Concept of death and adjustment

Concept of death and adjustment addresses people's adjustment to the inevitable phenomenon of death depending on the different perceptions of the phenomenon they have, whether or not there is a particular reason to think that death is imminent.

Most scientific studies on adjustment to death are done on subjects whose death is imminent due to a terminal illness or old age. Scientific researches on adjustment to death are theories based on researchers observing the subject's process of coming to terms with death, rather than the dying person noting down their experience and feelings themselves. Also, these studies do not always address how the general awareness of death affects every human being, irrespective of age and health, nor how each individual's concept of death of influences adjustment to life, although some theorists have suggested that adjustment or lack of adjustment to death can influence mental health. If not prepared for in advance, death often leaves no time to adjust at the time it occurs. Prior knowledge and preparation during life may increase the possibility of a comparatively favorable adjustment to imminent death when it is faced.

Theories on death and related anxiety
Theory of Sigmund Freud
Sigmund Freud (1856-1939) stated that most people have a fear of death, which he referred to as thanatophobia. Psychologically, death is a threat to any living person, irrespective of health and age. However, Freud postulated this fear was merely a disguise for a deeper source of concern. He believed that it was not actually death that people feared, because nobody believes in the reality of their own death. Freud believed the unconscious does not deal with the passage of time or with possible annihilation of the individual. That one's life could and would end does not seem real, since a living person has never experienced his own death. People who express death-related fears, Freud believed, actually are trying to deal with unresolved childhood conflicts that they cannot bring themselves to acknowledge and discuss openly.

Theory of Ernest Becker
Ernest Becker, author of The Denial of Death which won the Pulitzer Prize in 1974, presents an existential view of death anxiety theory. He states that death anxiety is not only real, but also it is people's most profound source of concern. He described this anxiety as so intense that it can generate fears and phobias in everyday life. Fears of being alone or in a confined space are some examples of its impact. According to this theory, much of people's daily behavior consists of attempts to ward off death or deny its reality, and thereby keep their basic anxiety under control.

Theory of M S Hossain
Mohammad Samir Hossain, an Asian mental health researcher and physician from Bangladesh, developed the Death and Adjustment Hypotheses that were published in the social science theory book Quest for a New Death: Death and Adjustment Hypotheses written on death and dying by Professor Hossain, and reviewed in Death Studies, the peer reviewed journal of Biomedical Social Sciences. The journal called the book a trendsetter in an important movement in science with the potential for making an unusual impact on civilization by giving death a central position in human life. The hypothesis has two parts. The first part postulates that death is not the end of existence. The second part postulates that a concept of death which involves human immortality should be coupled with a balanced attitude toward morality and materialism.

Other theories
Other approaches about death anxiety were introduced in the late twentieth century. Terror management theory is based on studies finding that people who felt better about themselves also reported having less death-related anxiety. Another approach, named regret theory, was proposed in 1996 by Adrian Tomer and Grafton Eliason. It approaches the way in which people evaluate the quality or worth of their lives. It postulates that the prospect of death is likely to make people more anxious if they feel that they have not and cannot accomplish something good in life.

Studies of adjustment
Elisabeth Kubler-Ross studied the subject of death and dying, and developed her model for the aged and the terminally ill. She found that the dying persons typically experienced a progression towards an adjustment to and an acceptance of death. She described five stages through which a dying person moves. The first stage is denial, in which the dying person denies the reality of death. The second stage is one of anger, a feeling that death is unjust. In the third stage the dying person attempts to bargain with the higher powers in an attempt to prolong life. This is followed by the fourth stage, a period of depression as the dying person realizes bargaining is futile. In the fifth stage the reality of death is accepted and the person finds relative peace.

Mohammad Samir Hossain, a researcher in Bangladesh, has extensively studied the subject of death and developed his own model pertaining to the healthy average person. Hossain used Kubler-Ross's stages as a starting point and established a new staging system. Hossain described six stages through which a healthy person moves in adjusting to death. He found that most people experience dissociation from death. At the time that the person is reminded of death, there begins a progression toward an adjustment to and an acceptance of death. Once they leave the state of dissociation, they then follow Kubler Ross' steps of denial, anger, bargaining, depression and acceptance.

