Death anxiety (psychology)

Death anxiety is anxiety of which the cause of the anxiety is thoughts of death. One source defines death anxiety as a "feeling of dread, apprehension or solicitude (anxiety) when one thinks of the process of dying, or ceasing to 'be'".[1] It is also referred to as thanatophobia (fear of death), and is distinguished from necrophobia, which is a specific fear of dead or dying persons and/or things (i.e. others who are dead or dying, not one's own death or dying).[2]

Additionally there is anxiety where the cause is death related (in thought-content[3]), which might be classified within a clinical setting by a psychiatrist as morbid and, or, abnormal, which for classification pre-necessitates a degree of anxiety which is persistent and interferes with everyday functioning.[4][5] Lower ego integrity, increased numbers of physical problems, and more psychological problems are predictive of higher levels of death anxiety in elderly people.

Types

Robert Langs distinguishes three types of death anxiety:[6]

Predatory death anxiety

Predatory death anxiety arises from the fear of being harmed.[7] It is the most basic and oldest[8] form of death anxiety, with its origins stemming from the first unicellular organisms’ set of adaptive resources. Unicellular organisms have receptors that have evolved to react to external dangers and they also have self-protective, responsive mechanisms made to guarantee survival in the face of chemical and physical forms of attack or danger.[9] In humans, this form of death anxiety is evoked by a variety of danger situations that put the recipient at risk or threatens their survival.[10] These traumas may be psychological and/or physical.[10] Predatory death anxieties mobilize an individual’s adaptive resources and lead to fight or flight, active efforts to combat the danger or attempts to escape the threatening situation.[10]

Predation or predator death anxiety

Predation or predator death anxiety is a form of death anxiety that arises from an individual physically and/or mentally harming another. This form of death anxiety is often accompanied by unconscious guilt.[11] This guilt, in turn, motivates and encourages a variety of self made decisions and actions by the perpetrator of harm to others.[12]

Existential death anxiety

Existential death anxiety is the basic knowledge and awareness that life must end. It is said that existential death anxiety directly correlates to language; that is, language has created the basis for this type of death anxiety through communicative and behavioral changes.[11] Existential death anxiety is known to be the most powerful form.[13] There is an awareness of the distinction between self and others, a full sense of personal identity, and the ability to anticipate the future.[14] Humans defend against this type of death anxiety through denial, which is effected through a wide range of mental mechanisms and physical actions many of which also go unrecognized.[14] While limited use of denial tends to be adaptive, its use is usually excessive and proves to be costly emotionally.[14]

Awareness of human mortality arose some 150,000 years ago.[15] 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 in its many forms.[15] Thus denial is basic to such diverse actions as breaking rules and violating frames and boundaries, manic celebrations, violence directed against others, attempts to gain extraordinary wealth and/or power—and more.[16] These pursuits often are activated by a death-related trauma and while they may lead to constructive actions, more often than not, they lead to actions that are, in the short and long run, damaging to self and others.[16]

Theories

Thanatophobia

Sigmund Freud hypothesized that people express a fear of death, called thanatophobia. 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.[6][17][18] 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.[6][17][18]

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.[6][17][18][19]

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.[20]

Death and adjustment hypotheses

Mohammad Samir Hossain postulated the Death and adjustment hypotheses. With the declaration of the hypotheses, two things were postulated. The first part of the hypotheses theorizes that death should not be considered the end of existence. The next segment states the belief that the immortal pattern of human existence can only be adopted in a morally rich life with the attitude towards morality and materialism balanced mutually.[6][17][18]

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”).[21]

Meaning management theory

Paul T. P. Wong's work on the meaning management theory[22] indicates that human reactions to death are complex, multifaceted and dynamic.[21] His “Death Attitude Profile” identifies three types of death acceptances as Neutral, Approach, and Escape acceptances.[23][24] 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.

