This is the first in our Coping with Mortality series, which looks at fear of death across the ages and how to cope with the dying process. Read the next article on helping children process death here.
Awareness of our mortality is part of being human. As author and existential philosopher Irvin Yalom said, we are “forever shadowed by the knowledge that we will grow, blossom and, inevitably, diminish and die”.
There is growing research exploring the overwhelming anxiety that the inevitability of death, and our uncertainty about when it will occur, has the power to create. A social psychological theory, called terror management theory (TMT), is one way to understand how this anxiety influences our behaviour and sense of self.
According to this theory, we manage our fear of death by creating a sense of permanence and meaning in life. We focus on personal achievements and accomplishments of loved ones; we take endless photos to create enduring memories; and we may attend church and believe in an afterlife.
These behaviours bolster our self-esteem and can help us feel empowered against death. For some, however, periods of stress or threats to their health, or that of loved ones, may result in ineffective and pathological coping mechanisms.
These people might focus their real fear of death on smaller and more manageable threats, such as spiders or germs. Such phobias may appear safer and more controllable than the ultimate fear of death.
This makes sense because when we look closely at the symptoms of several anxiety-related disorders, death themes feature prominently.
When children experience separation anxiety disorder, it is often connected to excessive fear of losing major attachment figures – such as parents or other family members – to harm or tragedy from car accidents, disasters or significant illness.
People with panic disorder frequently visit the doctor because they’re afraid of dying from a heart attack. Meanwhile, those with somatic symptom disorders, including those formerly identified as hypochondriacs, frequently request medical tests and body scans to identify serious illness.
Finally, specific phobias are characterised by excessive fears of heights, spiders, snakes and blood – all of which are associated with death. Phobic responses to seeing a spider, for instance, typically involve jumping, screaming and shaking. Some researchers argue these extreme responses could actually represent rational reactions to more significant threats, such as seeing a person with a weapon.
More evidence for the TMT hypothesis comes from studies showing that death anxiety is capable of increasing anxious and phobic responding.
These studies use a popular “mortality salience induction” technique to prime death anxiety in people with other anxiety disorders. The technique involves participants writing down the emotions that the thought of their own death arouses, as well as detailing what they think will happen as they die and once they are dead.
Spider phobics primed like this had increased reactions to spiders, such as avoiding looking at spider-related images, when compared to spider phobics not primed with death. And compulsive hand washers spent more time washing their hands and used more paper towels when primed with death.
Likewise, those with social phobias took longer to join social interactions. After they had been reminded of death, they also viewed happy and angry faces as more socially threatening – as these faces indicate judgement – than neutral, seemingly innocuous faces.
Is fear of death normal?
Given that we are all going to die at some point, death anxiety is a normal part of the human experience. For many of us, thinking about death can evoke fears of separation, loss, pain, suffering and anxiety about leaving those we love behind.
According to terror management theory, this fear has the power to motivate a life well lived. It stimulates us to cherish those we love, create enduring memories, pursue our hopes and dreams and achieve our potential.
Death anxiety becomes abnormal when it forms the basis of pathological thoughts and behaviours that interfere with normal living. Many obsessive-compulsive hand washers and checkers spend significant amounts of time each day in ritualistic behaviours designed to reduce the threat of dirt, germs, fire, home invasion or threats to themselves and loved ones.
Similarly, those with phobias may go to extreme lengths to avoid what they fear and react with extreme distress when confronted with it. When these thoughts and behaviours lead to impaired functioning, anxiety is no longer considered “normal”.
Treatments, such as cognitive behaviour therapy, for a range of disorders may need to incorporate new strategies that directly address death anxiety. Without such innovation, the spectre of death may tragically haunt the anxious across their lifespan, until it is too late.