Death and Our Own Dying – Death Related Anxiety And The Understanding Of Its Certainty Patterns Our Daily Life

In the last few weeks our family has had to come to terms with the fact that the health of our wonderful dog, Grauzer the Schnauzer, who whose been our faithful companion of eleven years, and has travelled with us from Cape Town in South Africa to Newcastle upon Tyne in the UK, and then back to Bloemfontein in South Africa, is failing, and as much as we don’t want it to happen and hope he lives on for a few years more, it is very likely in the next few weeks he will be taking the journey to the next world of unlimited lamp-posts and cats and ferrets that do not move as quickly as they do in this one. My old friend and world leading Sport and Exercise Scientist, Professor Andy Jones, last week retweeted some fascinating data of what folk die from during their lifetimes at different ages, and it was fascinating to see this and understand that one had got ‘safely past’ some of the childhood and early adult related cause of death, but that equally, now being well into middle-age, a whole host of nasty causes of death could potentially be one’s fate at any time from now into the future. My great brother, John, heard the unfortunate news that one of his school classmates had passed away of natural causes at the age of forty seven, and we soberly reflected over the Christmas period that ‘there by the grace of god went we’, and we resolved to pay more attention to our health and fitness, in the chance that this would make a difference and prolong for as long as possible into the future the inevitable fate which awaits all of us. All these got me thinking about death and dying, the biggest mystery of life, and perhaps the biggest factor at play in our lives and consideration of our future.

Death is defined as the final cessation of vital functions in an individual or organism which results in the ending of life. One’s death can be a result of a number of different phenomena, from senescence (biological ageing, or in more common terms, old age), disease, violence and murder, predation by wild animals, accidents, suicide, and any number of other mechanisms that potentially can cause one to die. While how exactly to define and diagnose the occurrence of death is still debated in medical circles, generally most folk would accept that someone has died when their heart and respiratory organs stop working and cannot be sustained without external artificial assistance, along with evidence of brain death as evidenced by a ‘flat-line’ EEG (which monitors the presence of rhythmical brain waves) and a lack of cortical function or primitive brain reflexes. When this happens, the body of any person or organism starts decaying and decomposing shortly after the onset of death. Interestingly, not all ‘living’ organisms die (the definition of what constitutes a ‘living’ organism is still hotly debated), with exceptions being the hydra and jellyfish species, which appear to be immortal and never die, and can maintain their existence ‘forever’ unless they are physically torn asunder. Similarly, organisms which reproduce asexually, and unicellular organisms, also appear to ‘live’ eternally. So one can postulate that death is a ‘by-product’ of a complex cellular structure, where somatic (body) cells are created in a complex arrangement by a combination of some ‘plan’ and some energy form, which allows the occurrence of ‘life’ as we know it, but decays with time and eventually deteriorates functionally to a degree that ‘death’ occurs.

What happens to us around the time and ‘after’ death is of course still a matter of conjecture. A fair bit of research has been done on folk who have had a near-death experience where they have been clinically ‘brought back from the dead’ after either a heart attack, or a near drowning, or accident related trauma, all which lead to hypoxia (shortage of oxygen supply) to and of the brain. Most describe a feeling that they are ‘blacking out’ for what to them is an unknown and unpredictable period of time, and an awareness that one is dying, until by chance / good medical practice they are ‘brought back to life’ by resuscitation and other clinical interventions. A lot of these folk also describe a sense of ‘being dead’, a sense of peace and wellbeing and painlessness, an out-of-body experience as if they were ‘floating’ above and ‘watching’ their physical self, a ‘tunnel experience’ of entering darkness via a tunnel of light, reviewing their life in a manner often described as ‘seeing their life history flashing before their eyes’, or seeing ‘beings of light’, all before the absolute darkness / nothingness of unconsciousness (‘death’) occurs, or they ‘return’ to their body as they are resuscitated. Of course all this is first person / qualitative descriptive information, and is impossible scientifically to replicate, but it is interesting that so many folk describe similar experiences as they ‘die’. We also do not know at all what then occurs after this phase, as all these folk are ‘brought back to life’, so we are not aware what happens ‘next’ as part of the death process. Into this knowledge void folk put their own interpretation of what happens, or will happen to them, when they do die – religious folk would describe and I guess hope for some type of ‘heaven’ as the ‘next phase’, or some transcendence or continuation of one’s ‘spirit’ or ‘soul’ into another body or as an entity which exists and ‘drifts’ through the ether eternally – while secular folk would either say they are not sure of what happens, or believe that there is nothing ‘after’ death, and everything just switches off and a blankness / nothingness occurs similar to when one is in a deep sleep. Of course all of these are pure conjecture, and it is for each of us to experience and understand what is ‘ahead’ for us after own deaths only when it happens, when all shall be made clear, or we will disappear into the eternity of nothingness, and know nothing about it or anything further of our life, past, current or future.

