Why don’t we talk about death?

Death is something that everyone will experience, yet many of us are afraid to talk about it.

Whilst in post, Andrew Thorns, former Director of Medicine at Pilgrims Hospices, explored why this might be and shared what can be gained from having this important conversation.

Death is something we don’t really think about, although I suppose I do as I work with dying people all the time and have done for more than 20 years. But why don’t we think and talk about death? Because we’re fearful of what it will be like? Because we are not sure what happens after? Because it challenges our beliefs, or it causes pain to those we love?

All are very relevant concerns and there are many others, but perhaps there is something deeper. Perhaps there is something as part of our evolution as a species, something within our make-up, that means as soon as any connection to death comes our way our behaviour and attitudes change. So instead of thinking ahead, planning, deciding what is important to us and making rational decisions about our healthcare, we put it all on the back burner.

We need to trust that talking and thinking about death doesn’t make death happen. When we’ve overcome this, the biggest fear, what more is there to worry about? Once we have planned for the worst, we can continue to hope for and achieve the best.

Dr Andrew Thorns

Sheldon Soloman and death anxiety

These thoughts had often gone through my mind, and were reinforced when reading the work of Sheldon Solomon, a US social psychologist. He gave an excellent talk at the Hospice UK conference in 2015. Briefly, his theory goes: According to Darwin’s Theory of Evolution, in order to evolve as a species we needed to strive to stay alive. However, at some point in this evolution we became aware that we are going to die and there is nothing we can do to avoid this. For our early predecessors, this would have caused terror and fear, and they were left trying to manage these feelings.

They did this, and we continue to do so, in various ways:

• We believe that some piece of ourself can live on after death. This manifests either as part of a religious faith, where one believes they will gain immortality in an afterlife, or by leaving behind a legacy, for example through their children or by recording their life story before they die.
• We look for ways to achieve a life that has meaning and value.
• We keep thoughts of death far from the front of our minds. Distracting ourselves with other day to day activites: ‘tranquilising with trivia’, as Solomon puts it.

Solomon and his colleagues confirmed this in a series of experiments. When interviewing people in front of cemeteries, funeral homes and other locations that evoke reminders of death, their behaviour and attitudes changed – even when the triggers were subliminal, with the person unaware of them. These behavioural changes were wide-ranging, including:

• Sticking with likeminded individuals and distancing themselves from others
• Support for war and suicide bombers
• Change in voting preferences towards previously unpopular politicians
• Distancing themselves from animals and nature

Overall, subjects in the experiment tended to prefer things that were familiar to them, and they distanced themselves from the thought of being close to animals.

How can these insights help us? We should consider it from three perspectives: individuals, society and the hospice movement.

How can we start to talk about death?

As individuals, we need to recognise that if we can get over this reflex fear of all things associated with death, then we can live better lives – we need to trust that talking and thinking about death doesn’t make death happen. When we’ve overcome this, the biggest fear, what more is there to worry about? Once we have planned for the worst, we can continue to hope for and achieve the best.

After all, it’s not just about a good death, but also living well until you die.

Dr Andrew Thorns

If this approach to the taboo of death became embedded in society, we would all benefit from the open conversations that would result. Decisions about healthcare and treatment would be more in line with individual peoples’ wishes This would remove pressure from their families who, in turn, would be better supported. Resources could be utilised more effectively and directed at what was most important to the individual. The fear associated with the word ‘hospice’ would disappear, and patients needing hospice support would be referred earlier, enabling them to experience greater benefit.

The importance of hospice care

So, what do hospices do? Despite many people thinking that they are places where people spend the last few days of their lives they actually do much more than this.  You may have heard that hospices can also improve comfort, ease symptoms and support families through difficult times. This they certainly do, but their most important and impressive achievement is enabling people to get over the fear of death and carry on living well. How do hospices do this? By helping to build a container of care around that person and their family. Why is this needed? When faced with the horrible, dark fear of death, the frightened soul or spirit tries, quite reasonably, to keep away from it.

Rather than this fearful soul left to confront this daunting prospect alone, a container of care is needed that fits carefully to that person’s needs and enables a smoother journey and adjustment to what is ahead. A hospice can build this around the person and those close to them, so that they can face up to the initial fear and keep on living well despite this knowledge.

After all, it’s not just about a good death, but also living well until you die.

Andrew Thorns is Director of Medicine at Pilgrims Hospices, the largest hospice charity in east Kent, UK. He strongly believes in the importance of research and skilled communication to improve patient care.

The views reflected here are his own.

There’s much more to death than we think; what if it isn’t just an ending, but an event we can plan for? Thinking beyond the four walls of hospices and hospitals, we have the chance to approach it with confidence and plan a good death. After Wards is a collection of insights and ideas from people who can help us all to re-imagine this essential part of life, and to live well until we die.