A Medley of Potpourri

Friday, September 17, 2021

Death anxiety (psychology)

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Death_anxiety_(psychology)

Death anxiety is anxiety caused by thoughts of one's own death; it is also referred to as thanatophobia (fear of death). Death anxiety is different from necrophobia, the latter is the fear of others who are dead or dying, whereas the former concerns one's own death or dying.

Popular psychotherapist Robert Langs proposed 3 different causes of death anxiety: Predatory, predator, and existential. In addition to his research, many theorists such as Sigmund Freud, Erik Erikson, Ernest Becker, and others have contemplated death and death anxiety and how it relates to human psychology.

Death anxiety has been found to affect people of differing demographic groups as well; such as men versus women, young versus old, etc.

Additionally, there is anxiety caused by death-recent thought-content, which might be classified within a clinical setting by a psychiatrist as morbid and/or abnormal. This classification pre-necessitates a degree of anxiety which is persistent and interferes with everyday functioning. Lower ego integrity, more physical problems and more psychological problems are predictive of higher levels of death anxiety in elderly people perceiving themselves close to death.

Death anxiety can cause extreme timidness with a person's attitude towards discussing anything to do with death.

Findings from one systematic review demonstrated that death anxiety features across several mental health conditions.

One meta-analysis of psychological interventions targeting death anxiety showed that death anxiety can be reduced using cognitive behavior therapy.

Types

Robert Langs distinguishes three types of death anxiety:

Predatory death anxiety

Predatory death anxiety arises from the fear of being harmed. It is the most basic and oldest form of death anxiety, with its origins in the first unicellular organisms' set of adaptive resources. Unicellular organisms have receptors that have evolved to react to external dangers, along with self-protective, responsive mechanisms made to increase the likelihood of survival in the face of chemical and physical forms of attack or danger. In humans, predatory death anxiety is evoked by a variety of dangerous situations that put one at risk or threaten one's survival. Predatory death anxiety mobilizes an individual's adaptive resources and leads to a fight-or-flight response: active efforts to combat the danger or attempts to escape the threatening situation.

Predation or predator

Predation or predator death anxiety is a form that arises when an individual harms another, physically and/or mentally. This form of death anxiety is often accompanied by unconscious guilt. This guilt, in turn, motivates and encourages a variety of self-made decisions and actions by the perpetrator of harm to others.

Existential

Existential death anxiety stems from the basic knowledge that human life must end. Existential death anxiety is known to be the most powerful form of death anxiety. It is said that language has created the basis for existential death anxiety through communicative and behavioral changes. Other factors include an awareness of the distinction between self and others, a full sense of personal identity, and the ability to anticipate the future.

Awareness of human mortality arose some 150,000 years ago. In that extremely short span of evolutionary time, humans have fashioned a single basic mechanism through which they deal with the existential death anxieties this awareness has evoked—denial. Denial is effected through a wide range of mental mechanisms and physical actions, many of which go unrecognized. While denial can be adaptive in limited use, excessive use is more common and is emotionally costly. Denial is the root of such diverse actions as breaking rules, violating frames and boundaries, manic celebrations, directing violence against others, attempting to gain extraordinary wealth and power—and more. These pursuits are often activated by a death-related trauma, and while they may lead to constructive actions, more often than not, they lead to actions that are damaging to self and others.

Theories

Thanatophobia

Sigmund Freud hypothesized that people express a fear of death, called thanatophobia. He said he saw this as a disguise for a deeper source of concern. It was not actually death that people feared, because in Freud's view nobody believes in their own death. The unconscious does not deal with the passage of time or with negations, which does not calculate amount of time left in one's life. Furthermore, that which one does fear cannot be death itself, because one has never died. People who express death-related fears, actually are trying to deal with unresolved childhood conflicts that they cannot come to terms with or express emotion towards. The name Thanatophobia is made from the Greek figure of death known as Thanatos.

Wisdom: ego integrity vs. despair

Developmental psychologist Erik Erikson formulated the psychosocial theory that explained that people progress through a series of crises as they grow older. The theory also envelops the concept that once an individual reaches the latest stages of life, they reach the level he titled as "ego integrity". Ego Integrity is when one comes to terms with their life and accepts it. It was also suggested that when a person reaches the stage of late adulthood they become involved in a thorough overview of their life to date. When one can find meaning or purpose in their life, they have reached the integrity stage. In opposition, when an individual views their life as a series of failed and missed opportunities, then they do not reach the ego integrity stage. Elders that have attained this stage of ego integrity are believed to exhibit less of an influence from death anxiety.

Terror management theory

Ernest Becker based this theory on existential views which turned death anxiety theories towards a new dimension. It said that death anxiety is not only real, but also it is people's most profound source of concern. He explained the anxiety as so intense that it can generate fears and phobias of everyday life—Fears of being alone or in a confined space. Based on the theory, many of people's daily behavior consist of attempts to deny death and to keep their anxiety under strict regulation.

As an individual develops mortality salience, i.e. becomes more aware of the inevitability of death, they will instinctively try to suppress it out of fear. The method of suppression usually leads to mainstreaming towards cultural beliefs, leaning for external support rather than treading alone. This behavior may range from simply thinking about death to severe phobias and desperate actions.

