1. Types of Death Anxieties

Death anxiety is caused by the fear of pain and also the unknown, of separation from the loved ones and permanent end of existence after death. Langs (2004) has classified three forms of death anxiety: (1) Predatory death anxiety (triggered by external situations that may be physically or psychologically dangerous, and anxiety ensures the survival of the organism in the face of adversities); (2) predator death anxiety (results from an individual harming someone either physically or mentally, which is often accompanied by unconscious guilt that may compel an individual to punish oneself); and (3) existential death anxiety (emanates from the knowledge that life has an end and distinguish self from others. Usually individuals defend against death anxiety through denial, and excess use of denial tends to be detrimental). A few research scholars have discerned four types of death anxiety, namely, personal death anxiety, personal dying anxiety, anxiety toward the death of someone close, and anxiety toward the death of someone close^[1][2] .

2. Theories on Death Anxiety

Several theoretical models relevant to the study of death anxiety have appeared in the literature. Leading theories about death anxiety were developed by Sigmund Freud (Thanatophobia), Ernest Becker (Terror Management Theory), Erik Erikson (Wisdom: Ego integrity vs. despair) and Kastenbaum (Edge theory).

Thanatophobia is fear of death. Sigmund Freud was the first theorist to coin death anxiety and hypothesized that individuals express a fear of death as a response to cope with unresolved childhood conflicts. Thanatophobia is evolved from the Greek mythological figure of death, Thanatos. Ernest Becker proposed terror management theory supported existential views which turned death anxiety theories towards a new dimension. Death anxiety can generate fears of existence such as fear of being alone. Many try to deny death and to keep their anxiety under strict regulation resulting in mortality salience, i.e., become responsive to the understanding of certainty of death and instinctively try to suppress it in response to fear. This method of suppression usually links towards cultural, spiritual, and religious beliefs, and seeks external support. Erik Erikson formulated the psychosocial theory which envelops the concept that once an individual reaches the latest stages of life, they reach “ego integrity”—a state when one comes to terms with their life and accepts it when one finds meaning or purpose in their life. On the contrary, when individual views their life as a series of failed and missed opportunities, then they do not reach the ego integrity stage and exhibit death anxiety. This stage is known as Wisdom: Ego integrity vs. despair. Kastenbaum’s Edge theory postulates that death anxiety contains a survival function that evolves in perceived life-threatening situations.

Hoelter and Hoelter (1978) conceptualized death anxiety as a multidimensional concept and offered eight elements of death anxiety: (1) Fear of dying process, (2) fear of premature death, (3) fear of death of significant others, (4) phobic fear of death, (5) fear of being destroyed, (6) fear of the body after death, (7) fear of the unknown, and (8) fear of the dead. Similarly, Florian and Mikulincer (1998) have articulated three mechanisms of death anxiety: Intrapersonal, interpersonal, and transpersonal. The intrapersonal component focuses on the impact death has on one’s body and psyche. Fear of losing the body after death is prominent during this phase. An interpersonal component brings attention to how interpersonal relationships get stricken by death and therefore the transpersonal component, on the opposite hand, is said with fears about the afterlife.

Paul Wong (2008) developed the meaning management theory. It highlights that human reactions to death are complex, multifaceted, and dynamic. The theory proposes three types of death acceptances as Neutral, Approach, and Escape acceptances. Besides these, it explains different aspects of the meaning of death that eventually regulates death anxiety include finality, uncertainty, annihilation, ultimate loss, disruption of life flow, leaving the loved ones, intense pain, sense of loneliness, prematurity of death, failure of life, unfulfilled work, judgment, and retribution. The theory indicates our existence is based on two primary motivations: To survive and to find meaning and reason for survival. The pursuit of meaning in life can be the best remedy to allay death anxiety. In other words, individuals who find meaning in their existence and contribute productively to the society may not feel threatened by inevitable death ^[3].

Other theories include self-realization theories ^[4][5], personal construct theory ^[6], an illusion of control theory ^[7][8], self-concept discrepancy theory ^[9], search-for-meaning theories ^[10][11][12], theories of denial ^[13], and a two-factor theory of death ^[14].

