Meaning of Death

Meaning Management Theory and Death Acceptance

Paul T. P. Wong
Paul T. P. Wong, Ph.D., C. Psych.
Toronto, Ontario

Human reactions to death are complex, multifaceted, and dynamic. The Death Attitudes Profile, as developed by Wong and his associates, contributes to death studies and thanatos psychology by recognizing three types of death acceptance in addition to death fear and death avoidance. This chapter focuses on death acceptance as it is related to the meanings of life and death. It highlights the differences between the defensive and proactive ways of coping with death anxiety. Finally, the paper points out the usefulness of meaning-management theory not only in transforming death anxiety but also in facilitating death acceptance and self-actualization.

Imagine yourself on board a train, which is out of control and doomed to end in a fatal crash. Nothing can be done to slow it down or to change the track. Worse still, there is no exit – no one can get out of the train. As a passenger, how would you cope? What would ease your death anxiety? Would denial help? How about illusion? How would you live a vital and meaningful life in spite of the anticipated terror of death? These are the challenging questions confronting all mortals.
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.
There is a tacit understanding that sooner or later, we all have to come to terms with our own mortality. As surely as night follows day, so death awaits us all. The certainty and inevitability of death makes its presence felt in every arena of human existence. There is no escape from its shadow, no refuge from its power. How we react to the prospect of personal death would have impact on how we live.
Biologically, death can be defined as the permanent cessation of all vital functions. However, because of the human capacities for meaning-construction and awareness of our own demise, the concept of death becomes very complex and broad – a wide variety of psychological, spiritual, societal, and cultural meanings have been attached to death. The meanings we attached to death have important implications for our well-being. The chapter is about meaning-management – how we manage the meanings of death and life in such a way that our meaning systems not only protect us against the terror of death but also propels us towards the path of accepting the reality of death and living a vital and productive life.
Elisabeth Kübler-Ross (1969) was largely responsible for making death a popular and respectable topic for research. Her five stages of coping with death (denial, anger, bargaining, depression, and acceptance) have had a powerful and lasting impact on our understanding and study of death. Although the sequential stage concept has been widely criticized, she has at least identified some of the defense mechanisms (denial and bargaining) and emotional reactions (anger and depression) involved in facing and accepting the reality of death. This chapter focuses on the meaning-based processes involved in death acceptance. The importance of the role of meaning and death acceptance in dealing with the end of life issues has received increasing recognition in recent years (Neimeyer, 2005; Wong, 2000; Wong & Stiller, 1999).

The different meanings of death acceptance

In the past forty years, the psychology of death has been dominated by how to measure death anxiety and what factors influence it (Kastenbaum, 2000; Neimeyer, 1994 a, b); there was only some recognition of death acceptance in the early literature. Ray and Najman (1974) developed a new scale to measure death acceptance, and found that it was not the opposite of death anxiety. In fact, it was even positively correlated with two measures of death anxiety. Wong and his associates (Gesser, Wong & Reker, 1987-88; Wong, Reker, & Gesser, 1994) developed the Death Attitude Profile, which identifies three distinct types of death acceptance: (1) Neutral death acceptance – facing death rationally as an inevitable end of every life; (2) Approach acceptance – accepting death as a gateway to a better afterlife, and (3) Escape acceptance – choosing death as a better alternative to a painful existence. Evidence is accumulating regarding the validity and reliability of DAP (Gesser et al, 1987-1988) and DAP-R (Wong at al, 1994). Neimeyer, Moser and Wittkowski (2003) confirm that DAP-R remains the main instrument to assess death acceptance.
Approach acceptance is rooted in transpersonal religious/spiritual beliefs in a desirable afterlife. To those who embrace such beliefs, afterlife is more than symbolic immortality, because there is a spiritual or transcendental reality. More specifically, Harding, Flannelly, Weaver, and Costa (2005) reported that scales that measure Belief in God’s existence and Belief in the Afterlife were both negatively correlated with death anxiety but positively correlated with death acceptance. Escape acceptance is primarily based on the perception that life is so painful and miserable that it’s not worth the trouble of living. Suicide and assisted suicide are expressions of Escape acceptance. Cicirelli’s (2006, chapter) observed that when individuals experience intractable pain or loss of function, they want to end their own lives. In such cases, the terror of death seems less fearful than the terror of living.
The construct of neutral acceptance needs closer examination. Clements and Rooda (1999-2000) examined the factor structure, reliability, and validity of DAP-R using a sample of 403 hospital and hospice nurses. They were able to replicate four of the first four factors reported by Wong et al (1994): Fear of Death, Death Avoidance, Approach Acceptance, and Escape Acceptance. However, the items which loaded on the Neutral Acceptance subscale were split across two factors. It seems reasonable to suggest that this subscale may not be measuring a unitary construct, because conceptually, Neutral Acceptance encompasses the whole spectrum, from the merely recognition that death is no more than the extinction of a candle, to a most positive variation such as identifying oneself with culture, completing one’s mission in life, and leaving a legacy. In fact, Cicirelli (2001) identified four different Personal Meanings of Death: Extinction, Afterlife, Motivator, Legacy. Belief in Afterlife is similar to Approach Acceptance; however, Extinction, Motivator, and Legacy can all come under the umbrella of Neutral Acceptance.