One way in which religiosity plays a role in death anxiety is through the concept of fear. There are two major claims concerning the interplay of fear and religion: that fear motivates religious belief, and that religious belief mitigates fear. From these, Ernest Becker and Bronislaw Malinowski developed what is called "Terror Management Theory." According to Terror Management Theory, humans are aware of their own mortality which, in turn, produces intense existential anxiety. To cope with and ease the produced existential anxiety, humans will pursue either literal or symbolic immortality. Religion often falls under the category of literal immortality, but at times, depending on the religion, can also provide both forms of immortality. Through Terror Management Theory, and other death-focused theories, there is a distinct pattern that develops indicating that those who are either very low or very high in religiosity experience much lower levels of death anxiety, meanwhile those with a very moderate amount of religiosity experience the highest levels of death anxiety. One of the major reasons that religiosity plays such a large role in Terror Management Theory, as well as in similar theories, is the increase in existential death anxiety that people experience. Existential death anxiety is the belief that everything ceases after death; nothing continues on in any sense. Seeing how people deeply fear such an absolute elimination of the self, they begin to gravitate toward religion which offers an escape from such a fate. According to one specific meta-analysis study that was performed in 2016, it was shown that lower rates of death anxiety and general fear about dying was experienced by those who went day-to-day living their religion and abiding by its practices, compared to those who merely label themselves as a member of a given religion without living in accord to its doctrines and prescribed practices.

Being, time and Dasein

Martin Heidegger, the German philosopher, on the one hand showed death as something conclusively determined, in the sense that it is inevitable for every human being, while on the other hand, it unmasks its indeterminate nature via the truth that one never knows when or how death is going to come. Heidegger does not engage in speculation about whether being after death is possible. He argues that all human existence is embedded in time: past, present, future, and when considering the future, we encounter the notion of death. This then creates angst. Angst can create a clear understanding in one that death is a possible mode of existence, which Heidegger described as "clearing". Thus, angst can lead to a freedom about existence, but only if we can stop denying our mortality (as expressed in Heidegger's terminology as "stop denying being-for-death").

Meaning management theory

Paul T. P. Wong's work on the meaning management theory indicates that human reactions to death are complex, multifaceted and dynamic. His "Death Attitude Profile" identifies three types of death acceptances as Neutral, Approach, and Escape acceptances. Apart from acceptances, his work also represents different aspects of the meaning of death fear that are rooted in the bases of death anxiety. The ten meanings he proposes are finality, uncertainty, annihilation, ultimate loss, life flow disruption, leaving the loved ones, pain and loneliness, prematurity and violence of death, failure of life work completion, judgment and retribution centered.

Existential theories

The existential approach, with theorists such as Rollo May and Viktor Frankl, views an individual's personality as being governed by the continuous choices and decisions in relation to the realities of life and death. Rollo May theorized that all humans are aware of the fact that they must one day die. However, he also theorized that humans must find meaning in life, which led to his main theory on death anxiety; that all humans face the dichotomy of finding meaning in life, but also confronting the knowledge of approaching death. May believed that this dichotomy could lead to negative anxiety that hindered life, or a positive anxiety that would lead to a life full of meaning and living to one's fullest potential and opportunities.

Other theories

Other theories on death anxiety were introduced in the late part of the twentieth century. Another approach is the regret theory which was introduced by Adrian Tomer and Grafton Eliason. The main focus of the theory is to target the way people evaluate the quality and/or worth of their lives. The possibility of death usually makes people more anxious if they feel that they have not and cannot accomplish any positive task in the life that they are living. Research has tried to unveil the factors that might influence the amount of anxiety people experience in life.

Personal meanings of death

Humans develop meanings and associate them with objects and events in their environment which can provoke certain emotions. People tend to develop personal meanings of death which could be either positive or negative. If the formed meanings about death are positive, then the consequences of those meanings can be comforting (for example, ideas of a rippling effect left on those still alive). If the formed meanings about death are negative, they can cause emotional turmoil. Depending on the certain meaning one has associated with death, positive or negative, the consequences will vary accordingly. The meaning that individuals place on death is generally specific to them; whether negative or positive, and can be difficult to understand as an outside observer. However, through a Phenomenological perspective, therapists can come to understand their individual perspective and assist them in framing that meaning of death in a healthy way.

Religiosity

A 2012 study involving Christian and Muslim college-students from the US, Turkey, and Malaysia found that their religiosity correlated positively with an increased fear of death.

A 2017 review of the literature found that in the US, both the very religious and the not-at-all religious enjoy a lower level of death anxiety and that a reduction is common with old age.

A 2019 study further examined the aspect of religiosity and how it relates to death and existential anxiety through the application of supernatural agency. According to this particular study, existential anxiety relates to death anxiety through a mild level of preoccupation that is experienced concerning the impact of one’s own life or existence in relation to its unforeseen end. It is mentioned how supernatural anxiety exists independently on a different dimensional plane than the individual and, as a result, is seen as something that cannot be directly controlled. Often times supernatural agency is equated with the desires of a higher power such as God or other major cosmic forces. The inability for one to control supernatural agency triggers various psychological aspects that induce intense periods of experienced death or existential anxiety. One of the psychological effects of supernatural agency that is triggered is an increased likelihood to attribute supernatural agency toward causality when dealing with natural phenomena. Seeing how people have their own innate form of agency, the attribution of supernatural agency to human actions and decisions can be difficult. However, when it comes to natural causes and consequences where no other form of agency exists, it becomes much easier to make a supernatural attribution of causality.

Death acceptance and death anxiety

Researchers have also conducted surveys on how being able to accept one's inevitable death could have a positive effect on one's psychological well-being, or on one's level of individual distress. A research study conducted in 1974 attempted to set up a new type of scale to measure people's death acceptance, rather than their death anxiety. After administering a questionnaire with questions regarding the acceptance of death, the researchers found there was a low-negative correlation between acceptance of one’s own death and anxiety about death; meaning that the more the participants accepted their own death, the less anxiety they felt. While those who accept the fact of their own death will still feel some anxiety about it, this acceptance could allow them to form a more positive perspective on it.

