Bert Hayslip Jr. Handbook of Death and Dying. Editor: Clifton D Bryant. Volume 1. Thousand Oaks, CA: Sage Reference, 2003.
Death anxiety is a common human attribute. May (1950) suggests that death is the most obvious symbol of the individual’s fear of “nonbeing,” in that each of us has a finite existence. Indeed, it has been said that all anxiety is rooted in our awareness of our own mortality (Kastenbaum 1992). In this context, Becker (1973) has similarly observed that the fear of death is universal, and indeed underlies all other fears that we as human beings have. Thus the “morbidly minded” argument (Becker 1973) regarding how humans come to fear death presumes that such fears are therefore threatening and must be defended against. Consequently, anxiety about death may be prototypical of all anxiety, emphasizing not the transcendence of death but its coexistence with loving relationships (May 1969). Recognizing death-related fears can enhance the quality of an individual’s life, whereas ignoring them may lead to self-deception (Nuland 1994).
Cultural Manifestations of Death Denial
Death and dying can be understood at many levels. Although we often think of the denial of death as an individual phenomenon, cultures vary in terms of the extent to which they deny the reality of death, and individuals’ responses to death are to a certain extent a function of the cultural contexts in which the individuals are born, grow, mature, and eventually die. Indeed, Kearl (1989) argues that death is socially and culturally constructed; that is, individuals’ feelings and attitudes about death and dying are reflected in their particular culture’s use of language, the culture’s religious or funeral rituals, and the values placed on different lives in the culture (e.g., the death of a child may be seen as more tragic than the death of an older person). In addition, a culture may attach greater social value to some deaths than it does to others (e.g., a death due to cancer may be more highly valued than one due to suicide or to AIDS, or the death of a highly visible public figure, such as John F. Kennedy, Jr., may be valued more than the death of a homeless person).
Events as small as a single robbery or as large as the terrorist attacks of September 11, 2001, force individuals to reconstruct their views about life’s predictability and the controllability of death. Like individuals, cultures have “thresholds” beyond which the emotional, interpersonal, political, and economic impacts of particular events are significant enough to lead cultural members to modify their daily lives. Such changes in the degree to which death is denied are therefore in part culturally driven, as when the United States mandated changes in security procedures at airports after the September 11 disaster, undermining our sense that we are immune to such tragedies. Depending on the gravity of the event, over a brief or longer period of time, a culture’s sensitivity to or preoccupation with death, like that of an individual, eventually returns to “pre-event” levels, and the predictability and rationality of life and death again become normative. This normal state of affairs is characterized by the “veil of order and meaning that societies construct against chaos” (Kearl 1989:26), which is often referred to as cultural ethos (Geertz 1973).
A culture’s stance toward death—its death ethos,—affects the everyday behavior of all cultural members (e.g., willingness to engage in risky behavior, the likelihood of taking out an insurance policy) as living human beings, as well as their attitudes toward a variety of issues, such as the justifiable loss of life through war, euthanasia, organ donation, reincarnation, the death penalty, abortion, and the possibility of an afterlife and resurrection (Kearl 1989). In this respect, as cultures can be characterized as death accepting, death denying, or death defying (DeSpelder and Strickland 2002; Kearl 1989), it follows that their respective thresholds regarding death vary as well, dictating the
quality and quantity of their responses to natural disasters, the deaths of public figures, and the loss of life through violence. Individuals’ responses to death are therefore intertwined with the death ethos of the cultures in which they are embedded.
