Thanatophobia: The Fear Of Death And Dying

​On his recent once-in-a-lifetime excursion into space in Jeff Bezos’s Blue Origin spaceship, the iconic space captain and nonagenarian, William Shatner, remarked about how he unexpectedly was filled with sadness. When looking out into space, instead of awe-inspiring wonder, Shatner recalled that all he saw was “a cold, dark emptiness . . . unlike any blackness you can see or feel on Earth. It was deep, enveloping, all-encompassing.” When turning his glance to the Earth Shatner was overwhelmed with the sadness of the degradation of our planet and how profound his attachment to the beauty and fragility of life on Earth was. Expressing what has been labeled, “the overview effect,” reported by previous astronauts, Shatner’s experience, I think, reflects the intense experience that the eternal beauty of nature and love as well as the vastness and finality that the mystery and terror of loss, death, and nonexistence can evoke.

Mysterium tremendum: The awe of existence

Fascination and bewilderment at the mystery of nature’s vastness is an experience most of us have had in certain moments: Standing at the beachhead peering at the vastness of the ocean before us, alone on a clear night gazing at the starry skies above, or witnessing the birth or death of a loved one. These are the deeply profound, rare moments that take us beyond the edge of understanding. These mysteries have interested writers such as Rudolph Otto, the 20th century German theologian, who described both the fear and awe he called numinous dread (“mysterium tremendum”) that is evoked by one’s insignificance when either contemplating or standing before the unimaginable magnitude of nature and existence. Modern philosophers, such as Martin Heidegger, put death front and center in his existentialist explanation for how life comes to life in our conscious minds. In other words, without the profound mystery and finality of death there would be nothing of sufficient force to make us aware of ourselves and our place and purpose in this existence. It alone is what makes us authentic and to bring experience to a place in awareness he called “present-at-hand.”  

The fear of death as a sociological phenomenon

“I am not afraid of death; I just don’t want to be there when it happens.”                                                                                                                                     Woody Allen

Not all great thinkers and writers have been so fascinated with mankind’s experience so much as his avoidance of the experience of death. In his Pulitzer-prize winning book, The denial of death (1974), the anthropologist, Ernest Becker, shows how throughout history mankind has gone to great lengths to deny the facticity of his eventual demise. The Great Freud was known to have been consumed with fears of his death throughout his adult life. According to Becker, Freud’s introduction of the controversial death instinct which never gained wide acceptance in the psychoanalytic community represented a subconscious sleight of hand to transform an underlying fear into a fundamental principle of nature itself. One of Freud’s most eminent acolytes, Otto Rank, recognized the significance of death anxiety that permeates throughout human history. In his lesser known, but ambitious treatise on this topic titled, Psychology and the soul (1920), Rank demonstrated how the prevailing religious and cultural belief systems specific to each era of human history reflect mankind’s efforts to secure his immortality. 


Thanatophobia: Fear of death as a clinical phenomenon

Thanatophobia, the fear of death and dying, is also a known phenomenon in clinical psychology. According to the Cleveland Clinic’s website, 3 to 10% of the general population are affected by it. Here are some of the risk factors associated with this fear:
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• Poor health or a diagnosis of a serious illness
• No religious beliefs
• Dissatisfaction with life
• Low self-esteem
• Presence of other phobias, depression, or anxiety
• Having a loved one ill or dying
• A lack of close friends or family
• Witness to violence, illness, or dying at their vocation
• Children of elderly parents peaking around middle age

The common symptoms associated with thanatophobia may include panic attacks, anxiety, depressed mood, ruminative dread or morbid preoccupation, avoidance of dangerous situations, and hyperattention to physical symptoms of potential illness. Precipitating factors may include a traumatic experience, a significant loss, or witnessing a painful or difficult death. I have found in my clinical practice a recent surge of preoccupation and fear of death I believe is associated with recent events unique to our times that threaten our basic need for security and that cast a shadow over our basic need to feel optimistic about our future and confidence in our fellow man.


Remedies and solutions

“It is not death that a man should fear, but he should fear never beginning to live.”                                                                                   Marcus Aurelius

The psychologist, Otto Rank, said that the fear of death is, at bottom, the fear of living. Therapy should, therefore, be devoted to helping a patient to establish or rediscover meaning and purpose in life and living as well as to diminish the dread about trying to come to terms with its unyielding finality. In clinical practice, research has shown the benefits of both the standard tools and newer, innovative approaches to address death-related fears. For example, psychodynamic therapy can help a patient understand the origins of their fears from childhood relationships as well the defenses that may prevent them from uncovering issues that can cause these phenomena. Psychotherapists may also help a patient put their fear of death and dying within an existential framework to help them understand how universal these concerns can be and how often they may be elicited by either profound experiences or natural transitions that are part of the life cycle. Cognitive therapy can help a patient examine the distortions in their thinking that make these fears prominent and exposure therapy can be helpful by assigning behavioral tasks such as making visits to a hospital, writing a will, or talking with someone with a terminal illness. With some of my patients, I have recommended lifestyle solutions such as creative, artistic endeavors, adopting an animal companion, connecting more with family and friends, and vacation traveling in order to checkmark the “bucket list.” Finally, there is more recent promising evidence demonstrating how by both introducing virtual-reality-induced “out-of-body” experience with a general population and prescribing hallucinogens in controlled, clinical settings with terminally ill patients  people can overcome or diminish their fear of death.