Other theories

Other theories on death anxiety were introduced in the late part of the twentieth century.[25] 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.[26] Another approach is the regret theory which was introduced by Adrian Tomer and Grafton Eliason.[27] The main focus of the theory is to target the way people evaluate the quality and/or worth of their lives.[27] 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.[27] Research has tried to unveil the factors that might influence the amount of anxiety people experience in life.[27]

Personal meanings of death

Humans develop meanings and associate them with objects and events in their environment, provoking certain emotions within an individual. People tend to develop personal meanings of death which could accordingly be negative or positive for the individual. If they are positive, then the consequences of those meanings can be comforting (for example, ideas of a rippling effect[28] left on those still alive). If negative they can cause emotional turmoil. Depending on the certain meaning one has associated with death, the consequences will vary accordingly whether they are negative or positive meanings.[29]

Religiosity's effect

The thought of death causes a different degree of anxiety for different individuals, depending on many factors.

A 2013 study involving people from the US, Turkey, and Malaysia found that religiosity is positively correlated with increased fear of death, meaning more religious individuals fear death more.[30]

Other studies have found a strong sense of religion in a person’s life can be related to a lower sense of anxiety towards the death.[31] Although there has been no association discovered between religiosity and death anxiety,[31] it has also been shown that death anxiety tends to be lower in individuals who regularly attend religious meetings or gatherings.[31] On a recent study, one hundred and sixty-five church participants have been asked to fill out the "Intrinsic Religious Motivation Scale, the Revised Death Anxiety Scale" and the results were analyzed using factor analyses, Pearson correlation, and linear and quadratic regression. All found an inverse relationship between intrinsic religious motivation and death anxiety. In short, the more religious you are, the less anxious you are about death because you may associate death with another beginning that is promised through many religions.[31] The study also found that gender did not have an effect on religiosity and total death anxiety.[32]

Children

The earliest documentation of the fear of death has been found in children as young as age 5.[33] 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.[33] There are many tests to study this including The Death Anxiety Scale for Children (DASC) developed by Schell and Seefeldt.[34] However the most common version of this test is the revised Fear Survey Schedule for Children (FSSC-R).[33] 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.[33] 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).[33] The fear studies show that children’s fears can be grouped into five categories. One of these categories is death and danger.[33] This response was found amongst children age 4 to 6 on the KFQ, and from age 7 to 10.[33] Death is the most commonly feared item and remains the most commonly feared item throughout adolescence.[33]

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.[35]

Relationship between adult attachment and death anxiety

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).[36]

Sexes

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.[37]

Through the evolutionary period, a basic method was created to deal with death anxiety and also as a means of dealing with loss.[38] Denial is used when memories or feelings are too painful to accept and are often rejected.[39] By maintaining that the event never happened, rather than accepting it, allows an individual more time to work through the inevitable pain.[39] 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.[39] Closer families often deal with death better than when coping individually.[39] 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.[39] 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.[40] It is this common role of women that leads to greater death anxiety as it emphasize the ‘importance to live’ for her offspring.[40] 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.[40]

Age

It is during the years of young adulthood (20 to 40 years of age) that death anxiety most often begins to become prevalent. 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. Surprisingly, levels of death anxiety then slump off in the old age 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).[41]

Measuring death anxiety

There are many ways to measure death anxiety and fear.[42] Katenbaum and Aeinsberg (1972) devised three propositions for this measurement.[42] From this start, the ideologies about death anxiety have been able to be recorded and their attributes listed.[42] 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.[42] The Lester attitude death scale was developed in 1966 but not published until 1991 until its validity was proven.[42] By measuring the general attitude towards death and also the inconsistencies with death attitudes, participants are scaled to their favorable value towards death.[42]

Quote

The thought of [our] destruction is like a light in the middle of the night that spreads its flames on the objects it will soon consume. We must get used to contemplating this light, since it announces nothing that has not been prepared by all that comes before; and since death is as natural as life, why should be so afraid of it?