The Death System
On the assumption that fears of death (nonbeing) are indeed universal, and given the assumption of cultural embeddedness (see above), it is important to examine how both cultures and individuals cope with threats to their mortality. At a cultural level, in the context of the construct of the “death systems” that characterize all cultures (Kastenbaum 2001; Corr, Nabe, and Corr 2000), there appear to be many manifestations of the need to deny, manipulate, distort, or camouflage death so that it is a less difficult threat with which to cope. All of the culturally relevant examples of the denial or distortion of death discussed here reflect the fact that “people conspire with one another to create cultural imperatives and institutions that deny the fact of mortality” (Firestone 1994:221)
All cultures’ death systems have several functions that relate to such a stance toward death. Among the various functions of death systems, the most relevant to denial as a defense mechanism against death are (a) preventing death, (b) disposing of the dead, (c) helping make sense of death, and (d) endorsing socially sanctioned killing. For example, to the extent that persons believe that medical personnel can save lives, this represents a form of denial. This belief may be reinforced through individuals’ donation of money toward medical research; that is, such donations support the belief that with enough resources, research, effort, and support, medical science can find cures for fatal illnesses or develop procedures for saving the lives of persons with acute or chronic illnesses that might kill them. Yet despite such advances, people continue to die from known illnesses (e.g., cancer, AIDS), and new illnesses develop that are beyond medicine’s current ability to treat (e.g., antibiotic-resistant strains of staphylococcus). Because not every life can be saved, our sensitivity to the failure of medical science to deal with life-threatening illness becomes more acute. Thus we need some form of denial to deal with such threats to our health and well-being.
Likewise, the use of metaphors or euphemisms that serve to soften the harshness of death (e.g., passed away, deceased, expired) clearly represents a culturally approved attempt to deny or camouflage death’s impact on our daily lives. Other cultural manifestations of denial are the displacement of the event of death from the home to the hospital, medical center, or nursing home (in contrast to the modern hospice movement) and the presumed “triumph” over death offered by the use of life-extending technology (DeSpelder and Strickland 2002). Aries (1981) discusses such a cultural perspective in his treatment of historical shifts in attitudes toward death, conceptualizing the latter as “remote and imminent death” (emphasizing its frightening nature) and “death denied-forbidden death” (emphasizing its pornographic, filthy, or indecent nature; see Gorer  1965).
Many attitudes toward the dead demonstrate denial. For example, the separation of churches from cemeteries and efforts by embalmers to make the dead look as if they are only sleeping reflect the perception of death as something to be avoided. Additional cultural manifestations of death denial are found in the shift in focus from dead persons themselves to our responses to the deaths and dying of others; the removal of death from our presence via brief funerals, accompanied by the prescription that our emotions should be muted; and the “medicalization” of death (the view that death represents the failure of medicine to cure illness or save lives, where indeed the emphasis is on the disease or cause of death) (see Corr et al. 2000). Indeed, the construct of death denial has been normalized among social scientists by the assertions of writers such as Jaques (1965), who states that midlife crisis is initiated by the individual’s fear of his or her own mortality, and Kübler-Ross (1969), who argues that persons first respond to the news of their own imminent death by denying its reality, as well as by debates about the validity of “near-death experiences” (Greyson 2000; Greyson and Bush 1992; Ring and Valarino 1998).
The Media as Agents of the Death System
It is difficult to address the culture’s role in the distortion or denial of death adequately without mentioning the mass media. Indeed, the media, through news and entertainment programming, often foster and/or reinforce denial by purposefully distorting the nature of death. The news media accomplish this distortion by selectively focusing on violent or mass death and on the deaths of the famous. Other media-driven efforts to distort death’s harshness are evidenced in fictionalized attempts to represent death. Movies and television programs display deaths caused by shootings and by plane and auto crashes; they portray “dramatic” deaths in hospitals and spectacularize the deaths of characters in action and horror films. Many video games portray the deaths of “victims.” As Corr et al. (2000) state, the deaths displayed in the media represent a “highly selective portrait of death and life in today’s society” (p. 85), as well as deaths that are “very unrealistic or fantasized” (p. 87). Indeed, a person’s having been exposed to death via the media has been found to be positively related to greater death anxiety (King and Hayslip 2002), which further necessitates either complete or partial death denial to minimize intrapsychic threat. Oddly enough, to the extent that such denial is successful, it may further insulate persons from their feelings about death, leading to more distant, depersonalized, or euphemized responses to their own deaths, more generally to death itself, or to dying or dead persons. Thus the relief of one’s anxiety when one engages in such distortive behaviors reinforces those very efforts to avoid thinking about one’s own mortality.
Death Denial: Normal or Pathological?
