From Death Anxiety to Death Acceptance

A meaning management model
Paul T. P. Wong
, Ph.D.
President, INPM
Research Director and Professor
Counselling Psychology Department
Trinity Western University, BC, Canada

All human drama is, to a great extent, a story of how human beings cope with the terror of death, and how they overcome death anxiety through a great variety of conscious efforts and unconscious defence mechanisms.

How we view death and how we cope with death anxiety can profoundly affect every aspect of our lives - either positively or negatively. This paper proposes that meaning management is more adaptive than terror management in dealing with death anxiety. Meaning management fits under the umbrella of positive psychology which is about how to live well and die well. Such wisdom and courage can only be acquired through accepting death and understanding its meanings. Ultimately, meaning management may be the only effective psychological model that protects us against loss and death.

(1) Introduction

  • Death has a thousand faces, but dying has a millions ways.
  • Death is ubiquitous and universal
  • Death attitudes affect how we live
  • We live in a death-denying culture

When you think of death, what kind of image comes to your mind? Is it a cold, stiff corpse lying in a coffin waiting to be buried, or is it a freeing of the human soul from the prison of a physical body?

Most of us have images of death that are negative and disturbing, and that evoke feelings of fear and anxiety.

Palmer (1993) interviewed many people from different cultures about death and dying. With the exception of a Zen Buddhist Monk who accepted death as the shedding his old skin, most of the people Palmer spoke to had developed ways to deal with their mortality. He concluded:

They haven't found Acceptance, but they haven't mired themselves in Anger or Depression either. And more often than not one of the ways they handle death is to give it a recognizable face. Death is terrifying because it is omnipotent, omnipresent, and brutally impartial. At the same time, death is unknown and completely mysterious to us, a monstrous invisible presence threatening to take away everything we care about in an instant.…The death entities we create have an effect on the way we live our lives. (p.19).

Many people fear dying more than death itself. According to Government statistics, there are about 6000 common ways of dying, such as heart failure, stroke, cancer, accident, lightning, natural disasters and infectious diseases, etc. But in fact, there are just as many unique ways of dying as distinct ways of living, because the former is influenced by the latter.

Most people are afraid of dying a violent or painful death. They prefer to die in their sleep - without pain and without awareness.

I am proposing that dying can be a positive and rewarding experience; it can be a time of personal freedom and growth. But dying well begins with death acceptance. Furthermore, dying well involves hard work, because dying is more than a physical process.

Dr. Paul Kuhn, a physician in the palliative unit of St. Paul Hospital in Vancouver, reported his experience with a patient named Alice who was dying of cancer. She complained of a nagging pain in her chest, which was not responding to the pain control medication. Dr. Kuhn ventured to ask her whether the pain was in her heart (i.e. more than just the physical heart). She responded affirmatively, for it turned out that she was worried about her only child-a daughter-who was planning to marry "the wrong person". This was the source of Alice's pain and agony.

Dr. Kuhn wrote: "Alice, like others before her and many since, taught me that dying is more than just a physical event. It is a process that includes one's whole being - physical, psychological, and spiritual…..Alice also taught me that dying is hard work, and that for the most part dying includes suffering, some of which may never be resolved" (Kuhl, 2002, xvii).

We may ask ourselves: Why is it so few people have found death acceptance? The answer, I believe, lies in our Western society; we live in a death-denying culture. We want to delay and slow the dying process through medical science, diet, and exercise. We want to maintain the illusion of youth through plastic surgery and adopting an active life style.

A more extreme form of death denial is the Life Extension Movement, which declares that death as a mortal disaster, a holocaust that kills 50 million people a year. Proponents of this movement wage an all out war against death on several fronts:

  • The calorie minimizers, who consume as little food as possible in order to lower the body temperature and slow down the human metabolism. They are a walking death - pale, cold and lacking vitality. They want to prolong their existence at the expense of the joy of living.
  • The supplementatarians, who consume a wide variety of supplements to slow down the process of aging, from vitamin pills to Chinese herbs. They are obsessed with their physical health and ignore the psychological and spiritual dimensions of health.
  • The cryonicists, who pay large amounts of money to have their heads or entire bodies frozen in a tank of liquid nitrogen until science finds a way to resurrect them. They invest their money and hope in fantasy and science faction.

(2) The bases of death anxiety

Death is the only certainty in life. All living organisms die; there is no exception. However, human beings alone are burdened with the cognitive capacity to be aware of their own inevitable mortality and to fear what may come afterwards. Furthermore, their capacity to reflect on the meaning of life and death creates additional existential anxiety.

According to Goodman (1981), "The existential fear of death, the fear of not existing, is the hardest to conquer. Most defensive structures, such as the denial of reality, rationalization, insulation erected to ward off religiously conditioned separation-abandonment fears, do not lend themselves readily as protective barriers against the existential fear of death" (p.5).

