Co-authored with Adrian Tomer, Ph.D., Associate Professor at the Department of Psychology at Shippensburg University, Pennsylvania.
Death remains the biggest threat as well as the greatest challenge to humanity. It is the single universal event that affects all of us in ways more than we care to know (Greenberg, Koole, & Pyszczynski, 2004; Wass & Neimeyer, 1995; Yalom, 2008). Because of the unique human capacity of meaning-making and social construction, death has evolved into a very complex and dynamic system, involving biological, psychological, spiritual, societal, and cultural components (Kastenbaum, 2000). Whatever meanings we attach to death may have important implications for our wellbeing. Thus, at a personal level, death attitudes matter: Death defines personal meaning and determines how we live (Neimeyer, 2005; Tomer, 2000; Tomer, Eliason, & Wong, 2008).
At the cultural level, death also makes its ubiquitous presence felt in a broad spectrum of social functions, from family, religion, and the entertainment industry to medical care (Kearl, 1989). How we relate to our own mortality is in turn mediated by family, society, and culture (Kastenbaum, 2000). In sum, all human activities are framed by death anxiety and colored by our collective and individual efforts to resolve this inescapable and intractable existential given.
In the post-9=11 era, the ever-present threat of terrorist attacks has injected into our collective awareness the unpredictable nature of mortal danger and mass destruction. Death attitudes even play a vital role in national security: Death defying suicide bombers have changed the landscape of geopolitical warfare, and victory in the war on terror depends in part on our ability to live with death threat.
In a wired global village, our death attitudes are further affected by the 24-hour news coverage of natural and man-made disasters around the world, from catastrophic earthquakes to genocides. Death has invaded our living rooms in grisly detail. Our passive acceptance of the endless coverage of carnage and atrocity betrays a love-hate relationship with death: We are simultaneously repelled by its terror and seduced by its mysteries. The popular appeal of violent video games, TV dramas, and Hollywood movies provide further evidence of our morbid fascination with death. In short, our relationship with death cannot be reduced to terror; a complete psychology of death needs to move beyond terror and denial and start investigating positive attitudes towards death.
The ubiquity of images of death may be seen as an opportunity. Lifting of the taboo may have paved the way for death to emerge as a popular subject for both psychological research and public education.
From Death Denial to Death Acceptance
All through history, human beings have pondered the meaning of mortality and developed elaborate defense mechanisms against the terror of death both at the individual and cultural levels. We now have a huge literature on death denial and terror management (Pyszczynski, Greenberg, & Solomon, 2002).
The problem with death denial is that no matter how hard we try to suppress and repress death awareness, anxiety about our demise can still manifest itself in a variety of symptoms, such as worries, depression, stresses, and conflicts (Yalom, 2008). Another problem with death denial is that it is doomed to fail. Sooner or later, various events in life, such as terminal illness or the death of a loved one, will thrust us right in front of the stark reality of mortality. Yalom (2008) maintained that both covert and conscious death anxiety, if not adequately addressed, may undermine our well-being and prevent us from fully engaging in life. To be obsessed with fear of death can prevent us from living fully and vitally because so much energy will be spent in the denial and avoidance of death. We keep on worrying about death to the extent that we are not free to live. We may avoid loving in order to avoid the pain of separation. Yalom pointed out that ‘‘some refuse the loan of life to avoid the debt of death’’ (p. 108). From an existential perspective, to live fully and happily, we need to engage what we most fear.
Considering the above, it is high time for psychologists to focus on the process of death acceptance. There are numerous reasons for embarking on this positive exploration of a traditionally dark subject matter. These include a fuller understanding of the meaning of life and a better preparation for living well and dying well. Indeed, research on the good death constitutes a new frontier of the current positive psychology movement. We need to learn how to talk about death in a way that is liberating, humanizing, and life-enhancing. Through an increased understanding of death acceptance we may learn to treat each other with respect and compassion.
The Different Meanings of Death Acceptance
Elisabeth Ku¨ bler-Ross (1969, 2009) was largely responsible for making death a legitimate topic for research and medicine. Her stage-model of coping with death (denial, anger, bargaining, depression, and acceptance) has left a lasting impact on our understanding of the psychological reactions to death. She has identified some defense mechanisms (denial and bargaining) and negative emotional reactions (anger and depression) involved in coming to terms with the reality of death. In the final stage, denial, fear, and hostility give way to embracing the inevitable end. However, her sequential stage concept has been widely criticized. For example, Bonanno (2009) has recently found that in coping with bereavement, most people can come to death acceptance without struggling through the previous stages. Only research explicitly designed to study death acceptance will reveal the pathways and mechanisms of coming to terms with death in a constructive way.
Nearly 25 years ago, Wong and his associates undertook a comprehensive study of death acceptance (Gesser, Wong, & Reker, 1987–1988). In addition to death fear and death avoidance, they identified three distinct types of death acceptance: (a) neutral death acceptance, facing death rationally as an inevitable end of every life; (b) approach acceptance, accepting death as a gateway to a better afterlife, and (c) escape acceptance, choosing death as a better alternative to a painful existence. The Death Attitude Profile (DAP) was later revised as DAP–R (Wong, Reker, & Gesser, 1994). Both instruments have been widely used. Neimeyer, Moser, and Wittkowski (2003) confirm that DAP–R remains the preferred instrument to assess death acceptance.