A more recent longitudinal study asked cancer patients at different stages to fill out different questionnaires in order to rate their levels of death acceptance, general anxiety, demoralization, etc. The same surveys administered to the same people one year later showed that higher levels of death acceptance could predict lower levels of death anxiety in the participants.

Children

Death anxiety typically begins in childhood. The earliest documentation of the fear of death has been found in children as young as age 5. Psychological measures and reaction times were used to measure fear of death in young children. Recent studies that assess fear of death in children use questionnaire rating scales. There are many tests to study this including The Death Anxiety Scale for Children (DASC) developed by Schell and Seefeldt. However the most common version of this test is the revised Fear Survey Schedule for Children (FSSC-R). The FSSC-R describes specific fearful stimuli and children are asked to rate the degree to which the scenario/item makes them anxious or fearful. The most recent version of the FSSC-R presents the scenarios in a pictorial form to children as young as 4. It is called the Koala Fear Questionnaire (KFQ). The fear studies show that children's fears can be grouped into five categories. One of these categories is death and danger. This response was found amongst children age 4 to 6 on the KFQ, and from age 7 to 10. Death is the most commonly feared item and remains the most commonly feared item throughout adolescence.

A study of 90 children, aged 4–8, done by Virginia Slaughter and Maya Griffiths showed that a more mature understanding of the biological concept of death was correlated to a decreased fear of death. This may suggest that it is helpful to teach children about death (in a biological sense), in order to alleviate the fear.

Relationship to adult attachment

There has been much literature that supports the existence of a correlation between one's state of coping skills, mental health, emotions and cognitive reactions to stressful events, and one's ability to regulate affect concerning one's death anxiety. A series of tests determined that significantly high levels of death anxiety tend to occur in close relationships with an intimate partner (more so amongst females than males).

Sexes

The connection between death anxiety and one's sex appears to be strong. Studies show that females tend to have more death anxiety than males. Thorson and Powell (1984) did a study to investigate this connection, and they sampled men and women from 16 years of age to over 60. The Death Anxiety Scale showed higher mean scores for women than for men. Moreover, researchers believe that age and culture could be major influences in why women score higher on death anxiety scales than men.

Through the evolutionary period, a basic method was created to deal with death anxiety and also as a means of dealing with loss. Denial is used when memories or feelings are too painful to accept and are often rejected. By maintaining that the event never happened, rather than accepting it, allows an individual more time to work through the inevitable pain. When a loved one dies in a family, denial is often implemented as a means to come to grips with the reality that the person is gone. Closer families often deal with death better than when coping individually. As society and families drift apart so does the time spent bereaving those who have died, which in turn leads to negative emotion and negativity towards death. Women, who are the child bearers and are often the ones who look after children hold greater concerns about death due to their caring role within the family. It is this common role of women that leads to greater death anxiety as it emphasize the 'importance to live' for her offspring. Although it is common knowledge that all living creatures die, many people do not accept their own mortality, preferring not to accept that death is inevitable, and that they will one day die.

Age

It is during the years of young adulthood (ages 20 to 40) that death anxiety gains prevalence. However, during the next phase of life, the middle age adult years (40–64 years of age), death anxiety peaks at its highest levels when in comparison to all other age ranges throughout the lifespan. Levels of death anxiety then decline in the later years of adulthood (65 years of age and older). This is in contrast with most people's expectations, especially regarding all of the negative connotations younger adults have about the elderly and the aging process (Kurlychek & Trenner, 1982).

Measuring

There are many ways to measure death anxiety and fear. Katenbaum and Aeinsberg (1972) devised three propositions for this measurement. From this start, the ideologies about death anxiety have been able to be recorded and their attributes listed. Methods such as imagery tasks to simple questionnaires and apperception tests such as the Stroop test enable psychologists to adequately determine if a person is under stress due to death anxiety or suffering from post-traumatic stress disorder.

The Lester attitude death scale was developed in 1966 but not published until 1991 until its validity was established. By measuring the general attitude towards death and also the inconsistencies with death attitudes, participants are scaled to their favorable value towards death.

One systematic review of 21 self-report death anxiety measures found that many measures have problematic psychometric properties.

Thursday, September 16, 2021

Death

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Death

The human skull is used universally as a symbol of death

Statue of Death, personified as a human skeleton dressed in a shroud and clutching a scythe, from the Cathedral of Trier in Trier, Germany

Death tending to his flowers, in Kuoleman Puutarha, Hugo Simberg (1906)

Death is the permanent, irreversible cessation of all biological functions that sustain a living organism. Brain death is sometimes used as a legal definition of death. The remains of a previously living organism normally begin to decompose shortly after death. Death is an inevitable, universal process that eventually occurs in all living organisms.

Death is generally applied to whole organisms; the similar process seen in individual components of a living organism, such as cells or tissues, is necrosis. Something that is not considered a living organism, such as a virus, can be physically destroyed but is not said to die.

As of the early 21st century, over 150,000 humans die each day.

Many cultures and religions have the idea of an afterlife, and also may hold the idea of judgement of good and bad deeds in one's life (Heaven, Hell, Karma).

Diagnosis

World Health Organization estimated number of deaths per million persons in 2012

1,054–4,598

4,599–5,516

5,517–6,289

6,290–6,835

6,836–7,916

7,917–8,728

8,729–9,404

9,405–10,433

10,434–12,233

12,234–17,141

Problems of definition

Symbols of death in a painting: it shows a flower, a skull and an hourglass

A flower, a skull and an hourglass stand for life, death and time in this 17th-century painting by Philippe de Champaigne

French – 16th-/17th-century ivory pendant, Monk and Death, recalling mortality and the certainty of death (Walters Art Museum)

The concept of death is a key to human understanding of the phenomenon. There are many scientific approaches and various interpretations of the concept. Additionally, the advent of life-sustaining therapy and the numerous criteria for defining death from both a medical and legal standpoint, have made it difficult to create a single unifying definition.

