Overcoming Fear of Death: Hapter
Overcoming Fear of Death: Hapter
OVERCOMING FEAR
OF DEATH
It is important for the clinician to ask clients about fear of death during
the assessment process. As noted in Chapter 5, several self-report ques-
tionnaire measures provide information about death anxiety and atti-
tudes toward death, including the Death Anxiety Scale (Templer, 1970)
and the Multidimensional Fear of Death Scale (Hoelter, 1979). If it is clear
that death anxiety is a concern, it is helpful to ask a few follow-up ques-
tions to develop a better understanding of the problem. We ask every
client whether they worry a lot about death and dying. If they indicate
yes, we ask a number of other questions to broaden our understanding of
the problem:
● Could you tell me more about your worries about death? How often do
these worries come to you? How do you react when you experience
these worries?
● When did you notice that you started to have more concerns about
death than most people? Were there any extra stresses in your life at that
point?
●
What have your personal experiences with death been like over the
years? Could you describe them?
● Are there situations you avoid because of concerns about death?
● How do you cope when you are dealing with anxiety about death?
Fears of illness and death are different from many other fears. Many of the
things that people fear are unlikely to happen. People who are afraid of flying, for
example, are extremely unlikely to be injured or killed in a plane crash. People
who are afraid of dogs are unlikely to be injured by a dog. All of us will have to
deal with serious illness at some time in our life, however, and all of us will die.
As the years go by we will also have to deal with illness and death in people who
are close to us.
Some people are so preoccupied by their fears of death that this fear con-
sumes much of their attention and energy. They feel that they cannot enjoy any-
thing unless they can be certain that they will not be dying soon. Without
realizing it, they use up the precious days of life worrying about something that
may not happen for many years. They were converting possibly happy days into
unhappy days. Other people are able to accept the reality of death, come to some
peace with the idea, and trust that they will be able to cope with these situations
when they come up. They can focus on the task of living a satisfying and happy
life.
1. Deciding what is important in life and what is not important. Not being
troubled by unimportant matters.
2. A sense of liberation: being able to choose not to do those things that they do
not wish to do.
3. An enhanced sense of living in the immediate present, rather than postponing
life until retirement or some other point in the future.
4. A vivid appreciation of the elemental facts of life: the changing seasons, the
wind, falling leaves, the last Christmas, and so forth.
5. Deeper communication with loved ones than before the crisis.
6. Fewer interpersonal fears, less concern about rejection, greater willingness to
take risks, than before the crisis (Yalom, 1980, p. 35).
OVERCOMING FEAR OF DEATH 153
You do not have to be near death to benefit from facing and accepting it. The aware-
ness of death can help you live your life with greater pleasure and satisfaction every
day. In helping people come to terms with death we have found that two approaches
are helpful. One approach is to overcome your fear of death by facing the reality of
loss and death. The second approach is to resolve to live life to its fullest and to get
as much enjoyment and satisfaction as possible from each precious day.
1. Write a story about your own death that includes your worst fears. Use this
story for 30–60 minutes each day to help you to vividly imagine situations
where you would have to face death.
2. Consider any situations that come up in life that you avoid because of anxiety
about death. If these are situations that other people would face and that you
would like to face, make a plan to face these situations in gradual steps with
repeated practice until the anxiety is reduced.
3. If you do not have a will already, prepare a will. If you do have a will review
it and make sure it is up to date. There is usually material at the local library
or bookstore to assist in preparing a will. It is wise to consult a lawyer about
taking the proper legal form in finalizing a will.
4. Write your own obituary using as examples obituaries from people of your age
in the local newspaper. (The obituary should be for your current age, not for
ten years down the road.) Review and save in a file the obituaries of people
close to your age. In reviewing the obituaries imagine what the circumstances
might have been around the death.
5. Decide what you would like in terms of funeral arrangements. There may be a
local funeral planning society or funeral home that can provide information
about choices. Consider whether you would like to follow some family or reli-
gious tradition or to plan something that fits with your beliefs and interests. If
you are in a relationship discuss these preferences with your partner or a close
family member or a friend.
