Death Anxiety

Long the focus of spiritual belief and philosophical conjecture, death and the attitudes of human beings toward it have become legitimate topics of psychological study since the middle of the 20th century. As ways of measuring death fear and anxiety have grown more sophisticated, and as the range of people studied has grown more diverse, researchers have produced a sizable scientific [Page 297]literature on the causes, correlates, and consequences of death anxiety and related responses. Ultimately, this work has begun to yield practical implications for such contexts as death education for school children and professionals, medical and institutional care for the infirm, and even social criticism of mass movements, such as the response of large groups of people or political parties and governments to war or terrorism.

The study of death attitudes has a long past but a short history. Rooted in religious and philosophical systems that are as old as recorded human thought, the focused psychological study of attitudes toward death began only with the research of Herman Feifel in the 1950s, steadily gaining momentum thereafter. Reflecting the abiding themes of the “death awareness movement,” early research focused on assessing fear of death and anxiety in relevant groups such as older adults and physicians, arguing that the discomfort reported by participants stemmed from a blend of individual factors (such as unconscious avoidance of personal mortality) and cultural attitudes (such as the American denial of death). Following the publication of Kübler-Ross's influential popular book, On Death and Dying, in 1969, research on death attitudes burgeoned, supported by publication of the first validated scales of death anxiety and related constructs. The result was a literature that became more methodologically sophisticated, more topically diverse, and ultimately more practical in its applications.

The Problem of Measurement

Early research on attitudes toward death used a patchwork of straightforward interviews; fantasy measures, such as asking participants to draw an image of death that was then rated for its positive or negative emotional tone; and projective tests, such as ambiguous death-related pictures to which participants would tell a story that could vary in its plot and theme. Among the most interesting of these methods were those that sought to assess perceptual defense by use of the Stroop color–word interference test, which flashed death- and nondeath-related words (such as cancer or basket) in different colors, with the instruction that the participant should quickly name the color; delay in doing so for the death-related words relative to the controls was taken as a measure of unconscious defense against the threatening perception of death, which could then be related to such factors as participants' gender, age, or medical status. Few of these variables, however, converged to yield coherent findings within or across studies, and few were carefully assessed for their reliability or validity in separate research.

By the mid-1970s research on death attitudes had increased in sophistication: Carefully constructed questionnaires were designed to assess global death anxiety, the threat that personal death posed to one's sense of identity as a living being, and the fears people reported concerning the state of death versus the process of dying as these centered on one's personal mortality versus loss of another. In the years that followed, instrument development continued, yielding reliable multidimensional measures of more subtle aspects of negative death attitudes, such as fears of premature death, concerns about bodily deterioration, anxiety about a protracted and painful dying, fears of nothingness or divine punishment, and worries regarding the impact of one's own death on loved ones. Finally, researchers began to recognize in their formal measures that death attitudes were not limited to a fearful preoccupation with mortality but also could include active behavioral avoidance, neutral acceptance of death as a part of life, and even active embracing of death as a form of surcease from a painful world or positive anticipation of an afterlife of reward. As a result, researchers are currently in a much better position to study how people actively process the reality of death in human life and relate it to other factors of theoretical or practical relevance.

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