The Different Meanings of Death Fear

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 that, 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 world 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. The disruption of the flow of life – Death can be very disruptive of existing relationships and ongoing projects.
  6. Fear of leaving the loved ones behind – The closer the relationships, the greater the fear of separation; this fear is often compounded by future regrets of not being able to care for them any more.
  7. 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.
  8. Fear of an untimely and violent death – Sooner or later people learn to accept their own mortality, but most people are afraid of dying prematurely and violently.
  9. 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.
  10. Fear of judgment and retributions – Western religions teach that there is judgment after death, while Eastern religions teach karma or retributions. In either case, individuals maybe worried about facing the negative consequences of all their bad deeds throughout their lifetime.

Mikulincer and Florian (2006) identify three dimensions of death fear: intrapersonal, interpersonal, and transpersonal death-related concerns. Intrapersonal death fear seems to be primarily concerned with whether one is able to accomplish major life goals and fulfill one’s meaning of life. In fact, the Fear of Personal Death scale developed by Florian and Kravetz (1983) reveals two subscales in the intrapersonal domain: Fear of loss of self-fulfillment (e.g. fear that my life has not been properly used) and Fear of self-annihilation (e.g., fear of the decomposition of my body). Thus, living a full life can at least reduce the fear of failure in self-fulfillment. Interpersonal death fear is based on worries about leaving the loved ones, being unable to care for them, or being forgotten by them. Having made ample provisions to take care of family members will help reduce interpersonal death fear. Transpersonal death fear is concerned with what happens after death, such as fear of punishment. Thus, efforts in seeking redemption and forgiveness may diminish transpersonal fear.

Managing the Meanings of Life and Death

The above analysis clearly shows that various meanings of death are intricately and irrevocably related to meanings of life (Mikulincer & Florian, 2006; Wong, 2000). If we have lived a meaningful life and achieved ego-integrity (Erikson, 1982), we are able to face death without fear However, when we have too many regrets and a profound sense of failure and despair, then death is feared, because of the fear that we have never really lived when death beckons us (Tomer & Eliason, 2006, Wong, 2000).
By accepting our mortality, we declare our intention to invest our energy and time in living the good life rather than defending ourselves against the inevitable death. Ideally, death acceptance should set us free from anxiety and energize us to live with vitality and purpose. By the same token, when we have lived a wonderful life and completed our life’s mission, we would be prepared to face death. Ultimately, death acceptance is one of the cornerstones for the good life.
However, we can never be completely free from death anxiety. As we grow older, we brace ourselves for the bad news with every annual physical checkup. With aging parents, we are always prepared for their death and burial. Somehow, the specter of death is always hovering over us, reminding us of our mortality. No matter how we rationalize or think about death, our instinctive reaction is rarely one of unalloyed joy.
The relationships between death acceptance and death fear are complex and dynamic. They may co-exist under some circumstances like a raining cloud in an otherwise blue and sunny sky. Furthermore, for most people different kinds of death attitudes may dominate, depending on their stage of development (Erikson, 1963, 1964, 1982) and life experiences and regrets (Tomer & Eliason, 2006). That is why death acceptance and death anxiety are not simply opposites (Ray & Najman; 1974; Tomer & Eliason, 2006; Wong et al, 1994).
In sum, we are all confronted with two fundamental psychological tasks: to protect ourselves against the terrors of loss and death (e.g., managing death anxiety) and to pursue the good life of living meaningfully and abundantly (e.g., managing death acceptance). These twin tasks of living well and dying well are interconnected in important ways because of the intimate relationships between the meanings of life and the meanings of death. This chapter makes the case that the most promising way to achieve these two major psychological tasks is through managing the meanings of life and death.