It is instructive to recognize that death anxiety and its complements, suppression and denial, exist along a continuum. For this reason, it may be difficult to distinguish between normal and neurotic components of anxiety associated with death, as they may be intermingled in most people, creating a conflict representing, ultimately, our helplessness and powerlessness in the face of death. In Freud’s (1946,  1955,  1959) discussions of the dualism of life and death instincts, he concludes that when fear of death arises, the ego is depleted of libido. To protect itself, the ego uses defense mechanisms that can drive anxiety into the unconscious. The greater the extent of one’s fears, the more energy one needs to defend against them, and the excessive use of defenses necessitated by high levels of anxiety compromises the ego, leading to diminished life satisfaction (Rychlak 1981; Santrock 1986). Alternatively, as people’s defenses are lifted, they may come to place greater value on their lives, while at the same time becoming more consciously fearful of death (Firestone 1993). Thus some degree of conscious death anxiety may be necessary for psychological health (see Servaty and Hayslip 1996).
According to Fromm (1941), the experience of living loses it meaning if death is ignored, thus the denial of death may represent both normal and pathological efforts to come to terms with mortality and ultimate separation from others. Becker (1973), based on the work of Otto Rank, describes high levels of conscious death anxiety as relating to the breakdown of defenses, especially denial. Thus the ability to deny death is normal and consistent with the personal cultural style that Kastenbaum and Aisenberg (1976) describe as “overcoming.”
Complete versus Partial Denial of Death
Kastenbaum (2001) proposes that death denial is better conceived in terms of “partial denial” than in terms of complete denial. Alternatives to classical, complete denial include selective attention (purposeful ignorance or avoidance of death stimuli), selective responding (hiding one’s feelings from others), compartmentalizing (allowing incongruencies, such as understanding a terminal diagnosis and making long-term plans), purposeful deception (lying), and resistance (not giving up or giving in to death). Such variations are intrapsychic, but they are also expressed interpersonally (in terms of individuals’ relationships with dying persons)—for example, in a “mutual pretense” awareness context (Glaser and Strauss 1965). Death denial is also situational—it may be minimized or exacerbated by the individual’s immediate situation (e.g., a hospital vs. a hospice environment). As Kastenbaum (2001) points out, although complete denial and complete awareness/acceptance of death can exist, they are extremes and comparatively rare. Even to the extent that individuals employ forms of partial denial, efforts to cope with the threat of death must be seen in an adaptive light.
Theoretical Perspectives on Death Denial: Terror Management Theory
A more recent conceptual equivalent to the analytic stance described above can be found in terror management theory (Greenberg, Pyszczynski, and Solomon 1986; Solomon, Greenberg, and Pyszczynski 1991), which asserts that because we can reflect on our own death, such knowledge terrifies us in light of our desire for survival. Denial in this case takes the form of the perception that the world is “controllable, fair, and just” (McCoy et al. 2000:39). Such culture-driven percepts permit us order amid chaos and ensure our immortality through a belief system that values history, accomplishment, and wealth. McCoy et al. (2000) suggest that in addition to denial, persons manage their anxiety about death by overestimating their time left to live, underestimating the likelihood that they will experience illnesses or accidents, and creating psychological distance between themselves and others who are dead or dying. Empirical support for terror management theory is extensive. Specifically, the “anxiety buffer” hypothesis (that internal psychological structures exist because they reduce anxiety) and the “mortality salience” hypothesis (that reminding persons of the source of their anxiety—their mortality—leads to greater use of defenses and greater liking of similarly minded persons to manage such fear) have been supported by research findings (for a review, see McCoy et al. 2000).
Accurately Identifying Death Denial
Kastenbaum and Costa (1977) and Firestone (1993, 1994) have discussed the pervasive nature and natural status of death anxiety, its relationship to separation, and the role of defenses in both the individual and the institution/culture. As Kastenbaum (1998) notes, however, the difficulty in operationalizing unconscious or covert death fear is that one must infer the existence of denial as a defense on the basis of a lack of behaviors that would otherwise suggest that individuals are anxious about some aspect of death. Moreover, if death anxiety is conscious in nature, persons should be aware of such concerns and should indeed purposefully and willfully behave in ways that reflect this awareness.
