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Got Death Anxiety?

Coming to terms with mortality.

Micahmedia at en.wikipedia
Source: Micahmedia at en.wikipedia

What does our reaction to the sudden demise of prominent public figures such as Prince and so many other celebrities in recent years say, if anything, about our collective attitude toward death? Almost always, our knee-jerk response, following the initial shock, sadness and disbelief, is to demand to know how and why someone died, what killed them (whether that person was 27, 57 or 87), but especially when he or she has apparently died prematurely or under suspicious circumstances. Why is that?

Of course there are very good legal and medical reasons for questioning, carefully investigating and determining cause of death in such sad cases. Foul play, for one thing, must be ruled out or in via forensic pathology and toxicology tests. So must possible suicide or accidental overdose. In the case of Prince, it is now looking more likely that he may have had a serious problem with opioid pain medication, but we won't know the cause of death until the autopsy results are released. Other possible causes of death such as stroke or cardiac arrest have not yet been ruled out. The fact is that people do die of natural causes in their late 50s and beyond. The stark truth is that we all must die of something, that death eventually comes to everyone, be it by overdose, accident or aging. Though we are as a culture fascinated, even obsessed, with the lives (and deaths) of so-called celebrities, I suspect this need to know goes far beyond mere titillation or morbid curiosity. We reflexively call for some medical explanation, some scientific cause of death. It is as if, at some level, we refuse to accept the fact that death is an existential fact of life, actually happens every day, and can do so any time to any one of us in any number of ways. Particularly when it happens to someone we idolize, lionize, or see as being somehow immortal or eternal, be they parents or pop stars. We are here today, gone tomorrow. Just like our ancestors all the way back to the biblical Adam and Eve. Nevertheless, whether the cause of death appears to be natural or unnatural, our need to try to explain it seems the same: Was it accidental, self-induced, or secondary to some fatally irreversible disease process? Even when death clearly occurs in and as a consequence of old age, we still find it difficult to accept, wanting to know precisely what process caused it, exactly which of the thousands of possible (and inevitable) failings of fragile human physiology is to blame. And could it have been prevented? What psychological purpose does this insistence serve?

One way of understanding this almost compulsive "need to know" phenomenon is that it relates to our latent death anxiety: Any time someone we are familiar with, close to, care about, or whose work we enjoy and admire passes away, we are reminded, usually subliminally, not only of the grim reality of death in general, but, on some subconscious level, of our own personal mortality, something we tend to have tremendous trouble fully accepting. As Freud (who struggled with his own death anxiety) observed (1915), "our own death is indeed unimaginable," concluding that "at bottom no one believes in his own death, or to put the same thing in another way, in the unconscious everyone is convinced of his own immortality." Intellectually we may acknowledge our own mortality, but deep down, we deny it. Witnessing or learning of the death of fellow human beings by way of the television news, word of mouth, or by scanning the newspaper obituaries allows us to continue to perceive and acknowledge death from a relatively safe distance as some abstract event that tragically happens always to someone else. But, sometimes it can, at least momentarily, break through the massive defense mechanism regarding our own mortality, triggering repressed death anxiety. This is why my former mentor, Rollo May, noted that prior to leaving the ministry to become a clinical psychologist, the only time his parishioners were really affected emotionally and deeply, and hence, receptive to his counseling, was during funerals. For it was then, on those tragic occasions when death became all too real, that their grief, sadness, rage, and death anxiety broke through their rigidly defensive personas.

