Here’s an interesting article  about medical writing and social media

antidepressant debate

January 13, 2010

There has been a debate for some time about the effectiveness of antidepressant medications, which are commonly used for anxiety and depression in routine psychiatric practice. A recent study published in the JAMA has reignited this debate, as it seems to indicate that there is little difference between antidepressants and placebo, for mild to moderate depression. In this large-scale randomised controlled trial patients with severe forms of depression benefited greatly from antidepressants when compared to placebo. Patients with mild to moderate depression seemed to respond both to antidepressants and to placebo.

This was discussed in depth at the Carlat Psychiatry Blog (written by a psychiatrist) It has been known for some time that the placebo response is powerful when it comes to depression and anxiety. This may indicate that these conditions naturally resolve with time, or perhaps it means that the power of belief has a very strong effect on mood – something we intuitively know to be true.

For psychiatrists, the question is whether or not we should prescribe antidepressants for the less serious forms of depression, and this is even more pertinent for GP’s who see the majority of such patients. It has been suggested that we should prescribe sugar pills for depression as the placebo response is so strong and this would benefit the patient without causing any side effects.

The majority of newer antidepressants have minimal side effects for the majority of patients. However there is a worrying trend towards increased suicidal thoughts in a small number of people, particularly adolescents. In practice antidepressant-induced suicide is virtually never seen, but this tends to show up in very large research trials.

I think this study also has implications for natural and alternative therapies, which are very popular but generally quite expensive for patients. We know that the placebo response is very strong, and so we can assume that the benefits of natural therapies are at least partly due to placebo response. Natural therapies are beneficial because they encourage healthy living and may assist mood in that way. It may be useful to bear in mind the placebo effect when considering the more costly therapies and may be advisable to seek a cheaper option!

Here is a new angle on the tsunami dreams – since the majority of visitors to this website are still looking up this topic (warning long post)

Dreams were seen as an important means of symbolic communication from God, in the Bible. Dream interpretation was an accepted activity and the most famous dream interpreter in the Bible was of course, Joseph. He had many dreams, made famous by popular musicals but none of them actually involved tsunamis or waves.

(Updated 20.10.2011 – have finally realised there is a Biblical connection to the Great Flood (duh!)

The word “tsunami” doesn’t occur in the Bible, HOWEVER I believe that the closest Biblical symbolism to a tsunami is the Great Flood. Therefore I am putting in the passage about the Flood from Genesis. It should also be noted that although it is hard to search Carl Jung’s writings about a “tsunami” it is easier to find references to a “flood archetype”.

The Great Flood

Genesis 6 – 8

Genesis 6

Increasing Corruption on Earth

1When man began to multiply on the face of the land and daughters were born to them, 2the sons of God saw that the daughters of man were attractive. And they took as their wives any they chose. 3Then the LORD said, “My Spirit shall not abide in man forever, for he is flesh: his days shall be 120 years.” 4The Nephilim were on the earth in those days, and also afterward, when the sons of God came in to the daughters of man and they bore children to them. These were the mighty men who were of old, the men of renown.

5 The LORD saw that the wickedness of man was great in the earth, and that every intention of the thoughts of his heart was only evil continually. 6And the LORD was sorry that he had made man on the earth, and it grieved him to his heart. So the LORD said, “I will blot out man whom I have created from the face of the land, man and animals and creeping things and birds of the heavens, for I am sorry that I have made them.” 8But Noah found favor in the eyes of the LORD.

Noah and the Flood

9These are the generations of Noah. Noah was a righteous man, blameless in his generation. Noah walked with God.10And Noah had three sons, Shem, Ham, and Japheth.