With respect to the assessment of death fear, low scores on self-report measures of death fear may therefore represent low anxiety or high denial; only extremely high scores on such measures represent responses to genuine degrees of threat (Kastenbaum 1992, 1998). As noted above, Kastenbaum (1998, 2001) proposes that, rather than presuming that most persons completely deny their fears about death (a strategy that is ultimately ineffective), we should examine degrees or types of death denial. Perhaps complete denial as a defense, where the self is incapable of recognizing “death-laden reality” (Kastenbaum 1998:20), can be adaptive, but only if it is temporary (when threat is overwhelming). Thus denial should be considered as adaptive to the extent that it is not overused, and there are certainly persons for whom its overuse is indeed pathological. The question of how much denial is normal has yet to be addressed (Kastenbaum 1998, 2001). Consequently, in light of an approach to denial as a potentially adaptive coping strategy, higher scores on a measure of covert (unconscious) death fear and/or lower scores on self-report (conscious/overt) measures of death fear may represent degrees of selective or incomplete denial that may or may not benefit the individual. In this light, Firestone (2000) claims that microsuicidal (symbolically self-destructive) behaviors reflect an individual’s anxiety about death typified in systematic self-cognitions (“the voice”) that devalue the self, instead motivating the individual to fear living and/or becoming too attached to life.
Research Perspectives on Death Denial
Approximately 95% of the studies that have examined death anxiety have utilized measures of conscious fear in the form of self-report questionnaires or scales (Neimeyer 1997-98). However, many of these assessment measures suffer from methodological shortcomings, such as insufficient evidence of reliability and validity. Many such studies also have utilized inadequate sampling and relied too heavily on correlation coefficients (Neimeyer 1997-98) that capitalize on chance and are often interpreted as implying causality, to the exclusion of more sophisticated statistical analysis techniques (e.g., causal modeling, factor analysis). In addition, the assessment of consciously admitted fears of death may be influenced by social desirability response bias; thus such studies may yield flawed estimates of such constructs. These shortcomings suggest that exclusive reliance on direct self-report measures of death anxiety (e.g., Lester 1991, 1994; Lester and Templer 1992-93; Templer 1970) is both conceptually and methodologically unsound.
Because death means different things to various individuals at different times, questions concerning the meaning a person attributes to death have the potential to evoke a variety of responses (Hayslip and Panek 2002). Indeed, understanding a person’s conceptions of death may be the key to predicting how that person responds to such questions. Death anxiety may be one response to questions concerning death’s meaning, and such anxiety may actually be a complex mixture of responses. Fear, denial, and ambivalence are among the most frequent interpretations of orientations toward death, reflecting affective and perceptual-cognitive components (Kastenbaum and Costa 1977). In this light, it is not surprising that there is some disagreement among researchers regarding the various dimensions of death anxiety (Neimeyer 1988, 1997-98; Neimeyer and Van Brunt 1995). This inconsistency results in a lack of synthesis in the many labels, levels, and techniques researchers use to assess death anxiety (see Levin 1989-90; Neimeyer and Van Brunt 1995). Some have even criticized the interchangeable use of the terms fear and anxiety in the research; these two terms imply disparate approaches to measurement (Kastenbaum and Costa 1977). Thus death anxiety most likely is multidimensional, and the above discussion of its theoretical underpinnings suggests that such anxiety may or may not be manifested at a conscious level of awareness (Kastenbaum and Costa 1977; Lonetto, Fleming, and Mercer 1979).
In addition to the conscious (overt) and unconscious (covert) dimensions of death anxiety, many research studies have differentiated the person’s fear of his or her own death from the person’s other fears related to dying and have separated responses to the death and/or dying of self from responses to the death and/or dying of significant others (Collett and Lester 1969; Kalish 1976; Kastenbaum and Costa 1977; Schulz 1978). This suggests a three-factor model of death anxiety, the three factors being conscious (overt) death and dying of self, conscious death and dying of others, and unconscious (covert) death anxiety. This model follows from the assumption that in order to understand and interpret anxiety regarding death adequately, researchers must view it from many perspectives (e.g., private, public).
