Being uncomfortable with the idea of death is the most natural and normal thing in the world. This basic psychological conflict arises due to having, on the one hand a self-preservation instinct, and on the other hand, an awareness that death is inevitable. This fear is common to virtually every human on the planet. But it being common doesn’t mean it’s well talked about or recognised. Far from it. So why is it that so many people are suffering in silence with this particular form of anxiety? 

Because it’s an extreme form of a very natural fear

When someone who is really struggling with intrusive thoughts about death or existential concerns open up to friends and family, they will often express sympathy. But it’s possible they don’t really grasp the extent of the distress the person is experiencing. By attempting to reasure their loved one that feeling anxious at the prospect of one’s mortality is quite normal, they may unwittingly be minimising the extent of the person’s distress.

So because it’s a normal, relatable fear, albeit perhaps an extreme version of, their disclosure perhaps doesn’t spark concern. If someone was to disclose to a friend or family member that they thought their phone had been tapped by the FBI, or they were hearing a voice telling them they were the messiah, the chances are their family member would be considering the need for support from a mental health professional. These fears seem bizarre and paranoid - irrational. But a fear of death, well that’s completely normal, right?

Because others aren’t quite sure how to help

Ultimately there is nothing that we can do to change the fact that we will all one day die. Family and friends may therefore feel uncomfortable in the face of their powerlessness to take away the thing that their loved one fears. If someone is fearful of dogs, or swimming pools or cotton wool, this may feel like a more straightforward fear to help their loved one face up to. But death? How does that work? 

This uncertainty in how to work with this fear is a factor in why even mental health professionals may be avoidant at times in truly acknowledging when an individual is struggling with this sort of anxiety. I have heard stories of professionals glossing over such fears, likening death to simply falling asleep. As a result of not feeling competent to support a person with this anxiety, they may subconsciously take therapy in another direction, focusing on more concrete concerns, thereby dodging the root of the problem. 

And to some extent maybe there is some truth in that the treatment for death anxiety is perhaps less straightforward than some other forms of anxiety. If there was a certain protocol to follow which guaranteed results, as a psychologist who works in this area I would certainly want to know about it. 

People are complex and likewise, so is death and existential anxiety. I don’t think there is one particular solution or ‘cure’ for death anxiety. I do believe however that there are ways to help a person have a different relationship with this anxiety and these intrusive thoughts, thereby reducing their impact and enabling a person to build a rich, full and meaningful life. And I think the first step towards this is fully acknowledging the nature and extent of the problem for any individual in the first place.

Because talking about death is taboo, morbid and uncomfortable....and may trigger other people’s death anxiety 

As we’ve already discussed, death anxiety is actually a very normal fear. So given it’s something that everybody feels to some extent, talking about it may trigger another person’s unconscious fear and so they may subconsciously discourage talking about it. 

Again I think this can apply to both friends and family, and also to mental health professionals. As well as happening at an individual level, I think this also happens at a societal level. Our modern world lives in denial of death. We idolise youth, we live in fear of illness, we are obsessed with medicine and extending life at any cost. The elderly and dying are kept out of sight. Our traditions and rituals around death have been worn away meaning that we are frequently completely removed and sanitised from the process of death. 

Obviously that we are living longer lives than ever before and infant mortality rates have dropped through the floor in many parts of the world is an incredible success story. But the result is perhaps that we have less personal experience of death. And no matter how much progress is made in terms of life expectancy around the world, the truth is that we are still mortal and we do still die.  

Because it’s not recognised as a medical condition in its own right

Death anxiety, or thanatophobia, is not considered a formal and separate condition in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) though for some individuals it might fit criteria for being considered a ‘specific phobia’. 

Now this is a controversial area and I’m not necessarily saying it should be conceptualised as a diagnosable psychiatric condition. Personally, I prefer the less medical sounding term death anxiety to the more pathologizing ‘thanatophobia’.

I don’t think the answer is necessarily to medicalise the experience and define criteria where, when a theoretical line is crossed, a person goes from not having a disorder to having a disorder. Even the answer to the question of whether an experience ‘interferes with a person’s ability to function’, a key criterion for any mental health condition, is subjective and open to wide variation in interpretation.

Giving something a name or a ‘label’ often seems to make it more of ‘a thing’. People identify with the term, relate to it and whilst this can be helpful for some in explaining their experience, it can also be self-perpetuating. Pharmaceutical companies arguably seem in favour of labelling various conditions. For them though, rather than this being about promoting awareness, maybe this is more about the way that once something has a name, then you can sell a drug for it. 

There are no right or wrong answers here and it’s a complex philosophical conundrum, as much as a psychological one. Language is a powerful thing and the various versions of the DSM certainly have a significant influence over how society conceptualises our understanding of our own minds.

So what to do about it?

If you are reading this post that means you’ve likely stumbled across my website and therefore now understand that you are not alone and that there are many people preoccupied by these same existential anxieties. 

My hope of course is that death anxiety becomes increasingly well recognised, mainly so that the people struggling with it feel less alone. I know of several social media groups where thousands of people with death anxiety connect and support each other and this can be incredibly helpful for some. 

But the other side of this conversation is not that just that we need to talk more about death anxiety as an issue. What we really should be talking more about is death in the first place.  Perhaps if we were more open about the reality of our mortality, the transience of life, and how one can find meaning in what for many people is a post-religious world, then there might be less anxiety around. And so maybe the sickness, if there is any, is not in any individual’s mind, but rather in our death-denying society itself.