What is for sure is that for most folk, the thought of one’s own imminent or potential mortality causes anxiety (and I have never heard anyone say with any sincerity that they really are totally not scared of death and dying, and in those that do, it is almost always manifestly evident bravado), often to a morbid degree, where it is known as thanatophobia. Thanatophobia, or death anxiety, is defined as a feeling of dread, apprehension or anxiety when one thinks of the process of dying, or the totality of death, and its impact on one’s own ‘life’ which is all that we know and ‘have’. Death anxiety can be related to the fear of being harmed and the way one will die, or to existential fear that nothing may exist after we die, or to the fear of leaving behind loved ones and things and processes we believe are reliant on us for their continuation. It has been suggested that folk ‘defend’ themselves against the anxiety they feel about their own death and dying (or that of loved ones) by ‘denial’, which results in a lot of transference, acting out, or ‘covering up’ behaviour either consciously or subconsciously, such as attempting to acquire excessive wealth or power, or committing violence against others, or breaking rules and life boundaries, or celebrating / living life in a manic way, all of which have an emotional cost, and do not usually attenuate the underlying death anxiety. Interestingly, a century and more ago, most folk used to die in a more ‘open’ way than what currently occurs, usually in the comfort (or discomfort) of their homes, surrounded by their loved ones. In contrast, today a greater proportion of folk die in hospitals or hospices, ‘away’ from the ‘visible’ world, and it is usual for most folk never to see someone actually die in their lifetime until their own death is imminent. It has been postulated that this ‘hiding’ of death from us may have paradoxically created a greater fear of death because of us never ‘seeing’ or being involved with death, and therefore death is an ‘unknown’ entity or occurrence which causes an exacerbated fear due to the fear of the unknown nature of death, rather than just a fear of death itself. It has been suggested that folk with more physical problems, more psychological problems or a ‘lower ego integrity’ (lower self-confidence) suffer from greater death anxiety. Folk like Viktor Frankl have suggested that having some life ‘meaning’, or a sense of peace from achieving life goals, or paradoxically letting go of life goals, may attenuate the feelings of death anxiety. Supporting this, death anxiety is apparently greatest during the ages of 35-65 (and is felt by children as young as five years old), but after 65, again paradoxically, death anxiety appears to decrease, perhaps because after retirement one ‘lets go’ of earthly goals and desires, or reaches a sense of peace regarding one’s life and achievements. Of course there has to be a relationship between goals / desires and death anxiety for this to be true, and it is not clear if such a relationship clearly exists, even if it does seem to be logical ‘link’.

Folk that ‘give their life away’, whether in combat as part of a perception of national duty, or to save a family member, or in a life-threatening emergency where they react to such a situation and are prepared to die to save others, are challenging to understand in relation to the death anxiety and fear of death issues described above which most folk would admit to having. Clearly having a ‘higher cause’ must be valenced by these folk to be more important than their own life, or their lives must be perceived to be meaningless enough to ‘give it away’ in such instances. It is difficult to tell which of these (a perception of a higher cause or a meaningless life) is most germane in these different examples, and indeed whether these folk have a fear of death or anxiety about it, but continue with their course of action despite feeling such, or whether some cognitive process or learned way of thinking removes this fear / anxiety before they perform their last act of sacrifice or wilful death. Sigmund Freud suggested that there is a death drive in all folk, which opposes the ‘Eros’ drive (lust for life / breeding / survival), and that when folk want to die, or risk their life doing for example extreme sports like parachuting or mountain climbing where there is a high chance of death occurring, it is part of some primordial desire to ‘go back’ to some pre-life state, though of course a theory like this is difficult to prove or disprove as we cannot yet measure ‘drives’ in a direct way.

So how does knowledge of this anxiety related to the awareness of death as the final life process we will go through, and indeed of death itself, both affect and assist us with how we live our life? We do seem to either consciously or unconsciously create a ‘scaffold’ or pattern of our life plans and life stages related to the relative perceived imminence of death. For example in our twenties we explore ‘life’ with mostly a freedom from the fear of death (though paradoxically this exploratory behaviour often can end in accidental death), perhaps because one believes that one has many years of life ahead of one, and death will occur at a time far in the distance ahead. As one enters one’s thirties, one is for some reason to a greater degree confronted by an understanding of one’s mortality, perhaps due to early signs of physical deterioration such as not being able to compete as well as one used to at sport, or hair loss / developing baldness, or experiencing the death of one’s parents which ‘brings’ awareness of both the reality and finality of death to oneself, amongst many other potential reasons. Because of this one therefore starts ‘planning’ the life left ahead of one based on average mortality figures (most folk believe and hope they will live to between 70-80 years if things go well for them) – for example buying a house that will be paid off before one ‘retires’, having children at a young enough age to see them grow up to adulthood, or writing a will for the first time. The concept of retirement is interesting related to death and dying, and is surely based on a ‘calculation’ of a death age beyond the retirement age, thereby allowing one to have a little ‘down time’ / a time of peace before shuffling off this mortal coil, even though paradoxically health reasons often do not allow folk as much enjoyment of this time as they would if they rather planned a work ‘gap period’ in their forties or early fifties where they took time out from work to relax or travel, and subsequently worked on until death occurred, rather than waiting until being ‘old’ to enjoy retirement with the time left before their death. So a lot of our life appears to be patterned and planned out based on an understanding that a finite amount of years are available to us. This is perhaps why when one has a health scare, or a cancer diagnosis, or when a young person goes to war where the chance of death is manifestly increased at this ‘incorrect’ time of the person’s life, fear of death, death anxiety and denial mechanisms come into play, that can be very difficult to attenuate or ‘put out’ of one’s mind.

