To be published as Wong, P. T. P. (in press). Death and dying. In A. Wenzel (Ed.), The SAGE encyclopedia of abnormal and clinical psychology (p. 0-0). New York, NY: SAGE.


The moment we are born, we are thrown into a precarious existence in a dangerous world; almost anything can end our earthly existence: accidents, diseases, disasters, or violence. No matter how carefully we avoid death and prolong life, sooner or later, we all die. Such is the vulnerability and mortality of human existence. Yet, beneath this everyday banality, lies a significant challenge—how we relate to our own mortality will affect how well we live and die. Self-awareness of our own demise can be our biggest threat or our greatest challenge, depending on the basic stance we take toward this inevitable reality. We can either limit our lives through death denial or fulfill our lives through death acceptance.

When our primary motivation is to deny death and avoid death awareness through various defense mechanisms, we go through life with a defensive posture. This negative motivation to avoid death anxiety can negatively impact individuals and society is a variety of ways. In contrast, when our primary motivation is to discover our true self and develop our unique potentials for the greater good in spite of death anxiety, we are able to face up to our demise courageously and live an authentic and fulfilling life. This positive motivation to live meaningfully is typically accompanied by faith in some enduring dimensions of ultimate meaning.

This entry explores the concepts of death anxiety and death acceptance, including relevant theories and effects, and ends by describing several ways to cultivate death acceptance as a means to a meaningful life.

The Fear of Death

According to Ernest Becker’s Death Denial, our unique human capacity to anticipate and reflect on our own mortality inevitably generates death anxiety. To protest our physical and psychological integrity, death avoidance has become a basic and universal human motivation. Much of human behavior is shaped by this motivation, because death anxiety can threaten our physical and psychological integrity in various ways.

As an umbrella concept, death anxiety encompasses numerous painful emotions, such as fear of the painful process of dying, a sense of despair and hopelessness regarding the inevitability of death, concern about the unknown after physical death, and the terror of the prospect of annihilation and separation. Death anxiety can be compounded when we witness the gruesome mayhem of wars, terrorism, and natural disasters on news broadcasts. The pain of actual loss of a loved one can be more difficult to bear than anticipated personal death; some people have reported that it is like living with a part of their heart ripped out and they cannot find anything to fill the hole in their lives.

In spite of all our defense mechanisms, there seems to be no solution for our fear of death. Attempts to numb our existential anxiety through distractions and addictions sometimes intensify our sense of vulnerability and the pain of our inner void. Embeddedness in intimate relationship networks can both protect us and torment us, because the greater the intimacy, the greater the pain of loss; yet, we cannot find a solution to this inherent conflict.

The Negative Effects of Death Denial

Much of human drama, at both individual and cultural levels, reflects our attempts at death denial. From mummies to pyramids, memorials to monuments, myths to religions, hospitals to funeral services, down through history, we have developed institutions, rituals, and symbolic immortality systems to shield us from the reality of death threat. We even engage in aggression and war when our cultural immortality systems are threatened.

At the individual level, death fear can drive people to seek escape in deadening routines, conformity to collective social orders and all kinds of distractions. Most people are pre-occupied with everyday busyness and pursuing happiness as a way to escape from death-related thoughts; they live as if death does not exist.

Defenses against death anxiety can exist at both conscious and unconscious levels. Conscious denial includes intentional avoidance or suppression of death-related thoughts, and deliberately postponing any discussion of end-of-life issues into the distant future, even when a loved one brings up the matter. Unconscious forms of denial include an illusion of one’s invulnerability, belief in the ultimate rescuer, addictive behaviors, and identification with cultural worldviews and institutions that outlast personal mortality.

Yet, no matter how elaborate our defense mechanisms, death anxiety can still manifest itself in a variety of symptoms, such as emotional disorders and relationship problems, as reported by Irvin Yalom. Similarly, Robert Firestone has stressed that if death anxiety is not adequately addressed, it may undermine our well-being and prevent us from fully engaging in a vital and authentic life. Firestone coins the term microsuicide to describe the maladaptive defensive lifestyle. Microsuicide encompasses a wide range of self-limiting and self-destructive behaviors, such as self-criticism, self-handicapping, self-harm, and suicide ideation.

