Death anxiety (psychology)
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Death anxiety is anxiety caused by thoughts of one's own death. Also referred to as thanatophobia (fear of death), death anxiety is distinguished from necrophobia, which is a specific fear of dead or dying people and/or things; the latter is the fear of others who are dead or dying, whereas the former concerns one's own death or dying.
Popular psychotherapist Robert Langs proposed 3 different causes of death anxiety: Predatory, predator, and existential. In addition to his research, many theorists such as Sigmund Freud, Erik Erikson, Ernest Becker, and others have contemplated death and death anxiety and how it relates to human psychology.
Death anxiety has been found to affect people of differing demographic groups as well; such as men versus women, young versus old, etc.
Additionally, there is anxiety caused by death-recent thought-content, which might be classified within a clinical setting by a psychiatrist as morbid and/or abnormal. This classification pre-necessitates a degree of anxiety which is persistent and interferes with everyday functioning. Lower ego integrity, more physical problems and more psychological problems are predictive of higher levels of death anxiety in elderly people perceiving themselves close to death.
Death anxiety can cause extreme timidness with a person's attitude towards discussing anything to do with death.
Predatory death anxiety
Predatory death anxiety arises from the fear of being harmed. It is the most basic and oldest:615 form of death anxiety, with its origins in the first unicellular organisms' set of adaptive resources. Unicellular organisms have receptors that have evolved to react to external dangers, along with self-protective, responsive mechanisms made to increase the likelihood of survival in the face of chemical and physical forms of attack or danger.:616[failed verification] In humans, predatory death anxiety is evoked by a variety of dangerous situations that put one at risk or threaten one's survival.:617 Predatory death anxiety mobilizes an individual's adaptive resources and leads to a fight-or-flight response: active efforts to combat the danger or attempts to escape the threatening situation.:617
Predation or predator
Predation or predator death anxiety is a form that arises when an individual harms another, physically and/or mentally. This form of death anxiety is often accompanied by unconscious guilt. This guilt, in turn, motivates and encourages a variety of self-made decisions and actions by the perpetrator of harm to others.
Existential death anxiety stems from the basic knowledge that human life must end. Existential death anxiety is known to be the most powerful form of death anxiety. It is said that language has created the basis for existential death anxiety through communicative and behavioral changes. Other factors include an awareness of the distinction between self and others, a full sense of personal identity, and the ability to anticipate the future.
Awareness of human mortality arose some 150,000 years ago. In that extremely 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 effected 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.
Sigmund Freud hypothesized that people express a fear of death, called thanatophobia. He said he saw this as a disguise for a deeper source of concern. It was not actually death that people feared, because in Freud's view nobody believes in their own death. The unconscious does not deal with the passage of time or with negations, which does not calculate amount of time left in one's life. Furthermore, that which one does fear cannot be death itself, because one has never died. People who express death-related fears, actually are trying to deal with unresolved childhood conflicts that they cannot come to terms with or express emotion towards. The name Thanatophobia is made from the Greek figure of death known as Thanatos.
Wisdom: ego integrity vs. despair
Developmental psychologist Erik Erikson formulated the psychosocial theory that explained that people progress through a series of crises as they grow older. The theory also envelops the concept that once an individual reaches the latest stages of life, they reach the level he titled as "ego integrity". Ego Integrity is when one comes to terms with their life and accepts it. It was also suggested that when a person reaches the stage of late adulthood they become involved in a thorough overview of their life to date. When one can find meaning or purpose in their life, they have reached the integrity stage. In opposition, when an individual views their life as a series of failed and missed opportunities, then they do not reach the ego integrity stage. Elders that have attained this stage of ego integrity are believed to exhibit less of an influence from death anxiety.
Terror management theory
Ernest Becker based this theory on existential views which turned death anxiety theories towards a new dimension. It said that death anxiety is not only real, but also it is people's most profound source of concern. He explained the anxiety as so intense that it can generate fears and phobias of everyday life—Fears of being alone or in a confined space. Based on the theory, many of people's daily behavior consist of attempts to deny death and to keep their anxiety under strict regulation.
