Psychological Implications of Death Attitudes: Anxiety and Acceptance

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This study involves exploring the two different ways on how people react to the idea of death: anxiety and acceptance and how it affects an individual’s perception taking into consideration the association of age, gender, and religiosity. The following theories and concepts are used to explain this behavior: The Death Anxiety Scale and Death Acceptance Scale; Three-component Model of Death Acceptance; Wong’s components of death anxiety; Terror Management Theory; Existential Theory. Death anxiety and death acceptance are the two theoretically identified ways of how people respond with the idea of death or dying that are usually associated with age, gender and religiosity which consequently have psychological implications to individuals and society.

Laboring to survive in the present, we simultaneously think about death because we know, of all things, death is the most inevitable thing in life. However, our feelings and beliefs about mortality differ because there are a lot of factors that influence our perceptions such as age, gender, and religiosity. There are people who dread about the idea of death while other people learn to accept it. These two different ways of understanding death can lead to different effects to our emotions and attitudes including our relationships with other people (Kastenbaum, 1986).

Death anxiety and death acceptance are the two theoretically identified ways of how people respond with the idea of death or dying. People have been trying to create a scale that encompasses the attitudes about the prospect of death the process of dying. Attempting to get a single measurement that encompasses fears about the prospect of death and the process of dying, the first scale called Templer’s Death Anxiety Scale was developed and “psychometrically-tested” (Harding, 2005, p. 253). “The Death Anxiety Scale draws on a range of fears related to death, including concerns about death, and fear of corpses and the process of dying” (Hill & Hood, 1999, p. 8). However, the fear of death was found to be incompatible with the psychological acceptance of its inevitability according to Ray and Najman (1974) who suggested instruments that provides measurement of death acceptance (Harding, 2005).They developed the Death Acceptance Scale and conducted a study where they compared the results to the Death Anxiety Scale. The results supported their notion that death acceptance and death anxiety are actually two different ways of an individual’s attitude toward the idea of death or dying (Harding, 2005).

Individual attitudes to death and dying vary because of many factors (MacLeod et al., 2016). One variable related to the level of death anxiety or death acceptance for an individual is age. Despite the complexity of the relationship between death attitudes and age, some research indicates that age is negatively correlated with anxiety because findings indicate that the elderly may experience ambiguous emotions toward death as compared to younger people (Depaola et al., 2003). Another variable is an individual’s gender. According to a study conducted regarding the role of gender in death anxiety (MacLeod et al., 2016), gender has a significant influence on the levels of death anxiety. Accordingly, female respondents were found to be more anxious about their own death and the death of someone they care for as compared to males. Lastly, various theories suggests that there is a significant connection between death attitudes and religiosity where “death anxiety is lowest among very religious and irreligious people and highest among uncertain individuals” as supported by the Terror Management Theory (Jong et al., 2018, p. 5).

“Death anxiety is considered as a basic fear underlying the development of many psychological conditions and emotional reactions to individuals and society” (MacLeod et al., 2016, p. 339). Death anxiety has significantly contributed to psychological issues and sleep problems for the past decades (Yalom, 1980). The inevitability and unpredictability of death cause people to feel horror, and this fear of death is a fundamental source of anxiety (Yalom, 1980) while mismanagement of death anxiety aggravates symptoms of mental disorders (Arndt et al., 2005). According to Gubar (2019), this anxiety can lead to both positive and negative effects as to how we live our lives every day. “Thinking of their own death is the ultimate struggle for all human beings” (Solomon et al., 2000, p. 200). This thought of mortality is the most certain and universal idea yet it is not usually apparent or observable. It actually comes as psychological symptoms which are often unconscious or denied (Yalom, 1980).

1. Death Anxiety

Death anxiety is a commonly-used term to describe dread or uneasiness generated with an individual’s awareness of death (Lehto & Stein, 2019). Death-anxiety was explained by Gubar (2019) as fear of self-loss, fear of missed opportunities, fear of suffering or even fear of the unknown. Wong (2008) outlined the components of death anxiety as follows: “The finality of death; the uncertainty of what follows; annihilation anxiety or fear of non-existence; the ultimate loss; fear of leaving loved ones behind; fear of the pain and loneliness in dying; fear of an untimely and violent death; fear of failing to complete life work; fear of judgments and retributions.” (Wong 2008, p. 67)

According to a study conducted by Cai et al. (2017), through principle-components analysis and confirmatory factor analysis, four aspects of death anxiety was discovered namely: Dysphoria, Death Intrusion, Fear of Death, and Avoidance of Death. Dysphoria is usually described as the feeling of being emotion tired and upset whenever an individual thinks about death. Death intrusion is when a person imagines or have nightmares regarding his or her own death. Fear of scared on the other hand is when someone has a fright of terror whenever he thinks about his own or someone’s death. Lastly, avoidance of death is an attempt that an individual does in order to not think or talk about death.

