How scared of death are we really – and how does that affect us?

Jonathan Jong, Coventry University

If death is the final taboo, it might not be for much longer. There has, in recent years, been increasing effort to promote conversations about death and dying, both in the home and in more public settings. For example, death cafes, first launched in Switzerland in 2004, have spread around the world, enabling people to speak about their fears over cake and coffee.

Our reluctance to talk about death is often taken as evidence that we are afraid, and therefore suppress thoughts about it. However, there is little direct evidence to support that we are. So what is a “normal” amount of death anxiety? And how does it manifest itself?

Experimenting with death

Judging by studies using questionnaires, we seem more bothered by the prospect of losing our loved ones than we do about dying ourselves. Such studies also show that we worry more about the dying process – the pain and loneliness involved, for example – than about the end of life itself. In general, when we are asked if we are afraid to die, most of us deny it, and report only mild levels of anxiety. The minority who report high levels of death anxiety are even considered psychologically abnormal – thanatophobic – and recommended for treatment.

On the other hand, our tendency to report only low levels of death anxiety might be a result of our reluctance to admit to our fear, to others and ourselves. Based on this hypothesis, social psychologists have, for almost 30 years now, examined the social and psychological effects of being confronted with our own mortality. In well over 200 experiments, individuals have been instructed to imagine themselves dying.

What’s worse: the death of a loved one or facing our own death?
Photographee.eu

The first study of this kind was conducted on US municipal court judges, who were asked to set bond for an alleged prostitute in a hypothetical scenario. On average, judges who were confronted with their mortality beforehand set a much higher bail than those who were not confronted – $455 versus $50. Since then, many other effects have been found among groups including the general population in many different countries.

Besides making us more punitive, thinking about death also increases our nationalistic bias, makes us more prejudiced against other racial, religious and age groups, and
leads to other such parochial attitudes. Taken together, these dozens of studies show that being reminded of death strengthens our ties to the groups we belong to, to the detriment of those who are different from us.

Reminders of death also affect our political and religious beliefs in interesting ways. On the one hand, they polarise us: political liberals become more liberal while conservatives become more conservative. Similarly, religious people tend to assert their beliefs more fervently while nonreligious people disavow more.

On the other hand, these studies have also found that thinking about death tempts us all – religious or otherwise – towards more religious belief in subtle, perhaps unconscious ways. And when the reminder of death is sufficiently powerful and when participants are not mindful of their prior political commitments, liberals as well as conservatives tend to endorse conservative ideas and candidates. Some researchers claim that this could explain the US political shift to the right after 9/11.

What do the results mean?

But why does the prospect of death make us more punitive, conservative and religious?
According to many theorists, reminders of death compel us to seek immortality. Many religions offer literal immortality, but our secular affiliations – such as our nation states and ethnic groups – can provide symbolic immortality. These groups and their traditions are a part of who we are, and they outlive us. Defending our cultural norms can boost our sense of belonging and being more punitive against individuals who violate cultural norms – such as prostitutes – is symptom of this.

Consistent with this interpretation, researchers have also found that reminders of death increase our desire for fame and for children, both of which are commonly associated with symbolic immortality. It turns out that we do want to be immortalised through our work and our DNA.

Thinking about death makes us dream of being famous.
Andrea Raffin

When asked, we do not seem, perhaps not even to ourselves, to fear death. Nor would we guess that thinking about death has such widespread effects on our social attitudes. But there are limits to our introspective powers. We are notoriously bad at predicting how we will feel or behave in some future scenario, and we are similarly bad at working out why we feel the way we do, or even why we have behaved a certain way. So, whether we realise it or not, it seems that to bring death to the surface of our minds is to open Pandora’s box.

So what should we make of these new efforts to demystify death and dying through conversation? It is hard to say. Increasing death’s profile in our imaginations, private and public, might make us all more punitive and prejudiced, as the research found. But then perhaps we get these negative effects precisely because we are unaccustomed to thinking and talking about death.

In exposure therapy, carefully exposing patients to the source of their anxiety – an object, an animal, or even a memory – reduces their fear. In the same way, perhaps this most recent taboo-breaking trend will inoculate us psychologically, and make us more robust in the face of death.

The Conversation

Jonathan Jong, Research Fellow, Coventry University

This article was originally published on The Conversation. Read the original article.

Elsewhere in the Palliverse – Halloween edition

photo by David Mao itsdavoToday (in some parts of the world) it’s Halloween or, as Caitlin Doughty (@TheGoodDeath) calls it, “Culturally Sanctioned Morbidity Appreciation Day.” Please enjoy these links, which have nothing to do with Halloween but may have something to do with palliative care.

Is death taboo? The Groundswell Project conducted a quick survey. The results may surprise you. (The Groundswell Project)

Health researcher on a mission to get Indigenous men talking about prostate cancer and sexual health (ABC News)

“It’s about starting a conversation…[Doctors need to] throw in a phrase like how you going, how’s the old boy, is he getting up, is he getting the job done?”

“…I find men want to talk about it, but someone has to start the conversation with them.”

The silver tsunami is actually silver-brown. How does end-of-life care differ for minorities? asks geriatrician and palliative care doctor VJ Periyakoil (@palliator) in the Washington Post.

Pulitzer prize-winner Tina Rosenberg visits La Crosse, Wisconsin, home of the Respecting Choices program, where 96% of adults reportedly participate in advance care planning discussions. (Talking Early About How Life Should End, New York Times).

And now, a video about advance care planning!

