Death and adjustment

Death and Adjustment addresses the ability to  adjust to one's own death when that death is not imminent. Therefore it deals with the vast range of events related to possible deaths and the various methods of adjustment to these possibilities. Death is the end of one's life. Adjustment to death indicates the personal adjustment of each person to the inevitability of death. This issue is usually studied scientifically when death is imminent    such as when the subject is aging or has a  terminal illness. Commonly research subjects are the observers of others' death and not the person dying. However, the knowledge of one's own death is a constant psychological challenge for every adult irrespective of age and health.The event of death occurring at the end of each human life leaves no time for the dying person to adjust with the event if the person has not done so previously. Fortunately, human species can adjust with a future event with his/her knowledge about it which is not in the capacity of other species. So primary adjustment with the universal phenomenon of death occurs with its knowledge in each of us.

Background Components
The stresses related to death demand adjustment. Death relates an average, healthy person to some common stresses. Adaptation or adjustment primarily becomes necessary due to those stresses.

Survival
Death is the cessation of survival. Everyday activities relate human to survival, directly or indirectly. Eating, drinking, sleeping, treating, protesting, or struggling - all for survival. The state of survival is nurtured till the terminal events of human life, like that is done in cases of funeral or burial of others. In abnormal circumstances, when pleasant survival is threatened people commit suicide. Will to survive or continue to exist is the biggest humane need that demands adjustment with death.

Psychology of survival
Freudian concept of the human mind describes thoughts related to survival as 'instinctual’. Thus, our instinctual drives are challenged by the universal truth – death. Psychologically, death is a danger for any living person, irrespective of health and age.

Adjustment with time
Over the course of human history, view towards death has changed as the other stresses in human life for better management strategy. The stress of the terrorizing knowledge of one’s own death for individual and society is under continuous effort for adjustment. It is hard to tell at which point this adjustment task will be accomplished. The biggest challenge for this adjustment issue comes from the fact that death does not leave any time for the dead or dying after the very event for adjustment. Time remains as a constant challenge on the way to adjustment for every average healthy individual.

Theories of death anxiety
There were two main theories about death anxiety until the late twentieth century.

Theory of Sigmund Freud
Sigmund Freud (1856–1939) postulated that people express a fear of death; he called it thanatophobia. However, this was merely a disguise for a deeper source of concern. It was not actually death that people feared, because nobody believes in her or his own death. The unconscious does not deal with the passage of time or with negations. That one's life could and would end just does not compute. Furthermore, that which one does fear cannot be death itself, because one has never died. People who express death-related fears, then, actually are trying to deal with unresolved childhood conflicts that they cannot bring themselves to acknowledge and discuss openly.

Theory of Becker
Becker's existential view turned death anxiety theory towards a new dimension. It stated 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 of 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 deny death and thereby keep their basic anxiety under control.

Some 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 on the way in which people evaluate the quality or worth of their lives. 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.

Evolution of adjustment
Philippe Aries, the French medievalist and historian of the family and childhood, has chronicled western attitudes towards death from the Middle Ages to the 20th century into five basic attitudes correlated with historical periods. These attitudes are the reflection of adjustment pattern of that particular period.

From 5th to 8th century
The first pattern, Tame Death, described the attitude from 5th to 8th centuries. At that time death was considered to be a sleep until the Second Coming of Christ followed by a nonthreatening consequence – either sleep or heavenly afterlife. So for the average people there was a supernatural aspect relating to death.

During 12th and 13th centuries
The second pattern, Death of the Self, evolved by the 12th and 13th centuries. It described death as followed by an afterlife that is signified by judgment and fate according to it. So afterlife became anxiety provoking to the average people and also more defined attitude towards the supernatural aspects related to death was established. It was more manipulating for human life, especially on the aspects of good and bad, that is morality.

From 16th to 18th century
The third pattern, Remote and Imminent Death, is a transitional phase in the changing attitude that prevailed during the 16th to the 18th century. It is considered to be important because in this phase the concept about death and related events are converted to natural ones from the supernatural association. But the anxiety was still there concerning death.

During 19th century
The fourth pattern, Death of the Other, bloomed fully during the 19th century. It was an attitude mainly concerned with the feeling of intolerable separation from the near ones and reunion regains its place as a hopeful aspect supporting the concept of death. But the supernatural aspect or the life after death was not present, practically, in it. Thus death remained as a natural event.

During 20th century
The fifth pattern, Death Denied, is the typical feature of the 20th century. In it the moment of death is banished from the view and focus remains on the survivors. Death is seen as dirty and indecent. So the journey of death that started as some regular part of life during the 5th century ended up in nothing or something ignorable for life.