Meaning-management Theory

What is Meaning Management?

In the business world, management simply means to manage various resources such as people, finances, and technology to achieve company goals. Management is needed to ensure that resources are developed and utilized strategically and efficiently in order to achieve short-term and long-term goals. In the business of living, management means how to manage one’s internal and external resources to achieve one’s life goals. Since we only have one life to live, and life is short, we really need to manage our time investment and choose our life goals wisely. Meaning management refers to managing our life through meaning. More specifically, it refers to the need to manage-based processes, such as meaning-seeking and meaning-making, in order to understand who we are (identity), what really matters (values), where we are headed (purpose), and how to live the good life in spite of suffering and death (happiness).
Therefore, meaning management is to manage our inner life, which is the sum total of all our feelings, desires, perceptions, thoughts, our inner voices and secret yearnings, and all the ebbs and flows of our consciousness. The objective of meaning management is to manage all our fears and hopes, memories and dreams, hates and loves, regrets and celebrations, doubts and beliefs, the various meanings we attach to events and people, in such a way as to facilitate the discovery of happiness, hope, meaning, fulfillment, and equanimity in the midst of setbacks, sufferings, and deaths.
Meaning management become increasingly important, because we live in the midst of ambiguity, uncertainty, and rapid social change, with the unraveling of values and traditions which used to provide reliable guides for living. That is why we need to develop our own inner life, which defines who we are, even when the world is falling apart all around us. At the core of this inner life are our assumptions, beliefs, and values. According to O’Neil and O’Neil (1967): “By managing ourselves we come to know more completely what we want for ourselves, we come to know our priorities, our needs, our wants far more clearly, and this knowledge inevitably brings a greater sense not only of freedom but of security. The person who knows himself or herself, and manages his or her life, can tolerate a higher level of ambiguity than before, can deal more successfully with anxiety and conflict because he is sure of his own capabilities” (p.243)
Meaning management capitalizes on the human capacities for awareness, reflection, imagination, symbolization, self-transcendence, creativity, narrative construction, and all sorts of meaning-based processes. However, it does not mean that it ignores behavior or environment. At the behavioral level, we act and react, and we are engaged in a variety of activities. People see us – our expressions, articulations, and behaviors. The outward manifestations are just a small part of what our true being, the inner life which is hidden from public view. We can act out different roles, but we cannot escape from ourselves – our inner being. That is why what is lived on the inside is more important than what is lived on the outside. We can live the life of a rich man and give the appearance of being a very happy person, but our inner life maybe starved, impoverished, and troubled. By the same token, our inner life may be abundant, rich, vibrant and peaceful, even when we live below poverty life.
Meaning management recognizes the importance of actions, because when our actions and activities are consistent with our core values and meaning-systems, they strengthen and enrich our inner life and at the same time contribute to the overall quality of life. Therefore, meaning management of our inner life involves making sure that our actions service our deepest psychological and spiritual needs. When people are centered in who they are and what they really want in life, they are able to focus their actions on life goals that really matter to them. Meaning-making in daily living is primarily based on purposeful and growth-oriented actions. O’Neil and O’Neil (1967): “It is the feedback between focusing and centering that gives meaning to our actions. And when our actions have meaning, we feel a sense of security. When the feedback mechanism breaks down, so does meaning, and without meaning, we feel lost and afraid” (p.150)
Meaning management also recognizes the importance of communication, because language plays a crucial role in how we construe reality and how we interact with each other. According to the theory of coordinated management of meaning (Cronen & Pearce, 1982; Pearce & Cronen, 1980), communication enables us to makes sense of the world and manage social reality. We interpret images and sounds, engage in speech acts, enter into social contracts, and follow cultural patterns through the process of communication. A major aspect of meaning-management has to do with how we manage the communication process in order to facilitate understanding of ourselves, other people, and the social reality.
Different from cognitive reframing, meaning-management is capable of transforming our assumptive world and core values. It also has the motivational function of empowering us to embrace and engage life regardless of physical condition and life circumstances. Furthermore, meaning management is relevant to a wide variety of psychological phenomena and life situations. However, this chapter will only focus on death, specifically death anxiety and grieving. It will show how meaning management can facilitate death acceptance in both personal mortality and bereavement.

