PERCEPTION OF DEATH

Man is a creature in time and space whose consciousness permits him to nullify their strictures. Because he is gifted with the capacity to conceptualize a future, awareness of inexorable death becomes for him a steering force. This is particularly cogent for the fatally ill individual who finds himself in a continuous confrontation with oncoming death. Systematic work in this area is experimentally difficult, and empiricai findings are presently sparse. Recent years, however, disclose increasing efforts to augment religio-philosophic formulations and clinical impressions with controlled research endeavors. In this frame, I offer certain’ findings that are emerging from an ongoing investigation of attitudes toward death in differing populations. The focus here is on contrasting perception of death between a group of 95 healthy normal persons and another of 92 seriously ill and terminally ill patients, cognizant of the life-threatening nature of their illnesses. Cancer and heart trouble are the major diseases represented in the group of patients. Both groups-the physically sick and the healthy-have a mean age of 40 years; are somewhat above average in intelligence and socioeconomic status; consist mostly of members of the Protestant faith; and, in the main, are mamed with children. More males and Catholics are represented in the group of patients than in the healthy one. Statistical analysis indicates, however, that these differences are without influence on the results being reported. The data were obtained, in large measure, by a team of diplomates in clinical psychology and psychiatry, who employed open-end questions, rating scales, and a number of tests. The necessity for cross-validation prompts some circumspection in generaling from the findings. Interestingly, a number of them correspond with clinical observations and common sense reflections. What are the findings? Our patients, significantly more often than the healthy, use denial and avoidance as ways to grapple with the concept of death. They block reliably more often on items pertaining to death imagery, are overly engrossed in minutiae, wish to die in a condition oblivious to death, and are significantly less accepting of death than their healthy counterparts. By contrast, the healthy utilize intellectualization as their major technique in coping with the problem. Being close to death or contemplating it from a distance apparently calls forth a differing strategy of defense. This does not imply, naturally, that denial is not available to a substantial proportion of the healthy or that patients do not indulge in intellectualization, to say nothing of such other shields as reaction-formation, isolation, and displacement. A derivative of this adaptational approach by our patients may be discerned in the finding that they hold a significantly more institutional-utilitarian or “extrinsic” orientation toward religion than do the healthy. Religion is perceived more in defensive and escapist terms than as “intrinsic,” that is, where religion functions integratively and as a true end in itself. Belief in a divine God and in a personal fate after death leading to heavenly environs is also definitely more characteristic of the patients. A no-atheist-in-foxhole outlook prevails. The healthy, in comparison, conceive of God not so much as ‘‘divine’’ as “a power greater than oneself‘