Alliance of historical concept and psychological model
The historical sequence of the concept of death, described by Philippe Aries, is similar to the stages of adjustment model by Elisabeth Kubler-Ross in reverse. Aries stated that there were exceptions in attitudes towards death, and it is possible that an unassessed but major portion of population never could completely accept death. The history of the west contains evidence in support of the changing attitudes.

Aries chronicled Western attitudes toward death from the Middle Ages to the 20th century into five basic attitudes. These attitudes are correlated with historical periods and reflect what Aries sees as the prevailing adjustment pattern of that particular period.

The first pattern, Tame Death, describes the attitude from 5th to 8th centuries. Christianity had an influence on people's concept of death. Death was considered to be as a sleep, awaiting the Second Coming of Christ. His coming was thought to be followed by a nonthreatening consequence; either sleep or a heavenly afterlife. For the average person there was a religious element in relating to death. However, the birth of Islam changed the attitude to death of those who believed in it or encountered it. Around the 12th century, some parts of Europe such as Greece were largely dominated by Muslims. Though Muslims were to some extent flexible in their attitudes toward knowledge and science, they were rigid about their philosophies. This was a facilitative period of time for the upcoming stage of preoccupation with judgement after death, which is a major part of Islamic belief and philosophy.

The second pattern, Death of the Self, evolved by the 12th and 13th centuries. At this point, death became an anxiety-provoking concept to the average person. Individuals had to form a relationship with their religious belief in judgment after death, which is part of both Islam and Christianity. People attempted to adjust to death by trying to manage aspects of how they lived their lives, their morality and religious obligations, in order to feel that death might lead to something not too terrifying to face.

The third pattern, Remote and Imminent Death, was a transitional phase associated with changing attitudes that prevailed during the 16th to the 18th centuries. During this phase people's conceptualization of death and related events moved away from a supernatural experience, toward more of a sense of it being a natural, physical process. However, anxiety about death was still present.

The fourth pattern, Death of the Other, culminated during the 19th century. This attitude was accompanied by a feeling of intolerable separation from loved ones. An optimistic view of the concept of death grew, with hope of reunion with those people had lost while alive. But evidence of life after death could not be proven by the material senses, and was no more than a hope to all but the most fervent believers in mediumship. Thus death remained as a natural rather than a supernatural event.

The fifth pattern, Death Denied, is a common feature of the 20th century. Society had become less religious. The moment of death was banished from awareness and the focus remains on the survivors. Death was seen as dirty and indecent. Those who are preoccupied by considering the reality of death are sometimes dismissed as morbid if they share their thoughts. So the journey of death that started as a normal part of life during the 5th century, was at its most concealed in the last part of the 20th century.

Psychological mechanisms of adaptation
Defenses against death
In dealing with unavoidable anxiety, people try to adapt to it. This adaptation is achieved by the formation of defense mechanisms. Defense mechanisms are classified as less and more mature. The more mature the defense, the more comfortable the adaptation. The attitude prevailed during the 5th to 8th centuries, compared to the next, were less anxiety provoking. So it can be assumed that the second attitude did not come as a defense or adaptation to deal with the first one. This 12th century attitude can be best explained by the newborn religion Islam in its recent past, and also the rule of the Muslim empire in many areas around that time. But as it was anxiety provoking, an adaptation process was due. The third stage, the attitude during the 16th century, can be seen as a defensive response to the second attitude and belief concerned with it. It is best explained by repression which prevents unacceptable feelings from reaching awareness. The fourth stage during the 19th century is another example of defense, that can be best explained by projection, another less mature defense like repression. Finally the 20th century attitude of denial of death is itself the least mature defense for adaptation.

