22 October 2021
Over the last 150 years, our life expectancy has grown, from 40 years in 1850 to over 90 years today in some countries. This can be attributed to advances in medical science, improvements in public health, and equitable access to healthcare, especially for maternal and infant care.
What will the future hold for our world? Will we be overwhelmed by a ‘silver tsunami’ of retirees with poor health, or will we use the latest research findings to rejuvenate the elderly and extend their lifespan?
Our Longevity Futures is a show where I, Chris Curwen, speak to scientists, engineers, entrepreneurs, doctors, politicians, and community activists who are giving the world the hope that we can all live longer and better, and improve our health.
In today’s episode of Our Longevity Futures, we are delighted to speak to Dr. Rachel Menzies. Rachel is clinical psychologist, and member of the Australian Psychological Society. Rachel completed her undergraduate degree at the University of Sydney, where she also went on to complete her masters of clinical psychology, and also her PhD.
Rachel has published extensively on the causes of various disorders, including depression, OCD, panic disorder, illness anxiety, social anxiety, but perhaps the topic in which she has delved most deeply into, and is most well known for writing about, is death anxiety.
Rachel has recently announced the publication of her new book “Mortals: How the Fear of Death has shaped human society” which she co-authored alongside her Dad, Prof. Ross Menzies.
Here are some of the highlights for my conversation with Rachel:
Chris: How was it writing a book with your Dad?
Rachel: Yeah, it was a fun experience to be honest with you. So we have written academically together for many years, but this was the first book we’ve written. That’s really aimed at the general reading public. I like to think that we work together well. I can imagine for a lot of people, the idea of working on such a big project with a parent might sound a bit like a nightmare, but I like to think we’ve made it work.
Chris: And he’s a psychologist as well. So how much influence has he had on the direction of your work and your career?
Rachel: Yeah, so he’s definitely had a big influence on it. But it’s also something I think I’ve always just been genuinely interested in. It was very much something growing up in a household where the father is a psychologist, there was always a lot of talk about mental health and psychology at home, which made me interested in it at quite a young age.
Then I guess working together over, what’s close to a decade now, we’ve shaped each other’s ideas, I think, and come to this topic together, which has been really nice to work on.
Chris: Where did your fascination around death come from?
Rachel: So it was always something I was quite personally interested in ever since I was quite young, I think, as a child, I was one of those kids that was really interested in ancient Egypt and mummies and pyramids, and all of those kinds of different symbols or images associated with death. And then at university, alongside my degree in psychology, I did a degree in ancient history, and again, in ancient history, there’s so much of a focus on fears of death, across different, ancient cultures.
You see this fear of death come up in all of the different ancient texts that I was reading as a student. Around the same time that I was, studying that my dad, from his own clinical practice, had started to notice how many different patients seem to be presenting with different manifestations of this fear of death.
So maybe they were presenting to treatment with something like OCD, obsessive compulsive disorder, where they were compulsively, washing their hands or checking stove tops, for instance. Or maybe someone else was presenting with something like panic disorder, where they were constantly worrying they were going to have a heart attack.
And so he was starting to notice how fears of death seemed to be the common thread underlying a lot of the different presentations he saw clinically. And so that’s when we really started to work on this area more. But you’re right, it’s definitely considered a taboo topic much to everyone’s detriment.
I think it just makes it very hard for people to talk about their fears about death and process them and to come to some acceptance of it.
Chris: Could you explain what death anxiety if for those listening who may not have heard of it before?
Rachel: Sure. So death anxiety, broadly speaking, is just the fear or dread of death. So it could be fear of our own death, it could be fear of losing a loved one, it could be fear of the dying process itself, so dying in pain or kind of physical degeneration, or it could be non-existence itself. People can really vary in their particular worries about death.
But essentially when we talk about death anxiety, as a term, it’s referring to people’s discomfort, or dread, or fear, or feelings of purposelessness that they feel at the idea of mortality. And this is something that can be conscious. So people might consciously talk and be aware of their own fears of death.
