Death Anxiety

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Death Anxiety

• Graham Farley
• Practice Educator
• Marie Curie Hospice Bradford

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(No Transcript)
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Death Anxiety An Overiew

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

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Just close your eyes for a moment.
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Theories of Death Anxiety

• Freud 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.

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Death A Universal Phenomenon

• We are all travelling on different roads to the
  same destinationAll roads lead not to Rome but
  to the grave
• (Pojman 1992, p29)

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Perspectives of death
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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

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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

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What causes anxiety about death? (contd)

• 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

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Some amusing quotes on death

• He would make a lovely corpse Charles Dickens
• We all have to die somedayif we live long enough
  Dave Farber
• Death is just natures way of telling you to slow
  down DickSharples
• 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 dont mind dying its just that you feel so
  bloody stiff the next day George Axelrod
• Life is pleasant death is peaceful its 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 dont want to achieve immortality through my
  work but through not dying Woody Allen

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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)

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Theories of Death Anxiety

• That death anxiety is the most intense and
  pervasive phobia
• That other phobias are based on death anxiety
• Much of peoples 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)

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Defenses against Death Anxiety (Yalom)

• Belief in Personal Specialness
• Compulsive Heroism
• Belief in an Ultimate Rescuer

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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)

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Coping with Death Anxiety
Symbolic immortality

• Biological living through children
  grandchildren
• Religious spiritual believing in an afterlife
  transition of soul to another dimension
• Creative living through ones works. Being
  remembered because of our accomplishments

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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)

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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

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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
existed, says Ms Papagno, sagely, they wouldnt
find dying so difficult. The Guardian 17th
November 1999
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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.

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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.

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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)

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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)

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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)

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How can TMT impact on HCPs?

• Exposure to another persons 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

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What gives your life meaning?
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Things that give some people meaning

• Altruism
• Beauty
• Self-actualization/Creativity
• Relationships(Wong 2002)

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Personal Meaning of death the philosophical
perspective
Integrity Versus
Despair
Regret Theory (Erikson,1963)
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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

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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)

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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)

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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,
  19901024)

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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 patients terminality use
  heroic measures (Schultz Aderman1978)

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Death Anxiety Comfort Levels during
Communication (Death Dying)

• Comfort levels of the nurse adversely affected by
  ? in Nurses death anxiety
• Positively affected by communication
  education(Deffner Bell 2005)

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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)

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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)
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Death Education for HCPs

• We are embedded in our time and cultureeach
  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

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Death Education

• How can we know death if we dont know how to
  live
• (Confucius)
• However Wong (1994) suggests
• How can we know how to live if we dont
  understand death

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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

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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