As much as one would like to, as the main character in the film ‘Lawless’ concluded after his much revered brother, who he thought was immortal, died at the end of the film, no-one leaves this world alive. Understanding this creates a sense of anxiety in us (unless we perhaps have strong religious beliefs), both for what we will lose, and for what we will leave behind. But, paradoxically, the thought of death perhaps also creates a sense of wonder each day we wake up that we are indeed alive for another day, and makes the grass seem greener, the sun shine brighter, and the water seem wetter, given we know that one day we will no longer ‘have’ all these things around us. Once in my youth I capsized when paddling down a river in my kayak and was pinned under a rock for a period of time, and had that ‘out of body’ feeling described above, and my whole life to that point played out in a fast sequential ‘movie’ in front of my eyes, and then I felt everything go black and remembered nothing more. Fortunately I was ‘let go’ / washed out from under the rock, and when I regained my senses everything did indeed seem much sweeter, lusher, brighter, and more brilliant, and does still to this day. I am of the age when according to the statistics I should most fear death, and indeed, with a young family, each day I do fear that I will not see my son and daughter grow up if I die suddenly. I held my wonderful dog Grauzer in my arms as I brought him home from the vet this morning with the news that I might not be able to hold him such for much longer, and a feeling of immense sadness and impending loss almost overwhelmed me. But then I thought about the good times we have had together, and understood that the circle of life, which for him is nearly complete, was and is a full and happy one, and I understood also that part of my sadness for him is my fear for my own mortality and the sense of permanence that accompanies his impending death. I took note of the fact that, as described above, at the end of one’s life the fear of death is usually paradoxically attenuated and lessens, and hoped that dogs get to that similar point of peace at the end of their time too. And yes, his fur does feel softer, his wagging tail and uplifted ‘happy’ face each time he sees me seems even ‘sweeter’, given I know that soon he will go forever into the great unknown, and will be with us no more. Death and dying is still the greatest mystery life has for us, and a challenge we all have to go through on our own, and we will only gain the knowledge of what death is ‘about’ when we go through the dying process ourselves. When eventually facing one’s own imminent death, perhaps the best one can do is try and find the courage to meet it ‘head on’, as suggested in the wonderful words of the Nick Glennie-Smith song, ‘Sgt. Mackenzie’, written in homage to his grandfather who died in the first Great war – ‘Lay me down in the cold, cold ground, where before many men have gone. When they come, I will stand my ground, and not be afraid’ – though of course we all hope that the need to do this will occur many years from now, with all our loved ones around us, and with the contentment of a life well lived in our final moments. But we can be sure of one thing, and that is we will never get out of this world alive, unless we are an amoeba or jellyfish. And maybe, just maybe, the world is a better place because of this, or at least it feels such in those moments when we ponder on the glory of life, with the aching awareness that at some future point in time we no longer will be ‘in it’, and will go off on our own journey, alone, into the great big, wide, unknown.

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About Alan (Zig) St Clair Gibson

Professor Alan (Zig) St Clair Gibson MBChB PhD MD - Dean of the Faculty of Health, Sport and Human Performance, University of Waikato, New Zealand View all posts by Alan (Zig) St Clair Gibson

One response to “Death and Our Own Dying – Death Related Anxiety And The Understanding Of Its Certainty Patterns Our Daily Life

  • Malherbe

    Hi Zig,
    Long time since i have had contact with you. Congrats on a very well written piece. I enjoyed it thoroughly. A few thoughts from me on the topic:

    – you mention that everyone is “scared of death”. I agree with you, but the reason for this can simply be found in our most powerful instinct- that of survival. Without the will to live a species has no right to life. The absence of survival instinct will almost certainly guarantee extinction. The fear of death may therefore be deemed a by-product of this instinct. In my opinion it (this fear) should be embraced, because it illustrates our degree of mental health. Once this goes, the mind gives up and death sets in.

    – The arrogance of humankind: Why is it that humans feel they are any different (in terms of life) than a dog or an ant or a leaf dropping from a tree. We do not ponder when we step on an ant on our way to work or whereever. We don’t give it a second thought. We accept the fact that the ant is dead. Imagine someone suggesting the ant “seeing a bright light” on its passage to death. We’d probably suggest the person being crazy. That, to me, points to the arrogance of humankind. We would love to think that we’re different from other living things. We are not. The truth is, we’re not, or rather; there is currently zero evidence that we are any different from a leaf falling from a tree – its contribution completed. Personally, i live my life hoping that in some small way i also contribute, make an impact, leave a legacy. Perhaps not like an Einstein or Nightingale. Perhaps my legacy is the example I set to my children, who will hopefully one day pass it on to theirs. If so, that is good enough for me.

    Thats my two cents Zig. All the best and let me knowcwhen you’re visiting SA.

    Keep well,
    Donnie

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