As an individual develops mortality salience, i.e. becomes more aware of the inevitability of death, they will instinctively try to suppress it out of fear. The method of suppression usually leads to mainstreaming towards cultural beliefs, leaning for external support rather than treading alone. This behavior may range from simply thinking about death to severe phobias and desperate actions.:603
One way in which religiosity plays a role in death anxiety is 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 and Bronislaw Malinowski 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. Through Terror Management Theory, and other death-focused theories, there is a distinct pattern that develops indicating that those who are either very low or very high in religiosity experience much lower levels of death anxiety, meanwhile 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. According to one specific meta-analysis study that was performed in 2016, it was shown that lower rates of death anxiety and general fear about dying was experienced by those who went day-to-day living their religion and abiding by its practices, compared to those who merely label themselves as a member of a given religion without living in accord to its doctrines and prescribed practices.
Being, time and Dasein
Martin Heidegger, the German philosopher, on the one hand showed death as something conclusively determined, in the sense that it is inevitable for every human being, while on the other hand, it unmasks its indeterminate nature via the truth that one never knows when or how death is going to come. Heidegger does not engage in speculation about whether being after death is possible. He argues that all human existence is embedded in time: past, present, future, and when considering the future, we encounter the notion of death. This then creates angst. Angst can create a clear understanding in one that death is a possible mode of existence, which Heidegger described as "clearing". Thus, angst can lead to a freedom about existence, but only if we can stop denying our mortality (as expressed in Heidegger's terminology as "stop denying being-for-death").
Meaning management theory
Paul T. P. Wong's work on the meaning management theory indicates that human reactions to death are complex, multifaceted and dynamic. His "Death Attitude Profile" identifies three types of death acceptances as Neutral, Approach, and Escape acceptances. Apart from acceptances, his work also represents different aspects of the meaning of death fear that are rooted in the bases of death anxiety. The ten meanings he proposes are finality, uncertainty, annihilation, ultimate loss, life flow disruption, leaving the loved ones, pain and loneliness, prematurity and violence of death, failure of life work completion, judgment and retribution centered.
The existential approach, with theorists such as Rollo May and Viktor Frankl, views an individual's personality as being governed by the continuous choices and decisions in relation to the realities of life and death. Rollo May theorized that all humans are aware of the fact that they must one day die. However, he also theorized that humans must find meaning in life, which led to his main theory on death anxiety; that all humans face the dichotomy of finding meaning in life, but also confronting the knowledge of approaching death. May believed that this dichotomy could lead to negative anxiety that hindered life, or a positive anxiety that would lead to a life full of meaning and living to one's fullest potential and opportunities.
Other theories on death anxiety were introduced in the late part of the twentieth century. Another approach is the regret theory which was introduced by Adrian Tomer and Grafton Eliason. The main focus of the theory is to target the way people evaluate the quality and/or worth of their lives. The possibility of death usually makes people more anxious if they feel that they have not and cannot accomplish any positive task in the life that they are living. Research has tried to unveil the factors that might influence the amount of anxiety people experience in life.
Personal meanings of death
Humans develop meanings and associate them with objects and events in their environment which can provoke certain emotions. People tend to develop personal meanings of death which could be either positive or negative. If the formed meanings about death are positive, then the consequences of those meanings can be comforting (for example, ideas of a rippling effect left on those still alive). If the formed meanings about death are negative, they can cause emotional turmoil. Depending on the certain meaning one has associated with death, positive or negative, the consequences will vary accordingly. The meaning that individuals place on death is generally specific to them; whether negative or positive, and can be difficult to understand as an outside observer. However, through a Phenomenological perspective, therapists can come to understand their individual perspective and assist them in framing that meaning of death in a healthy way.
A 2017 review of the literature found that in the US, 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.
A 2019 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 anxiety exists independently on a different dimensional plane than the individual and, as a result, is seen as something that cannot be directly controlled. Often times 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.
Death Acceptance and Death Anxiety
Research has also been done on how being able to accept one’s inevitable death could have a positive effect on their psychological well-being, or their level of individual distress. A research study conducted in 1974 attempted to create a new type of scale to measure people’s death acceptance, rather than their death anxiety. After administering a questionnaire with questions regarding the acceptance of death, the researchers found there was a low-negative correlation between acceptance of one’s own death and anxiety about death; meaning the more a participant accepted their own death, the less anxiety they felt about. While those who accept the fact of their own death will still feel some anxiety about it, this acceptance could allow them to form more positive perspective on it.