One of the challenges in defining death is in distinguishing it from life. As a point in time, death would seem to refer to the moment at which life ends. Determining when death has occurred is difficult, as cessation of life functions is often not simultaneous across organ systems. Such determination, therefore, requires drawing precise conceptual boundaries between life and death. This is difficult, due to there being little consensus on how to define life.

It is possible to define life in terms of consciousness. When consciousness ceases, a living organism can be said to have died. One of the flaws in this approach is that there are many organisms that are alive but probably not conscious (for example, single-celled organisms). Another problem is in defining consciousness, which has many different definitions given by modern scientists, psychologists and philosophers. Additionally, many religious traditions, including Abrahamic and Dharmic traditions, hold that death does not (or may not) entail the end of consciousness. In certain cultures, death is more of a process than a single event. It implies a slow shift from one spiritual state to another.

Other definitions for death focus on the character of cessation of something. More specifically, death occurs when a living entity experiences irreversible cessation of all functioning. As it pertains to human life, death is an irreversible process where someone loses their existence as a person.

Historically, attempts to define the exact moment of a human's death have been subjective, or imprecise. Death was once defined as the cessation of heartbeat (cardiac arrest) and of breathing, but the development of CPR and prompt defibrillation have rendered that definition inadequate because breathing and heartbeat can sometimes be restarted. This type of death where circulatory and respiratory arrest happens is known as the circulatory definition of death (DCDD). Proponents of the DCDD believe that this definition is reasonable because a person with permanent loss of circulatory and respiratory function should be considered dead. Critics of this definition state that while cessation of these functions may be permanent, it does not mean the situation is irreversible, because if CPR was applied, the person could be revived. Thus, the arguments for and against the DCDD boil down to a matter of defining the actual words "permanent" and "irreversible," which further complicates the challenge of defining death. Furthermore, events which were causally linked to death in the past no longer kill in all circumstances; without a functioning heart or lungs, life can sometimes be sustained with a combination of life support devices, organ transplants and artificial pacemakers.

Today, where a definition of the moment of death is required, doctors and coroners usually turn to "brain death" or "biological death" to define a person as being dead; people are considered dead when the electrical activity in their brain ceases. It is presumed that an end of electrical activity indicates the end of consciousness. Suspension of consciousness must be permanent, and not transient, as occurs during certain sleep stages, and especially a coma. In the case of sleep, EEGs can easily tell the difference.

The category of "brain death" is seen as problematic by some scholars. For instance, Dr. Franklin Miller, senior faculty member at the Department of Bioethics, National Institutes of Health, notes: "By the late 1990s... the equation of brain death with death of the human being was increasingly challenged by scholars, based on evidence regarding the array of biological functioning displayed by patients correctly diagnosed as having this condition who were maintained on mechanical ventilation for substantial periods of time. These patients maintained the ability to sustain circulation and respiration, control temperature, excrete wastes, heal wounds, fight infections and, most dramatically, to gestate fetuses (in the case of pregnant "brain-dead" women)."

While "brain death" is viewed as problematic by some scholars, there are certainly proponents of it that believe this definition of death is the most reasonable for distinguishing life from death. The reasoning behind the support for this definition is that brain death has a set of criteria that is reliable and reproducible. Also, the brain is crucial in determining our identity or who we are as human beings. The distinction should be made that "brain death" cannot be equated with one who is in a vegetative state or coma, in that the former situation describes a state that is beyond recovery.

Those people maintaining that only the neo-cortex of the brain is necessary for consciousness sometimes argue that only electrical activity should be considered when defining death. Eventually it is possible that the criterion for death will be the permanent and irreversible loss of cognitive function, as evidenced by the death of the cerebral cortex. All hope of recovering human thought and personality is then gone given current and foreseeable medical technology. At present, in most places the more conservative definition of death – irreversible cessation of electrical activity in the whole brain, as opposed to just in the neo-cortex – has been adopted (for example the Uniform Determination Of Death Act in the United States). In 2005, the Terri Schiavo case brought the question of brain death and artificial sustenance to the front of American politics.

Even by whole-brain criteria, the determination of brain death can be complicated. EEGs can detect spurious electrical impulses, while certain drugs, hypoglycemia, hypoxia, or hypothermia can suppress or even stop brain activity on a temporary basis. Because of this, hospitals have protocols for determining brain death involving EEGs at widely separated intervals under defined conditions.

In the past, adoption of this whole-brain definition was a conclusion of the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research in 1980. They concluded that this approach to defining death sufficed in reaching a uniform definition nationwide. A multitude of reasons were presented to support this definition including: uniformity of standards in law for establishing death; consumption of a family's fiscal resources for artificial life support; and legal establishment for equating brain death with death in order to proceed with organ donation.

Aside from the issue of support of or dispute against brain death, there is another inherent problem in this categorical definition: the variability of its application in medical practice. In 1995, the American Academy of Neurology (AAN), established a set of criteria that became the medical standard for diagnosing neurologic death. At that time, three clinical features had to be satisfied in order to determine "irreversible cessation" of the total brain including: coma with clear etiology, cessation of breathing, and lack of brainstem reflexes. This set of criteria was then updated again most recently in 2010, but substantial discrepancies still remain across hospitals and medical specialties.

The problem of defining death is especially imperative as it pertains to the dead donor rule, which could be understood as one of the following interpretations of the rule: there must be an official declaration of death in a person before starting organ procurement or that organ procurement cannot result in death of the donor. A great deal of controversy has surrounded the definition of death and the dead donor rule. Advocates of the rule believe the rule is legitimate in protecting organ donors while also countering against any moral or legal objection to organ procurement. Critics, on the other hand, believe that the rule does not uphold the best interests of the donors and that the rule does not effectively promote organ donation.