6. Practice dealing with first person accounts of someone (especially someone
who is similar to you in some ways) coming toward their own death or the
death of a close friend or family member. This may be done through books,
magazines, television programs, or movies. This is even more helpful if the
cause of death is one of the areas you fear.
7. Visit the grave of a family member or friend.
8. Visit a place that is associated with death for you such as a hospital emergency
department, a funeral home, any other place that others would visit but is dif-
ficult for you because of death anxiety.
9. Write about or make an audio tape describing a difficult past experience of
terminal illness or death that involved a family member or a friend. Use the
written account to clearly imagine and face these difficult memories.
© 1998 by Furer and Walker
154 CHAPTER 10
use clinical judgment about the best timing for these assignments. We
tend to introduce them early in therapy but if a client is depressed and
reporting suicidal thoughts, clearly we would focus on treating depres-
sion first and would not focus on death anxiety until there was a clear and
persistent improvement in mood.
Cognitive Reappraisal
Certain thoughts and beliefs about death are common. In exploring this
area, it is helpful to review clients’ personal experiences with death.
Helping the client to move toward more balanced views of these issues
may help them to cope more calmly with the prospect of death. Therapists
may be able to provide corrective information based on their personal
experiences with illness and death. Handout 10.2 lists some of the unreal-
istic beliefs about death that we commonly encounter and some more
realistic beliefs for the client and the clinician to work toward.
Case Example
The initial assessment with Anna, age 35, indicated that death anxiety,
beginning in late adolescence, was her main concern. She reported no cur-
rent problems with fear of illness or somatization. A review of her current
situation indicated she was very satisfied with her work and family life.
Her enjoyment of everyday life was very solid, so in this case (unlike
many others) it was not necessary to focus on the enjoyment of life. She
produced this very eloquent story later as part of her work in imaginal
exposure.
For many years now, I have been preoccupied with worries about money, career,
relationships, and material things. As the years passed, I spent little time think-
ing about the broader picture, the meaning of my life. From time to time, I have
had anxiety about death but I never really thought about it realistically, that it
could really happen to me. It was always just a fear that I tried to push aside
and not think about. That is why what is happening to me now has hit me like
a thunderbolt.
156 CHAPTER 10
● If I find out that I am going to die, I will ● Many people are understandably
not be able to cope with my feelings. frightened when they find out that
My emotions and actions will be so out death is approaching. They manage to
of control that I will be in constant cope with these emotions as time goes
emotional suffering. This may create on and most people approach the end of
great distress for those around me. life with dignity. This is also true of
people who have a lot of anxiety
about death.
● Dying is likely to involve terrible pain ● Most of us will have many days of
and suffering in addition to terrible fear. health and happiness in our lives.
Unfortunately, most of us will also have
some days of illness and pain. People
have help to deal with the illness and
pain and are able to get through this with
a good deal of support. Relief of pain is
now a high priority in treatment of the
dying.
● If I die before my children are grown, ● Leaving my children behind will be
it will ruin their lives forever. difficult but there are other people who
care about them who will help them. It is
important to do the best job possible of
parenting now. Part of this job is making
sure that the children have others who
care about them.
● I would not be able to cope with death ● People with all different types of
because I do not have a religious faith religious beliefs, including no beliefs,
that gives me confidence and peace in cope well with death. It is valuable to
what comes after death. consider your philosophy about life
and death.
OVERCOMING FEAR OF DEATH 157
A few months ago, I noticed that my vision would get blurred and from time
to time I would have trouble getting up quickly from sitting to standing. I would
feel dizzy for a couple of seconds. But I didn’t take it seriously and went on with
my life as usual. However, as the weeks progressed, I started having migraines. At
first, they came once a week, but then they started to be more frequent. I made an
appointment with the doctor. I hoped that these physical changes were hormonal
or related to my diet. The doctor gave me a complete physical and found nothing
wrong with me. At first I was relieved because I didn’t want anything to be found.
