Confronting ‘death anxiety’ in the face of a pandemic

The Covid-19 pandemic, with millions of people around the world falling ill and dying, has forced us to confront many existential issues, particularly the fear of one’s own death. In fact, thanatophobia, or death anxiety, has fascinated and terrorised mankind for as long as humans have been recording their history. The Egyptian practice of mummification, for example, was done to ensure ‘life after death’ through which one’s spirit could journey to the Underworld. Senior clinical psychologist with Cognifyx Infinitum Chad Yip unearths the buried fears about our mortality, and suggest ways we can learn to make the best of them.

Death anxiety, which can occur at both the conscious and unconscious levels, is unavoidable for human beings. Through evolution, our emotions convey to us important messages, such as informing us that we are experiencing distress in one way or another in this current pandemic. Death anxiety reminds us that life and death are interdependent and exist simultaneously. More importantly, our attitudes toward death can significantly influence how we live our life, amid difficult and unavoidable circumstances. Yet, discussions around death and dying remain taboo in many societies, including a modern society like Singapore.

Historically, the average human lifespan was between 30 and 40 years of age. Fast forward to the present day, and the average life span has doubled due to advances in health and medical knowledge. At the same time, this increase in lifespan has given the illusion that our existence in this world is infinite. Thus, unexpected catastrophic events, including the pandemic, have given us a stark reminder that our time in his world is finite.

On a more personal level, we can also be jolted into confronting our own mortality when people close to us die, such as our parents and our friends; when we fall sick especially when stricken with a terminal illness; when we look at ourselves in the mirror and acknowledge the signs of aging.

Death anxiety is a significant, underlying feature across a wide range of anxiety and depressive-related symptoms, such as social anxiety, illness anxiety and depression. Yet, a a gamut of existential concerns lurks beneath the experience of death anxiety, such as questioning the meaning and purpose of life and lamenting a life full of regrets.

To give a few clinical vignettes, a client, in his 60s, started to experience a heightened level of anxiety in the past few years – he was frantic with worry and started worshipping religious objects and statues. On introspection, he realised that he had engaged in very few meaningful activities throughout his life, and he was afraid of dying with regrets.

In contrast, another client, in her 80s, spoke of how she was ready to die because she had done everything she had wanted to do and had lived a colourful life. This account parallels the life of renowned Australian botanist and ecologist David Goodall, who at the age of 104, was “ready to go” after a lifetime of contribution to society. A long-time campaigner for euthanasia, he ended his life at a Swiss clinic after administering a lethal drug under the guidance of doctors.

Research has also indicated that the fear of dying is made up of smaller but discrete fears as elucidated by Diggory and Rothman (1961):

My death would cause grief to my relatives and friends.
All my plans and projects would come to an end.
The process of dying might be painful.
I could no longer have any experiences.
I would no longer be able to care for my dependents.
I am afraid of what might happen to me if there is a life after death.
I am afraid of what might happen to my body after death.

Indeed, unexpected deaths around us, like deaths caused by Covid-19, are likely to amplify the above-mentioned fears resulting in greater death anxiety.

A client, in his late 50s, recounted how he had been suffering from bouts of anxiety for no apparent reason in the past year. Further disclosure revealed that his parents were old and susceptible to dying from Covid-19. Consequently, it reminded him of his own mortality – as the death of one’s parents is often a reminder that one is next in line. On further reflection, he also realised that he had not achieved anything that he considered meaningful in his life, other than making a lot of money and having mostly superficial friendships.

These days, we are often all consumed by seemingly busy schedules and daily activities and we hide behind the illusion of living a life as if tomorrow never ends.

Albeit tragic, the pandemic has forced many of us to relinquish a sense of control, and to confront our own mortality, which might trigger death anxiety in some. At the same time, it also makes us realise that our days filled with endless activities may simply be distractions from living a fulfilled life with meaning, purpose and moral conviction.

Life will inevitably end; death will come.

One of the biggest issues with trying to look for an answer or explanation, or wishing it would not occur due to a tragic event like the pandemic, is that we are caught up in a futile and never-ending process without logic or reason.

Instead, we might choose to focus on living a life that emphasises rebuilding what matters to us. For example, after years of working with terminally ill cancer patients, Irvin Yalom (1980) found that many of them had used their personal crisis as an opportunity for life-transforming personal growth. This includes:

Re-arranging life’s priorities and focusing on doing what truly mattered.
Having an enhanced sense of living and appreciating every passing moment.
Having a sense of freedom to choose what one wished to do rather than waiting for things to happen.
Forming deeper and more meaningful relationships with loved ones.
An increased willingness to take risks and lived life to the fullest.

The current pandemic has triggered death anxiety for many of us. At the same time, the experience of death anxiety also proffers new opportunities for personal growth if we so choose to seize them; to relive our life with a greater sense of meaning and purpose.

Only humans are able to grasp life’s existential meaning, and have the freedom to choose our attitudes towards life’s circumstances. Tragic circumstances can and will put us through profound grief and sadness, reminding us about the fragility of life and our own mortality.

To assuage death anxiety, we need to view death as a sober reminder of the infinite time we have in this world. We need to take notice of each passing moment and appreciate the people and beauty around us. We need to start living a life worth living.

Chad Yip is a registered clinical psychologist, who provides psychotherapy and psychological assessment and treatment for children, adolescents and adults.