What is death anxiety? To know we will die is to know death anxiety. Death anxiety can be understood as the self's will to continue, to survive, to persevere, to prosper, thrive and multiply in a world which makes this difficult and, finally, impossible. The constant threats posed by existence itself to its own continuation, the perception of life's fragility, its inherently tenuous and ultimately impermanent, transitory nature, engender death anxiety. Naturally, all living things seek to live as long and fully as possible, to survive all threats to their existence. This seems to be an innate, instinctual tendency toward life and its perpetuation. But, apart from human beings, do they do so out of fear of death? Do plants, or insects, or animals experience death anxiety? Perhaps so, particularly immediately prior to the moment of death. But, on the other hand, we human beings are able to think about death, anticipate it, ponder, reflect and wonder about it, and, therefore, fear it. Death, despite what science tells us, remains the great unknown. And humans carry deep within them a powerful primal fear of the unknown. What happens after death? No one really knows. But the burgeoning public fascination with television programs on the supernatural, ghosts, spirits, demons and the demonic, and with individuals who claim to be able to communicate with and speak for the dead indicates our innate need to deny the finality of death and to try to make meaning of it. Indeed, it could be argued that this need underlies our attraction to religion, which traditionally attempts to help people confront, accept and make sense of the stark reality of death.

Death anxiety, in some cases, is a morbid dread of death. Not merely dread of the physical and emotional suffering that can accompany dying, but a profound dread of the presumed nothingness that comes with death.The anticipated eternal darkness, sterility and coldness of non-being. It can also consist of anticipatory anxiety about loss: loss of consciousness, loss of loved ones, loss of the experience of being alive, loss of meaning, and loss of control over what happens to us during and following death. Death signifies for some not only loss of the physical body, but of the ego, spirit or soul. Moreover, death anxiety could be correlated with the inherent human drive toward what Jung called "individuation" and Maslow termed "self-actualization," the teleological tendency toward wholeness and maturation, and thus may intensify when one feels he or she has not yet fully achieved or attained this goal despite the ever present possibility of one's life being precipitously cut short. Neurotic or psychotic death anxiety typically includes an obsessive focus on these various dreadful aspects of mortality. Such excessive death anxiety can sometimes become debilitating and require therapeutic amelioration, something existential psychotherapy can assist in constructively addressing: not by suppressing it pharmacologically or otherwise--though in severe cases this may temporarily be necessary--but rather by confronting it head on. When normal existential death anxiety is chronically repressed or avoided, it frequently, at least in part, likely underlies and drives various psychiatric symptomatology and mental disorders such as panic disorder, agoraphobia, depression, bipolar disorder, and psychosis. But we all harbor some degree of existential death anxiety which is normal, healthy, and an inescapable part of being human.

Existentially speaking, death is a symbol par excellence of non-being or non-existence, and, therefore, death anxiety can be understood, in Kierkegaard's words, as the "fear of nothingness." Death is understood by many Americans as a dead end, not a doorway. For Westerners, in particular those that take a more secular, rationalistic, scientific view of the world, death is by far the greatest evil to befall us, our most feared and despised foe. We believe that death totally negates and terminates being, that human existence and consciousness abruptly ceases at the moment of death, followed by absolute and eternal nothingness. That no aspect of who we were--be it our soul, spirit, energy, consciousness, etc.-- survives the biological destruction of body and brain. This highly materialistic, hyper-rational worldview taken by science, whether in physical medicine, psychiatry or psychotherapy, can serve to distance helping professionals from dying patients and their suffering, and from their own unconscious anxiety about death. Indeed, our entire system of modern medical treatment is implicitly influenced by this fearful and hostile attitude toward death, which is why every effort is made by doctors to heroically stave it off or postpone it for as long as humanly possible. It could be argued that this perennial battle against death is medicine's primary raison d'etre. Western society strives desperately to control, suppress, sugar-coat, deny, and defeat death at all cost, even at the price of the dying patient's dignity. Indeed, to forestall it forever if possible. Hence our fascination, nay obsession, especially in Western culture, with youth (and the beauty and vitality of youth) and its prolongation by way of plastic surgery, compulsive exercise, and other means of making us look and feel younger than we actually are. Here in America in particular, we worship youth and dread old age, which we associate closely with death.