Yalom suggests that connectivity and creative works are our best defenses against death fear. But the more successful we are in our careers or married lives, the more we are scared of losing it all due to death. Paradoxically, we cannot live fully and vitally, without facing up to the reality of death and making a conscious choice to make this life count for something worthwhile. Yalom is known to have said that although the physicality of death kills, the idea of death may save many lives. It is through confronting our finitude that we can make the best of this brief life.

Becker also suggests that death denial is not inevitable, and that it is possible for us to face up to the finitude of human existence. Only when we confront death honestly and openly without resorting to defenses can we be free to live authentically and fully. However, the main thrust of his book is on death denial but he never fully articulates his analysis of death acceptance.

The Adaptive Function of Death Acceptance

An alternative to the defensive posture is one of death acceptance and pursuing an authentic and meaningful life. Martin Heidegger proposes the concept of “being-towards-death” as essential to living an authentic life. Choosing to incorporate death as an integral part of “being in the world” removes the need for defenses against death anxiety. According to Paul Tillich, the solution to death anxiety is the idea of courage—courage is the affirmation of being in spite of non-being. Courage allows us to transcend nothingness through faith.

Viktor Frankl is probably the most articulate spokesperson for the alternative positive orientation toward death. Briefly, his approach consists of three parts. First, he postulates the will to meaning as a primary motivation. Thus, all people have the innate yearning for both situational meaning and ultimate meaning. Second, he considers meaning in life to necessarily include meaning of suffering and meaning of death. The courage to confront and transcend the dark human conditions is considered by Frankl to be the highest human achievement. Third, he emphasizes self-transcendence and spirituality as an effective way to be free from self concerns to serve a higher purpose for the greater good. This positive stance toward the human condition not only frees one from death anxiety, but motivates one to develop one’s full potential. An important element of this pursuit of self-transcendence is the development of a sense of the sacred and transcendental, an expanding consciousness or awe of the mysteries of human existence. The pursuit of meaning cannot be complete without considering the existential issues of death.

One distinct advantage of this positive orientation is the conception of the interrelatedness of life and death. On one hand, when we live well, we will die well, without regrets and fears. On the other hand, if we do not find some positive way of coming to terms with our mortality, we may go through our final exit kicking and screaming. Worse still, we may, on our death beds,we realize that we have never really lived, because we have spent our whole lives trying to avoid and escape from death anxiety.

Recognizing the difference between these two basic orientations is important. Two individuals can have the same religion, but one person can be motivated by fear of death while the other is motivated by pursuit of meaning. The first person takes a defensive posture and relates to religion as an insurance policy against death threat, but this does not reduce death anxiety. As a result, he or she still lives a defended and shallow life, seeking pleasure, wealth, and other distractions. The second person takes a positive orientation of pursuing meaning in life; he or she embraces religion as an unperishable dimension of ultimate meaning in spite of death anxiety, and at the same time fully engages with perishable dimensions of everyday meaning. Both literal and symbolic immortality systems can be used either as a defense mechanism or as an enduring dimension of meaning, depending on whether one takes the defensive approach or the positive meaning-oriented approach.

The Different Meanings of Death Acceptance

The positive orientation entails death acceptance, an area that has received much less attention than death anxiety. Elisabeth Kübler-Ross was largely responsible for recognizing the importance of death acceptance. Her stage-model of coping with death (denial, anger, bargaining, depression, and acceptance) has left a lasting impact on our understanding of 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. Her sequential stage concept has been criticized; however, the importance of death acceptance has not been questioned.

Paul T. P. Wong and his associates undertook a comprehensive study of death acceptance. In addition to death fear and death avoidance, they identified three distinct types of death acceptance: (1) neutral death acceptance—facing death rationally as an inevitable end of every life; (2) approach acceptance—accepting death as a gateway to a better afterlife, and (3) escape acceptance—choosing death as a better alternative to a painful existence. This Death Attitude Profile (DAP) was later revised as DAP-R. Both instruments have been widely used. According to Wong’s analysis, death fear and death acceptance belong to the defensive posture, while neutral and approach acceptance belong to the positive posture. It is possible for a person to adopt a positive posture but still experience some levels of death anxiety. The case of escape acceptance is unique in the sense that the person does not necessarily accept death, but considers it to be a better alternative than a miserable existence of pain and meaninglessness.