In a more recent longitudinal study, cancer patients at different stages were asked to fill out different questionnaires in order to rate their levels of death acceptance, general anxiety, demoralization, etc. One year later they were asked to fill out the same surveys and it was found that higher levels of death acceptance could predict lower levels of death anxiety in the participants.
The earliest documentation of the fear of death has been found in children as young as age 5. Psychological measures and reaction times were used to measure fear of death in young children. Recent studies that assess fear of death in children use questionnaire rating scales. There are many tests to study this including The Death Anxiety Scale for Children (DASC) developed by Schell and Seefeldt. However the most common version of this test is the revised Fear Survey Schedule for Children (FSSC-R). The FSSC-R describes specific fearful stimuli and children are asked to rate the degree to which the scenario/item makes them anxious or fearful. The most recent version of the FSSC-R presents the scenarios in a pictorial form to children as young as 4. It is called the Koala Fear Questionnaire (KFQ). The fear studies show that children's fears can be grouped into five categories. One of these categories is death and danger. This response was found amongst children age 4 to 6 on the KFQ, and from age 7 to 10. Death is the most commonly feared item and remains the most commonly feared item throughout adolescence.
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.
Relationship to adult attachment
There has been much literature that supports the existence of a correlation between one's state of coping skills, mental health, emotions and cognitive reactions to stressful events, and one's ability to regulate affect concerning one's death anxiety. A series of tests determined that significantly high levels of death anxiety tend to occur in close relationships with an intimate partner (more so amongst females than males).
The connection between death anxiety and one's sex appears to be strong. Studies show that females tend to have more death anxiety than males. Thorson and Powell (1984) did a study to investigate this connection, and they sampled men and women from 16 years of age to over 60. The Death Anxiety Scale showed higher mean scores for women than for men. Moreover, researchers believe that age and culture could be major influences in why women score higher on death anxiety scales than men.
Through the evolutionary period, a basic method was created to deal with death anxiety and also as a means of dealing with loss. 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. Women, who are the child bearers and are often the ones who look after children 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.
It is during the years of young adulthood (ages 20 to 40) that death anxiety gains prevalence. However, during the next phase of life, the middle age adult years (40–64 years of age), death anxiety peaks at its highest levels when in comparison to all other age ranges throughout the lifespan. Levels of death anxiety then decline in the later years of adulthood (65 years of age and older). This is in contrast with most people's expectations, especially regarding all of the negative connotations younger adults have about the elderly and the aging process (Kurlychek & Trenner, 1982).
There are many ways to measure death anxiety and fear. Katenbaum and Aeinsberg (1972) devised three propositions for this measurement. From this start, the ideologies about death anxiety have been able to be recorded and their attributes listed. Methods such as imagery tasks to simple questionnaires and apperception tests such as the Stroop test enable psychologists to adequately determine if a person is under stress due to death anxiety or suffering from post-traumatic stress disorder.
The Lester attitude death scale was developed in 1966 but not published until 1991 until 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.
- Death row phenomenon
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- The American Heritage® Dictionary of the English Language, Fourth Edition copyright ©2000 by Houghton Mifflin Company. Updated in 2009. Published by Houghton Mifflin Company
- Combs, Heidi. "Mental Status Exam" (PDF). University of Washington. Retrieved 2017-06-05.
- Gold, Liza H. (June 2014). "DSM-5 and the Assessment of Functioning: The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0)". Journal of the American Academy of Psychiatry and the Law. 42 (2): 173–181. PMID 24986344. Retrieved 2017-06-05.
- "Anxiety Disorders". Diagnostic and Statistical Manual of Mental Disorders. DSM Library (5th ed.). American Psychiatric Association. May 2013. doi:10.1176/appi.books.9780890425596.dsm05. ISBN 9780890425558.
- V. Fortner, Robert A. Neimeyer, Barry (June 1999). "Death Anxiety in Older Adults: A Quantitative Review". Death Studies. 23 (5): 387–411. doi:10.1080/074811899200920. ISSN 0748-1187. PMID 10558505.
- DeSpelder, Lynne Ann; Strickland, Albert Lee (2015). The Last Dance: Encountering Death and Dying. New York: McGraw-Hill Education. pp. 27–28. ISBN 9780078035463. OCLC 842883173.
