Death Anxiety Graham Farley Practice Educator Marie Curie Hospice Bradford.

Death Anxiety

Graham FarleyPractice EducatorMarie Curie Hospice Bradford

Death Anxiety – An Overiew

• Death• Attitudes towards death• Death Anxiety• The need for Death

Education

Just close your eyes for a moment….

Theories of Death AnxietyFreud suggests that it is quite

impossible for us to imagine what it is like to be dead.

He says that whenever we try to do this ‘we survive as spectators’ because deep down everyone thinks they are immortal.

Death – A Universal Phenomenon

‘We are all travelling on different roads to the same destination……All roads lead not to Rome but to the grave’

(Pojman 1992, p29)

Perspectives of death

Attitudes towards Death• Death integral part of

human existence• Consequently a subject of

anguish & concern at some stage in our lives

• Individual attitudes vary• Collective view based on a

variety of world events• Interplay between the two

What causes anxiety about death?

• Unknown nature of what lies beyond• Indiscriminate• Human knowledge & science have

failed to stop death which makes death ill-understood

• When we fail to understand a phenomenon we construct our own image of it which tends to be negative & destructive

What causes anxiety about death? (cont’d)

• Terrifying – it is ever present & brutally impartial

• Monstrous invisible presence• Threatening to take away

everything we care about in an instant

• Inevitability• Loss of control

Some amusing quotes on death• He would make a lovely corpse ~ Charles Dickens• We all have to die someday…if we live long enough ~ Dave Farber• Death is just nature’s way of telling you to slow down – Dick

Sharples• They say such nice things at funerals that it makes me sad that I am going to

miss mine by just a few days ~ Garrisson Keiller• I don’t mind dying it’s just that you feel so bloody stiff the next day ~ George

Axelrod• Life is pleasant death is peaceful it’s the transition that is troublesome ~ Isaac

Asimov• A dead atheist is someone who is all dressed up with nowhere to go ~ James

Duffecy• Death is a very dull, dreary affair, and my advice is to have nothing to do with it ~

Somerset Maughan• I don’t want to achieve immortality through my work but through not dying ~

Woody Allen

Definition of Death Anxiety‘Death anxiety (thanatophobia) is

defined as a feeling of dread, apprehension or solicitude (anxiety) when one thinks of the process of dying, or ceasing to be or what happens after death. Death is defined as the state of non-being, the termination of biological life’ (Bond 1994,p4)

Theories of Death Anxiety

• That death anxiety is the most intense and pervasive phobia

• That other phobias are based on death anxiety

• Much of people’s daily behaviour consists of attempts to deny death & thereby keep their basic anxiety under control

• Function of society is to strengthen individual defences against death anxiety (Ernest Becker, 1973)

Defenses against Death Anxiety (Yalom)

• Belief in Personal Specialness

• Compulsive Heroism• Belief in an Ultimate

Rescuer

Death Acceptance• Neutral – neither fearing

nor welcoming the event but acceptance of inevitability of death

• Approach – based on belief of life after death

• Escape – welcome alternative to a life that is full of misery(Wong 2002)

Coping with Death Anxiety

• Biological – living through children grandchildren

• Religious & spiritual – believing in an afterlife – transition of soul to another dimension

• Creative – living through one’s works. Being remembered because of our accomplishments

Symbolic immortality

Coping with Death Anxiety• Natural – through the

survival of nature itself. When we die we return to nature which lives forever.

• Cultural – through identification with an institution or tradition, which transcends our own death. (Wong, 2002)

Life Extension Movement who wage war on death

• Calorie minimizers – who consume little food - pale cold & lacking vitality

• Supplementarians – obsessed with physical health & ignore spiritual psychological dimensions

• Cryonists – preserving bodies

Desairology!A strong contender for Book of the Month is published in America. Noella Papagno, a Florida hairdresser who specialises in corpses, is the author of Desairology: Hairstyling for the Deceased. “If people knew this service If people knew this service existedexisted,” says Ms Papagno, sagely, “they wouldn’t find dying they wouldn’t find dying so difficultso difficult.”

The Guardian 17th November 1999

Going back to Our Roots• Sweden's new funeral rite -

bodies freeze-dried, powdered and made into tree mulchBy Kate Connolly in Berlin

• The technique was conceived by a Swedish biologist, Susanne Wiigh-Masak, 49, who said: "Mulching was nature's original plan for us, and that's what used to happen to us at the start of humanity - we went back into the soil.

