Why do we fear death, and how does this fear influence our lives? In this most insightful book, the authors explore the intriguing idea that the awareness of our mortality pervasively and profoundly influences almost every aspect of our lives. They argue that ‘the terror of death is the driving factor behind most human activities, from myths, religion, rituals, art, and language, to economics, science, agriculture and technology (pages x and 73-81). The ideas the authors explore make up terror management theory, the assertion that human activities developed primarily to overcome or control the existential terror of death.
The book cites several lines of research which demonstrate the impact of the fear of death on our daily behaviours. When reminded of death, for example, we tend to ‘react generously to anyone or anything that reinforces our cherished beliefs, and reject anyone or anything that calls those beliefs into question’ (page 13). This, the authors suggest, may explain why people may develop a hatred of those who do not share their worldview, saying ‘our longing to transcend death inflames violence toward each other’ (page 130). Indeed some research they quoted showed that the ‘fear of death magnifies the desire to physically harm those who challenge and insult our beliefs‘ (page 145). Other effects of the fear of death are less malign, such as when judges pass harsher sentences on prostitutes when they are reminded of their own mortality (page 11-12).
An interesting theme the book explores is the relationship between the fear of death and self-esteem. The authors show that a healthy self-esteem protects us from our existential fears, and when our self-esteem is undermined, our fear of death increases (page 45). The book argues that self-esteem serves as a very critical psychological security in managing our fear of death, describing it as ‘our symbolic protection from death’, and our ‘critical bulwark against the fear of death’ (pages 39, 52-60). Because self-esteem wards off the terror of death, the book argues that people will do ‘just about anything’ to increase their feeling of self-worth, including the inordinate and irrational pursuit of fame, celebrity, and wealth (pages 114 and 47-45). People and groups may also take extreme and unreasonable measures to protect their self-esteem, including underhand methods such as derogation, dehumanization, cultural assimilation, demonisation, and destruction (pages xi and 132-139).
Most of the ways people deal with the fear of death are however routine and traditional. These include religious rituals which the authors argue effectively assuage our terror of death even if this is by fostering the illusion that we can control it (pages 67-88). Another effective approach is the assumption of symbolic immortality, ‘the sense that we are part of something greater than ourselves that will continue long after we die’. This often manifests in the various efforts we put into maintaining and defending our cultural worldviews (pages 8-9). The book explores many other diverse defensive strategies against the fear of death which include diversionary tactics to avoid thinking of death (page 26), the adoption of a belief in a personal saviour (page 27), and the use of cultural and religious icons such as crucifixes and flags (page 32).
The authors, psychologists following in the tradition of anthropologist Ernest Becker, used many illustrative anecdotes to support their arguments. They argue for example that Ted Kennedy, in championing the cause of the underprivileged, was actually assuaging his fear of death by striving for significance (page 46). They used the story of Seung-Hui Cho to show how loss of self-esteem may provoke reactions as extreme as murdering fellow students (page 54). They referred to several historical attempts at literal immortality such as by the Chinese emperor Qin Shi Huang (pages 85-86). They also cite several examples of symbolic immortality such as the poet John Keats, and the present-day celebrity culture (pages 101-109). They discuss the prophets of symbolic immortality with the examples of Adolf Hitler, Vladimir Lenin, and Mao Zedong, noting that ‘charismatic leaders become more appealing when existential concerns are aroused’ (pages 120-121).
Many of the topics the authors discuss have particular resonance to healthcare, such as how the fear of death contributes to the development of psychological and psychiatric disorders. They refer for example to studies which show that ‘schizophrenics suffer from an overriding fear of, or persistent ruminations about, death’ (pages 189-209). Phobias on the other hand ‘often entail projecting fears of big, uncontrollable concerns, like death, onto smaller, more manageable problems, like spiders’ (page 193). The authors reviewed the role of proximal and distal psychological defences which keep death thoughts away from consciousness; they suggest that appreciating this concept may help in developing more effective health promotion strategies’ (pages 172-183). They addressed other medical topics such as anxiety, depression, OCD, PTSD, anorexia, alcoholism, drug addiction, suicide, and existential therapy. The book also discussed related concepts such as the epicurean cure (page 216), transcendence (page 221), John Bowlby‘s attachment theory (pages 16-18), and Jean Piaget‘s stages of cognitive development (page 26).
The book’s arguments are generally logical and explain a lot about the role death plays in human societies. The authors draw on a long history of research in the field, and have succeeded in giving the subject great coherence. The bulk of support for the theory is supported by research although some ideas appear to be speculative, for example the book’s attribution of criminal activity to low self-esteem. The relationship of self-esteem to the fear of death is particularly instructive in the care of people who are terminally unwell. The range of topics the book covers is exhaustive, and most have direct relevance to health care.
This book is an eye-opener, an excellent primer on the role the fear of death plays in all aspects of human life. The implications to healthcare are profound. An appreciation that the terror of death is manageable is significant not only for people who are healthy, but those who are acutely facing their mortality due to ill health. The lessons in this book are invaluable and I highly recommend it to all doctors.
Publisher, Place, Year: Penguin Books, London, 2015
Number of Chapters: 11
Number of Pages: 274
Star rating: 5