– Louis, chevalier de Jaucourt, for Diderot's Encyclopédie[43]

See also

References

  1. ↑ Definition by Farley G.: Death anxiety. National Health Service UK. 2010, found in: Peters L, Cant R, Payne S, O'Connor M, McDermott F, Hood K, Morphet J, Shimoinaba K (2013). "How death anxiety impacts nurses' caring for patients at the end of life: a review of literature." (PDF). Open Nurs J. 7: 14–21. doi:10.2174/1874434601307010014. Archived from the original (PDF) on 2013-10-14.
  2. ↑ The American Heritage® Dictionary of the English Language, Fourth Edition copyright ©2000 by Houghton Mifflin Company. Updated in 2009. Published by Houghton Mifflin Company
  3. ↑ H. Combs - mental status exam (runs to 4 pages) University of Washington Accessed June 5th, 2017
  4. ↑ L.H. Gold - 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 Online June 2014, 42 (2) 173-181 Accessed June 5th, 2017
  5. ↑ Article American Psychiatric Association Accessed June 5th, 2017 (added to pre-existing content)
  6. 1 2 3 4 5 http://www.escp.org/death_anxiety.html; Langs, R. (2004). "Death anxiety and the emotion-processing mind," Psychoanalytic Psychology, vol. 21, no.1, 31-53; Langs, R. (2004) Fundamentals of Adaptive Psychotherapy and Counseling. London: Palgrave-Macmillan
  7. ↑ Langs, R. Three Forms of Death Anxiety. Retrieved from http://www.escp.org/death_anxiety.html; Langs, R. (2004). "Death anxiety and the emotion-processing mind," Psychoanalytic Psychology, vol. 21, no.1, 31-53; Langs, R. (2004) Fundamentals of Adaptive Psychotherapy and Counseling. London: Palgrave-Macmillan
  8. ↑ Castano.Leidner.Bonacossa.Nikkah.Perrulli.Spencer.Humphrey."Ideology, Fear of Death and Death Anxiety "Political Psychology.2011.p615
  9. ↑ Castano.Leidner.Bonacossa.Nikkah.Perrulli.Spencer.Humphrey."Ideology, Fear of Death and Death Anxiety "Political Psychology.2011.p616
  10. 1 2 3 Castano.Leidner.Bonacossa.Nikkah.Perrulli.Spencer.Humphrey."Ideology, Fear of Death and Death Anxiety "Political Psychology.2011.p617
  11. 1 2 Langs, R. (1997). Death Anxiety and Clinical Practice. London: Karnac Books; Langs, R. (2004). "Death anxiety and the emotion-processing mind," Psychoanalytic Psychology, vol. 21, no.1, 31-53; Langs, R. (2004) Fundamentals of Adaptive Psychotherapy and Counseling. London: Palgrave-Macmillan
  12. ↑ McDonald.Hilgendorf. Death imagery and death anxiety. Journal of Clinical Psychology. 1996. p88
  13. ↑ Sterling. "Identity and Death Anxiety"Central Michigan University.1985.p10
  14. 1 2 3 Sterling. "Identity and Death Anxiety"Central Michigan University.1985.p11
  15. 1 2 Simin."War, death anxiety, death depression and religion" California School of Professional Psychology.1996.p13
  16. 1 2 Simin."War, death anxiety, death depression and religion" California School of Professional Psychology.1996.p14
  17. 1 2 3 4 http://highered.mcgraw-hill.com/sites/dl/free/0078883601/680442/Additional_Lifespan_Development_Topics.pdf
  18. 1 2 3 4 Meyers, Karen; Golden, Robert N.; Peterson, Fred (1 January 2009). "The Truth about Death and Dying". Infobase Publishing – via Google Books.
  19. ↑ http://www.socialemotiveneuroscience.org/pubs/hj_etal97tm.pdf
  20. ↑ Castano, Emanuele. (2011). Ideology, Fear of Death, and Death Anxiety 603.
  21. 1 2 Mohammad Samir Hossain and Peter Gilbert. 2010. Concepts of Death: A key to our adjustment. Illness, Crisis and Loss, Vol 18. No 1
  22. ↑ Wong, P. T. P. (2008). Meaning-management theory and death acceptance. In A. Tomer, G. T. Eliason, & P. T. P. Wong (Eds.), Existential and spiritual issues in death attitudes (pp. 65-87). New York, NY: Erlbaum.