11Now the earth was corrupt in God’s sight, and the earth was filled with violence. 12And God saw the earth, and behold, it was corrupt, for all flesh had corrupted their way on the earth. 13And God said to Noah, “I have determined to make an end of all flesh, for the earth is filled with violence through them. Behold, I will destroy them with the earth. 14Make yourself an ark… of gopher wood. Make rooms in the ark, and cover it inside and out with pitch. 15This is how you are to make it: the length of the ark 300 cubits, its breadth 50 cubits, and its height 30 cubits. 16Make a roof for the ark, and finish it to a cubit above, and set the door of the ark in its side. Make it with lower, second, and third decks. 17 For behold, I will bring a flood of waters upon the earth to destroy all flesh in which is the breath of life under heaven. Everything that is on the earth shall die. 18But I will establish my covenant with you, and you shall come into the ark, you, your sons, your wife, and your sons’ wives with you. 19And of every living thing of all flesh, you shall bring two of every sort into the ark to keep them alive with you. They shall be male and female. 20Of the birds according to their kinds, and of the animals according to their kinds, of every creeping thing of the ground, according to its kind, two of every sort shall come in to you to keep them alive. 21Also take with you every sort of food that is eaten, and store it up. It shall serve as food for you and for them.” 22Noah did this; he did all that God commanded him.

Genesis 7

1Then the LORD said to Noah, “Go into the ark, you and all your household, for I have seen that you are righteous before me in this generation. 2Take with you seven pairs of all clean animals, the male and his mate, and a pair of the animals that are not clean, the male and his mate, 3and seven pairs of the birds of the heavens also, male and female, to keep their offspring alive on the face of all the earth. 4For in seven days I will send rain on the earth forty days and forty nights, and every living thing that I have made I will blot out from the face of the ground.” 5 And Noah did all that the LORD had commanded him.

6Noah was six hundred years old when the flood of waters came upon the earth. 7And Noah and his sons and his wife and his sons’ wives with him went into the ark to escape the waters of the flood. 8Of clean animals, and of animals that are not clean, and of birds, and of everything that creeps on the ground, 9two and two, male and female, went into the ark with Noah, as God had commanded Noah. 10And after seven days the waters of the flood came upon the earth.

11In the six hundredth year of Noah’s life, in the second month, on the seventeenth day of the month, on that day all the fountains of the great deep burst forth, and the windows of the heavens were opened. 12And rain fell upon the earth forty days and forty nights. 13On the very same day Noah and his sons, Shem and Ham and Japheth, and Noah’s wife and the three wives of his sons with them entered the ark,14they and every beast, according to its kind, and all the livestock according to their kinds, and every creeping thing that creeps on the earth, according to its kind, and every bird, according to its kind, every winged creature. 15They went into the ark with Noah, two and two of all flesh in which there was the breath of life. 16And those that entered, male and female of all flesh, went in as God had commanded him. And the LORD shut him in.

 17The flood continued forty days on the earth. The waters increased and bore up the ark, and it rose high above the earth. 18The waters prevailed and increased greatly on the earth, and the ark floated on the face of the waters. 19And the waters prevailed so mightily on the earth that all the high mountains under the whole heaven were covered. 20The waters prevailed above the mountains, covering them fifteen cubits deep. 21And all flesh died that moved on the earth, birds, livestock, beasts, all swarming creatures that swarm on the earth, and all mankind. 22Everything on the dry land in whose nostrils was the breath of life died. 23He blotted out every living thing that was on the face of the ground, man and animals and creeping things and birds of the heavens. They were blotted out from the earth. Only Noah was left, and those who were with him in the ark. 24And the waters prevailed on the earth 150 days.

Genesis 8

The Flood Subsides

1But God remembered Noah and all the beasts and all the livestock that were with him in the ark. And God made a wind blow over the earth, and the waters subsided. 2 The fountains of the deep and the windows of the heavens were closed, the rain from the heavens was restrained, 3and the waters receded from the earth continually. At the end of 150 days the waters had abated, 4and in the seventh month, on the seventeenth day of the month, the ark came to rest on the mountains of Ararat. 5And the waters continued to abate until the tenth month; in the tenth month, on the first day of the month, the tops of the mountains were seen.

6At the end of forty days Noah opened the window of the ark that he had made 7and sent forth a raven. It went to and fro until the waters were dried up from the earth. 8Then he sent forth a dove from him, to see if the waters had subsided from the face of the ground. 9But the dove found no place to set her foot, and she returned to him to the ark, for the waters were still on the face of the whole earth. So he put out his hand and took her and brought her into the ark with him. 10He waited another seven days, and again he sent forth the dove out of the ark. 11And the dove came back to him in the evening, and behold, in her mouth was a freshly plucked olive leaf. So Noah knew that the waters had subsided from the earth. 12Then he waited another seven days and sent forth the dove, and she did not return to him anymore.