Kastenbaum and Costa (1977) suggest that death anxiety may reside in the unconscious, but reviews by Neimeyer (1997-98) and by Fortner, Neimeyer, and Rybarczyk (2000) fail to give much credence to this notion. For some time, scholars have stated concerns about existing self-report measures’ ability to tap any dimension of death concerns other than conscious or public attitudinal concerns (see Fulton 1961; Rheingold 1967). Some psychoanalytic thinkers believe that conscious fear of death occurs when an individual experiences a serious breakdown of his or her defenses (Becker 1973), and there is some literature to suggest that the conscious and unconscious aspects of death anxiety are relatively independent of one another (Feifel and Hermann 1973; Templer 1971).
The Measurement of Death Denial
The measurement of the unconscious dimensions of death anxiety has been largely ignored (Kurlychek 1978-1979).Where exceptions can be found (e.g., Pinder and Hayslip 1981; Shrut 1958; Stroop 1938), there is, not surprisingly, a lack of a uniform approach to the assessment of covert death fear. Indeed, because of the variety of methods researchers have used to tap unconscious death fear (e.g., dream content analysis, galvanic skin response, the Stroop Color Word Interference Test [Stroop 1938], the Thematic Apperception Test), it is difficult to compare results across studies. Several researchers have noted the need for studies that assess unconscious aspects of death anxiety (especially the person’s concerns about his or her own death rather than the death of someone else) through the use of projective techniques (Feifel and Hermann 1973; Richardson and Sands 1986-87).
In this light, researchers have employed several indirect measures to assess death anxiety at an unconscious level. Many such techniques—such as the Thematic Apperception Test (Diggory and Rothman 1961; Lowry 1965), measurement of galvanic skin response and reaction time to the presentation of death-related versus neutral words via word-association or tachistoscopic word-recognition techniques (Alexander and Adlerstein 1958; Feifel and Branscomb 1973; Feifel and Hermann 1973; Lester and Lester 1970), and dream analysis (Handal and Rychlak 1971)—are either time-consuming or otherwise not practical for screening purposes. In addition, these methods may be threatening in themselves and may produce subject reactivity (Campbell and Stanley 1963), which can have adverse effects on reliability and validity.
In view of the methodological concerns noted above regarding the possibilities for subject reactivity and the pragmatic aspects of attempting to assess unconscious death fear, it is important to note that Shrut (1958) was the first to employ a sentence-completion technique to assess the covert aspects of this construct. However, Shrut’s study treated anxiety about death as unitary, and the measures utilized to assess covert death fear lacked reliability and validity. Consequently, their use could not be supported on a conceptual or empirical basis. Nevertheless, Shrut’s work provided the impetus for further research.
Hayslip, Pinder, and Lumsden (1981) and Pinder and Hayslip (1981) expanded on this perspective toward understanding fear of death by creating a scoring system for the sentence-completion method that is reliable and can differentiate groups of individuals in a manner that suggests it is a valuable approach for assessing death anxiety at an unconscious level. The scoring system comprises nine dimensions of unconscious death anxiety, each dimension yielding a separate score. Summing across all nine dimensions produces a total score. The dimensions are defined as follows:
- Overt mention of death or dying
- Fear of separation or isolation
- Fear of dependency or loss of control
- Fear of stasis or stagnation
- Fear of loss of goals
- Fear of injury to or disease in oneself
- Fear of pain/suffering
- Fear of punishment or rejection by others
- Concern over time (futurity)
Each of these dimensions can be reliably scored (Hayslip, Galt, and Pinder 1993-94; Hayslip et al. 1981; Pinder and Hayslip 1981).
Since these initial studies were conducted, a great deal of evidence has been accumulated regarding the method’s validity, as such scores have been found to be sensitive to (a) the impact of death education (Hayslip and Walling 1985-86; Hayslip et al. 1993-94; Servaty and Hayslip 1996), (b) variations in occupational choice (Lattaner and Hayslip 1984-85), (c) individual differences in communication apprehension regarding the dying (Servaty and Hayslip 1996), (d) relationships to locus of control (Hayslip and Stewart-Bussey 1986-87), and (e) the impact of terminal illness (Hayslip, Luhr, and Beyerlein 1991; Hayslip et al. 1996-97).