What are your fears of death? Likely they are rooted in the bases of death anxiety:

  1. The finality of death - There is no reversal, no remedy, no more tomorrow. Therefore, death signifies the cessation of all hope with respect to this world.
  2. The uncertainty of what follows - Socrates has made the case since we really don't know what will happen, we should not fear. But uncertainty coupled with finality can create a potential for terror.
  3. Annihilation anxiety or fear of non-existence - The concept of non-being can be very threatening, because it seems to go against a strong and innate conviction that life should not be reduced to non-being.
  4. The ultimate loss - When death occurs, we are forced to lose everything we have ever valued. Those with the strongest attachments towards things of this word are likely to fear death most. Loss of control over affairs in the world and loss of the ability to care for dependents also contribute to death anxiety.
  5. Fear of the pain and loneliness in dying - Many are afraid that they will die alone or die in pain, without any family or friends around them.
  6. Fear of failing to complete life work - According to Goodman's (1981) interviews with eminent artists and scientists, many people are more afraid of a meaningless existence than death itself; their fear of death stems from fear of not being able to complete their mission or calling in life.

(3) Coping with death anxiety

  • Elizabeth Kuber-Ross (1969) proposes five stages of coping: Denial, anger, bargaining, depression, and acceptance. Most dying people do go through these stages, but they tend to move in and out of the various stages in no particular order. Since "Life is a terminal disease" (Palmer, 1993, p.18), Kuber-Ross's model is applicable to all of us. I will show how these stages are expressed in various behaviours, from extreme sports to terrorism.
  • Wong, Reker & Gesser (1994) believe there are three types of death acceptance: Neutral, Approach and Escape. I will report some data on how these three types of death acceptance are related to our well-being and behaviours.
  • Terror management theory (Pyszczynski, Greenberg, & Solomon, 2002) assumes that humans spend a great deal of psychological energy in their attempts to manage or deny their subconscious terror. Terror management may lead to cognitive construction of immortality through attaching ourselves psychologically to institutions, traditions, or symbols. When these constructs are threatened, we resort to anger and violence to bolster our sense of security and protect our illusion of immortality.

To cope with fear of non-being, we resort to various kinds of symbolic immortality:

  • Biological - living through children grandchildren. Theoretically, we can live forever through progeny.
  • Religious and spiritual - believing in afterlife. The soul never dies, and death simply means transition to a different dimension of existence.
  • Creative - living through one's works. We will be long remembered because of our accomplishments.
  • Natural - through the survival of nature itself. When we die, we return to nature, which lives forever.
  • Cultural - through identification with an institution or tradition, which transcends our own death.

(4) Facilitating death acceptance

Acceptance involves a willingness to let go and detach ourselves from events and things which we used to value. A positively oriented acceptance also entails the recognition of the spiritual connection with a transcendental reality and the vision of sharing spiritual life with loved ones for all eternity.

Pathways to death acceptance:

  • Life review (Wong, 1995) - Life review is important in bringing order and coherence to life and maintaining one's identity.
  • Self-acceptance - We need to discover who we really are before we die. We need to connect with the inner essence of our being. Saint Augustine once said, "It is only in the face of death that man's self is born."
  • Religious/spiritual beliefs (Wong, 1998) - There is a difference between intrinsic and extrinsic religiosity. There is a connection between spirituality and the quest for meaning. Kubler-Ross (1997) emphasized the importance of religiously based death acceptance.
  • Embracing one's own life - The best way to be prepared for death is to live life to the full.
  • Death education - More correctly, it should be called a life and death education. Confucius said, "How can we know death when we don't know how to live." I would say, "How can we know how to live if we don't understand death." To contemplate our death is to contemplate our life that leads to death.

Dennis Yoshikawa, a Shin Buddhist, explained that according to Shin Buddhist teaching, "to solve the problem of death, one must first solve the problem of life, living life. If one is able to do that, to live a truly human life, then there's nothing to be feared by the experience of death, because the experience of death is a natural part of life" (Palmer, 1993, p.279).

According to Konosuke Matsushita, "What we should fear is not so much death itself as being unprepared for the eventuality….To be prepared for death is to be prepared for living; to die well is to live well" (as cited by Yamaaguchi, 1994). Matsushita also believes that one has to find out the mission God has given one to fulfill in this world.

Archbishop Desmond Tutu, who won the 1984 Nobel Prize for his role in the antiapartheid movement in South Africa, said, "When you have a potentially terminal disease, it concentrates the mind wonderfully. It gives a new intensity to life. You discover how many things you have taken for granted - the love of your spouse, the Beethoven symphony, the dew on the rose, the laughter on the face of your grandchild" (as cited by Kuhl, 2002, p.17-18).