13In the six hundred and first year, in the first month, the first day of the month, the waters were dried from off the earth. And Noah removed the covering of the ark and looked, and behold, the face of the ground was dry. 14In the second month, on the twenty-seventh day of the month, the earth had dried out. 15Then God said to Noah, 16“Go out from the ark, you and your wife, and your sons and your sons’ wives with you.17Bring out with you every living thing that is with you of all flesh—birds and animals and every creeping thing that creeps on the earth—that they may swarm on the earth, and be fruitful and multiply on the earth.” 18So Noah went out, and his sons and his wife and his sons’ wives with him. 19Every beast, every creeping thing, and every bird, everything that moves on the earth, went out by families from the ark.

God’s Covenant with Noah

20Then Noah built an altar to the LORD and took some of every clean animal and some of every clean bird and offered burnt offerings on the altar. 21And when the LORD smelled the pleasing aroma, the LORD said in his heart, “I will never again curse the ground because of man, for the intention of man’s heart is evil from his youth. Neither will I ever again strike down every living creature as I have done. 22 While the earth remains, seedtime and harvest, cold and heat, summer and winter, day and night, shall not cease.”

There are also quite a few Bible passages about waves. So to help people interpret their tsunami dreams I have listed the main Bible passages which talk about strong, powerful waves. There are a few main themes

– God stirring up the huge waves (Old Testament)

– God calming the waves (OT)

– The story of Jonah: who disobeys a command from God, who then sends massive waves against him and Jonah ends up being hurled into the sea. He then prays to God and is rescued via a large fish!

– And in the New Testament, Jesus naturally calms a storm on the water.  There are a few verses comparing people to waves, which suggests immaturity / infancy, or lack of belief, or worse.

I guess it depends on the individual which, if any of these are relevant! Here are the Bible passages.

Waves in the Bible

Psalm 42: 7

Deep calls to deep, in the roar of your waterfalls; all your waves and breakers have swept over me.

Psalm 65: 5-7

You answer us with awesome deeds of righteousness, O God our Savior, the hope of all the ends of the earth and of the farthest seas, who formed the mountains by your power, having armed yourself with strength, who stilled the roaring of the seas, the roaring of their waves, and the turmoil of the nations.

Psalm 93: 2-4

Your throne was established long ago; you are from all eternity. The seas have lifted up, O LORD, the seas have lifted up their voice; the seas have lifted up their pounding waves. Mightier than the thunder of the great waters, mightier than the breakers of the sea the LORD on high is mighty.

Psalm 107: 23

Others went out on the sea in ships; they were merchants on the mighty waters. They saw the works of the LORD, his wonderful deeds in the deep. For he spoke and stirred up a tempest that lifted high the waves. They mounted up to the heavens and went down to the depths; in their peril their courage melted away. They reeled and staggered like drunken men; they were at their wits’ end. Then they cried out to the LORD in their trouble, and he brought them out of their distress. He stilled the storm to a whisper; the waves of the sea were hushed. They were glad when it grew calm, and he guided them to their desired haven. Let them give thanks to the LORD for his unfailing love and his wonderful deeds for men.

Isaiah 51:14-16

The cowering prisoners will soon be set free; they will not die in their dungeon, nor will they lack bread. For I am the LORD your God, who churns up the sea so that its waves roar the LORD Almighty is his name. I have put my words in your mouth and covered you with the shadow of my hand I who set the heavens in place, who laid the foundations of the earth, and who say to Zion, ‘You are my people.’ ”

Jeremiah 5:21-23

Hear this, you foolish and senseless people, who have eyes but do not see, who have ears but do not hear: Should you not fear me?” declares the LORD. “Should you not tremble in my presence? I made the sand a boundary for the sea, an everlasting barrier it cannot cross. The waves may roll, but they cannot prevail; they may roar, but they cannot cross it. But these people have stubborn and rebellious hearts; they have turned aside and gone away.

