. Several attributes are most common in death anxiety scales. The first is the emotion accompanying the disappearance that accompanies death (Lehto et al., 2009). A person essentially ceases to exist when they die, which contravenes most living organisms' fundamental needs to exist and multiply. The cognitive acceptance of death is also an important component of many death anxiety scales (Lehto et al., 2009). People tend to accept death as a phenomenon differently, with some cognitively processing it more readily than others. The scales also examine the contributions of a person’s developmental stages to their perception of death anxiety, such as old versus young individuals (Lehto et al., 2009). Sociocultural shaping plays an important role in determining people’s responses to death, such as avoiding talking about death and placing the sick and dying away from public view (Lehto et al., 2009). By considering numerous aspects of death anxiety, the scales demonstrate that thanatophobia is a complex phenomenon that relies on multiple aspects of a person’s life and personality to develop.

Managing Death Anxiety

Psychotherapeutic interventions can significantly increase a person’s ability to cope with the finality of death. According to Grossman et al. (2017), relief from death anxiety should allow people to balance between enjoying the remainder of their lives and being aware that death is imminent and inevitable. This approach ensures that persons do not let themselves dwell too much on the fear of death that prevents them from fulfilling their responsibilities or enjoying life (Menzies et al., 2018). It also allows them to implement appropriate and rational measures to avoid death or increases their engagement in activities that prolong their lives. Such interventions are particularly useful for chronically ill patients or those with pathological anxiety about death. Psychotherapeutic interventions should help clients directly and positively find meaning in the life they currently have (Menzies et al., 2018). They can achieve this through life review and dignity therapy, which require them to recount their experiences and realize that they have lived a meaningful life, sometimes even developing a legacy document that their family and friends can remember them by (Grossman et al., 2017). Psychotherapy can help individuals to reduce death anxiety significantly.

Social support and education are also beneficial in mitigating death anxiety. Persons who feel isolated from society because they lack robust social support systems such as close relationships with family and friends might be more anxious about death and feel like their lives are unfulfilling (Menzies et al., 2017). Reestablishing broken family relationships, creating new friends, and strengthening current friendships can allow people to minimize their fear of death. Additionally, people often have a poor understanding of the process of dying, which causes them to hold an irrational fear of death. Therefore, it is crucial to ensure that people understand what death entails so that they can reduce the anxiety and fear which they attach to its process. Some attitudes about death, especially those propagated by religion, can be counterproductive, and individuals might need to receive education to counter or at least modify these attitudes (Jackson et al., 2017). Such education should begin from an early age since many of these negative attitudes start in early life. A healthy understanding of death can also help people support those whose death is imminent, such as the chronically ill or the aged. Social support and education about death can help diminish thanatophobia and allow those who are dying to receive better care and support from friends, family, and caregivers.

Conclusion

Death anxiety is multifactorial and varies among different people. The more religious a person is, the more likely they are to fear death irrationally. However, religion can also be a useful coping mechanism, allowing people to accept death’s finality and find meaning in their current life. Older people are less afraid of death than younger people. Younger people may, therefore, benefit more from interventions to reduce death anxiety. Women are also more anxious about death than men, so they must receive more support to manage such stress. Health conditions and social support systems also contribute to thanatophobia. Interventions to reduce anxiety about death should include psychotherapy, education, and improving social support systems.

• References

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