What is Meaning-management Theory (MMT)?

MMT is rooted in existential-humanistic theory (Wong, 2005a) and constructivist perspectives (Neiyemer, 2001b), but it also incorporates cognitive-behavioral processes. It is a comprehensive psychological theory about how to manage various meaning-related processes to meet our basic needs for survival and happiness. It can be subjected to empirical testing as well as applied to clinical situations. Here are a several basic propositions or tenets of MMT:

  1. Humans are bio-psychosocial-spiritual beings. The increasing recognition of spirituality as an important area of research reflects the widespread acceptance of this holistic perspective. We are wired for community and transcendence and we cannot be fully human by ignoring the social and spiritual aspects of our being. MMT predicts that all things being equal, the incorporation of spiritual values and beliefs can facilitate and protect against death fear and facilitate death acceptance better than without recognizing the spiritual dimension.
  2. Human beings are meaning-seeking and meaning-making creatures, living in a world of shared, socially constructed meanings. They react to perceived meanings rather than actual events, and they actively and constantly engaged in meaning-construction in order to make sense of life. In spite of the often contradictory and fragmented nature of life experience, their capacities for symbolic meanings and story-telling help achieve a sense of unity and coherence. MMT predicts that a sense of meaning and purpose not only offers the best protection against the terrors of life and death, but also contributes the most to healing and well-being as compared to other psychological variables such as internal control and self-efficacy.
  3. Humans have two primary motivations: (a) to survive and (b) to find the meaning and reason for survival. The quest for meaning is necessary, because of our capacity to become aware of our eventual demise and the fear of extinction. Such awareness awakens in us not only the defense mechanisms against the terror of death, but also the quest for meaning and purpose for living in the face of death. Suffering has a similar effect on us. MMT predicts that when the business of mere survival is fraught with struggle and suffering, it will trigger a quest for reasons for living in spite of the pain.
  4. Meaning can be found in all situations, including the most hopeless and horrific situations such as Nazi concentration camps. Individuals are capable of growth and transformation in spite of mounting problems, because of their capacity for self-transcendence and their freedom to choose their own destiny. MMT predicts that meaning is essential for maintaining hope and happiness in the face of suffering and death.
  5. The motivational tendencies of avoidance and approach may complement each other to maximize positive motivation. For example, fear of failure and the desire to succeed can work together to maximize goal striving to achieve success. Similarly, the tendency to avoid death and seek a happy life can work together to maximize our motivation to live and die well.

These two complementary tendencies in us represent two different paradigms of research on death and life attitudes. The defensive tendency to avoid pain, suffering, dangers, anxieties, and death serves a protective function. It is the tendency to seek security and self-preservation in a chaotic and dangerous world. It involves various defense mechanisms, both unconscious and conscious ones, to safeguard our psychological and physical integrity. Those who prefer a defensive stance would be very cautious and timid, afraid of making change or taking risk.
The positive and proactive tendency to create a happy and meaningful life serves a growth-oriented function. The positive individuals would be willing to confront the crisis and create opportunities for personal development. Their tendency is to take on the difficult tasks and risk even death in order to achieve some significant life goals, such as competencies, self-efficacy, creativity or a higher purpose. When individuals are primarily propelled by an irresistible urge towards self-actualization and fulfillment, then less energy is invested in defensive mechanisms, even though death anxiety may still be present. Therefore, meaning-management theory predicts that if one wants to live a vital and meaningful life, it is better to focus on the positive tendency of personal growth rather than on defensive mechanisms against death fear. MMT also predicts that the best way to reduce death anxiety is to facilitate death acceptance and positive tendencies.
These five basic propositions form the foundation for both the research and applications of various meaning-based processes. This chapter will briefly discuss three basic processes and how they can facilitate death acceptance. The literature often uses meaning-seeking, meaning-making and meaning-reconstruction interchangeably (Neimeyer, 2001a, 2004). This chapter differentiates these three processes to facilitate research, communication, and counseling.

