Each of us, especially in this period of emergency and uncertainty, has thought about death at least once. Either because we were directly affected by it or because the challenge to the disease, which affects the whole country, has inevitably touched us, even if only through a news on the news. Clearly, those who came into direct contact with the disease or worse still death due to COVID-19 or the health difficulties that the virus has imposed, also had to deal with mourning, a mourning that we could define as complicated. Complicated because in this situation death is tinged with colours that we have rarely seen, in which death is without a body, without the possibility of celebrating it through a rite and therefore without sharing. But, why are people afraid of dying?

Also, the over information about the kind of death to be expected is frightening and leads to terrifying images and fantasies about how one can die. It is therefore a theme, that of death and the fear of dying, very current for the social and health context we are experiencing. But for many people it was also prior to this emergency, as it is linked to psychopathological problems that we see below.

Fear of dying and family environment

The fear of dying is found in numerous disorders involving mental health, as a basic fear that leads to the development of the symptom or as an existential condition, linked to personological aspects.

As humans we are the only species aware of our existence, and this allows us to reason about ourselves, leading to two kinds of consequences. These lie at the poles of a continuum that goes from being terrified that we all have to die and that it can happen at any moment, to trying to live life in the best possible way because it is the only one we have.

We are not born with the fear of dying. In fact, children up to three or four years old are not aware of death and therefore cannot worry about it. The idea is too abstract, far from one’s own experience of play, action, entertainment, nourishment and sharing. They don’t understand what it means to disappear forever. Only over time does one learn to understand that there is a “thing” called “death” that takes people away forever. This gradual awareness allows us to assimilate the reluctant idea that sooner or later affects everyone, favouring its acceptance around the age of ten, eleven.

Death anxiety in children

But we can see how, for some children, they have been anxious about the subject from an early age. This happens when the family environment does not satisfy the needs necessary to give that “emotional nourishment” that allows us to accept even a terrible idea like that of death.

Children left on their own, untreated, unseen, see their world decay and must make sense of this degradation, but they do not have the emotional and cognitive abilities to cope with it.

On the other hand, children who have had loving and caring mothers have the opportunity to mitigate anxieties related to fears of death and integrate them into their system of meanings. Children who have had these kinds of experiences will develop a secure base as adults and will not be subject to the fear of annihilation or the fear of death.

In these conditions, death is integrated into one’s worldview, but the idea does not poison one’s self-confidence in the course of life.

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Fear of dying and personality disorders

The dysfunctional family and environmental conditions described above can lead to the structuring of a personality disorder. That is, a constant pattern of inner experience and behaviour that markedly deviates from the expectations of the individual’s culture, is pervasive and inflexible, begins in adolescence or early adulthood, is stable over time and causes discomfort or impairment.

For example, we find the fear of dying in Narcissistic Personality Disorder, when the profound sense of emptiness, which comes from historical experiences of emotional deprivation, peeps out. This happens when these people do not feel admired by others, and enter a state of loneliness, in which the thought of death becomes terrifying. The fear of death thus enters to weigh down the terrifying depressive mental state, in which they imagine themselves alone until the end.

Sometimes even in dependent personality disorder we find existential themes related to death. In this case, when the person to rely on is lost, the true lack of purpose and desire emerges, the central heart of this disorder. Death thus becomes yet another meaningless theme, which you may be afraid of, if you think that it can be lived alone, therefore unable to face it.

Fear of dying and panic disorder

If we pay attention to other disorders we can observe that the fear of dying is a typical thought during the first panic attacks.

In fact, the person who experiences a panic attack, with the related physical and physiological manifestations of hyperactivation, may fear losing control, going crazy or dying. In the latter case, symptoms such as palpitations, chest pains, a feeling of dizziness or fainting, can lead you to believe you have a heart attack, ischemia and therefore be on the verge of death.

Usually medical examinations prevent this possibility, but the person is now afraid of being able to try again this state and panic disorder is structured, at the base of which there is the fear of feeling like this again, as during the first attacks.

After the first episodes of panic, usually the individual understands that his life is not in danger and he is no longer afraid of dying, but of experiencing the frightening physical and physiological sensations and it is this dysfunctional thinking that increases anxiety and leads to a new attack or avoidances and protective behaviors (not going to the cinema) that maintain the disorder.

Fear of dying and illness anxiety disorder

Contrary to what common sense leads us to believe, in sickness anxiety disorder (formerly hypochondria) the basic fear is not so much the fear of dying as the terrible and unbearable condition of the disease.

In fact, it is often believed that anyone who worries about physical symptoms as a sign of disease is worried about dying. In reality, the underlying concern concerns the inability to cope materially and emotionally with the condition of the disease.

Catastrophic interpretations of bodily anomalies are cantered on possible long-term fatal outcomes, rather than imminent ones, as is the case in panic.

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The cognitive behavioral treatment

The fear of dying is rarely treated as a symptom in itself, such as a phobia (thanatophobia). In fact, it is more a condition that must be defined within the psychopathological framework in which it unfolds, whether they are personological, symptomatological or both.

When the theme of death is linked to aspects of a dysfunctional personality, the work is extensive. In summary, it consists in providing that emotional nourishment that was lacking in childhood, helping the person to build personal goals and desires and giving new meanings related to death, which can be integrated into the value system by the patient.

While with regard to thoughts related to death in symptom disorders such as panic disorder and health anxiety disorder, cognitive restructuring, work on brooding and rumination and managing emotions, used in cognitive behavioural therapy, are valid tools.

Practical advice

In general, it is possible to follow some indications to manage the fear of death, which are also useful in this historical moment of difficulty and emergency. Death is therefore neither “right” nor “wrong”. It is not a failure, nor a punishment. It is a natural fact that in equal measure, without distinction of race, animal species and social class, we will all experience.