Signs

Signs of death or strong indications that a warm-blooded animal is no longer alive are:

The stages that follow after death are:

Pallor mortis, paleness which happens in the 15–120 minutes after death
Algor mortis, the reduction in body temperature following death. This is generally a steady decline until matching ambient temperature
Rigor mortis, the limbs of the corpse become stiff (Latin rigor) and difficult to move or manipulate
Livor mortis, a settling of the blood in the lower (dependent) portion of the body
Putrefaction, the beginning signs of decomposition
Decomposition, the reduction into simpler forms of matter, accompanied by a strong, unpleasant odor.
Skeletonization, the end of decomposition, where all soft tissues have decomposed, leaving only the skeleton.
Fossilization, the natural preservation of the skeletal remains formed over a very long period

Legal

The death of a person has legal consequences that may vary between different jurisdictions. A death certificate is issued in most jurisdictions, either by a doctor, or by an administrative office upon presentation of a doctor's declaration of death.

Misdiagnosed

Antoine Wiertz's painting of a man buried alive

There are many anecdotal references to people being declared dead by physicians and then "coming back to life", sometimes days later in their own coffin, or when embalming procedures are about to begin. From the mid-18th century onwards, there was an upsurge in the public's fear of being mistakenly buried alive, and much debate about the uncertainty of the signs of death. Various suggestions were made to test for signs of life before burial, ranging from pouring vinegar and pepper into the corpse's mouth to applying red hot pokers to the feet or into the rectum. Writing in 1895, the physician J.C. Ouseley claimed that as many as 2,700 people were buried prematurely each year in England and Wales, although others estimated the figure to be closer to 800.

In cases of electric shock, cardiopulmonary resuscitation (CPR) for an hour or longer can allow stunned nerves to recover, allowing an apparently dead person to survive. People found unconscious under icy water may survive if their faces are kept continuously cold until they arrive at an emergency room. This "diving response", in which metabolic activity and oxygen requirements are minimal, is something humans share with cetaceans called the mammalian diving reflex.

As medical technologies advance, ideas about when death occurs may have to be re-evaluated in light of the ability to restore a person to vitality after longer periods of apparent death (as happened when CPR and defibrillation showed that cessation of heartbeat is inadequate as a decisive indicator of death). The lack of electrical brain activity may not be enough to consider someone scientifically dead. Therefore, the concept of information-theoretic death has been suggested as a better means of defining when true death occurs, though the concept has few practical applications outside the field of cryonics.

There have been some scientific attempts to bring dead organisms back to life, but with limited success. In science fiction scenarios where such technology is readily available, real death is distinguished from reversible death.

Causes

The leading cause of human death in developing countries is infectious disease. The leading causes in developed countries are atherosclerosis (heart disease and stroke), cancer, and other diseases related to obesity and aging. By an extremely wide margin, the largest unifying cause of death in the developed world is biological aging, leading to various complications known as aging-associated diseases. These conditions cause loss of homeostasis, leading to cardiac arrest, causing loss of oxygen and nutrient supply, causing irreversible deterioration of the brain and other tissues. Of the roughly 150,000 people who die each day across the globe, about two thirds die of age-related causes. In industrialized nations, the proportion is much higher, approaching 90%. With improved medical capability, dying has become a condition to be managed. Home deaths, once commonplace, are now rare in the developed world.

American children smoking in 1910. Tobacco smoking caused an estimated 100 million deaths in the 20th century.

In developing nations, inferior sanitary conditions and lack of access to modern medical technology makes death from infectious diseases more common than in developed countries. One such disease is tuberculosis, a bacterial disease which killed 1.8M people in 2015. Malaria causes about 400–900M cases of fever and 1–3M deaths annually. AIDS death toll in Africa may reach 90–100M by 2025.

According to Jean Ziegler (United Nations Special Reporter on the Right to Food, 2000 – Mar 2008), mortality due to malnutrition accounted for 58% of the total mortality rate in 2006. Ziegler says worldwide approximately 62M people died from all causes and of those deaths more than 36M died of hunger or diseases due to deficiencies in micronutrients.

Tobacco smoking killed 100 million people worldwide in the 20th century and could kill 1 billion people around the world in the 21st century, a World Health Organization report warned.

Many leading developed world causes of death can be postponed by diet and physical activity, but the accelerating incidence of disease with age still imposes limits on human longevity. The evolutionary cause of aging is, at best, only just beginning to be understood. It has been suggested that direct intervention in the aging process may now be the most effective intervention against major causes of death.

Le Suicidé by Édouard Manet depicts a man who has recently committed suicide via a firearm

Selye proposed a unified non-specific approach to many causes of death. He demonstrated that stress decreases adaptability of an organism and proposed to describe the adaptability as a special resource, adaptation energy. The animal dies when this resource is exhausted. Selye assumed that the adaptability is a finite supply, presented at birth. Later on, Goldstone proposed the concept of a production or income of adaptation energy which may be stored (up to a limit), as a capital reserve of adaptation. In recent works, adaptation energy is considered as an internal coordinate on the "dominant path" in the model of adaptation. It is demonstrated that oscillations of well-being appear when the reserve of adaptability is almost exhausted.

In 2012, suicide overtook car crashes for leading causes of human injury deaths in the U.S., followed by poisoning, falls and murder. Causes of death are different in different parts of the world. In high-income and middle income countries nearly half up to more than two thirds of all people live beyond the age of 70 and predominantly die of chronic diseases. In low-income countries, where less than one in five of all people reach the age of 70, and more than a third of all deaths are among children under 15, people predominantly die of infectious diseases.