But the symptoms only progressed and I started to feel that maybe I needed to see
a neurologist to get to the bottom of the matter.
During the weeks that led up to my appointment for a CT scan, I was very
nervous. I felt the nerves in my chest and I was often short of breath. I worried
that I would die young. I had concerns about how my family, in particular my
children, would cope. The idea of not having control over my body or my mind
scared me. What concerns me the most is the physical manifestation of my own
death. I am an atheist. I wish I wasn’t. Believing in the afterlife would be a relief.
But I can’t believe what I don’t believe. To me, death is mechanical. It is a turn-
ing off, a closing down of the mind. That idea is morbid to me. I’m the center of
my existence. I’m afraid of not seeing, not hearing, not knowing what is happen-
ing around me or what is happening to my body. I can’t accept the idea that
I will be underneath the ground. It’ll be cold there and my body will freeze.
In the summer, it will be hot and my body will rot. My skin will shrivel up and
my organs will decompose. I’m afraid of the world going on without me. I’m sure
this seems egotistical. But I’m all that I’ve got! After I die, there is no ME any-
more. I will disappear and never reappear again. There will never be another ME
in history, for as long as the world exists, forever and ever. The inevitability of
death makes me feel trapped. I can’t escape it no matter what I do. I feel chained
to this ultimate course of life. I feel doomed!
After the CT scan, I try to forget about my fears. I call the doctor three days
later to find out the results. My heart is beating so rapidly. It feels as if it’s
pumping right through my chest as I wait on the phone for her to answer. The
doctor finally answers the phone and tells me she has bad news and that the CT
scan results showed that I have a brain tumor. I feel the blood drain from my face.
My worst fears have come true. I ask if she is sure and she says, “I’m afraid,
yes.” How is that possible? I ask if there is something to do about it, and she
says, “The tumor has already spread and is incurable.” I only have a few months
left to live.
I feel as if I’ve entered the abyss. I’m still alive but my life seems no
longer to belong to me, to be under my control. We go home and I go straight
to bed. I want to be unconscious for a while so I won’t have to think about
158 CHAPTER 10
this. That night, my husband and I sit down to tell the children that I’m
“going away.” They ask for how long, and we say “I’m going to heaven and
that I will meet them there.” Even though I don’t believe this, I feel it’s the
best way for them to cope with my death. They start to cry and we all cry
together and hug and don’t want to let go. I feel so sorry for them. I feel that
this will shatter their own lives, it’ll change who they are and I don’t know if
they will be able to cope. My son looks terrified and my daughter is confused.
I can’t do anything to save them from this. It makes me feel very sad and
utterly hopeless. I think about their deaths someday and that this life is a
tragedy. What is life worth if it all funnels into the same waste? I apologize
to them over and over again and tell them that I love them and will always
love them no matter what.
Two months later, I’m admitted to hospital. The cancer has taken over my
brain and I am having trouble thinking and speaking coherently. My head hurts
constantly and I am given pain relief. I feel dizzy all the time and have lost my
appetite. I have nightmares that I won’t wake up. I’m afraid to fall asleep. I can’t
come to accept this fate. I’m fighting it. But I’m not winning. On the tenth day,
with my family around me, holding on to me, I feel that I am losing conscious-
ness. I try to talk. I want to say “goodbye” and tell them that I love them for
the last time. But I can’t say the words. All I can feel is their touch, their hands
holding my hands and I hold on as tightly as possible. I try to see them clearly
but they are a blur and I would do anything to snap out of this condition. I gasp
for breath. I try to force air into my lungs but they feel like they’re closing off. My
head feels heavy and my eyes close. I am not at peace. I need more time. I’m not
ready. But then, in a moment, I am gone.
Anna and her husband did not have a will, despite having young children,
so they quickly arranged to complete a will. Anna also found it helpful to
work out plans for funeral arrangements, even though the discussion of
this area with her husband was emotionally challenging. With practice in
using her story to assist imaginal exposure, she found that there was a
steady decrease in her anxiety about death.
OVERCOMING FEAR OF DEATH 159
CONCLUSION