But as we talk a lot about in the book is also often unconscious. So there’s a field in social psychology called terror management theory, which shows through experiments in the borrow stories that people respond to. Subtle reminders of death with these dramatic changes in their behavior that they’re often not even aware of.
So we know, for example, that reminding people of death in really subtle ways, Answering two questions about death in a packet of a hundred questionnaires makes people more aggressive towards people who are of different religious backgrounds, different racial backgrounds makes people more willing to spend money on luxury items.
Make people more likely to strive for academic success, more willing to have more children and so on. Often these fears of death and not even necessarily something people are conscious of, which is what we see from those experimental studies that people show this dramatic change in their behaviour, even when they have no idea that it’s because of that subtle reminder of death that they’d been given a 20 minutes before.
Chris: Is there an evolutionary reason for some individuals to seek ‘death defying’ experiences, like base-jumping or sky-diving?
Rachel: One possible explanation for that is that death anxiety, like a lot of anxiety exists on a spectrum. So some people will have significant levels of death, anxiety to the point where they might even be avoiding things like driving their car.
Or flying or being in high places and so on. Most people will obviously fall in that middle range of the spectrum. Some people will fall at that lower end where they might have very low fears of death. And so this might be what’s happening where we see people engaging in these sort of death, defying behaviors.
Another possible perspective is where terror management comes in. We might get more into this later in the chat, but essentially terror management shows us that one way we have a protecting ourselves from the fear of death is through bolstering our self esteem. So we’ve, I have high levels of self esteem.
I will view myself as a significant important person. I would view myself as someone who will be remembered after I’m gone and essentially keeping our self-esteem high is one way that human seemed to protect ourselves from death. And so what we see in the laboratory is that when people are reminded of death, they’ll do whatever they’ll engage in whatever behaviours they typically do to maintain their self.
And this is how we see that even risky behaviours that actually increase the risk of someone dying can still be related to death anxiety. So for example, if you get young men who express that driving really, driving quickly, driving fast cars is related to their self esteem and you put them in these.
If you prime them with death, they actually drive faster on driving simulations or people who smoke. For example, if someone who smokes view smoking as being really central to their self-concept to their self esteem, reminders of death actually make people more likely to want to smoke, but only if it’s relevant to their self esteem.
Which of course has huge implications for things like health messaging, because obviously. Most health campaigns about cigarettes. For example, focus on these are going to kill you when we actually know from social psychology, that those sorts of messages make people want to smoke more. So this is one explanation for why we might still, people might still see people doing risky behaviours that can still be derived from that underlying unconscious fear of.
Chris: Aversion to death is something you stereotypically find in younger people, in adolescents, does our perception of death change as we grow older?
Rachel: It’s a really good question. So for a long time, people assumed that children didn’t understand death, and therefore couldn’t fear it, but we now know that’s not true. So we now know that by the end of the first decade of life, children have a pretty complete understanding of death by the time they’re 10, they understand that death is inevitable, that it’s irreversible, that all living things will die and that includes them.
And this is around the same age that children start to develop phobias and start to develop fears of death. So throughout childhood and adolescence, when you give young people questionnaires assessing their anxiety, throughout childhood and adolescence, fears of death for the most commonly endorsed items on those questionnaires. So it seems like something that young people do tend to actually worry about.
Interestingly, as people get older, that fee tends to diminish. So people often have this kind of intuitive sense that the elderly should be the most fearful of death, but actually it’s the opposite. So people who are in that elderly age range actually tend to be far more accepting of death and less fearful of it compared to younger people.
Chris: Does this inherent fear of death vary from person to person, irrespective of age?
Rachel: Yeah absolutely, it’s really variable. So some, you’ll certainly find some young people that are completely accepting of death are less consciously. And then of course you’ll find some elderly people who are incredibly fearful of death. I’m not accepting of death. On the whole though, we see that kind of effect that as people typically get to the elderly.