Autopsy

An autopsy is portrayed in The Anatomy Lesson of Dr. Nicolaes Tulp, by Rembrandt

An autopsy, also known as a postmortem examination or an obduction, is a medical procedure that consists of a thorough examination of a human corpse to determine the cause and manner of a person's death and to evaluate any disease or injury that may be present. It is usually performed by a specialized medical doctor called a pathologist.

Autopsies are either performed for legal or medical purposes. A forensic autopsy is carried out when the cause of death may be a criminal matter, while a clinical or academic autopsy is performed to find the medical cause of death and is used in cases of unknown or uncertain death, or for research purposes. Autopsies can be further classified into cases where external examination suffices, and those where the body is dissected and an internal examination is conducted. Permission from next of kin may be required for internal autopsy in some cases. Once an internal autopsy is complete the body is generally reconstituted by sewing it back together. Autopsy is important in a medical environment and may shed light on mistakes and help improve practices.

A necropsy, which is not always a medical procedure, was a term previously used to describe an unregulated postmortem examination . In modern times, this term is more commonly associated with the corpses of animals.

Senescence

Dead Camelthorn tree within Sossusvlei

Senescence refers to a scenario when a living being is able to survive all calamities, but eventually dies due to causes relating to old age. Animal and plant cells normally reproduce and function during the whole period of natural existence, but the aging process derives from deterioration of cellular activity and ruination of regular functioning. Aptitude of cells for gradual deterioration and mortality means that cells are naturally sentenced to stable and long-term loss of living capacities, even despite continuing metabolic reactions and viability. In the United Kingdom, for example, nine out of ten of all the deaths that occur on a daily basis relates to senescence, while around the world it accounts for two-thirds of 150,000 deaths that take place daily (Hayflick & Moody, 2003).

Almost all animals who survive external hazards to their biological functioning eventually die from biological aging, known in life sciences as "senescence". Some organisms experience negligible senescence, even exhibiting biological immortality. These include the jellyfish Turritopsis dohrnii, the hydra, and the planarian. Unnatural causes of death include suicide and predation. From all causes, roughly 150,000 people die around the world each day. Of these, two thirds die directly or indirectly due to senescence, but in industrialized countries – such as the United States, the United Kingdom, and Germany – the rate approaches 90% (i.e., nearly nine out of ten of all deaths are related to senescence).

Physiological death is now seen as a process, more than an event: conditions once considered indicative of death are now reversible. Where in the process a dividing line is drawn between life and death depends on factors beyond the presence or absence of vital signs. In general, clinical death is neither necessary nor sufficient for a determination of legal death. A patient with working heart and lungs determined to be brain dead can be pronounced legally dead without clinical death occurring. As scientific knowledge and medicine advance, formulating a precise medical definition of death becomes more difficult.

Cryonics

Technicians prepare a body for cryopreservation in 1985.

Cryonics (from Greek κρύος 'kryos-' meaning 'icy cold') is the low-temperature preservation of animals and humans who cannot be sustained by contemporary medicine, with the hope that healing and resuscitation may be possible in the future.

Cryopreservation of people or large animals is not reversible with current technology. The stated rationale for cryonics is that people who are considered dead by current legal or medical definitions may not necessarily be dead according to the more stringent information-theoretic definition of death.

Some scientific literature is claimed to support the feasibility of cryonics. Medical science and cryobiologists generally regards cryonics with skepticism.

Reperfusion

"One of medicine's new frontiers: treating the dead", recognizes that cells that have been without oxygen for more than five minutes die, not from lack of oxygen, but rather when their oxygen supply is resumed. Therefore, practitioners of this approach, e.g., at the Resuscitation Science institute at the University of Pennsylvania, "aim to reduce oxygen uptake, slow metabolism and adjust the blood chemistry for gradual and safe reperfusion."

Life extension

Life extension refers to an increase in maximum or average lifespan, especially in humans, by slowing down or reversing the processes of aging. Average lifespan is determined by vulnerability to accidents and age or lifestyle-related afflictions such as cancer, or cardiovascular disease. Extension of average lifespan can be achieved by good diet, exercise and avoidance of hazards such as smoking. Maximum lifespan is also determined by the rate of aging for a species inherent in its genes. Currently, the only widely recognized method of extending maximum lifespan is calorie restriction. Theoretically, extension of maximum lifespan can be achieved by reducing the rate of aging damage, by periodic replacement of damaged tissues, or by molecular repair or rejuvenation of deteriorated cells and tissues.

A United States poll found that religious people and irreligious people, as well as men and women and people of different economic classes have similar rates of support for life extension, while Africans and Hispanics have higher rates of support than white people. 38 percent of the polled said they would desire to have their aging process cured.

Researchers of life extension are a subclass of biogerontologists known as "biomedical gerontologists". They try to understand the nature of aging and they develop treatments to reverse aging processes or to at least slow them down, for the improvement of health and the maintenance of youthful vigor at every stage of life. Those who take advantage of life extension findings and seek to apply them upon themselves are called "life extensionists" or "longevists". The primary life extension strategy currently is to apply available anti-aging methods in the hope of living long enough to benefit from a complete cure to aging once it is developed.

Location

Kyösti Kallio (in the middle), the fourth President of the Republic of Finland, had a fatal heart attack a few seconds after this photograph was taken by Hugo Sundström on December 19, 1940 at Helsinki railway station in Helsinki, Finland.