- Langs, Robert (2004). "Death Anxiety and the Emotion-Processing Mind". Psychoanalytic Psychology. 21 (1): 31–53. doi:10.1037/0736-9718.104.22.168.
- Langs, Robert (2003). Fundamentals of Adaptive Psychotherapy and Counselling: An Introduction to Theory and Practice. Macmillan International Higher Education. ISBN 978-0-230-62953-0.[page needed]
- Castano, Emanuele; Leidner, Bernhard; Bonacossa, Alain; Nikkah, John; Perrulli, Rachel; Spencer, Bettina; Humphrey, Nicholas (August 2011). "Ideology, fear of death, and death anxiety". Political Psychology. 32 (4): 601–621. doi:10.1111/j.1467-9221.2011.00822.x.
- Langs, R. (1997). Death Anxiety and Clinical Practice. London: Karnac Books
- Purton, M. D. (1976). "Extravascular cells within the perisinusoidal space of the avian liver". Experientia. 32 (6): 737–40. doi:10.1007/BF01919862. PMID 950021. S2CID 8965176.
- Sterling, Christopher M. (December 1985). Identity and Death Anxiety (M.A. thesis). Mount Pleasant, MI: Department of Psychology, Central Michigan University. pp. 10–11. OCLC 13818865. ProQuest 220097024.
- Roshdieh, Simin (1996). War, Death Anxiety, Death Depression, and Religion (Ph.D. thesis). Fresno, CA: California School of Professional Psychology, Fresno. pp. 13–14. OCLC 57154910. ProQuest 304323908.
- "Additional Lifespan Development Topics" (PDF). highered.mcgraw-hill.com. 2009. Retrieved 2019-08-04.
- Meyers, Karen; Golden, Robert N.; Peterson, Fred (2009). The Truth about Death and Dying. Infobase Publishing. p. 106. ISBN 978-1-4381-2581-7.
- Harmon-Jones, Eddie; Simon, Linda; Greenberg, Jeff; Pyszczynski, Tom; Solomon, Sheldon; McGregor, Holly (January 1997). "Terror management theory and self-esteem: evidence that increased self-esteem reduces mortality salience effects" (PDF). Journal of Personality and Social Psychology. 72 (1): 24–36. doi:10.1037/0022-3522.214.171.124. PMID 9008372. S2CID 32261410. Archived from the original (PDF) on 2020-10-02.
- Jong, Jonathan; Ross, Robert; Philip, Tristan; Chang, Si-Hua; Simons, Naomi; Halberstadt, Jamin (May 5, 2016). "The religious correlates of death anxiety: a systematic review and meta-analysis". Religion, Brain & Behavior. 8: 4–20. doi:10.1080/2153599X.2016.1238844. S2CID 54049149.
- Hossain, Mohammad Samir; Gilbert, Peter (January 2010). "Concepts of Death: A Key to Our Adjustment". Illness, Crisis & Loss. 18 (1): 19–36. doi:10.2190/IL.18.1.c. S2CID 145665243.
- Wong, Paul T. P. (13 May 2013). "Meaning-management theory and death acceptance". In Tomer, Adrian; Eliason, Grafton T.; Wong, Paul T. P. (eds.). Existential and Spiritual Issues in Death Attitudes. Psychology Press. pp. 65–87. ISBN 978-1-136-67691-8.
- Gesser, Gina; Wong, Paul T. P.; Reker, Gary T. (March 1988). "Death Attitudes across the Life-Span: The Development and Validation of the Death Attitude Profile (DAP)". OMEGA - Journal of Death and Dying. 18 (2): 113–128. doi:10.2190/0DQB-7Q1E-2BER-H6YC. S2CID 144000196.
- Wong, Paul T. P.; Reker, Gary T.; Gesser, Gina (1994). "Death Attitude Profile – Revised: A multidimensional measure of attitudes toward death". In Neimeyer, Robert A. (ed.). Death Anxiety Handbook: Research, Instrumentation, and Application. Taylor & Francis. pp. 121–148. ISBN 978-1-56032-282-5.
- Schacter, Daniel L. "Psychology" 2011. Chapter 12, page 488.
- Hergenhahn, B.R.; Olson, Matthew H. (2007). An Introduction To Theories Of Personality (7 ed.). Pearson Prentice Hall. p. 508. ISBN 9780131942288.