Death Denial and Age
In a study conducted with a sample of young and middle-aged adults, Hayslip et al. (1981) found that age and conscious death fear were negatively related, whereas age and covert fear were positively related. In this light, Galt and Hayslip (1998-99) expanded on the Hayslip et al. (1981) study by cross-sectionally exploring the relationship of age to levels of death fear, utilizing samples of younger and older (age 60 and over) adults and measuring death anxiety at multiple levels of awareness. Results indicated that there were reliable age differences in both overt and covert levels of death fear. In contrast to earlier findings (see Neimeyer and Van Brunt 1995), older adults reported higher levels of overt personal death fear and expressed greater conscious fears over the loss of others. On the other hand, younger adults evidenced higher levels of conscious fear of pain associated with death and scored higher regarding conscious fears of their own dying. These results suggest that cumulative differential loss experiences over the course of a lifetime may covary with an individual’s lessened need to deny fears of his or her own death.
Kastenbaum (1992) advises, however, that we must not jump to the conclusion that conscious death fears decrease with age or that young adults are typically more death anxious when compared with members of older age groups. Because most of the studies in this area have been cross-sectional, differences may be due to cohort effects (see Baltes 1968), and thus may not reflect intraindividual change over time; longitudinal designs are more advantageous for investigating intraindividual change (Baltes 1968). Neimeyer and Van Brunt (1995) suggest that
additional work is necessary if we are to understand the apparent negative relationship between death fear and age in adulthood. Attention to the multilevel nature of death anxiety may illuminate this relationship further, especially if older adults are found to have lower conscious but higher unconscious death fear scores, suggesting that individuals’ needs to deny their fears about death vary with age because of older adults’ greater experience of threats to their mortality brought about by illness, injury, and the deaths of others, such as childhood friends, siblings, parents, grandparents, and spouses.
Relationships Between Covert and Overt Death Fears
Galt and Hayslip (1998-99) also found a reciprocal relationship between conscious (overt) and unconscious (covert) levels of death fear; that is, if conscious death anxiety is higher, unconscious death fear is lower (indicating less denial), and vice versa. Indeed, negative relationships between self-reported death fears and both repression-sensitization and galvanic skin responses have been noted (Templer 1971). Greyson (1994) found that persons who had had near-death experiences scored lower on a measure of death threat, indicating that having an NDE may lessen denial, perhaps by instilling or reinforcing the belief that one can transcend the destruction of one’s body and/or the belief that life will go on beyond physical death.
Hayslip, Guarnaccia, and Servaty (2002) have found evidence supporting a blended projective/psychometric measurement model that allows for the assessment of both overt and covert death anxiety to explore the factorial composition of death fear, utilizing confirmatory factor-analytic techniques (LISREL; Hayduk 1996; Jöreskog & Sörbom 1993), which are more powerful than correlational/exploratory factor-analytic techniques for ascertaining the latent structure of death anxiety (see Tabachnick and Fidell 1996; Ullman 1996). Hayslip et al. (2002) tested the robustness of a six-indicator, two-factor model of overt and covert death anxiety utilizing data from two randomly selected halves of a parent sample of 392 adults. The researchers used these data to translate a theoretical model into an empirically valid factor model, wherein the model was developed in one sample and then was cross-validated with the second sample.
In the Hayslip et al. (2002) study, in the development of both the cross-validation samples, the two-factor (overt and covert fear) and three-factor (overt-other, overt-self, and covert death fear) model fits were quite adequate, yet the ease with which the two-factor model was fit to both the first and second data sets suggests that death anxiety does appear to have a two-factor structure—that is, overt death anxiety and covert death anxiety. Consequently, on the joint basis of parsimony and the two-factor model’s superiority in the first (development) sample, Hayslip et al. retained the two-factor model to represent the structure of death anxiety.
In this light, the fact that covert death fear can be identified as a separate yet interrelated dimension of death anxiety suggests that a person’s conscious awareness of his or her mortality can be minimized, distorted, or denied, principally through the operation of defenses such as denial and regression or through the development of self-nourishing habits that protect the individual from existential anxiety (see Firestone 1994). The fact that the two (overt and covert) components of death anxiety are negatively related is supported by previous research (Galt and Hayslip 1998-99; Hayslip et al. 2002) as well as by Firestone’s (1994) observations, which suggest that “death anxiety increases as people relinquish defenses, refuse to conform to familial and societal standards, reach new levels of differentiation of the self, or expand their lives” (p. 237). Thus the conscious awareness of one’s fears about mortality is inversely related to the extent to which one’s defenses effectively mask such fears. Consequently, the relationship between conscious (overt) and unconscious (covert) death fear is best thought of in dynamic rather than static terms, consistent with the degree of threat the individual experiences and the individual’s need to deal with resultant anxiety through the utilization of defenses in the context of a culture that, in varying degrees, promotes the denial and/or distortion of death.