Managing Meaning-seeking

Meaning seeking is probably the most primitive-based process. We are born into a world full of sensory data – a continuous flood of confusing, meaningless information that needs to be received and processed. In order to survive, we need to at least predict and control some of the significant events. Both Pavlovian conditioning and operant condition teach us the significance of various stimuli. In addition, we also actively engage in attribution processes to discover not only cause-and-effect relationships but also the reasons and purpose for certain events (Wong, 1991;Wong & Weiner, 1981). The existential search for meaning and purpose has not received nearly as much research attention as causal attribution, but it is more important for meaning-seeking in the face of unavoidable suffering and death. In such cases, causal understanding is less helpful than existential understanding. Existential attribution also includes the proverbial search for the silver lining, a process similar to benefit-seeking. Both causal and existential attributional processes enable us to make sense of the world.
We are able to adapt to the ever-changing world through the above processes almost without any conscious effort. However, a variety of situations may trigger an urgent quest for meaning; these situations include life transitions, major stressful events, trauma, natural disaster, life-threatening illness, and untimely death of a loved one. Whenever an event shatters our assumptive world or challenges our very identify (Janoff-Bulman, 1989; Janoff-Bulman & Frantz, 1997), meaning-seeking is activated. In some individuals, even becoming aware of death and suffering is sufficient to trigger a persistent quest for meaning as in the case of the Buddha.
MMT differentiates between causal attribution and existential attribution (Wong, 1991), and between situational meaning and ultimate meaning (Wong, 1998). Managing meaning-seeking involves empowering and guiding these different search processes until one is satisfied with the finding. MMT predicts that we can adjust to the transitions, disruptions, and awakenings to the extent that we are able to discover attributions and meanings that enhance our sense of meaning, hope, and control or (b) discover some benefits of blessings for our sufferings. Therefore, finding meaning and benefits makes it easier for us to accept death and face life with hope.

Frankl (1984) has consistently insisted that meaning is to be discovered rather than created. I suspect meaning is not something that can be arbitrarily created based on one’s ambition and bias, such as Hitler’s mad ambition for domination of Europe and destruction of the Jews. True meaning of life has to be based on some long-lasting time-tested values. Another reason for his position is that one’s life is accountable to a Task Master, a Higher Power. Frankl reports that the following three values are the royal roads to discovering meaning.

  1. Creative value – What I give to life through making a difference in the world
  2. Experiential value – What I take from life through experiencing the joy and pain of living
  3. Attitudinal value – How I view life – accepting what cannot be change and taking a defiant attitude towards suffering

Creative value emphasizes the giving of ourselves or dedicating our lives to something larger than ourselves. Creative value seems similar to the idea of creating meaning through personal projects and I would classify it as an example of meaning-making because involves active, creative work. However, Frankl considers it a pathway of discovering meaning, because it involves (a) an awareness or realization that one’s creative work is meaningful and (b) it needs to be consistent with some proven cultural values. Experiential value emphasizes the joy of simply receiving what life has to offer, this includes listening to music, taking in the sunset, and or enjoying the view from a mountain top. It also includes the joy and peace one experiences in mindful meditation, especially the experience of oneness with the universe at a higher level of consciousness. This pathway to meaning frees us from cognition and thinking and enables us to soak in the beauty of life without the mediation of language.
Attitudinal value is essential in situations of unavoidable and inescapable suffering. The only way to find meaning in such situation is the recognition that one is chosen and given the privilege to suffer with courage, equanimity, and joy. This positive stance in the face of suffering serves as an encouragement to fellow sufferers, a testimony to the defiant human spirit or the all sufficient grace of God. Most people do not realize that attitudinal value is similar to the existential coping, which involves two coping strategies, namely, accepting what cannot be changed, and affirming that there is something valuable and meaningful in suffering (Wong, 1993; Wong, Reker & Peacock, 2005). Frankl’s three pathways to meaning are very helpful. They provide insights and guidelines on how to discover meaning when life is full of uncertainty and troubles. Frankl has described many clinical examples illustrating how these three avenues can help people who are overwhelmed by a sense of hopelessness and meaninglessness.

