Why Do We Fear Death And How Can We Overcome It?

(Dr. Rachel Menzies is a clinical psychologist, research fellow, and the director of the Menzies Anxiety Centre, which she established to offer psychological treatment for death anxiety. Rachel has co-authored five books on the topic of existential issues, including “Mortals: How the Fear of Death Shaped Human Society”, and “Free Yourself from Death Anxiety: A CBT Self-Help Guide for a Fear of Death and Dying”.)

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Do you ever worry about your own death, feel that life is too short, or dread the day you will lose someone you care about? You are not alone.

The awareness and fear of death (also known as “death anxiety”) is a universal part of being human. Where does death anxiety come from? As humans, our brains have evolved to be incredibly sophisticated. Our mind has the ability to move forwards or backwards in time. This gift has been tremendously helpful for the survival of our species, allowing us to reflect on previous experiences and anticipate future problems. But it comes with a cost. By the end of the first decade of life, all humans understand where their future inevitably lies — the grave.

This understanding in childhood can open the floodgates for anxiety, a feeling which can be either softened or sharpened by various experiences across our life. For example, if caregivers communicate about death in a calm and matter-of-fact way, we may grow to view death as something normal and not to be feared. On the other hand, if the topic of death is swept under the rug, or if we are raised with an excessive focus on safety and preventing harm, we may be more likely to see death as unnatural, or even preventable.

Our culture also has a big role to play when it comes to the way we feel about death. For many of us in the West, our culture has left us shockingly unequipped to deal with death. We are subtly taught from a young age that death is something you shouldn’t talk about. We use euphemisms such as “pass away”, and tell the bereaved we are sorry for their “loss”.  This issue even presents itself at the end of life, when language used by medical professionals may fail to clearly convey to patients or caregivers that a person is in fact dying, out of fear that such direct language may be too confronting or upsetting.

We also lack rituals which help us grieve or maintain a continuing bond to our dead loved ones. In fact, the idea of maintaining a connection to our dead has even been pathologized, viewed as an inability to cope with the death, rather than a normal part of the grieving process. Not so for many other cultures around the world. In Central and South America, yearly festivals such as Dia De Los Muertos encourage the remembrance of the dead, including visiting their graves to gather and celebrate with others.  In other parts of the world, such as Japan, a shrine to dead loved ones often takes up center stage in a family’s home. Interestingly, practices such as grave visits and household shrines to the dead have been linked to better psychological wellbeing, and reduced distress. And yet, in many Western cultures, we are encouraged to do exactly the opposite — to keep death at arm’s length.

The geography of death has also changed dramatically over human history. Up until the late 19^th century, the dying used to be cared for in our homes, and once dead, bodies would be bathed and prepared for burial by their closest kin. They would be buried in the local graveyard, nestled amongst the day-to-day life of the local village. Today, at least in the West, most people will die in the hospital, prepared for burial or cremation by a funeral home, and their remains will typically be taken to cemeteries some distance away from where their families reside. With death now moved to the outskirts of our cities and societies, it becomes easy to ignore what we do not see regularly, and so too, to fear it.

For some of us, the fear of death may be subtle, even unconscious. Hundreds of psychological studies in the area of Terror Management Theory show us that death anxiety influences our behavior in striking and often unexpected ways, ways that we are usually not even aware of. We may strive to stand out in our career, to own the newest gadgets or live in an impressive house, to leave a legacy, or to pass on our DNA through having children. As we explain in our book, Mortals, the research is clear — each of these, in one way or another, is an unconscious attempt to gain a feeling of significance and permanence in the face of death, to live a grand life that others will remember us for, and to allay our fear of our own mortality.

But what happens when these unconscious coping strategies don’t work? Research conducted with my colleagues has demonstrated that strong death anxiety is linked to worse mental health outcomes, including the development of mental illness. In fact, many common mental health conditions may be driven by the fear of death, including obsessive-compulsive disorder, panic disorder, health anxiety, and even social anxiety.

As a result, there is a growing recognition in clinical psychology that it may be necessary to directly treat death anxiety, if our aim is to produce long-term improvement in people’s mental health. The need to treat death anxiety is also gaining more recognition in the context of terminal illness; a topic that has been surprisingly understudied. Approaches such as psychedelic-assisted therapy have attracted widespread attention in recent years due to their potential to reduce death anxiety, while psychological therapies which focus on feelings of meaning also appear to show benefits.

Of course, we don’t need to have a mental health condition, or be terminally ill, to benefit from addressing our fear of death. If acceptance of death is associated with better psychological wellbeing and quality of life, then working towards such acceptance is a valuable goal for all of us.

How to we start to overcome our fear of death? In 2018, we examined the results of 15 randomized controlled trials. These trials could use any psychological intervention to be included in our study, as long as they measured death anxiety before and after the intervention. When we examined our results, we found that one treatment stood out above the rest — cognitive behavior therapy (CBT). In particular, studies which used graded exposure therapy, by helping people gradually and deliberately face things which remind them of death, showed the biggest improvements in people’s fear of death.

The takeaway message from our research was clear — to overcome our fear of death, we need to face it.

It is only in the last few years that the notion of exposure therapy for treating death anxiety has gained traction among clinical psychologists. But the idea is remarkably old, with roots stretching back into antiquity.

As early as two thousand years ago, the Stoic philosophers of ancient Greece and Rome had already mastered this idea. Around the 1^st Century BC, Seneca wrote, “Study death always, so that you’ll fear it never.”

In some ways, Seneca’s words sum up the work I now do as a clinical psychologist. By helping people to “study” death, whether by examining their own beliefs and assumptions about it, imagining the dying process of their loved ones, or preparing for their own death, such as by writing a will, we work to cultivate acceptance of death, and lessen the dread a person may feel in anticipation of it.

Using CBT, we shine a spotlight on our thinking patterns and our behaviors to figure out what may be driving our fear. Cognitive strategies, such as identifying and examining our thoughts about death, can allow us to develop more helpful attitudes to death and dying. Behavioral strategies (such as exposure therapy) help us to tolerate our feelings of anxiety, and reduce our reliance on the unhelpful behaviors which maintain this anxiety (such as seeking a lot of reassurance, engaging in rituals which give us a false sense of safety, or avoiding things which make us uncomfortable).

By doing so, we can start to view death as normal and natural. Instead of fearing and fighting the inevitable, we can instead focus our efforts on something far more valuable — building a deliberate and authentic life, and savoring the time we have on earth, however brief.

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Final Exit Network (FEN) is a network of dedicated professionals and caring, trained volunteers who support mentally competent adults as they navigate their end-of-life journey. Established in 2004, FEN seeks to educate qualified individuals in practical, peaceful ways to end their lives, offer a compassionate bedside presence and defend a person’s right to choose. For more information, go to www.finalexitnetwork.org.

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