They become more comfortable, which is probably for a couple of reasons, probably one explanation is by that point the kind of physical pain and fatigue and illness symptoms and so on, make death seem more appealing than it is when you’re in prime picture of health in your youth.
And also of course, by that point, you’ve experienced a lot more death. You’ve lost, loved ones. You’ve seen death happen more often. It’ probably seems a lot more normal and natural than it does when you’re quite young and everything feels invincible.
Chris: The goal of the longevity field is, ultimately, to push the reach of healthy human lifespan as far as possible, which some view as ‘cheating death’. What is your view on the reasons driving this mission?
Rachel: Yeah it’s a great question. So the idea of, for those who aren’t familiar with the term immortality projects, it’s essentially any way that we gain a sense of immortality, whether that’s a literal immortality, such as, the belief in an afterlife, for example, offers people, literally mortality, but also anything that gives a sense of symbolic immortality in terms of anything that gives us a sense that we’re continuing after we die.
So having children would be one example of an immortality project, where we live on through the next generation. Writing this book is in many ways in immortality project because hopefully, fingers crossed, the book outlives me and lasts after I die.
Creating art, or architecture, or photography, or musical, or ideas, anything else that lives on after we die would be an example of an immortality project. And so in terms of, how that relates to ideas of longevity; certainly I think, based on the research, at least people who have high levels of fears of death on the whole seem to be far more interested in extending their life through any means possible. Whether that’s through taking a lot of vitamins in the belief that a ward off illness, whether that’s through looking into things like, cryogenics or other ways of keeping them lasting.
Whereas people who have what’s called neutral acceptance of death tend to have more negative attitudes towards extending life. So neutral acceptance of death refers to the idea of I accept death because I see it as a natural part of life. Death is not a good, no bad. It is what it is, it’s outside of my control, so I take an indifferent attitude towards death. People who have that kind of acceptance of death tend to be far more critical and far more interested in those attempts to extend the last.
Chris: One of the questions I get asked the most when I tell people I work in the longevity field is “Is that the right thing to do? Death is a natural part of life, do we want to push it back and live longer?” Are these people more accepting of death?
Rachel: Yeah, I would say so the people who have that attitude of death is a natural part of life. I neither welcome it nor do I reject, tend to be more accepting of death and on the whole tend to actually have better psychological wellbeing.
So they tend to have less depression, a greatest sense of subjective wellbeing, and I think partly that comes with the benefits that we see from accepting mortality. That if I accept that I have a finite time on earth and I don’t know how long that time will be, it could be the average of 86 years, it could be far shorter than that, it gives me the opportunity to focus on making the most of the time I do have, and really trying to live an authentic life in a way that gives me a sense of purpose now. That’s certainly what the psychological research on this seems to say.
Chris: Has society’s views of death evolved over the past 100 years as average human life expectancy has increased dramatically? Because now we are living longer, is there more of an acceptance of death as we grow older?
Rachel: One thing I think is fairly clear is that, with the development of modern medicine, death has increasingly been viewed as a failure that the medical system is set up to view death as failure of medical treatment.
And this is something that Atul Gawande writes a lot about in his book ‘Being Mortal’, that you’re trained as a doctor to view death as the failure of your treatment. And so we know, for example, that doctors, when they’re interviewed, will admit to giving futile treatments to patients. Treatments that they know will do nothing for the person’s physical health, but they do it at the insistence often of the family. This sense of the family are not willing to let this person die, so I’ll give them treatments that don’t work.
For thousands and thousands of years there seems to have been this, on the whole, acceptance of death in terms of accepting that it’s going to happen and there’s not much we can do to prevent it, because of course, things like illness, war, shorter life expectancies, back then. But as modern medicine has become more and more advanced, which obviously has huge benefits for many of us, we seem to have increasingly seen this refusal to accept.
Chris: Is death anxiety something that has come around in more recent history?