Jeremiah 31:34-36

No longer will a man teach his neighbor, or a man his brother, saying, ‘Know the LORD,’ because they will all know me, from the least of them to the greatest,” declares the LORD. “For I will forgive their wickedness and will remember their sins no more.” This is what the LORD says, he who appoints the sun to shine by day, who decrees the moon and stars to shine by night, who stirs up the sea so that its waves roar the LORD Almighty is his name: “Only if these decrees vanish from my sight,” declares the LORD, “will the descendants of Israel ever cease to be a nation before me.”

Jeremiah 51:41-43

The sea will rise over Babylon; its roaring waves will cover her.

Jonah’s Prayer (Jonah 2)

From inside the fish Jonah prayed to the LORD his God. He said: “In my distress I called to the LORD, and he answered me. From the depths of the grave I called for help, and you listened to my cry. You hurled me into the deep, into the very heart of the seas, and the currents swirled about me; all your waves and breakers swept over me. I said, ‘I have been banished from your sight; yet I will look again toward your holy temple.’

…. And the LORD commanded the fish, and it vomited Jonah onto dry land.

Jesus Calms the Storm (Matthew 8)

Then he got into the boat and his disciples followed him. Without warning, a furious storm came up on the lake, so that the waves swept over the boat. But Jesus was sleeping. The disciples went and woke him, saying, “Lord, save us! We’re going to drown!” He replied, “You of little faith, why are you so afraid?” Then he got up and rebuked the winds and the waves, and it was completely calm. The men were amazed and asked, “What kind of man is this? Even the winds and the waves obey him!”

Unity in the Body of Christ (Ephesians 4: 1-17)

Then we will no longer be infants, tossed back and forth by the waves, and blown here and there by every wind of teaching and by the cunning and craftiness of men in their deceitful scheming. Instead, speaking the truth in love, we will in all things grow up into him who is the Head, that is, Christ. From him the whole body, joined and held together by every supporting ligament, grows and builds itself up in love, as each part does its work.

James 1:5-7

If any of you lacks wisdom, he should ask God, who gives generously to all without finding fault, and it will be given to him. But when he asks, he must believe and not doubt, because he who doubts is like a wave of the sea, blown and tossed by the wind. That man should not think he will receive anything from the Lord;

Jude 1:12-14

These men are blemishes at your love feasts, eating with you without the slightest qualm—shepherds who feed only themselves. They are clouds without rain, blown along by the wind; autumn trees, without fruit and uprooted—twice dead. They are wild waves of the sea, foaming up their shame; wandering stars, for whom blackest darkness has been reserved forever.

Extra post for today, since I missed yesterday’s post. Putting sex in the title is sure to attract more visitors.

Today  someone sent me this article – new antidepressant increases sex drive – about a new antidepressant called flibanserin. The article refers to the drug as a “female Viagra” but really it’s nothing like Viagra at all (which affects blood circulation) but works on the brain in a similar way to other antidepressants.

The aphrodisiac properties of the medication were discovered by accident, at the end of a research trial. Basically, women tried on this drug were doing everything they could to hold onto it at the end of the trial, so someone started asking the questions.

It seems funny to me that many of our major medical breakthroughs were discovered by accident. Penicillin is the obvious one, but also lithium for Bipolar disorder – I just can’t think of any others, but feel free to leave a comment if you know one.

Anyone who is familiar with our common antidepressants will know that they often cause problems with libido. The patient is sometimes left with a choice of being depressed, or having no sex life – a really fun choice, at that. I imagine this drug will be one to watch when it is finally released, which may be several years in Australia at least.

Another interesting antidepressant to watch is agomelatine, a melatonin agonist. Melatonin is an important hormone in regulating our sleep-wake cycle and insomnia is a huge feature (cause and effect) of depression. So this one will be an interesting drug for the treatment of depression and insomnia. It’s already available in the UK but not Australia or the USA.

 

Mental health of Australians

November 18, 2009

Here’s my summary of the 2007 Australian National Survey of Mental Health and Wellbeing

This was a national face-to-face household survey of 8841 (60% response rate) community residents aged between 16 and 85. And the main points were:

• Nearly half of all Australians (45.5%) have experienced a mental disorder in their lifetimeOne in five Australians had experienced a mental disorder in the past 12 months

Anxiety disorders (14.4% in past 12 months) were the most common class of mental disorder. 6.2% had experienced mood disorders in past year (ie depression, bipolar disorder) 5.1% had experienced substance use disorders in past year

Disability: Mental disorders, particularly mood disorders, were disabling. On average, people with a mental disorder experienced nearly 4 days per month when they were unable to perform some or all of their usual activities. People with an anxiety disorder had 4 days out of role, people with a substance use disorder had 3 days out of role, while people with a mood disorder had 6 days out of role.