In spite of the empirical basis for the existence of death denial, it is instructive to take note of Kastenbaum’s (1998) observations on the illusive nature of denial as a defense against death (see above); it may still be premature to attempt to speak definitively to the status of covert death fear without sufficient behaviorally and affectively anchored work to substantiate its existence. Methodologically, however, the use of both self-report and projective methods to assess and understand how persons cope with death anxiety represents an advantage over other methods that emphasize one approach over the other. Moreover, it can be argued that a confirmatory factor-analytic approach to this question (see Hayslip et al. 2002) is much superior to either an exploratory one or a strictly correlational strategy (see Neimeyer 1997-98; Tabachnick and Fidell 1996; Ullman 1996). That both the two-factor and three-factor models convincingly fit the data in both the developmental and cross-validation samples taken by Hayslip et al. (2002) is especially impressive given the modest internal consistency of both the Templer (1970) and Collett and Lester (1969) measures of conscious death fear.
Death Denial: Where Are We Going?
Perhaps most important, attention to the assessment of death denial reflects Neimeyer’s (1994) calls for innovation and movement in the field of death anxiety. For example, use of the Incomplete Sentence Blank to assess covert death fears is grounded in psychoanalytic theory,
and given the integration of self-report and projective approaches in the measurement of death anxiety, such research lays the groundwork for further studies of an interventive (psychotherapeutic, death educative) nature, in which specific hypotheses might be tested based on the dualistic nature of death fear. Additionally, given the necessarily developmental relationship between an individual’s exposure to the deaths of others and the nearness/likelihood of his or her own death (see, e.g., Devins 1979), a dualistic yet integrated conception of death fear permits a greater understanding of the temporal relationship between chronologically (age) driven experiences and the individual’s need to construct defenses to maintain the illusion of immortality (see Firestone 2000; Galt and Hayslip 1998-99; Hayslip et al. 1996-97). Thus research speaking to the nature of overt and covert death fear embodies many of Neimeyer’s (1994) observations regarding the development of new and more theoretically and methodologically sophisticated approaches to the study of death fears that would move the field forward so as to enhance our understanding of death attitudes.
To understand and measure the denial of death, we must attend to the nature of the responses of both cultures and individuals to the fact that all humans die. Moreover, such responses are driven by the fact that the manners in which some deaths occur are more likely than others to evoke strong denial. A step forward in our attempts to understand the denial of death would be the development of theory that integrates attitudes toward death at both individual and cultural levels. Clearly, individuals’ and cultures’ reactions to death are interwoven, as we observed on September 11, 2001. The events of that day not only altered Americans’ sense of their own vulnerability and mortality, but threatened the stability of their relationships with others and their careers (as a person might also be threatened by a diagnosis of cancer).It is also important to observe that the very meaning and role that death plays in shaping the cultural ethos is altered by death-related events, be they unique to individual lives or culturally symbolic in nature. For example, Americans’ collective identity as citizens of a powerful nation was shaken by the events of September 11, and our responses to this change have ranged from the institutionalization of greater security measures to the embrace of our collective belongingness, grief, and spirituality, to the targeting of individuals whose appearance and/or heritage cause us to be suspicious of their motives. Such responses are best understood on multiple levels—they are at once interpersonal, sociocultural, and idiosyncratic in nature.
As researchers, theoreticians, practitioners, and human beings, we face the challenge of finding better ways to understand the dynamic interplay between individual life events and cultural change, so that we can appreciate more fully the role of the denial of death in helping to shape our own individual lives as well as our culture’s death system. In many respects, this will be an ongoing endeavor, as events whose role in reinforcing the denial of death become clearer and as events that have yet to occur challenge our sense of individual and collective security. Such events may exceed our idiographic and cultural thresholds, affecting whether we respond to death by embracing it or by denying its impact on our lives.