Before about 1930, most people in Western countries died in their own homes, surrounded by family, and comforted by clergy, neighbors, and doctors making house calls. By the mid-20th century, half of all Americans died in a hospital. By the start of the 21st century, only about 20–25% of people in developed countries died outside of a medical institution. The shift away from dying at home towards dying in a professional medical environment has been termed the "Invisible Death". This shift occurred gradually over the years, until most deaths now occur outside the home.

Psychology

Death studies is a field within psychology.

Many people are afraid of dying. Discussing, thinking, or planning their own deaths causes them discomfort. This fear may cause them to put off financial planning, preparing a will and testament, or requesting help from a hospice organization.

Different people have different responses to the idea of their own deaths.

Philosopher Galen Strawson writes that the death that many people wish for is an instant, painless, unexperienced annihilation. In this unlikely scenario, the person dies without realizing it and without being able to fear it. One moment the person is walking, eating, or sleeping, and the next moment, the person is dead. Strawson reasons that this type of death would not take anything away from the person, as he believes that a person cannot have a legitimate claim to ownership in the future.

Society and culture

The regent duke Charles (later king Charles IX of Sweden) insulting the corpse of Klaus Fleming. Albert Edelfelt, 1878.

Dead bodies can be mummified either naturally, as this one from Guanajuato, or by intention, as those in ancient Egypt.

In society, the nature of death and humanity's awareness of its own mortality has for millennia been a concern of the world's religious traditions and of philosophical inquiry. This includes belief in resurrection or an afterlife (associated with Abrahamic religions), reincarnation or rebirth (associated with Dharmic religions), or that consciousness permanently ceases to exist, known as eternal oblivion (associated with Secular humanism).

Commemoration ceremonies after death may include various mourning, funeral practices and ceremonies of honouring the deceased. The physical remains of a person, commonly known as a corpse or body, are usually interred whole or cremated, though among the world's cultures there are a variety of other methods of mortuary disposal. In the English language, blessings directed towards a dead person include rest in peace (originally the Latin requiescat in pace), or its initialism RIP.

Death is the center of many traditions and organizations; customs relating to death are a feature of every culture around the world. Much of this revolves around the care of the dead, as well as the afterlife and the disposal of bodies upon the onset of death. The disposal of human corpses does, in general, begin with the last offices before significant time has passed, and ritualistic ceremonies often occur, most commonly interment or cremation. This is not a unified practice; in Tibet, for instance, the body is given a sky burial and left on a mountain top. Proper preparation for death and techniques and ceremonies for producing the ability to transfer one's spiritual attainments into another body (reincarnation) are subjects of detailed study in Tibet. Mummification or embalming is also prevalent in some cultures, to retard the rate of decay.

Legal aspects of death are also part of many cultures, particularly the settlement of the deceased estate and the issues of inheritance and in some countries, inheritance taxation.

Gravestones in Kyoto, Japan

Capital punishment is also a culturally divisive aspect of death. In most jurisdictions where capital punishment is carried out today, the death penalty is reserved for premeditated murder, espionage, treason, or as part of military justice. In some countries, sexual crimes, such as adultery and sodomy, carry the death penalty, as do religious crimes such as apostasy, the formal renunciation of one's religion. In many retentionist countries, drug trafficking is also a capital offense. In China, human trafficking and serious cases of corruption are also punished by the death penalty. In militaries around the world courts-martial have imposed death sentences for offenses such as cowardice, desertion, insubordination, and mutiny.

Death in warfare and in suicide attack also have cultural links, and the ideas of dulce et decorum est pro patria mori, mutiny punishable by death, grieving relatives of dead soldiers and death notification are embedded in many cultures. Recently in the western world, with the increase in terrorism following the September 11 attacks, but also further back in time with suicide bombings, kamikaze missions in World War II and suicide missions in a host of other conflicts in history, death for a cause by way of suicide attack, and martyrdom have had significant cultural impacts.

All is Vanity by Charles Allan Gilbert is an example of a memento mori, intended to represent how life and death are intertwined

Suicide in general, and particularly euthanasia, are also points of cultural debate. Both acts are understood very differently in different cultures. In Japan, for example, ending a life with honor by seppuku was considered a desirable death, whereas according to traditional Christian and Islamic cultures, suicide is viewed as a sin. Death is personified in many cultures, with such symbolic representations as the Grim Reaper, Azrael, the Hindu god Yama and Father Time.

In Brazil, a human death is counted officially when it is registered by existing family members at a cartório, a government-authorized registry. Before being able to file for an official death, the deceased must have been registered for an official birth at the cartório. Though a Public Registry Law guarantees all Brazilian citizens the right to register deaths, regardless of their financial means, of their family members (often children), the Brazilian government has not taken away the burden, the hidden costs and fees, of filing for a death. For many impoverished families, the indirect costs and burden of filing for a death lead to a more appealing, unofficial, local, cultural burial, which in turn raises the debate about inaccurate mortality rates.

Talking about death and witnessing it is a difficult issue with most cultures. Western societies may like to treat the dead with the utmost material respect, with an official embalmer and associated rites. Eastern societies (like India) may be more open to accepting it as a fait accompli, with a funeral procession of the dead body ending in an open-air burning-to-ashes of the same.

Consciousness

Much interest and debate surround the question of what happens to one's consciousness as one's body dies. The belief in the permanent loss of consciousness after death is often called eternal oblivion. Belief that the stream of consciousness is preserved after physical death is described by the term afterlife. Neither are likely to ever be confirmed without the ponderer having to actually die.

In biology

Earthworms are soil-dwelling detritivores.

After death, the remains of an organism become part of the biogeochemical cycle, during which animals may be consumed by a predator or a scavenger. Organic material may then be further decomposed by detritivores, organisms which recycle detritus, returning it to the environment for reuse in the food chain, where these chemicals may eventually end up being consumed and assimilated into the cells of a living organism. Examples of detritivores include earthworms, woodlice and dung beetles.