- Langs, Robert (August 2003). "Adaptive Insights into Death Anxiety". The Psychoanalytic Review. 90 (4): 565–582. doi:10.1521/prev.90.4.565.23914. PMID 14694764.
- Yalom, Irvin D. (2008). "Rippling". Staring at the sun: overcoming the terror of death. San Francisco: Jossey-Bass. pp. 83–92. ISBN 9780787996680. OCLC 155715164.
Each of us creates—often without our conscious intent or knowledge—concentric circles of influence that may affect others for years, even generations.
- Cicirelli, Victor G. (November 1998). "Personal meanings of death in relation to fear of death". Death Studies. 22 (8): 713–733. doi:10.1080/074811898201236. PMID 10346699.
- Yontef, Gary M. (1981). "Gestalt therapy: Past, present and future". PsycEXTRA Dataset. Retrieved 2021-03-20.
- Ellis, Lee; Wahab, Eshah A.; Ratnasingan, Malini (February 2013). "Religiosity and fear of death: a three‐nation comparison". Mental Health, Religion & Culture. 16 (2): 179–199. doi:10.1080/13674676.2011.652606. S2CID 145063539.
- Flanelly, Kevin J. (2017). Religion, Spirituality and Health: A Social Scientific Approach. Springer International Publishing AG. p. 154. ISBN 978-3-319-52488-7.
- Peters, Frederic (2019-09-12). "Existential anxiety and religiosity". Critical Research on Religion. 7 (3): 275–291. doi:10.1177/2050303219874382. ISSN 2050-3032. S2CID 203436243.
- Nieuwboer, Wieteke (2019). Supernatural Agency Attributions. Ridderprint BV. pp. 74–75. ISBN 978-94-6375-247-3.
- Ray, J. J.; Najman, J. (1975-01-01). "Death Anxiety and Death Acceptance: A Preliminary Approach". OMEGA - Journal of Death and Dying. 5 (4): 311–315. doi:10.2190/MHEL-88YD-UHKF-E98C. ISSN 0030-2228.
- Philipp, Rebecca; Mehnert, Anja; Lo, Chris; Müller, Volkmar; Reck, Martin; Vehling, Sigrun (2019). "Characterizing death acceptance among patients with cancer". Psycho-Oncology. 28 (4): 854–862. doi:10.1002/pon.5030. ISSN 1099-1611.
- Slaughter, Virginia; Griffiths, Maya (October 2007). "Death Understanding and Fear of Death in Young Children". Clinical Child Psychology and Psychiatry. 12 (4): 525–535. doi:10.1177/1359104507080980. PMID 18095535. S2CID 19709740.
- 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.
- Harrawood, Laura K.; White, Lyle J.; Benshoff, John J. (March 2009). "Death Anxiety in a National Sample of United States Funeral Directors and its Relationship with Death Exposure, Age, and Sex". OMEGA - Journal of Death and Dying. 58 (2): 129–146. doi:10.2190/OM.58.2.c. PMID 19227002. S2CID 12459852.
- Pettigrew, C. Gary; Dawson, Joseph G. (1979). "Death anxiety: 'State' or 'trait'?". Journal of Clinical Psychology. 35 (1): 154–158. doi:10.1002/1097-4679(197901)35:1<154::aid-jclp2270350125>3.0.co;2-e. PMID 422719.
- Templer, Donald I.; Salter, Charles A. (1979). "Death Anxiety and Mental Ability". Essence. 3 (2): 85–88. ERIC EJ210539.
- Trenner (1982). "Accuracy of perception and attitude: An intergenerational investigation". Perceptual and Motor Skills. 54 (1): 271–274. doi:10.2466/pms.19126.96.36.1991. S2CID 145191046.
- Tomer, Adrian; Eliason, Grafton (July 1996). "Toward a comprehensive model of death anxiety". Death Studies. 20 (4): 343–365. doi:10.1080/07481189608252787. PMID 10160570.
- Craddock, Nick; Mynors-Wallis, Laurence (2014). "Psychiatric diagnosis: Impersonal, imperfect and important". British Journal of Psychiatry. 204 (2): 93–95. doi:10.1192/bjp.bp.113.133090. PMID 24493652.