- Although people are now more open to talking about it, a fear of death is still common.
- Fear of death has been considered a root cause of psychiatric illness.
- Possible treatment options exist to help manage the fear.
Have you noticed that people seem to be more open to talking and learning about death? In the past half-century people have been exposed to a significant increase in death education. They are more open about their thoughts and feelings about death and willing to share them at places such as Death Cafes and Coffin Clubs. We are more familiar now with hospices and palliative care and turn to them as death approaches. Death doulas serve as companions to the dying and their families, providing support and education at life’s end. There are many books also available to us about people's own experiences with death and loss.
Once dismissed, exceptional experiences at the deathbed—including near-death experiences, deathbed visions, and deathbed dreams—are now acknowledged as legitimate experiences that help the dying and their family experience peace and serenity at the end of life, positively impacting their grief as well.
However, the fear of death is still a very real factor in many of our lives. There is likely to be some degree of death anxiety in all of us, which is not unusual. Most of us fear the unknown. There is such a thing as a healthy fear of death that keeps us from engaging in dangerous and self-destructive activities, protecting others as well as ourselves. However, for some, the fear becomes a phobia so intense that it disrupts and changes the way they live their lives.
Fear of death is not just a single fear but consists of many different aspects. For example, are you more afraid of the act of dying, or of the idea of death itself? If the act of dying is more fearful, it is important to examine which aspects contribute to it. Is it pain and suffering, losing control of your body and mind, fear of the unknown, being alone, or concerns for the people you will leave behind? If death itself is the greater fear, you might explore concerns about non-existence. Is there an afterlife and, if so, might there be eternal suffering involved? Some might be concerned that there isn't an afterlife and we just fade into oblivion.
Psychiatrist Irvin Yalom (2008) believed that much of our anxiety and psychopathology has its roots in death anxiety. For example, our phobias are associated with fears of things that can hurt us or cause our death. Some examples would be hypochondriasis, the fear of becoming ill and dying, or agoraphobia, in which going outside is seen as dangerous, possibly leading to one’s death. The fear of flying is another example.
What can be done for people who have a death phobia? In therapy, it is important to identify which of the different aspects is the most disturbing and begin to focus on that. The goal of therapy is to make the fear more manageable and less negative. Cognitive Behavior Therapy (CBT) has been shown to be an effective treatment approach for phobias, as its focus is on the interconnectedness of our thoughts, feelings, and behaviors.
In CBT, one learns to challenge their thoughts so that they achieve a different perspective on the issue. Graded exposure and behavioral experiments are used as ways to develop a tolerance for anxiety. More specific information about using CBT for death phobia can be found in Menzies and Veale’s book, Free Yourself From Death Anxiety: A CBT Self-Help Guide for a fear of Death and Dying.
Recently, a study from Johns Hopkins University of Medicine (2022) found that when psychedelic drugs, such as lysergic acid diethylamide (LSD), psilocybin, and N,N-dimeyhyltryptamine (DMT) were administered to people, their fear of death significantly decreased. This result is similar to one of the major changes found in those who have had a near-death experience. "Experiencers" have also reported generalized feelings of well-being and a different attitude toward life and death. While the psychedelics did not bring about all the transformative changes that occur after a near-death experience, it does appear as though their fear of death was significantly altered.
Psychedelic drugs have already shown success with the terminally ill, especially with those who experience a form of existential distress and suffering at the end of life. In particular, cancer patients tend to have twice the suicide risk of the general population. With the appropriate dosing and medical supervision of the psychedelics, a patient's sense of hopelessness often changes into feelings of acceptance and gratitude, decreasing the suicidal risk. Many even describe their experience as having been mystical.
While more research is needed about the use of psychedelics for the dying, the initial results seem positive. peoples anguish over death and dying can be transformed. Whether it be through psychedelics or other forms of talk therapy, people's anguish over death and dying can be changed. To paraphrase Dylan Thomas, who among us would not want to be able to go gently into that good night?
1) Yalom, Irvin (2009). Staring at the Sun: Overcoming the Terror of Death. Jessica Kingsley Publishers, Great Britain.
Menzies, Rachel E. and Veale, David (2022). Free Yourself from Death Anxiety: A CBT Self-Help Guide for a Fear of Death and Dying. Jessica Kingsley Publishers, London and Philadelphia.
3) Sweeney MM, Nayak,s Hurwitz ES, Mitchell LN, Swift TC,Griffiths RR (2022) Comparison of psychedelic and near-death or other non-ordinary experiences in changing attitudes about death and dying. PLoS ONE 17(8):eO271926 https://doi.org/10.1371/journal.pone.0271926.