Rachel: I’d love to be able to go back in time 2000 years ago, and have questionnaires about death anxiety, but when we look at the evidence we do have; so for example, if we look at literature across the ages, so the oldest surviving great work of literature we have is the Babylonian epic poem, the epic of Gilgamesh.
So this was written around 4,000 years ago and the epic of Gilgamesh centers on this tale of King Gilgamesh who witnesses the death of his close friend. He becomes horrified at the idea that he’s also mortal, and he goes on this lengthy quest to try and find the secret to immortal. So the oldest surviving work of literature we have, this 4,000 year old text sent us purely on this story of this man’s search for immortality and his eventual realization that it’s not going to happen for him and he needs to accept his lot as a mortal man.
And we see this across, the epic poems of Rome, and Greece, and other cultures. That awareness and fear of death seems to be wired into us as humans and it’s present in basically every culture for thousands and thousands of years. But what I do think we see more now is this separation almost of death and life, where for most of human history, for thousands of years, people witnessed death frequently children died when they were infants, women died in childbirth, typically the dead or the dying were cared for by the family themselves. You would bathe the corpse, you would prepare the corpse, you would take care of the dying. This would all happen in the home, everyone could see this happening. And obviously now that’s not the case in most cultures. That now people die in hospital or nursing homes, and so we have this real separation of death and life.
Even the way we bury the dead is drastically different. So for hundreds of years, the dead were buried near us at the local kind of church graveyard, for example, they were in the town. Whereas now typically the data buried and huge cemeteries outside of the main city. This fear of death seems to be present for at least the last 4,000 years, but certainly over the past 100 or 200 years, we’ve seen this separation of a life and death where most people don’t see a dying person very often in their life. And I do think that makes it quite hard for people to accept and come to terms of death when it’s not something that for most of us is part of our daily lives.
Chris: Is religion and the afterlife purely a symptom of society’s fears around death?
Rachel: Every religion in some way, offers a solution to the fear of death, that every religion offers, some kind of continuation of the soul. That might look different for different religions.
That might look like reincarnation of souls versus an afterlife where you’re physically brought back to life in your human form, as you are on earth. So the form that, that afterlife takes can vary dramatically across time and across culture. But every religion has offered some kind of solution to death and religions have been, over history, replaced by religions that offer better solutions to death.
So for example in Norse myth, there was an afterlife, there was Valhalla, where you would go and you would face and drink and live a great life. But in parts of Norse myth the world still ended with the battle of Ragnarok, where even after reaching the afterlife of Valhalla, it was believed that the whole world would come to an end.
So Norse myth seems like an interesting example of a religion that doesn’t promise eternal immortality. But of course, most of us are not now believing in Norse myth, because Norse myth was replaced by Christianity, which taught believers that you will physically be brought back in an afterlife and reunited with loved ones, and there would be no battle that would wipe out the whole earth.
It’s this kind of approach of offering some kind of solution or afterlife is the common ingredient found in every religion across time in history that we know of.
Chris: Terror management theory talks about how we seek to imbue our lives with meaning as a way of managing our fear of death, by granting us ‘symbolic immortality’. Were we to one day achieve real immortality, do you think this drive to find meaning would be reduced?
Rachel: It’s hard to know it’s for me, obviously not being in this kind of area, it’s hard to even imagine what that would look like. In terms of what achieving immortality would look like for humans. But I do think to some extent that the knowledge that all of this is one day going to end is often a really big motivator for people, that if I know this is all going to end one day and I only have so long on this earth, then I’d better make the most of it; I’d better write, I better enjoy my time with friends and family, because all of it seems so precious.
If there’s the chance, this is where the knowledge, this is one day going to be taken away from me. So it’s a really good question. I think it’s possible theoretically, but if death wasn’t there, if death wasn’t a problem, then people might feel a sense of purposelessness and meaninglessness knowing that this is all just going to go on and.
