1. Graham Farley Practice Educator Marie Curie Hospice Bradford
Death Anxiety
Graham Farley
Practice Educator
Marie Curie Hospice Bradford

3. Death Anxiety – An Overiew
Attitudes towards death
Death Anxiety
The need for Death Education

4. Just close your eyes for a moment….

5. 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.

6. 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)

7. Perspectives of death There are so many diverse views of death
There is the cold body on the slab or the freeing of the soul
Although we are confronted with the cold harsh reality of death (which the first picture portrays) this may not be the image we carry around with us. As thinking feeling human beings (unlike many animals) we have the knowledge that one day we are going to die yet we need to get on with living without being dominated by an ever present sense of foreboding….
Perhaps therefore we develop a more emotionally acceptable way of viewing death that holds a degree of reality without leaving us with a huge sense of dread with our every waking moment. Perhaps therefore we develop more etherial and spiritual ways of viewing death

8. 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

9. 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

10. 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

11. 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

12. 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)

13. 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)

14. Defenses against Death Anxiety (Yalom)
Belief in Personal Specialness
Compulsive Heroism
Belief in an Ultimate Rescuer
Specialness ‘while we believe that we will die at some point that this rational understanding may be met by a more powerful belief that whereas others are doomed to die we are som

15. 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)

16. 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 one’s works. Being remembered because of our accomplishments

17. 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)

18. 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
Calorie minimizers – who consume as little food as possible lower the body temperature and slow down the human metabolism
A walking death – pale cold and lacking vitality
They want to prolong existence at the expense of joy of living
Doctor if I ….will I live longer?
Supplementarians
Who consume a wide variety of supplements to slow down the process of ageing, from vitamin pills to Chinese herbalism – they are obsessed with their physical health and ignore the psychological and spiritual dimensions of death
The cryoniists, who pay large amounts of money to have their heads or entire bodies frozen in a tank of liquid nitrogen until science finds a way to resurrect them. They invest their money and hope in fantasy and science faction.

19. 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 wouldn’t find dying so difficult.”
The Guardian 17th November 1999

20. Going back to Our Roots
Sweden's new funeral rite - bodies freeze-dried, powdered and made into tree mulch By 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.

21. 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.

22. 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)

23. 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)

24. 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)

25. 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

26. What gives your life meaning?

27. Things that give some people meaning
Altruism
Beauty
Self-actualization/Creativity
Relationships (Wong 2002)

28. Personal Meaning of death: the philosophical perspective
Integrity Versus Despair
Regret Theory
(Erikson,1963)
Erikson (1963) states that in order for individuals in the final stages to reconcile themselves with death, they need to resolve the crisis of integrity vs despair
Integrity refers to the state of mind relates to the firm belief that life is worthwhile and meaningful.
There is also an acknowledged acceptance of the differences between the reality of that lived life and what would have been the ideal. The differences between the two are reconciled.
Despair refers to individuals who feel that they have frittered away the years without true investment in their life and are likely to feel a sense of despair and in this case will fear death
Frankl (1965) suggest that finding a meaning in life helps to negate a person’s sense of fear of death.

29. 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

30. 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)

31. 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)
The nurse wrestles with the need to engage in a strong meaningful relationship while conscious of the simultaneous need for self preservation.

32. 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)

33. 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)

34. 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)

35. 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)

36. 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)

37. 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

38. 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’

39. 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

40. 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