Going to work, writing letters for the future and speaking your mind: Day-to-day living when you know you’re dying (Independent, UK)

In Australia: Federal Government to legalise growing of medicinal cannabis; Labor calls for nationwide scheme (ABC News). Apparently, we’re all for it: Legalised medical marijuana opposed by only 7% of Australians, poll shows (Guardian Australia)

Here’s a strange story to finish the list – “Parkinson’s disease: Scottish woman Joy Milne prompts study after claiming ability to smell condition.” Odd. Thanks to my colleague Dr Bornshin for the link. (ABC News)

Let’s talk about death, baby! Tweet chat 5th November 19:00 AEDT #pallANZ

And we are back! After our very successful inaugural tweet chat last month, let’s rock again with our next effort, and Let’s talk about death, baby together with Palliative Care Australia.

A tweet chat is a virtual meeting on twitter. This chat has the hashtag #pallANZ. Remember to use this hashtag in all your tweets, otherwise people will miss your comment.  If you are not familiar with tweet chats,  check out our Twitter 101 and 102 articles on this site.

It’s hard to talk about dying, or as we sometimes say (only half joking), the D word.
Here are some great references on the subject recently:
What do you think?
Are we letting our fear of saying the wrong thing, get in the way?

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A real death: what can you expect during a loved one’s final hours? via @ConversationEDU

A real death: what can you expect during a loved one’s final hours?

Charles Corke, Deakin University and Peter Martin, Barwon Health

It’s hard to predict events in the final days and hours of a person’s life. Some deaths are wonderful – a gentle decline preceding a gracious demise. Certainly these are the sorts of deaths we see in films or on television, where the dying patient bids farewell to gathered family and friends before softly closing his eyes.

These gentle departures happen in real life too – many people simply die in their sleep, and many families and friends share the privilege of witnessing the calm and serene departure of a loved one. Of course, grief follows, but those left behind are able to take solace in the knowledge and memory of a peaceful passing.

Unfortunately for every “good” death, there are many which are much more stormy and drawn out. These deaths can leave families traumatised for many years or simply make the grief that much harder.

Out of sight Continue reading

Elsewhere in the Palliverse – Weekend Reads

photo by David Mao itsdavo

Welcome to this weekend’s reads. People seem to enjoy the cute animal stories, so I’ve included one (near the end, if you want to read it first).

The latest paediatric palliative care video (below) from Little Stars is about treating chronic pain in children. It’s nice to see how the interdisciplinary team interacts with, and respects, the girl in the video.

An article that is all over my social media feeds this week: Knowing How Doctors Die Can Change End of Life Discussions. It also brought back to mind this article on How Doctors Die. (NPR)

“I felt like I was beating up people at the end of their life…I would be doing the CPR with tears coming down sometimes, and saying, ‘I’m sorry, I’m sorry, goodbye.’ Because I knew that it very likely not going to be successful. It just seemed a terrible way to end someone’s life.” Continue reading

Elsewhere in the Palliverse – Weekend Reads

I have so many links to share with you. Here are a few of them:

Australian critical care doctor and blogger Andy W writes about death and taxes and asks, “…why is it that we seem to spend so much time talking about the taxes, and not nearly enough about death?” Thought-provoking stuff. “The Things That Are Certain“, The Flying PhD

Death isn’t failure. But avoiding these conversations is.” UK Palliative Care Physician Katherine Sleeman shares her story in this beautiful piece, “While medicine gets better, dying gets worse: Doctors are so good at saving lives that we forget about death.” (The Independent UK) Continue reading

Is the health system designed to crush the creativity and spirit of health professionals?

Do you ever feel like health professional education and the health system are designed to take talented, intelligent, creative individuals and turn them into machines with no ability to innovate? Do you find yourself banging your head against a wall when even the smallest change for improvement requires hours of paperwork (that you probably submitted via fax), approval by numerous committees and months of waiting? Do you feel trapped in a health care silo? Do you feel ridiculous attending “multidisciplinary” meetings when the multiple disciplines are merely different specialties within your own profession?

If the answer to any of these questions is “Yes”, please keep reading. Continue reading

Elsewhere in the Palliverse – holiday addition

If you’re lucky enough to have a break over the summer holiday season, I would advise that you to avoid anything work-related. However, if you just can’t pull yourself away from the worlds of palliative care and research, here (in no particular order) are some related links:

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Tweets from the afterlife: social networking with the dead – from @ConversationEDU

This is another article from the Death and Dying series on the fantastic website The Conversation. We’ve shared a couple of these articles before and I would recommend reading the rest over at The Conversation.

Tweets from the afterlife: social networking with the dead

By Bjorn Nansen, University of Melbourne; James Meese, University of Melbourne; Martin Gibbs, University of Melbourne; Michael Arnold, University of Melbourne, and Tamara Kohn, University of Melbourne

Media technologies have operated as both a means of communicating news of a death and memorialising the deceased for a significant period of time, moving from traditional epitaphs, eulogies, wakes and inscription in stone to centuries-old obituaries printed and circulated in newspapers. So where are we now? Continue reading

Children On Death

As both mere humans and as professionals in the palliative care sphere, how often do we catch ourselves or those around us contemplating the big questions of life, or more specifically, death? Quite often, I imagine… Yet many of us still find ourselves tongue-tied on the subject. Even as professionals in the ‘business’ of dying, we may approach conversations on the subject with a certain reluctance. How do we gauge the readiness of a person to face their own mortality? How do we establish a person’s preferences for disclosure? These are complex questions with perhaps no one easy answer – unless of course, you’re a kid, right? Continue reading