DEATH ANXIETY

Although humans have always thought about death, empirical research on death anxiety did not begin in earnest until the late 1950s. Over one thousand articles have now appeared on the topic, and death anxiety remains an important issue in thanatology (the study of psychological and social aspects of death and dying).

What is death anxiety?

There have been substantial changes in the way Western scientists have interpreted or understood the concept of death anxiety. Early writings, which were heavily influenced by psychodynamic theory, stressed that fear and anxiety about death were universal, and, in an attempt to deal with their neurotic concerns about death, most individuals repressed or denied their true, negative feelings. In other words, everyone feared or was anxious about death, no matter what they said or how they acted. As death research matured, however, investigators discovered not only that some people actually had little or no anxiety about death, but also that the term death anxiety was really a misnomer for a variety of related negative reactions to death. These reactions include elements of fear, anxiety, concern, threat, worry, and confusion, and they can be focused on different death-related issues. For instance, distinctions should be made regarding anxiety about one's own death or the deaths of others, reactions to a painful dying process, uncertainties about when and how one will die, and concerns about an afterlife.

Another major transformation that occurred in thanatological theory and research involved the recognition that individuals can also have positive views and feelings about death. Death is not always viewed completely negatively. For instance, death can give life meaning and can accentuate a positive philosophy of life. People can view death positively, for instance, if it brings relief of pain and suffering, gives loved ones a chance to come together and express their care and concern for each other, or if death and dying helps to refocus attention on important personal values and needs. Finally, dealing with death can reveal strengths in terminally ill individuals, their family members and friends, and health care professionals. In sum, attitudes and feelings about death are multidimensional, and people can simultaneously have both positive and negative sentiments about a broad array of death-related phenomena.

Correlates of death anxiety

Although there are exceptions, it is possible to summarize the association between death anxiety and several demographic and experiential factors. For instance, both gender and age are often related to death anxiety. Females tend to report higher death anxiety than males, and a negative relationship is often seen between age and death anxiety. Younger populations (primarily high school and college age students) tend to report higher levels of death anxiety than elderly persons. The reasons for these differences are not clear.

The effect of contact or experience with death is not straightforward. On the one hand, some workers, such as firefighters and police, whose duties places them at heightened risk for injury and death may have heightened concerns or thoughts about death, which is realistic given their jobs. On the other hand, those working directly with dying or bereaved individuals, such as physicians, nurses, funeral directors, or hospice and AIDS volunteers, do not, as a rule, demonstrate heightened death anxiety and may, in fact, show greater sensitivity and acceptance of death than other groups. Bereavement does not seem to have any direct impact one way or another on feelings about death.

As one might expect, religion and death have often been studied together. Belief in an afterlife or having a religious affiliation seems to have no specific effect on death anxiety, however, though one's religious orientation is important. Individuals whose religious and spiritual beliefs have been internalized, and therefore have an influence on their general behavior, values, and personal world view (a construct often identified as intrinsic religiosity ) tend to report less death anxiety, while those whose religion serves a more social than ideological function (called extrinsic religiosity ) report greater death anxiety.

Assessing and changing death anxiety

The most common method used to assess death anxiety is the self-report questionnaire, which has been employed in over 95 percent of all studies. Several of the more carefully validated measures, including those assessing positive feelings about death are reviewed in Robert Neimeyer's Death Anxiety Handbook (1994). Projective instruments (e.g., the Rorschach inkblot test or Thematic Apperception Test), which were once popular assessment methods, are no longer in favor due to the inability of researchers to document the reliability and validity of projective techniques.

Feelings about death can be modified, although there is still much to learn about causal factors. There is information about two types of events: near-death experiences and death-education programs. Near-death experiences are situations in which individuals feel their death is imminent as a result of an accident, a near-accident, a medical condition, or some other event. Near-death experiences often have a salutary effect by reducing negative feelings and increasing positive feelings about death.

Death education can also influence death anxieties, but it depends on the type of program. Experiential death education refers to classes or workshops that help participants examine and discuss their personal views and feelings about death. This is usually achieved through a combination of readings, movies, videos, experiential exercises, and frank discussions. In contrast, didactic death education is primarily educational in nature and tends to include lectures and readings, but little or no exploration and disclosure of personal feelings. Whereas experiential death education significantly reduces death anxiety, didactic programs have no significant impact.

Death anxiety and behavior

The few studies relating death anxiety and behavior suggest that caregivers who are comfortable with death are more likely to interact positively with the terminally ill, to speak directly and honestly about death, and to be emotionally comforting and supportive to others in need. In contrast, high levels of death anxiety may influence people to avoid seeking needed medical attention or to plan appropriately for their own and others' medical care (e.g., by refusing to consider or execute advanced directives, which are documents such as living wills or a Durable Power of Attorney for Health Care that provide a person some control about how terminal features of their medical care should be handled). High death anxiety can also create missed opportunities to help others, such as someone who is bereaved and needs to speak about their feelings or children struggling to understand and cope with death-related experiences.

Joseph A. Durlak

See also Anxiety; Death and Dying.

BIBLIOGRAPHY

Durlak, J. A., and Riesenberg, L. A. "The Impact of Death Education." Death Studies 15 (1991): 39–58.

Neimeyer, R. A., ed. Death Anxiety Handbook: Research, Instrumentation, and Application. Washington, D.C.: Taylor and Francis, 1994.

Neimeyer, R. A., and Vanbrunt, D. "Death Anxiety." In Dying: Facing the Facts, 3d ed. Edited by H. Wass and R. A. Neimeyer. Washington, D.C.: Taylor and Francis, 1995. Pages 49–88.

Ring, K. Life at Death: A Scientific Investigation of the Near-Death Experience. New York: Quill, 1982.

Spelder, L. A., and Strickland, A. L. The Last Dance: Encountering Death and Dying, 5th ed. Mountain View, Calif.: Mayfield Publishing.

Tokunuga, H. T. "The Effect of Bereavement upon Death Related Attitudes and Fears." Omega 16 (1985): 267–280.