Microorganisms also play a vital role, raising the temperature of the decomposing matter as they break it down into yet simpler molecules. Not all materials need to be fully decomposed. Coal, a fossil fuel formed over vast tracts of time in swamp ecosystems, is one example.

Natural selection

Contemporary evolutionary theory sees death as an important part of the process of natural selection. It is considered that organisms less adapted to their environment are more likely to die having produced fewer offspring, thereby reducing their contribution to the gene pool. Their genes are thus eventually bred out of a population, leading at worst to extinction and, more positively, making the process possible, referred to as speciation. Frequency of reproduction plays an equally important role in determining species survival: an organism that dies young but leaves numerous offspring displays, according to Darwinian criteria, much greater fitness than a long-lived organism leaving only one.

Extinction

A dodo, the bird that became a byword in the English language for the extinction of a species

Extinction is the cessation of existence of a species or group of taxa, reducing biodiversity. The moment of extinction is generally considered to be the death of the last individual of that species (although the capacity to breed and recover may have been lost before this point). Because a species' potential range may be very large, determining this moment is difficult, and is usually done retrospectively. This difficulty leads to phenomena such as Lazarus taxa, where species presumed extinct abruptly "reappear" (typically in the fossil record) after a period of apparent absence. New species arise through the process of speciation, an aspect of evolution. New varieties of organisms arise and thrive when they are able to find and exploit an ecological niche – and species become extinct when they are no longer able to survive in changing conditions or against superior competition.

Evolution of aging and mortality

Inquiry into the evolution of aging aims to explain why so many living things and the vast majority of animals weaken and die with age (exceptions include Hydra and the already cited jellyfish Turritopsis dohrnii, which research shows to be biologically immortal). The evolutionary origin of senescence remains one of the fundamental puzzles of biology. Gerontology specializes in the science of human aging processes.

Organisms showing only asexual reproduction (e.g. bacteria, some protists, like the euglenoids and many amoebozoans) and unicellular organisms with sexual reproduction (colonial or not, like the volvocine algae Pandorina and Chlamydomonas) are "immortal" at some extent, dying only due to external hazards, like being eaten or meeting with a fatal accident. In multicellular organisms (and also in multinucleate ciliates), with a Weismannist development, that is, with a division of labor between mortal somatic (body) cells and "immortal" germ (reproductive) cells, death becomes an essential part of life, at least for the somatic line.

The Volvox algae are among the simplest organisms to exhibit that division of labor between two completely different cell types, and as a consequence include death of somatic line as a regular, genetically regulated part of its life history.

Religious views

Buddhism

In Buddhist doctrine and practice, death plays an important role. Awareness of death was what motivated Prince Siddhartha to strive to find the "deathless" and finally to attain enlightenment. In Buddhist doctrine, death functions as a reminder of the value of having been born as a human being. Being reborn as a human being is considered the only state in which one can attain enlightenment. Therefore, death helps remind oneself that one should not take life for granted. The belief in rebirth among Buddhists does not necessarily remove death anxiety, since all existence in the cycle of rebirth is considered filled with suffering, and being reborn many times does not necessarily mean that one progresses.

Death is part of several key Buddhist tenets, such as the Four Noble Truths and dependent origination.

Christianity

Hinduism

Illustration depicting Hindu beliefs about reincarnation.

In Hindu texts, death is described as the individual eternal spiritual jiva-atma (soul or conscious self) exiting the current temporary material body. The soul exits this body when the body can no longer sustain the conscious self (life), which may be due to mental or physical reasons, or more accurately, the inability to act on one's kama (material desires). During conception, the soul enters a compatible new body based on the remaining merits and demerits of one's karma (good/bad material activities based on dharma) and the state of one's mind (impressions or last thoughts) at the time of death.

Usually the process of reincarnation (soul's transmigration) makes one forget all memories of one's previous life. Because nothing really dies and the temporary material body is always changing, both in this life and the next, death simply means forgetfulness of one's previous experiences (previous material identity).

Material existence is described as being full of miseries arising from birth, disease, old age, death, mind, weather, etc. To conquer samsara (the cycle of death and rebirth) and become eligible for one of the different types of moksha (liberation), one has to first conquer kama (material desires) and become self-realized. The human form of life is most suitable for this spiritual journey, especially with the help of sadhu (self-realized saintly persons), sastra (revealed spiritual scriptures), and guru (self-realized spiritual masters), given all three are in agreement.

Islam

Judaism

A yahrzeit candle lit in memory of a loved one on the anniversary of the death

There are a variety of beliefs about the afterlife within Judaism, but none of them contradict the preference of life over death. This is partially because death puts a cessation to the possibility of fulfilling any commandments.

Language around death

Study of Skeletons, c. 1510, by Leonardo da Vinci

The word death comes from Old English dēaþ, which in turn comes from Proto-Germanic *dauþuz (reconstructed by etymological analysis). This comes from the Proto-Indo-European stem *dheu- meaning the "process, act, condition of dying".

The concept and symptoms of death, and varying degrees of delicacy used in discussion in public forums, have generated numerous scientific, legal, and socially acceptable terms or euphemisms for death. When a person has died, it is also said they have passed away, passed on, expired, or are gone, among numerous other socially accepted, religiously specific, slang, and irreverent terms.

As a formal reference to a dead person, it has become common practice to use the participle form of "decease", as in the deceased; another noun form is decedent.

Bereft of life, the dead person is then a corpse, cadaver, a body, a set of remains, and when all flesh has rotted away, a skeleton. The terms carrion and carcass can also be used, though these more often connote the remains of non-human animals. The ashes left after a cremation are sometimes referred to by the neologism cremains.

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