Comorbidity: One in four people (25.4%) with mental disorders in the past 12 month had more than one class of mental disorder. • One-third (34.9%) of people with a mental disorder (about 7% of population) used health services for mental health problems in the 12 months prior to the interview.

Females had a higher rates of depression & anxiety disorders • Males had higher rates of substance use disorders

Young adults: 25% (age 16-24) had experienced a mental disorder in the past 12 months, and young adults are the least likely group to access health services (22%)

• the prevalence of mental disorders declined with age

Service use: Females were more likely to use services than males. Those with mood disorders were most likely to make use of services (58.6%), followed by those with anxiety (37.8%) and substance use disorders (24.0%), respectively. 2.6% received treatment from a hospital, whereas 35% consulted a community-based provider – particularly general practitioners and psychologists. People aged 45-54 most likely to access services (42%)

• Comparison with 1997 Survey: It would appear that the 12 month prevalence of any anxiety disorder is higher in the 2007 NSMHWB (14.4%) compared to the 1997 NSMHWB (9.7%, 3). Although this may reflect a true change in prevalence over time, it may also be explained, at least in part, by differences in the two instruments used in the two surveys.

• The results of the survey place Australia as a country with one of the highest rates of mental disorder worldwide, in line with other developed countries such as the USA (26.2%, 25) and New Zealand (20.7%, 26).

• As was found in the Australian survey, anxiety disorders were the most common class of mental disorder in both the USA and New Zealand surveys. The prevalence of mood disorder was lower in the Australian survey compared to the USA and the New Zealand surveys. In contrast, the prevalence of substance use disorder was higher in the Australian survey compared to both the USA and New Zealand surveys.

Limitations: the survey interview does not attempt to detect low-prevalence and difficult-to-assess mental disorders, such as schizophrenia, personality disorders and dementia. Homeless people, people resident in nursing homes, hostels, and hospices and those in prison or other corrective service facilities were not surveyed • There was a lower than expected response rate (60%) which has implications for the validity of any estimates of the survey

formula for depression

November 15, 2009

Here’s a nifty little formula about depression, which is derived from some great research done in 1978 (Brown & colleagues – no reference sorry!)

This research just confirms something we know instinctively, that people develop depression when their ability to cope with life is overwhelmed. This is not always the case, with some of the more severe (melancholic) forms of depression, it may just occur without any provoking event.

But for the majority of people, we become depressed when our coping resources are overwhelmed. So adversity can trigger depression, but interestingly the researchers found that adversity did not always invariably cause depression. In a study of women they managed to isolate another factor that influenced people’s response to adversity, which was social support.

So in looking at a group of women who had experienced one or more stressful life events, those who did not have social support were more likely to become depressed. Seems obvious right? Those with good social support were more able to survive adversity without developing depression. This just goes along with the theory that humans are really herd animals.

adversity minus social support = depression

adversity plus social support = resilience

I would say that this formula does not always work for everyone; some people still get depressed with all the social support in the world (I’m sure we all know those people) and some just cope heroically on their own with all kinds of misfortunes.

And the same goes for postnatal depression. I am a huge advocate of how wonderful babies and parenting are, don’t get me wrong I believe it is the most positive life experience there is. But nevertheless it is a stressful event requiring a lot of physical and emotional resources. So the same formula can apply to postnatal depression, with the baby as the “adversity”.

What that means is we all need to support new mothers, as well as Dads who do often also develop postnatal depression from some new research. That’s something that we seem to know instinctively, from the traditions of baby showers and dinner deliveries that hopefully occur when someone has a baby.

But it also means thinking outside your own family or social group to others who may not be so well connected and maybe just dropping in on them to see how they are going. Pass on your baby clothes to someone new or deliver them a meal.

And more generally don’t be afraid to go visit people you know when they are having a hard time, especially when they are isolated.