Scientific model of adjustment
Elisabeth Kubler-Ross studied the subject of death and dying, and developed her model. She found that the dying persons typically experienced a progression toward an adjustment to and an acceptance of death. She described five stages through which a dying person moves. They consisted of, first - the stage of denial, then the second comes as the stage of anger. Next, in the third stage the dying person attempts to bargain with the higher powers. This is followed by the fourth stage, a period of depression, until the reality of impending death is accepted with relative peace as the fifth or final stage.

Alliance of Historical concept and Scientific model
The sequence of description by Aries in reverse manner is similar to the stages of adjustment model by Elisabeth Kubler-Ross. Aries described that there were exceptions in the attitudes towards death, it is possible that an unassessed but major portion of population never could completely accept death.

Changes in civilization with the evolution in adjustment
The history of the west contains evidences in support of the mechanism behind changing attitude.

Period of Religious Influence
During the 5th to 8th centuries, western culture and philosophy were mainly influenced by Christianity. Religion was given some importance but birth of the new religion - Islam was a major event. There was some decline in customs and religious activity in the western society too. This time the tame death attitude prevailed.

Period of Influence from the Rulers
After the tame death, during around 12th century Europe was largely dominated by Muslims. Though Muslims were flexible for knowledge and science, they were very rigid about their philosophies. So it was a helpful time for the upcoming of the concept of the judgment after death which is a major point in Islamic belief and philosophy.

Period of Religious Reform
During 16th to 18th century, there was religious freedom and reform of religious institution occurred. Progress in the materialistic part of civilization with deterioration in the religious aspect was worth noting. Deviated religious activities also started bypassing the rigidly maintained philosophy. This was a transitional period when the supernatural component of the concept of death went down.

Period of Religious Freedom
During the 19th century the freedom from religion was more prominent and social administration was completely separated from religious philosophies. At this time death of self or judgment of self after death was out of the scene and death of near ones replaced the empty space.

Period of Denial
Finally, in 20th century, when religions are even regarded as weapon of discrimination and avoided in many important social portion of life, death is completely ignored or denied. So the concept or attitude towards death reached its most hidden stance in the last, 20th century.

Defense for Death
In dealing with anxiety human ego approaches for adaptation. This adaptation approach is known as defense of human mind. Defense mechanisms are classified as less mature and 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, i.e. adaptation, for the first one. This 12th century attitude can be best explained by the newborn religion Islam in its near past and also the ruling of Muslims around that time. But as it was anxiety provoking, adaptation process was due. The third stage attitude during the 16th century can easily be placed as a defense 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 attitude during the 19th century is another picture of defense that can be best explained by projection, another less mature defense like repression. Finally the 20th century attitude of denial is itself the least mature defense for adaptation.

Defense Originating from Religion
The anxiety provoking concepts and attitudes towards death for average healthy individuals are mainly related to religion and religious beliefs. From the 5th to 8th centuries the older version of the available religious concept - Christianity was under process of adaptation already. If the latest and most anxiety provoking religious concept and attitude towards death is related to Islam, considering the time of birth of Islam and also the ruling group’s religion, then the 5th to 8th century attitude can be compared to splitting - another less mature defense for adaptation. But that can only happen if the core concept from the religion before that was similarly anxiety provoking like that of Islam.

Study on Physicians' Attitude
Research on these attitudes are increasing day by day. A recent Hungarian study assessed physicians’ attitudes toward dying patients by 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.

Study on Americans' Attitude
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. There is a possibility that adaptation got more mature in the mentioned cases, which may represent defenses like intellectualization or other similar ones.

Study on Ethnicity
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.

Study on Culture
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.

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

Researches on adjustment with death
Most specific research on adjustment with death for average individual adult was conducted by Dr. Mohammad Samir Hossain PhD in Bangladesh. He worked for various degrees of adjustment with 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 - The Hypothesis' is an evolving work by the same researcher at present.

Adjustment versus death anxiety
According to Hebb’s classic formulation (1995), moderate level of arousal or anxiety is needed for good performance. In different performances there are sub-components of anxiety like cognitive, somatic etc. The multidimensional theory of anxiety suggests positive effects related to cognitive anxiety in the days before a crucial event. The neurotransmitter in human brain that is best known for arousal or anxiety, Glutamate, dominate 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, while death anxiety is rooted to religion, it works as a modulator for moral judgment and performance. So question does remain about the necessity of death anxiety in life like anxiety needed in case of good learning performance or sports activity. But according to the science of mental health, good adjustment should be there even if the death anxiety is useful.