Because the idea of death evokes a number of fears,
researchers have suggested that the fear of death is
actually a multidimensional concept. Hoelter and
Hoelter (1978) distinguish eight dimensions of the
death fear: fear of the dying process, fear of
premature death, fear for significant others, phobic
fear of death, fear of being destroyed, fear of the
body after death, fear of the unknown, and fear of the
dead. Similarly, Florian and Mikulincer (1993) suggest
three components of the death fear: intrapersonal
components related to the impact of death on the mind
and the body, which include fears of loss of
fulfillment of personal goals and fear of the body's
annihilation; an interpersonal component that is
related to the effect of death on interpersonal
relationships; and a transpersonal component that
concerns fears about the transcendental self, composed
of fears about the hereafter and punishment after
death. Because of the complexity of death fears, some
authors suggest using the term death anxiety to
describe the amorphous set of feelings that thinking
about death can arouse (Schultz 1979). Because of the
complexity of death fears, scholars have debated
whether such fears are natural or whether they are
social constructs. The most common view that runs
through the history of thought on death is that the
fear of death is innate, that all of life tends to
avoid death, and that the underlying terror of death is
what drives most of the human endeavor.

But religions - to use the plural - differ radically in
the degree to which they succeed in calming this primal
anxiety. In general, death seems far less terrifying as
we move eastward on the face of the planet. For the
Buddhist, or the many versions of Oriental religion
that have been touched by Buddhism, life is not defined
by its termination. There is instead what I will call a
"cyclical affirmation," a sense of life's unquenchable
continuity, that appears to approach the exalted state
called, in the New Testament, "faith," and that is
attributed by Jesus himself to young children.

In fact, it is the other way round--at least according
to a study published in the Journal of the American
Medical Association by Andrea Phelps and her colleagues
at the Dana-Farber Cancer Institute in Boston.
Religious people seem to use their faith to cope with
the pain and degradation that "aggressive" medical
treatment entails, even though such treatment rarely
makes much odds.

Dr Phelps and her team followed the last months of 345
cancer patients. The participants were not asked
directly how religious they were but, rather, about how
they used any religious belief they had to cope with
difficult situations by, for example, "seeking God's
love and care". The score from this questionnaire was
compared with their requests for such things as the use
of mechanical ventilation to keep them alive and
resuscitation to bring them back from the dead.

The correlation was strong. More than 11% of those with
the highest scores underwent mechanical ventilation;
less than 4% of those with the lowest did so. For
resuscitation the figures were 7% and 2%.

Explaining the unpleasantness and futility of the
procedures does not seem to make much difference,
either. Holly Prigerson, one of Dr Phelps's co-authors,
was involved in another study at Dana-Farber which was
published earlier this month in the Archives of
Internal Medicine. This showed that when doctors had
frank conversations about the end of life with
terminally ill cancer patients, the patients typically
chose not to request very intensive medical
interventions.

According to Dr Prigerson, though, such end-of-life
chats had little impact on "religious copers", most of
whom still wanted doctors to make every effort to keep
them alive. Saint Augustine of Hippo, one of
Christianity's most revered figures, famously asked God
to help him achieve "chastity and continence, but not
yet". When it comes to meeting their maker, many
religious people seem to have a similar attitude.

Nor is it mere coincidental that these same Eastern
societies are both more community-minded than we are,
far more bound up with each other in everyday life, and
far more humane in their treatment of the elderly, far
less willing to render their senior citizens impotent
and babyish.

Death is the theme that connects these attitudes and
behaviors. The fact that Buddha lived to a ripe old
age, and that Christ died in agony while still a young
man, helps to illuminate the extent to which the
challenge of death, the terror of death, and the
anguished question of death has helped to define the
central concerns of Western culture.

But of course, the centrality of death in our thinking
goes back even further, right up the two tributaries of
our thinking called "Greco-Roman" and
"Judeo-Christian." Death is obsessively the theme of
the Iliad, the very earliest surviving work of Greek
literature; the theme of being "stricken unto death" is
one that unites such widely-spaced Biblical figures as
Adam, Jacob, Joseph, Moses, Samson, Elijah, Job and, in
their successive historical crises, the entire Jewish
people. Strewn throughout the ruins of the Roman
Empire, in silver or mosaic, are images of reclining
skeletons, often with the words "Know thyself" beneath
them, and the death-obsession of the Roman pagans
points like an arrow to what Huizinga called "The
waning of the Middle Ages" - the period in the 15th
century when European artists vied to outdo each other
in their portrayals of mouldering corpses and grinning
death's-heads. And what European cathedral is complete
without a tympanum in which we can contemplate the
agonies of the damned, skewered by devils as they boil,
roast, and writhe?

*

In a culture so saturated with the fear of death, what
can an old person be but a terrifying question mark,
one foot already in the grave, who raises the
possibilities that even our deodorants, our make-up,
and our plastic surgeons cannot resolve? The
evasiveness one still occasionally encounters about
revealing one's true age lies, does it not, in the fact
that the number of years we have survived also suggest
by how much we have approached the day of our death.
And if old people are therefore walking symbols of that
which we are most afraid of, then symbolism - with its
customary elasticity - can also be extended backward to
the first of our wrinkles, the earliest of our grey
hairs.

And "trying not to think about dying" becomes just as
challenging as "trying not to think about an elephant."
The images of eternal youth and horrible old age with
which the media engage so much of our attention are the
paradoxical result. The manufacturers have found - as
empirically as Hitler or Goebbels - that they can
effectively get us to buy their products by suggesting
that the products will keep us out of the grave; that
they are, in fact, the key to a "no-grave" world never
visited by the Grim Reaper. But you don't have to take
a Ph. D. in psychology to realize that the fear of
death, at a deep level, is going to be as much
stimulated as allayed by the suggestion that Coca-Cola
is the elixir of life, that rouge will hide your
deathly pallor, and that a good roll-on deodorant will
keep you from stinking like a corpse.

Fear may be exacerbated by the way death unfolds in
modern America. Over the last several generations,
death's place in society has changed radically.

"Death was always public," wrote Philippe Aries in "The
Hour of Our Death," his landmark 1981 history of
Western civilization's changing attitudes over the last
thousand years. "Death was not a personal drama but an
ordeal for the community."

For centuries, friends, family and even passersby would
gather in the bedroom while the dying person said final
goodbyes, asked forgiveness and received sacraments.
After death, bodies were laid out in parlors while
people visited.

In the 19th Century, that began to change in the United
States.

The modern hospital came into being. Caring for the
dying at home began to seem dirty and unpleasant.

In prosperous Western societies, medicine and hygiene
largely eliminated childhood death, once mankind's most
common encounter with mortality. Death disappeared into
medical institutions.

As far as the community is concerned, "You don't see
anything," said Daniel Callahan, director of the
International Program at The Hastings Center, a
bioethics think tank.