Live your life fully, moment by moment, without following unrealistic fantasies about experiences and without running away from what we live. Being present therefore, allowing ourselves to experience our emotions, our joys, our fears in an ever deeper way. 

Here is a list of things you can do to practice living life with no regrets:

1. Realize that it’s okay to make mistakes. Just make sure to learn from them, forgive yourself, and move on.
2. Make your health and wellness a top priority and always take care of yourself so you’re ready to take care of others.
3. Follow your own path, not one that others want you to follow.
4. Find the humour in life and laugh like there is no tomorrow.
5. Relax and move with the flow of life by being unafraid of change.
6. Be adventurous by trying new things and taking more risks.
7. Have more intellectual curiosity and embrace creativity.
8. Try to find happiness with as many different people as you can.

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9. Think for yourself instead of letting other people’s opinions influence you too much.
10. Try not to judge people before you get to know them.
11. Be thankful for what you have now instead of thinking about what you don’t have.
12. Wish well upon everyone equally and try to admire without envy.
13. Share your happiness with others instead of hoarding it all for yourself.
14. Don’t try to change someone—love who they are now.
15. Enjoy the journey, not just the destination.
16. Know that happiness is bigger than any bank account.
17. Control negative thoughts so that they don’t contribute to the outcome of your life.
18. Use your energy wisely because spending energy complaining, worrying, or being impatient is just wasted energy.
19. Be bold. Find the courage to change things that should be changed and accept that there are some things that cannot be changed.
20. Love your work. If you don’t currently love what you do, figure out what you would love and take the first step toward that life.
21. Turn your discontent into a mystery and enjoy trying to solve it.
22. Face problems from different angles in order to find solutions.
23. Gain independence by realizing that on this earth we are all dependent upon each other.
24. Change your perspective by taking on a wider view of things.
25. Don’t waste time trying to bring disagreeable people around to liking you.
26. Become the person you would like to spend the rest of your life with.
27. Be honest with yourself and others by saying what you mean and meaning what you say.
28. Treat people with respect and compassion.
29. Live in the now by loving the present and being aware of your thoughts and actions. Think happy thoughts and speak powerful words.
30. Try not to put things off until later.
31. Never hold grudges.
32. Face your fears head on and try to do the things that you think you cannot do.
33. Spend time with people who make you happy while also not depending on other people for your own happiness.
34. Stand up for yourself and others and don’t let anyone or anything hold you back.

35. Be yourself and love who you are now.

36. Be a participant in life rather than an observer.
37. Do the things that you love to do as much as you can.
38. Write out a list of goals and achieve them by doing them step by step. Don’t give up when things get difficult.
39. Do something every day that makes you feel proud of yourself—commit random acts of kindness whenever you get the chance.
40. And always keep on moving forward.

It’s important to make room for difficult feelings and try to be kind to yourself

Unpleasant feelings are “programmed” to continue to manifest as this crisis develops: fearanxietyangersadnessguiltloneliness, frustration, confusion, and many more.

We cannot stop them from emerging, they are normal reactions. But we can choose to open up and make room for them: recognize that they are normal, allow them to be there (even if they hurt), and treat us kindly as we experience them.

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Get back in contact with your body

  • Try to feel in the body if there is a point without tension and that can be identified with a feeling of calm. Focus it and, starting from that point, let the feeling of calm of that part can expand, perceiving its propagation with your eyes closed.
  • Decrease the tension of the shoulders, as if giving way to gravity and align the spine, feeling the back straight, but not stiff.
  • If you place your hand on the part of your body that feels the most tension, you may notice the sensation of warmth during self-contact.
  • Bring attention to the buttocks resting on the chair, relax them as if they took up all the space. Sit softly and relax the support on the chair.
  • Feeling the feet resting on the floor and the feeling of grounding it offers (as if our feet were the roots of a tree).

Participate in what you are doing

Looking at the environment as you have never seen it before, with curiosity and without judgment: what do you see? Look around the room, turning your neck. Do you see the colors? The writings? Do you see any objects in particular? Do you hear any noises in the room? Out of the room? Do you have any taste in your mouth? What kind of flavor is it? Do you feel your clothes on your skin? The shoes? Can you touch your arm? Observing in detail what is around us allows us to be in contact with the present moment.

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Do the things that really matter

There are simple ways to take care of yourself. What kind, thoughtful, and supportive actions can you take? During self-isolation or social distancing, what are the most effective ways to spend that time?

Some tips include exercising to stay fit, cooking healthy food, listening to music, writing, caring for animals, reading, doing meaningful activities alone or with others (Psychology Tools Limited, 2020). If you are familiar with mindfulness, or other mindfulness-based approaches, you can actively practice some of these mindfulness skills.

Follow your values

The actions we take should be guided by our core values: what is it important to fight for in the face of this crisis? What kind of person do you want to be as you go through this period? How do you want to treat yourself and others?

Your values ​​could include love, respect, humor, patience, courage, honesty, care, openness, kindness… or numerous others. It is important to find useful ways to “sprinkle” these values ​​into your day. Only by rediscovering goals, desires and objectives that fall within your reference values, can the fear of death be managed and take on another meaning.

The fear of death is one of the fundamental fears that, as living beings, we share. When the moment of death arrives we cannot escape, we cannot postpone, we must let go of this life and the experiences we have lived, the good ones and also the ones we didn’t like. This perspective presents two possibilities: forcibly letting go, accompanied by so much suffering, panic and perhaps regrets, which at the moment of death are evident in their intensity; or arrive ready to let go, having lived a full and meaningful life, satisfied, with no or few regrets and perhaps curiosity.

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