Diamonds are Forever

The LifeGem® is a certified, high-quality diamond created from the carbon of your loved one as a memorial to their unique life.

Handsets get taken to the grave

• More people than ever are asking to be buried or cremated with their mobile phones when they die, say researchers.

(BBC News March 2006)

Terror Management Theory• Assumes humans spend a great

deal of psychological energy to manage/deny subconscious terror

• Defences include - Cognitive immortality (attachment to institutions, traditions, symbols)- Self esteem enhancement

• When these beliefs are threatened we resort to anger/violence to bolster our sense of security & protect our illusion of immortality (Greenberg et al 1997)

How can TMT impact on HCPs?• Defences may be threatened by

encounter with a person with serious illness

• Western societies promote ideal standards of physical appearance & beauty

• A person with physical illness may fail to conform to the physical expectations of world views (Mosher & Danoff-Burg 2007)

How can TMT impact on HCPs?• Exposure to another person’s

illness or disability evokes fear of suffering the same fate & psychological distancing.

• Thus observing vulnerability in others may impair defences against death awareness

• This can result in greater death anxiety & social avoidance of affected individuals

What gives your life meaning?

Things that give some people meaning

• Altruism

• Beauty

• Self-actualization/Creativity

• Relationships

(Wong 2002)

Personal Meaning of death: the philosophical perspective

Integrity Versus Despair

Regret Theory(Erikson,1963)

Meaning management model• We are born with innate need for meaning but

it may lie dormant because of our preoccupation with business of living

• Death & suffering awaken in us an urgent need to search for meaning & purpose for life and death

• We can discover and create meaning in every situation even in the face of death

Meaning management model• Helps to deepen our faith & spirituality helps

us construct useful psychological & spiritual models that helps to protect us against fear of death & dying

• Motivates us to embrace life to engage in the business of living regardless of our physical condition & present circumstances

• Helps us to re-think our values, beliefs and meaning systems (Wong 2002)

Self Preservation vs Forming Close Relationship

‘ a possible paradox may arise between the need …to develop a close relationship (with the patient) and the increased risk of emotional damage by becoming closely involved’

(Farley, 2004: 75)

Death Anxiety in Staff‘part of a well established

tradition that has recently begun to be questioned is the idea that somehow, somewhere in the education of hcps, something magic

happens to free them from the personal reaction of pain, mutilation, and death’ (Foy, 1990:1024)

The Effects of Death Anxiety on Staff

• Terminal patients of physicians with high death anxiety survive longer during final hospital stay than terminal patients of physicians with low death anxiety.

• Physicians high in death anxiety seem to be less willing to accept patient’s terminality & use heroic measures (Schultz & Aderman1978)

Death Anxiety & Comfort Levels during Communication (Death &

Dying) • Comfort levels of the nurse

adversely affected by in Nurse’s death anxiety

• Positively affected by communication education(Deffner & Bell 2005)

The Need for Death Education• Death anxiety seen as a contributory factor

with regard to occupational stress that is associated with cancer and palliative care (Llewallyn & Payne, 1995)

• The way in HCPs experience death and the general public is vastly different therefore the traditional grief models do not apply (Papadatou, 2000)

The Need for Death Education• HCPs who work in

hospices have lower Death Anxiety than colleagues in other settings

• Factors that correlate strongly with scores on Death Attitude Index were:- Death Education - Sacred Value system (Carr & Merriman, 1996)

Death Education for HCPs

We are embedded in our time and culture…each generation contends with presence of death – raging against it, embracing it, attempting to domesticate it Feifel (1982)

Although we are more knowledgeable & realistic about death there is a persisting avoidance

Death Education

‘How can we know death if we don’t know how to live’

(Confucius)

However Wong (1994) suggests

‘How can we know how to live if we don’t understand death’

Death Education‘To solve the problem of death,

one must first solve the problem of life, living life. If one is able to do that, to live a truly human life, then there is nothing to be feared by the experience of death, because the experience of death is a natural part of life’

Dennis Yoshikawa – Shin Buddhist

Summary• We care for the dying• The dying look to us for comfort & solace• We can provide this more effectively if we

have an openness & self awareness of our own mortality.

• Death Education allow us to explore a range of issues & raise our sense of self awareness

• Death Education can help us to develop effective coping strategies