Managing Meaning-making

While meaning-seeking emphasizes the processes of questing and finding meaning, meaning-making focuses on the processes of actively construing, constructing, and creating meanings. There are three major avenues for meaning-making: Social construction, story-telling, goal-striving and personal development. Social construction of meaning through language and culture plays a major part. It involves the socialization and acculturation processes. As cultural beings, we collectively construct patterns of meaning and values to imbue life with coherence and significance. We learn to identify with enduring cultural norms and icons and derive meaning by behaving accordingly. Story-telling encompasses a wide range of narrative devices and processes, such as letter-writing, journaling, life review and reminiscence, and myth making. It involves the ability to weave a story by connecting different fragments, filling in the gaps, reconciling the contradictions. Story-telling is essential to develop self-identify and holistic self-understanding. All the study of attribution processes, defense mechanism, and belief systems only reveal some aspects of us. Only the creative process of story telling is capable of revealing the whole, full-bodied person actively engaged in the dynamic business of living.
Goal-striving involves the pursuit of long-term life goals as well as short-term specific projects. Meaningfulness depends on both the significance and success in goal-striving. I have identified several major coping strategies (Wong, 1993, 1995) and spelled out that persistence and flexibility are important in meaning-making (Wong, 2006). Emmons (1992, 1997) has found that differential orientations in goal striving may have different effects on people’s physical and psychological well-being.
Personal development is also fundamental to meaning-making. It typically involves the development of one’s worldviews, philosophy of life, values and beliefs systems. Education, religion, culture, and personal and family experiences all contribute to personal development. It is possible that this development may be arrested or facilitated, depending on person-environment interactions. The stage of development we may be in, and who we are profoundly, influence how well we cope with the challenges of life and death. All other processes of meaning-seeking and meaning-making are shaped by the lenses we wear.
Wong’s (1988) has identified seven sources of personal meanings. Further research with samples from other cultures, such as Japan (Takano & Wong, 2004), Korea (Kim, Lee, & Wong, 2005) and China (Lin & Wong, 2006) has shown that these sources appear to be universal. Therefore, managing meaning-making will likely yield positive results, if it is concentrated in any one of the following areas:

  1. Achievement and goal striving (agency)
  2. Intimacy and family (love)
  3. Relationships (community)
  4. Self-transcendence (larger cause)
  5. Religion (spirituality)
  6. Self-acceptance (maturity)
  7. Fair treatment (justice and morality)

Managing Meaning Reconstruction

Meaning-reconstruction occurs whenever one cannot assimilate events that shatter one’s assumptive world and question one’s cherished life goals. The reconstruction process often involves intense meaning-seeking and meaning-making aimed to restore a sense of order and coherence. The biggest challenge is how to transform very negative events and integrate them with positive events and future planning. The transformative process can be both narrative and personal. Personal transformation entails revamping one’s worldviews and core values. Narrative transformation entails re-authoring and re-storying. Other processes involved in meaning-reconstruction include confronting and re-experiencing the past, reviewing and reconstructing the past, collecting relevant information from various sources, re-examining one’s assumptions, and exploring alternative assumptions and meanings.

MMT and Death Acceptance

All three processes are intentional, conscious efforts to imbue life and death with meaning, thus facilitating death acceptance. They are often interrelated and interact with each other in the service of finding and creating positive and adaptive meaning for living. There is heuristic value in disentangling these processes and studying them separately.
The main message of MMT is that the best defense is offense. While recognizing the value of defensive mechanisms, MMT maintains that the most effective way to protect oneself against death anxiety is to focus on how to live a vibrant, meaningful life.
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).
Awareness of personal death may actually energize rather than paralyze individuals. 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 Yamaguchi, 1994). Matsushita also believes that one has to find out the mission God has given to fulfill in this world. Archbishop Desmond Tutu, winner of 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).