A defense originating from religion
For people with a devout religious belief, the anxiety provoking concepts and attitudes towards death are often related to those beliefs. From the 5th to 8th centuries the older version of the available religious concept, Christianity, was undergoing a process of adaptation already. If the latest and most anxiety-provoking religious concept and attitude towards death, judgement, is related to Islam, considering the time of birth of Islam and also that it was the ruling group’s religion in those parts of the world governed by the Muslim empire, then the 5th to 8th century attitude can be compared to splitting; another less mature defense for adaptation. But that could only happen if the core concept from the religion prior that was anxiety provoking in a similar way to Islam.

Research on attitudes towards death
Research on these attitudes is increasing. A recent Hungarian study assessed physicians’ attitudes toward dying patients with a questionnaire. They found that physicians have very little knowledge of death and dying, along with negative attitudes toward dying people. The study concluded that this, combined with their own fear of death, can negatively influence their relationships with dying patients and may cause them to avoid dealing with the questions worrying dying people.

In contrast, a 1994 survey found that Americans are much more willing to talk about death and dying now than they were 10 years earlier. More actively dealt with the practical and legal aspects, and the majority said they talk more openly about death now than before.
A 2001 study of attitudes in Italy concluded that Italians are only slightly more likely to discuss incurable disease, death and dying than they were in a similar study conducted in 1988. For example, only 13 percent said they would want to be told if they were near death. It is a possibility that adaptation has become more mature in these cases, which may represent defenses such as intellectualization.

One study concluded that religiosity helps Muslims adjust with death. The study was conducted on the Muslims of Bangladesh, and difference in levels of religiosity was found to be related to difference in adjustment to death. Dr. Samir, a Bangladeshi mental health researcher, measured and compared religiosity and adjustment to death. In this study, statistical significance of the relationship was very marked.

Another study focused on the cultural impact of ethnicity on attitudes toward death and dying, by comparing African Americans, Asian Americans, and Hispanic Americans with a comparison group of white Americans. They compared their findings to those from Kalish’s and Reynolds’s 1970s Death and Ethnicity Study (now considred a landmark study), and found a shift in focus to more personal issues. A recent study on attitudes toward death and dying in Chinese-Americans living in New York City found many Chinese attitudes and practices embedded in Asian cultural values about family life, combined with aspects of Confucianism, Buddhism, Taoism, and local folklore.

Recent world events bring up vividly the question of differing views of death in different parts of the world. Most Western analysis of Muslim attitudes towards death concentrates on terrorist groups, with little interest in the philosophies of average non-Western individuals.

Research on adjustment to death
Mohammad Samir Hossain in Bangladesh, worked under BIU (Madrid, Spain) with various degrees of adjustment to death among different groups of people. He postulated that the stages described by Elisabeth Kubler-Ross are arranged somewhat in reverse sequence, as were the changing philosophies toward death over time described by Philippe Aries. He integrated the two concepts with his research by demonstrating that a concept of death is more flexible when death is seen as a significant event, but not the absolute end - when there is a belief in an afterlife. 'Death and Adjustment Hypotheses' is an extract from this research work by the same researcher.

Adjustment versus death anxiety
According to Hebb’s classic formulation, moderate levels of arousal or anxiety are needed for good performance. In different performances there are sub-manifestations of anxiety such as the cognitive, somatic, and so on. The multidimensional theory of anxiety suggests positive effects related to cognitive anxiety in the days before a crucial event. The neurotransmitter in the human brain that is best known for arousal or anxiety, Glutamate, dominates about 80% of the synapses of human brain. Also glutamate plays very vital role in neuronal differentiation and migration. So theoretically, anxiety is also biologically linked to essential parts of life.

Socially, when death anxiety is rooted in religion, it works as a modulator for moral judgment and performance. Death anxiety may then lead to better performance in life, in a similar way to the anxiety needed in case of good learning performance or sports activity. It may also encourage people to make the most of the time they have. But according to the science of mental health, good adjustment is beneficial to well-being, even if some death anxiety is useful. When the concepts contribute to adjustment, thus ultimate wellbeing, it is now an flourishing field of research in thanatology whether we need to consider or reconsider our perception of death at personal and social levels.

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