(5) Living and dying well through meaning management. The meaning management model posits the following:

  1. Human beings are born with the innate need for meaning, but it may lie dormant because of our preoccupation with the business of living;
  2. Death and suffering awaken in us the urgent need to search for meaning and purpose for life and death;
  3. We can discover and create meaning in every situation, even in the face of death;
  4. Meaning management helps deepen our faith and spirituality; it also enables us to achieve a better understanding of the meaning and purpose of life;
  5. Meaning management helps construct a useful psychological and spiritual model that offers us the best protection against the fear of death and dying;
  6. Meaning management motivates us to embrace life - to engage in the business of living, regardless of our physical condition and present circumstances;
  7. Meaning management is not just rationalization or cognitive reframing, but a reconstruction and transformation of our values, beliefs and meaning systems.

How we live foreshadows how we die. When we live a meaningful life, we will leave a meaningful life. Have you lived the life you have always wanted to live? Have you lived a life that is worth living? Do you have the faith to embrace death with joy and hope? If you can answer these questions affirmatively, then you know how to live and die well.

(6) Conclusions

  • Our death attitudes not only influence our own lives but also the future of our society.
  • We can choose to face death with fear or with hope .
  • What matters most in life and death? Life is too short and too valuable to waste on things don't really matter.
  • What is worth living and dying for?
  • Faith can provide hope and solace in the lonely journey of dying.
  • "Do I embrace life, or do I prepare to die? And for all of us, the answers are ultimately similar. Living fully and dying well involve enhancing one's sense of self, one's relationships with others, and one's understanding of the transcendent, the spiritual, the supernatural. And only in confronting the inevitability of death does one truly embrace life" (Kuhl, 2002, p.291).

Death is our master teacher. By accepting death and understanding its full meaning, we acquire wisdom. Be accepting death through faith, we find courage and an undying hope.

In his presentation on Claire Philip's journal and poems in her dying days, Thomas Cole (1994) concluded with this powerful statement:

Her journal and poetry showed me that it is possible to live out the paradox contained in the old proverb: "Live every day as if you will be able to do good for a hundred years and live every day as if it were your last." In reading Claire Phillip, I met a friend whose courageous growth will reassure me in times of doubt that the human spirit can continue to evolve until the every end of life.

I would like to end this paper by quoting the Apostle Paul, who has given us perhaps the most eloquent statement on positive acceptance through faith:

When the perishable has been clothed with the imperishable, and the mortal with immortality, then the saying that is written will come true: "Death has been swallowed up in victory: Where, O Death, is your victory? Where, O Death, is your sting?" (1 Corinthians 15: 54-55)



Cole, T. R. (1994). Gaining and losing a friend I never knew: Reading Claire Philip's journal and poetry. Presented at the symposium on "Personal Narrative in the face of death: Claire Philip's journal and poem" at the Gerontological Society Meeting, Atlanta, November 19.

Goodman, L. M. (1981). Death and the creative life: Conversations with eminent artists and scientists as they reflect on life and death. New York: Springer Publishing Company

Kubler-Ross, E. (1969). On death and dying. New York: Macmillian

Kubler-Ross, E. (1997). The wheel of life: A memoir of living and dying. New York: Simon & Schuster.

Kuhl, D. (2002). What dying people want: Practical wisdom for the end of life. Toronto: Doubleday Canada

Palmer, G. (1993), Death: The trip of a lifetime. San Francisco, CA: HarperSanFrancisco

Pyszczynski, T., Greenberg, J., & Solomon, S. (2002). In the wake of 9/11: The psychology of terror. Washington, DC: American Psychological Association.

Yamaguchi, T. (1994). Fear of dying. Intersect, December, p.48.

Wong, P. T. P. (1995). The adaptive processes of reminiscence. In B. K. Haight & J. D. Webster (Eds.), Reminiscence: Theory, research methods, and applications. Washington, DC: Taylor & Frances.

Wong, P. T. P. (1998). Spirituality, meaning, and successful aging. In P. T. P. Wong & P. S. Fry (Eds.), The human quest for menaing: A handbook of psychological research and clinical applications (pp.359-394). Mahwah, NJ: Lawrence Erlbaum.

Wong, P. T. P. (2000). Meaning in life and meaning in death in successful aging. A. Tomer (Ed.), Death attitudes and the older adults: Theories, concepts and applications (pp.23-35). Philadelphia, PA: Bruner-Routledge.

Wong, P. T. P., Reker, G. T., & Gesser, G. (1994). Death attitude profile-Revised: A multidimentional measure of attitudes toward death. In R. A. Neimeyer (Ed.). Death anxiety handbook: Research, instrumentation and application (pp. 121-148). Washington, DC: Taylor & Francis.

* Keynote address delivered at the Conference on Life and Death Education in National Changhua University of Education, Taiwan, December, 14, 2002.

©1998-2007, International Network on Personal Meaning, Unless otherwise noted
Visit for more information.