Living and Dying Well Through Meaning Management

MMT provides a conceptual framework and guidelines on how to facilitate death acceptance and meaningful living as an indirect but effective way to combat death anxiety. Meaning management helps deepen our faith and spirituality. It also enables us to achieve a better understanding of the meaning and purpose of life. More importantly, it motivates us to embrace life – to engage in the business of living, regardless of our physical condition and present circumstances.
From the perspective of MMT, we can either face death with fear or with hope, and we can either be concerned with death or with life. The choice is entirely ours. We need to ask what matters most? What is worth living and dying for? Life is too short and too valuable to waste on things that don’t really matter.
“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). MMT suggests that we should view death as our master teacher rather than monster terror. By accepting death and understanding its full meaning, we acquire wisdom. By 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 very end of life.

From Death Anxiety to Death Acceptance and Self-actualization

When people are exposed to mortality salience, both Terror Management Theory (TMT) and MMT predict an increase in pro-culture and pro-esteem activities, but for very different reasons. The former is for minimizing terror of death, but for the latter, it is for maximizing death acceptance and self-actualization. The main difference is between a fear-based defensive posture towards life and a meaning-based positive posture. This difference can have real consequences in how people live their lives and make critical choices.
We need defensive responses to protect our ego against anxieties, uncertainties and threats, but we also need the authentic, creative responses to pursue our dreams and what life has to offer. Life cannot be lived in the defensive mode; it needs to be lived in the proactive creative mode. Martin, Campbell, and Henry (2004) point out the paradox that in order to live authentically, we need to confront what we try to avoid – death, uncertainty, and anxiety. This is a conscious choice to create meaning in the face of death. Paradoxically, we need to choose to embrace the unknown, the uncertainty and the threats in order to feel really alive; we need to embrace death in order to live meaningfully and fully (Frankl, 1984; Wong, 2005a, b, c; Yalom, 1980). In terms of motivations, the defensive mode is mostly related to anxiety and despair, while the creative mode is mostly related to positive emotions such as optimism and life satisfaction.
According to Morrant and Catlett (2006), Robert Firestone sees the basic human conflict as between self-affirming and defensive aspects of personality. The core conflict is between avoiding painful existential givens and embracing life without denying death. Firestone (1997a) considers defenses as maladaptive as they may lead to self-denial, self-accusation, substance abuse, bodily harm, and even suicide. He challenges people to make each day count by pursuing goals that transcend self-interests and infusing life with spirituality and compassion. “We must mourn our own end to fully accept and value our lives.” (Firestone, 1997a, p.298)
Self-actualization becomes dominant when one comes to value it more than self-preservation. Thus, life without love is not worth living; life without freedom is not worth living; and one can fill in the blanks for many similar statements. For these self-actualizers, their greatest fear is not death, but not being able to do what is dearest to their hearts. When self-actualization focuses on something larger than oneself, one reaches the state of self-transcendence. This “something larger” may be religion, ideology, community, or a social cause. A truly transcendental view of life lifts the person above self-centered concerns about self-preservation or self-esteem, because self is spent or lost in something larger and more long-lasting than oneself. For example, the psalmist prays: “The Lord will fulfill his purpose for me; your love, O Lord, endures forever — do not abandon the works of your hands” (Psalm 138:8). A sense of purpose and calling imbues the psalmist’s life with meaning, but here the responsibility for success no longer rests entirely with the individual. There is a strong sense of partnership between God and the psalmist. To live or die is to fulfill God’s purpose in his life.

From the perspective of MMT, we do not need to over-rate the terror of death, nor do we need to deny its existence. MMT recognizes that death anxiety can have a negative or positive effect, depending on how to react to it. To invest a life time to defend ourselves against death anxiety can be very costly, because the defensive of mode of denial and self-preservation may deprive us of many opportunities to expand ourselves and to leave exciting fulfilling lives. However, if we review death simply as a reminder of our own mortality and the need to live authentically, death anxiety will not only facilitate death acceptance, but also encourage self-actualization and self-transcendence.