Hossain and Gilbert (2010) postulated Death and Adjustment Hypotheses (Hossain and Gilbert 2010). It postulated two things; first, death should not be considered the end of existence, second, the belief that the immortal pattern of human existence can only be adopted in an exceedingly morally rich life with the attitude towards morality and materialism balanced mutually.

The recurrent four themes in these theories are death as self-defeating, radical transformation, a threat to the purpose of life, and a threat to the realization of life potential. Such diversity in theoretical approaches has led to varied perspectives on death anxiety; however, these theories have substantial overlapping concepts (Barnett et al. 2018). It means threats to death anxiety can be classified based on two factors: External causes, such as presence and search for meaning in life; and the internal evaluation of the self (Florian and Mikulincer 1998).

3. Psychological Effects of Death Anxiety

Researches indicate that people tend to become increasingly defensive in ways that are harmful to themselves as well as to others when death anxiety is aroused. Although people may initially embrace life more fully, over time, most people shift to a more defended action. However, as we discussed in an earlier section, these reactions vary across religiosity, age, and gender. People with death anxiety deny death to protect themselves and fail to value other relevant and meaningful influences by giving importance to insignificant issues in their lives.

In one experiment conducted by Solomon and colleagues (2015), subjects (judges) were subliminally presented with the word “death”. After these subjects strongly endorsed the worldview of their own ethnic group or nation while, at the same time, they denigrated members of other groups whose worldviews differed from their own (Solomon et al. 2015). It means that judges who were exposed to the word “death” exercised more punitive sentences than those in the control group who were not exposed. If the single word “death” introduced in an experimental setting can produce significant changes in subjects’ attitudes and actions, one can imagine the powerful effect of the word “death” in countless situations in the real world on attitude and actions.

As researches indicate a belief in religion represents the denial of death. Some individuals rationalize death, taking a more philosophical position to keep themselves away from feeling about their own mortality (Kastenbaum 2000). Others may believe that someone will ultimately save them—a relationship partner, a guru, or other (Kastenbaum 2000). Some defenses against death anxiety have beneficial side effects; for example, the symbolic immortality, finding lasting meaning in devotion to family, friends, and people at large, and attempting to leave a positive legacy generally has a good effect. Other defenses, such as living on through one’s children, have a generally negative effect (Hart and Goldenberg 2008).

4. Death Anxiety and Mental Health Conditions

Previous research has identified a connection between death anxiety, quality of life, and a range of mental health conditions (Galek et al. 2007; Sherman et al. 2010; Bahrami et al. 2013; Iverach et al. 2014; Willis et al. 2019). A recent study indicated death anxiety as a predictor of mental health conditions (Menzies et al. 2019) and numerous studies have demonstrated symptomatology of various disorders, including anxiety disorders, post-traumatic stress disorder, obsessive-compulsive disorder, depression, and eating disorders (Iverach et al. 2014; Le Marne and Harris 2016; Menzies and Dar-Nimrod 2017; Ongider and Eyuboglu 2013).

A few studies have explored the causal role of death anxiety in mental illnesses. These studies have revealed that death anxiety increases avoidance of stimuli that generates fear among phobics, social avoidance and attentional biases towards threats among the socially anxious, and even restricted consumption of high caloric foods amongst women, suggesting the relevance of death anxiety in eating disorders (Finch et al. 2016; Strachan et al. 2007; Iverach et al. 2014). One study examined the effect of mortality salience on compulsive handwashing in a large sample of individuals diagnosed with obsessive-compulsive disorders (Menzies and Dar-Nimrod 2017). In another recent study, participants with a panic disorder or a somatic symptom-related disorder were shown increased time checking one’s body for physical symptoms, increased perceived threat of one’s symptoms, and also increased intention to visit a medical specialist in the near future (Menzies and Menzies 2020). Therefore, these findings establish that death anxiety causes anxious behavior for those vulnerable to health-related worries (Menzies and Menzies 2020).

Implications of studies on death anxiety in Indian cotext

While much is known about death anxiety, religiosity and universality, the role of death anxiety in psychological distress and mental illness; how culture inhibits or exhibits an expression of fear of death; how it can be assessed and addressed in therapeutic processes and any interventions that can enhance well-being by addressing death anxiety is still unknown.