Chris: I saw a clip of Ricky Gervais arguing about whether there is an afterlife or not with a religious american late night show host – I believe it wa Stephen Clobert – one of Stephens arguments for the fact that there is an afterlife is that he can’t imagine not existing and to that Ricky asks, “How did you feel before you were born?”, to which he replies “Well, I don’t know, I wasn’t born yet” and Ricky says “Well exactly, that’s how it will be after you die”. Before that I had the same sort of thought as Stephen “I can’t imagine not existing”, but Ricky’s statement really had an impact on the way I thought about death. If I describe my own thoughts around it, I guess the most prominent thought around it is that I hope it doesn’t hurt, I guess that is the same as most people, but I think my biggest fear of it is that I won’t get to see all of the technological advancements in the future.
Rachel: I think I know the clip you mean and I think Ricky talks in that clip as well about that idea of, unless I could be thinking of a different interview, but I’ve heard him talk about that idea of the fact that it’s all going to end it makes everything so much more wonderful.
It’s a great idea. So that idea of ‘I’ve already experienced non-existence’ actually stems back to the stoic philosophers who are writing about 2000 years ago. They were writing, for those of you who have heard of cognitive behaviour therapy, which is one of the most evidence-based psychological treatments for anxiety, depression and so on, the psychologist who developed CBT wrote about how they based it on this ancient philosophy of stoicism.
The stoics were writing at really turbulent times with very short life expectancy, living under emperors who were a bit nuts, like Nero who would at any moment sentence you to commit suicide and you had to do it, so they were forced to come to this acceptance of death. They wrote beautifully 2000 years ago about how we’ve all experienced non-existence before we were born and wouldn’t it be foolish to weep over the fact that I didn’t exist for the last X thousand years. So shouldn’t it be just as foolish to weep over the fact that I will one day not exist for thousands of years. So it’s a really persuasive idea and, I can say why it really helped to challenge your thoughts about it.
Chris: Personally my fear of death, stems from the thought ‘is death going to hurt?”, but also what worries me the most is the fact that I will miss out on all of the technological innovations that occur after my death, it’s essentially the ultimate fear of missing out.
Rachel: Yeah, definitely. And that fear of dying and pain that you mentioned, it’s somewhat easier to shift a little bit because you can show people the research from palliative care, for example, that shows that most people don’t actually die in pain. It’s something like 85% of people give or take don’t die in pain.
But that feeling of missing out is harder to work with. One thing that I think sometimes can be useful is, borrowing from Richard Dawkins writes really eloquently in ‘Unweaving the Rainbow’, the opening paragraph “We are going to die and that makes us the lucky ones. Most people are never going to die because they’re never going to be born”, and he just beautiful explains this idea of the one in a billion chance we had, each of us individually, had ever had of coming into existence. That for me to be here, it relied on a unique string of DNA being created, each of my ancestors for thousands and thousands of years had to survive, find a mate with that particular person, and that’s the only way that I would’ve been here.
It’s sometimes tricky to really grasp that idea. But if I can truly understand that my being here was a statistical miracle, I was never guaranteed this spot on earth, can sometimes make that fear of missing out on everything seem a lot more manageable that I’ve won this ticket to the best party on earth that billions and billions of people are never going to get to this party. I shouldn’t be too sad knowing that party at one point has to come to an end for me.
Chris: What is your view of your own death? Does it worry you?
Rachel: So I think it’s definitely something I’ve reflected on. I’ve been doing this work for close to 10 years and so as part of that, basically every day, I’m thinking about death, writing about death, often talking to people about death, whether or not they’re interested in that conversation.
It does really force you to grapple with your own mortality. And certainly now I’ve come to the point where I like to think I have this kind of stoic acceptance of death. That part of me will be disappointed to see it all end one day, but I feel really lucky to have had this kind of golden ticket to the theme park, as Richard Dawkins says, that me having been here in the first place seems like such a tremendous shot, that I feel reasonably okay with the idea that one day that will that way.
We really appreciate Rachel for taking the time out of their day to come and talk to us. A massive thank you from Chris and everyone on the Gowing life team. You can keep up-to-date with everything that Rachel is doing here.