Life and death are two sides of the same coin. There is no life without death and there is no death without life. Traditional existentialism focuses how people make sense of life in the shadow of death (Tomer and Liason’s chapter in this book). According to this view, people consciously and unconsciously defend themselves against the terror of death. Their defense mechanisms include denial, avoidance, cultural defense, and self-esteem. In contrast, positive existential psychology as initiated by Frankl and expanded by Wong (2005a,b) focuses on the potential of fulfilling life’s meaning. For those with a growth orientation, they are so preoccupied with the business of living a purposeful, authentic and vibrant life that death is no longer a major concern. Mortality salience would trigger defensive mechanisms in death-oriented individuals, but has little effect on individuals who are already totally engrossed with pursuing what really matters in life. I would also predict that longevity salience (e.g, extending life indefinitely) would reduce defensive mechanisms in death-oriented individuals, but may increase the quest for meaning in life-oriented individuals, because it becomes a bigger challenge to sustain meaning and passion for living for all eternity.

In sum, MMT represents a new development in positive existential psychology and existential psychotherapy (Wong, 2005a,b). It provides a more positive and hopeful perspective than TMT, and can be very useful in working with people struggling with end-of-life issues. Jane Thibault (2000) recommends that the practitioner’s task is to help the patient find or create meaning in the last stage of life, however long that may be. For example, individuals diagnosed as terminal cancer patients do not need to spend their remaining days waiting for death. Ten years ago, my own older brother was told that he had only three months to live, but he is still very much alive, still dreaming about getting some money to get married. He may be suffering from illusion or delusion, but he is still pursuing his dreams that are meaningful to him. Meaning-centered counseling (Wong, 1997, 1998, 1999, 2000, 2002), which is based on MMT, provides many helpful skills and strategies to facilitate meaning-seeking, meaning-making, and meaning-reconstruction. We can never escape from the reality of death, but we can always use our capacity for meaning and narrative construction to transform death anxiety into a source of inspiration for authentic living.

In sum, MMT represents a new development in positive existential psychology and existential psychotherapy (Wong, 2005a,b). It provides a more positive and hopeful perspective than TMT, and can be very useful in working with people struggling with end-of-life issues. Jane Thibault (2000) recommends that the practitioner’s task is to help the patient find or create meaning in the last stage of life, however long that may be. For example, individuals diagnosed as terminal cancer patients do not need to spend their remaining days waiting for death. Ten years ago, my own older brother was told that he had only three months to live, but he is still very much alive, still dreaming about getting some money to get married. He may be suffering from illusion or delusion, but he is still pursuing his dreams that are meaningful to him. Meaning-centered counseling (Wong, 1997, 1998, 1999, 2000, 2002), which is based on MMT, provides many helpful skills and strategies to facilitate meaning-seeking, meaning-making, and meaning-reconstruction. We can never escape from the reality of death, but we can always use our capacity for meaning and narrative construction to transform death anxiety into a source of inspiration for authentic living.

Recommended readings

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Neimeyer, R. A. (2005). From death anxiety to meaning making at the end of life: Recommendations for psychological. Clinical Psychology: Science and Practice, 12(3), 354-357

Wong, P. T. P. (1998). Meaning-centered counseling. In P. T. P. Wong & P. S. Fry (Eds.), The human quest for menaing: A handbook of psychological research and clinical applications (pp.395-435). Mahwah, NJ: Lawrence Erlbaum.

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

Wong, P. T., & Stiller, C. (1999). Living with dignity and palliative care. In B. de Vries (Ed.), End of life issues: Interdisciplinary and multidimensional perspectives (pp. 77-94). New York: Springer.



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This is an abbreviated version of a longer paper: Wong, P. T. P. (in press). Meaning management theory and death acceptance. In A. Tomer, E. Grafton, & P. T. P. Wong (Eds.), Death attitudes: Existential & spiritual issues. Mahwah, NJ: Lawrence Erlbaum Associates.