Terror Management Theory Versus Meaning Management Theory

According to Jeff Greenberg, Sheldon Solomon, and Tom Pyszczynski’s terror management theory (TMT), avoidance of death anxiety is the primary motive while the quest for positive meaning is secondary, because the latter is used as a way to shield us from the terror of death. The main hypothesis of TMT is that people identify with their chosen immortality systems, whether literal or symbolic, as a defense against the terror of death. In addition to this cultural hypothesis is the self-esteem hypothesis; individuals seek to excel in values of their chosen culture systems. Most people adopt the defensive posture. A great deal of research has supported both the cultural hypothesis and the self-esteem hypothesis.

For these defensively oriented individuals, their pressing question is “How can I enjoy life without being threatened by death anxiety?” In contrast, meaning management theory (MMT) hypothesizes that for individuals whose primary orientation is one of pursuit of meaning, their pressing questions are “How should I live? How can I live a fulfilling good life?” MMT, as developed by Wong, is a psychological model that focuses on meaning-seeking as a primary motivation and death acceptance as a necessary condition for meaningful living.

The negative defensive life orientation focuses on anxiety, terror, and unconscious defensive mechanisms. 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. The main difference is between a fear-based defensive posture and a meaning-based authentic posture. This difference can have real consequences in how people live their lives and make critical choices.

The limitation of TMT is that it fails to recognize that some individuals through personal insights or spiritual and psychological interventions may choose to confront death anxiety and transform their unconscious defenses into a conscious pursuit of new dimensions of meaningful living. In such cases, death may remain a source of threat, but death anxiety is now under conscious control, and no longer drives people to engage in self-limiting or self-destructive behaviors. In short, those who learn how to live with death and devote all their energy to the pursuit of meaning are relatively free from the pervasive and negative influences of death defense. More specifically, it is the life-enhancing and life-expanding quest for meaning that enables one to live fully in the light of death. A complete psychology of death requires an integration of both types of models.

Ways to Cultivate Death Acceptance

The practice of dying, a phrase attributed to Socrates and adopted by both psychologists and death educators, is an effective method to be free from the terror of death. Such practice of confronting the full impact of death reduces its terror so that one can fully engage in life. When Socrates stated that an unexamined life is not worth living, he was talking about examining the vulnerability and mortality of human existence as an important part of self-reflection.

Another practice is to embrace an enduring dimension of meaning, as suggested by Becker and Frankl. Such faith is based on the mysteries of human existence and the enduring ideals of goodness, truth, and beauty. It is in being open to death that one can have the courage to engage in what is enduring, good, and what really matters.

The positive orientation is considered to be preferable to the defensive orientation. Death awareness makes one live kinder and wiser in everyday living. Looking at things from the perspective of the finitude of life can purify one’s motives and clarify one’s priorities, so that one can live with wisdom, joy, and gratitude. Authentic happiness and flourishing are more likely to take place in the context of openness to death anxiety.

See also Acceptance; Addiction; Anxiety Disorders: Risk for; Cultural Identity; Defense Mechanism; Existential Theoretical Framework; Spirituality/Religion and Health; Anxiety and Stress and

Further Readings

  1. Becker, E. (2007). The denial of death. New York, NY: Simon and Schuster.
  2. Firestone, R. W., & Catlett, J. (2009). Beyond death anxiety. New York, NY: Springer.
  3. Frankl, V. E. (1985). Man’s search for meaning (Revised & updated ed.). New York, NY: Washington Square Press.
  4. Kubler-Ross, E. (2009). On death and dying (40th anniversary ed.). Abingdon, UK: Routledge.
  5. Pyszczynski, T., Greenberg, J., & Solomon, S. (2002). In the wake of 9/11: The psychology of terror. Washington, DC: American Psychological Association
  6. Tomer, A., Eliason, G. T., & Wong, P. T. P. (2008). Existential and spiritual issues in death attitudes. New York, NY: Erlbaum.
  7. Wong, P. T. P. (2008). Meaning-management theory and death acceptance. In A. Tomer, G. T. Eliason, & P. T. P. Wong (Eds.), Existential and spiritual issues in death attitudes (pp. 65-87). New York, NY: Erlbaum.
  8. Wong, P. T. P., Reker, G. T., & Gesser, G. (1994). Death Attitude Profile – Revised: A multidimensional measure of attitudes toward death (DAP-R). In R. A. Neimeyer (Ed.), Death anxiety handbook: Research, instrumentation, and application (pp. 121-148). Washington, DC: Taylor & Francis.
  9. Yalom, I. D. (2008). Staring at the sun: Overcoming the terror of death. San Francisco, CA: Jossey-Bass.