The Dual-System Model of Coping with Death
Imagine yourself as a marine serving in Afghanistan, knowing that every time you are on patrol duty, you may be blown to pieces by an improvised explosive device. How would you carry out your mission in spite of the imminent mortal danger? Any professional soldier knows that it does not pay to live in terror, because excessive fear will paralyze you and reduce your combat effectiveness and increase the likelihood of getting killed. Similarly, denial may also be fatal. Wong’s (in press) dual-system model of achieving the good life can be readily applied to the challenge of how to cope with death anxiety while striving for life-enhancing goals.
According to this model, one has to depend on the cooperation and interaction between approach and avoidance systems. These two complementary tendencies represent two different motivations and life orientations. The defensive tendency to avoid pain, suffering, dangers, anxieties, and death serves a protective function. It is the tendency to seek security and self-preservation in a chaotic and often dangerous world. It involves various defense mechanisms, both unconscious and conscious, to safeguard our psychological and physical integrity. It also involves coping behaviors to reduce threats and negative outcomes. Those who take a defensive stance toward life and death tend to be very cautious and timid, afraid of making changes or taking risks. Paradoxically, their defensive orientation may actually increase their level of fear and anxiety.
The approach system is primarily concerned with pursuing worthwhile life goals, such as career success, raising a happy and healthy family, or defending national security. Engagement in such life expanding projects cannot be maintained without dealing with setbacks, negative thoughts, and fear of untimely death. Optimal functioning depends on transforming the negative to strengthen the positive, thus, involving worth approach and avoidance systems.
Positively oriented individuals are willing to confront the crisis and create opportunities for growth. Their preferred tendency is to take on the difficult tasks and risk even death in order to achieve some significant life goals. They are primarily motivated by their desire to accomplish their life mission, whatever the risks, because they have found something worth dying for. Death exposes the fragility of life and the futility of everyday busyness and strivings. Death focuses and clarifies. The terror of death teaches us what really matters and how to live authentically. The human quest for meaning and spirituality occupies the center stage, while death anxiety belongs to the background. Thus, the sting of death is swallowed up by our engagement in a meaningful life. In sum, the positive orientation is more concerned with what makes life worth living in spite of suffering and death anxiety. Kahlil Gibran (1994) expressed this idea well: “It is life in quest of life in bodies that fear the grave” (p. 104).
Terror Management Theory (TMT) Vs. Meaning Management Theory (MMT)
According to terror management theory (TMT; Pyszczynski, Greenberg, Solomon, Arndt, & Shimel, 2004; Pyszczynski, Greenberg, Solomon, & Maxfield, 2006), avoidance of death anxiety is the primary motive while the quest for positive meaning is secondary, because the later is used as a way to shield us from the terror of death. Meaning creation and maintenance are primarily considered to fulfill a defensive purpose. Symbolic immortality is a particular type of meaning. One attains symbolic immortality by living up to, or even better, exceeding prevalent standards of value (Goldenberg, Pyszczynski, Greenberg, & Solomon, 2001). Because the concept of symbolic immortality is so close to the concept of self esteem, derogation of the self or derogation of one’s culture or system of value are likely to produce a defensive reaction. Moreover, an increase in mortality salience is likely to increase one’s propensity to defend self and=or the belief=meaning system (Psyzczynski, 2006). To sum up, while TMT does not negate the existence of a growth motivation (e.g., Pyszczynski, Greenberg, & Goldenberg, 2003), the search for meaning and meaning making are considered from a defensive perspective. In contrast, according to meaning management theory (MMT), the quest for meaning is a primary motive, because we are meaning-seeking and meaning-making creatures living in a world of meanings. Thus, the pressing question for most people is, How should I live? How can I live a good, fulfilling life?
The negative defensive life orientation focuses on anxiety, terror, and unconscious defensive reactions. The positive life orientation focuses on growth, authenticity, and meaning. It advocates proactive and transformative confrontation with the human condition in its totality. When people are exposed to mortality salience, both TMT and MMT would predict an increase in pro-culture and pro-esteem activities, but for very different reasons. The former is for minimizing terror, but for the latter, it is for maximizing meaning, fulfillment, and joy.
From the perspective of MMT, the heart and soul of overcoming death anxiety and living an authentic happy life lies in the human capacity for meaning making and meaning reconstruction (Neimeyer, 2001; Tomer et al., 2008; Wong, 2008). More specifically, it is the life-enhancing and life-expanding quest for meaning that enables us to live fully in the light of death. Ryan and Deci (2004), based on their self-determination theory (SDT), also emphasized the idea that healthy people seek authentic meaning, as opposed to the defensive or contingent self-esteem emphasized in TMT.
What we need to achieve a complete psychology of death is a good articulation between defense-oriented theories such as TMT and growth-oriented models such as SDT and MMT that emphasize the meaning seeking=making as basic human motivation.
We have just begun the dialog on death acceptance. We still know very little about the pathways and stages of death acceptance. We also remain uninformed about the individual differences and contextual variables in shaping the process of death acceptance. We can only speculate about the optimal ways of combining death denial and death acceptance to achieve well-being in various situations. Finally, so much can be done to apply the concepts and empirical knowledge of death acceptance to clinical populations (Banfman, 2002; Frankl, 1986, Yalom, 2008, Wong, in press). This special issue represents some of the preliminary efforts to explore the new frontier of the positive psychology of death acceptance.
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Wong, P. T. P., & Tomer, A. (2011). Beyond terror and denial: The positive psychology of death acceptance. Death Studies, 35(2), 99-106. Retrieved from http://www.drpaulwong.com/documents/wong-PP-of-death-acceptance-death-studies2011.pdf