This pervasive fear and disdain of death, though amplified in Western cultures, is primal and archetypal. For when has humanity not been at war with death? When have we not sought to somehow overcome or outwit death, like the sly Sisyphus from Greek mythology, for instance? For many Westerners, the fact of death itself is a phenomenon that tends to negate life's meaning when it happens, making all human existence seem futile, senseless and absurd. Why must we die? How can our existence have any significance when it is ultimately and finally obliterated by death? What does it matter what we do with our life knowing it will inevitably end in death and nothingness? Why are we even born, if only destined to die? This sort of nihilism is often specifically (though not always accurately) associated with the continental philosophy of existentialism, though it may be much more pervasive in the general population than we realize. Such a thoroughly finalistic view of death is the main source of our existential death anxiety. The denial of death, as anthropologist and philosopher Ernest Becker (1973) contends, is a kind of collective neurosis. But if so, what is the cure?

Clearly, how one thinks about death and what happens after we die can influence significantly one's degree of death anxiety. For someone suffering intolerably in life, death (either from natural causes, suicide or euthanasia) may be seen as a welcome escape from that living hell. But if that same person believes that death is not an end to suffering but rather a repetitive and endless cycle of birth, death and rebirth (as in the Hindu doctrine of karma), death may become much less appealing, in the same way that the terrifying image of Hell in the Judeo-Christian tradition serves to dissuade some from jumping from frying pan into the fire, while simultaneously evoking terror of ending up there after death. At the same time, hoping to attain to Heaven upon dying can be quite comforting to the downtrodden, discouraged, disenfranchised members of society who find this one existence more than enough. On the other hand, the militant Muslim terrorist or radical jihadist convinced that he will be greeted after death by a flock of lustful heavenly virgins may tend to hold life less dear.

Despite its universality, death is addressed differently in other cultures and religions, where it is honored and accepted as a necessary, natural, and integral part of life. Eastern religions like Buddhism, Sufism, and Hinduism, for instance, take a healthier and more direct approach to the enigmatic phenomenon of death, in some cases encouraging daily conscious contemplation by the young and healthy in meditation and mental imagery death's ruinous inevitability, capriciousness, and physical finality. Such sobering, consistently practiced acceptance of death and existential death anxiety, humbly, consciously and willingly becoming in one's mind's eye this anticipated lifeless, decomposing corpse that is every creature's fate--the physical symbol of death's unfathomable facticity--may paradoxically be one of the best antidotes to death anxiety.

Death has always, in all cultures, been a mysterium tremendum. It can be argued that religion in general arose essentially to help people deal with the existential fact of death and to psychologically cope with and make some meaning of mortality. What happens after death--if anything beyond decay, decomposition and gradual disintegration--is still pure speculation. And, psychologically, such speculation, whether that of science or religion, serves one primary purpose: the demystification of death in an endeavor to mediate or eliminate our existential anxiety about it. Yet, paradoxically, it is only in forthrightly and courageously facing and embracing the frightening and devastating reality of death that we learn to fully embrace life and accept it on its own terms. Indeed, such consciously confronted death anxiety can be a creative force, spurring us to seize the moment, make difficult decisions, mobilize assertive action, foreswear chronic procrastination, and fight furiously (albeit finally futilely) against annihilation. Thus, death anxiety can be a positive phenomenon, forcing us to face our finitude and our personal responsibility to live as passionately, lovingly, creatively and meaningfully as we can while we are still here.To "Rage, rage against the dying of the light," as Dylan Thomas wrote about his own father's death. Indeed, this may be the healthiest response to death anxiety: to acknowledge, accept and use it to live life more authentically, passionately and appreciatively in the present. For as another poet, John Donne (1624), so poignantly tells us, "never send to know for whom the bell tolls; it tolls for thee."

Portions of this post are taken directly from "The Violence of Knowing: Medicine, Metaphysics, and the War against Death," Dr. Diamond's review of The Anticipatory Corpse: Medicine, Power, and the Care of the Dying by Jeffrey P. Bishop, M.D. (2011) in PsycCRITIQUES and from "The Demystification of Death," Dr. Diamond's review of Healing with Death Imagery by A.A. Sheikh and K.S. Sheikh (Eds.) (2007) in PsycCRITIQUES.

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