  23. ↑ Gesser, G., Wong, P. T. P., & Reker, G. T. (1987-88). Death attitudes across the life span. The development and validation of the Death Attitude Profile (DAP). Omega, 2, 113-128.
  24. ↑ Wong, P. T. P., Reker, G. T., & Gesser, G. (1994). Death Attitude Profile – Revised: A multidimensional measure of attitudes toward death (DAP-R). In R. A. Neimeyer (Ed.), Death anxiety handbook: Research, instrumentation, and application (pp. 121-148). Washington, DC: Taylor & Francis.
  25. ↑ Langs." Adaptive Insights into Death Anxiety" The Psychoanalytic Review.2003.p570
  26. ↑ Schacter, Daniel L. "Psychology" 2011. Chapter 12, page 488.
  27. 1 2 3 4 Langs. Adaptive Insights into Death Anxiety. The Psychoanalytic Review.2003.p575
  28. ↑ 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.
  29. ↑ Cicirelli, Victor G. (November 1998). "Personal meanings of death in relation to fear of death". Death Studies. 22 (8): 713–733. PMID 10346699. doi:10.1080/074811898201236.
  30. ↑ Ellis, L.; Wahab, E. A.; Ratnasingan, M. (2013). "Religiosity and fear of death: A three‐nation comparison". Mental Health, Religion & Culture. 16 (2): 179. doi:10.1080/13674676.2011.652606.
  31. 1 2 3 4 Wen, Y. (2010). Religiosity and death anxiety. The Journal of Human Resource and Adult Learning, 6(2), 31-37. Retrieved from http://search.proquest.com/docview/867401301
  32. ↑ Wen, Ya-Hui. The Journal of Human Resource and Adult Learning6. 2 (Dec 2010): 31-37.
  33. 1 2 3 4 5 6 7 8 Griffiths, M. (2007). Death Understanding and Fear of Death in Young Children. The Journal of Clinical Child Psychology and Psychiatry, 12 (4), 525-535. Retrieved from http://resolver.scholarsportal.info/resolve/13591045/v12i0004/525_duafodiyc
  34. ↑ Slaughter, Virginia; Griffiths (October 2007). "Death Understanding and Fear of Death in Young Children". Clinical Child Psychology and Psychiatry. 12 (4): 525–535. doi:10.1177/1359104507080980.
  35. ↑ Slaughter, V., Griffiths, M. (2007). Death Understanding and Fear of Death in Young Children. Clinical Child Psychology and Psychiatry. 12 (4) pg 525-535
  36. ↑ 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.
  37. ↑ Harrawood, L. K., White, L. J., & Benshoff, J. J. (2008). Death Anxiety in a National Sample of United States Funeral Directors and Its Relationship with Death Exposure, Age, and Sex. Omega: Journal Of Death & Dying, 58(2), 129-146. doi:10.2190/OM.58.2.c
  38. ↑ Pettigrew.Dawson."Death anexiety:State or Trait" Journal od Clinical Psychology.1979.pg158
  39. 1 2 3 4 5 Donald.Charles. "Death Anxiety and Mental Ability" Essence: Issues in the Study of Ageing, Dying and Death. 1979.p85
  40. 1 2 3 Langs. "Death Anxiety and the Emotion-processing Mind" Psychoanalytic Psychology .2004.p43
  41. ↑ Trenner (1982). "Accuracy of perception and attitude: An intergenerational investigation". Perceptual and Motor Skill. 54 (1): 271–274.
  42. 1 2 3 4 5 6 Tomer.Eliason."Toward a comprehensive model of death anxiety" Death Stuides.1996.p353
  43. ↑ Jaucourt, Louis, chevalier de. "Death." The Encyclopedia of Diderot & d'Alembert Collaborative Translation Project. Translated by Malcolm Eden. Ann Arbor: Michigan Publishing, University of Michigan Library, 2007. http://hdl.handle.net/2027/spo.did2222.0000.836. Originally published as "Mort" in Encyclopédie ou Dictionnaire raisonné des sciences, des arts et des métiers, 10:716–718 (Paris, 1765).

Bibliography

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