Measures of death anxiety are diverse because of the significant development of the scale and sub-scale aspects regarding the study. As mentioned above, the first scale developed in 1970 was Templer’s Death Anxiety Scale (DAS). However, the definition of death anxiety has “evolved from uni-dimensional to a multidimensional through the development of measuring techniques for death anxiety” (Cai et al., 2017, p. 8). Factor structures have varied through developing research and increasing evidence until they conceptualized a “multidimensional construct” of death anxiety in 2005 (Cai et al., 2017).

2. Death Acceptance

Death acceptance was defined by Klug and Sinha (1987) as “being relatively at ease with one’s awareness of personal mortality” (p. 229) or “the deliberate intellectual acknowledgement of the prospect of one’s own death and the positive emotional assimilation of the consequences” (p. 230). They presented two components of death acceptance: confrontation and integration. Confrontation of death is the cognitive component; it is actually accepting and facing an individual’s own death (Neimeyer, 1994). It is more about the “prospect of death and not the process of dying” (Klug and Sinha, 1987, p. 230). On the other hand, integration of death is the negative or positive effective reaction to confrontation. Consequently, they developed a scale which aims to provide a measurement of the degree of death acceptance through measuring these two components of death acceptance called the Klug Death Acceptance Scale.

With the aim of providing a scale measurement for death acceptance, Wong introduced a Three-component Model of Death Acceptance (1994):

Neutral Acceptance – It is neither welcomed nor feared. Neutral acceptance depicts a point of view that considers “death as a fundamental part of life; someone simply accepts it as one of the inevitable facts of life” (Neimeyer, et al. 2004 p. 309);
Approach-oriented Acceptance – Death is considered as a passageway to a happy afterlife. It implies belief of the afterlife where an “optimistic future time perspective correlated with it leads to an optimistic view on death” (Neimeyer, et al. 2004 p. 309);
Escape-oriented Acceptance – Death is regarded as an escape from a painful existence. “It usually results from poverty, mental condition, or severe living conditions that are felt unbearable by the individual where death looks like a good alternative to life” (Neimeyer, et al. 2004 p. 309).

3. Associations of Death Attitudes to Age, Gender, and Religiosity

Gender

The majority of the research conducted about gender’s role in death anxiety conclude that females tend to have higher level of death anxiety as compared to males. The main reason for this is that “women tend to view death in more emotional terms whereas men tend to view perceive death in more cognitive terms” (Depaola et al. 2003 p. 338).

It shows that the female participants displayed a higher level of Multidimensional Fear of Death Scale (MFODS). MFODS is a scale measurement developed by Neimeyer (1994) using eight factors to compare death anxiety by gender. These factors are fear of dying, fear of death, fear of being destroyed, fear of death of significant others, fear of the unknown, fear of consciousness when dead, fear for the body after death and fear of premature death.

Religiosity

According to the Terror Management Theory, there is an impressive amount of evidence that religiosity correlates with death anxiety. Accordingly, “death anxiety prompts religiosity which in turn mitigates death anxiety or in other words, religiosity increases with increased death anxiety for non-believers while death anxiety decreases with increased religiosity among believers” (Jong et al., 2018, p. 4). This is commonly called the inverted-U relationship where “death anxiety is lowest among very religious and irreligious people and highest among uncertain individuals” (Jong et al., 2018, p. 5). One possible reason for this as explained by Homan (1941) is because non-religious individuals can become more concerned about their death because they are afraid of the post-mortem punishment which will consequently result to them becoming more religious. However, there is an exception with atheists who completely do not believe in religion and after-life who probably will give no concern about death. On the other hand, very religious individuals will be less worried about their death because they are certain of their salvation after death.

On a religious note, someone who opted to accept death lives a more spiritual life (Roman Catholic Spiritual Direction, 2014). We can achieve a sense of fulfillment that we don’t have to worry if we die today or tomorrow if we choose to live every day with righteousness; often times, a person who has fully accepted the idea of death can have a peace of mind compared to one who dreads about it.

4. Conclusion

Death anxiety and death acceptance are the two theoretically identified ways of how people respond with the idea of death which have been discovered to have psychological implications to individuals and are usually associated with age, gender and religiosity.

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Psychological Implications of Death Attitudes: Anxiety and Acceptance

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