 

As someone who had kids fairly late in life, I have had the advantage of more stability in many ways (social, mental and financial!) which hopefully has given my kids some benefit as I’m more mature as a mother than I would have been 10 years earlier. I observe this trend of later motherhood and for many people like me it turns out fine in the end, but not for all. However, there is a part of me that believes this is not the natural or most ideal state of affairs, that maybe humans as a species are actually designed in many different ways to reproduce earlier. Here’s why.

The biological side is obvious, there is the obvious problem with declining fertility in males and females. All the infertility experts urge us to start earlier. There is a greater risk of pregnancy complications, birth defects, miscarriage, just about any problem. Older mothers have less energy to stay up all night and run around after the little ones.

What about the psychological or emotional side? I’m really only referring to Western society here, and I am still considering this theory so it’s a work in progress, bear with me. Younger adults or adolescents have different brains, which become “adult” in structure only at around 25. Young people are highly social and connected, concerned with forming their identity. Sometimes they  are more impulsive, flexible, risk-takers with a lack of empathy and a sense of invincibility. They are also highly social. All this is now confirmed with brain research that shows our brain connections are not fully established until the mid-20s.

If child-rearing was to occur in the teens or early 20’s , psychologically parents would be more flexible, able to cope with chaotic baby behaviour without too much need to impose an artificial routine. The highly social nature of teenagers is also adaptive because a social environment is necessary or extremely preferable for children. The effect of having a baby is (for most people) to increase empathy or the ability to put another’s needs before your own. So I think the benefit of early parenting (for the parent) would be actually to help emotional development, at a critical time of development, onto a more productive and cooperative path. We know from psychology that cooperativeness is a great character strength which leads to positive health outcomes (There are other parts of this theory that don’t work like impulsivity & invincibility, so I am working on those)

Socially, having children earlier would have benefits for the extended family. Grandparents would be younger, and could therefore support parents more, rather than having children when one’s own parents are very old and may require care themselves. Having children earlier would mean that they were able to help the parents to care for their own grandparents in old age.

I would see all this as having a benefit for babies in terms of attachment. A more highly supported social network for the mother may lead to a secure baby. Of course a theory like this can’t be universal and I guess there are down sides to this as well.

Why is parenting delayed? These days, largely because of financial expectations we expect to establish careers and do a lot of intellectual work (at least in the West) in our teens and 20s – to get into a reasonable financial position before we have the children. However this kind of career focus requires the maturity of a more adult brain, and in some ways it would be better to wait until over 25 when we may have more capacity for self-knowledge to choose an appropriate career path, wisdom to make responsible decisions for society and the persistence or discipline required for a complex workplace.

The other reason is relationships. People in their 20s now have the cultural expectation of transient relationships, often based on pleasure and self gratification, multiple relationships in order to find the best fit “try before you buy” without expectation of commitment or care of the other. We also expect to have “fun” and leisure before settling down to the “hard slog” of parenting, but I’ll get to that later. I think there is some evidence that this approach to relationships might be damaging. We know that broken relationships can be a grief event, and some of the most traumatic experiences from a psychological, mental health point of view – leading to depression, suicide and insecurity. By practicing serial monogomy or low-commitment and low-care relationships we are actually un-learning the art of real relationship by practising uncaring behaviours. This is actually bad for us in the long run, and sometimes it takes a long time to catch up and heal from the wounds of multiple relationship losses.

Anyway, that’s about all for this theory for today – as I said it’s a work in progress and so it could probably use some references, but this blog is just about ideas, not necessarily references!

Adios for today.

This looks like an interesting book, haven’t read it myself. There is a lot going around about happiness and positive psychology these days.

linkto story

technologies of faith

November 8, 2006

OK here’s another PhD idea for when I’m 40. Examine the “technologies” of the major religious faiths ie prayer and meditation, psychology from the Bible and the Buddha. Compare to psychological therapies.

Invent a form of cognitive therapy based on Jesus’ teachings.

thanatophobia

November 2, 2006

Here at the white elephant, we are not afraid to tackle the big issues… It’s almost my bedtime here and I am just scraping in with a post on the second day of NaBloPoMo.

So what is thanatophobia? It’s defined as a fear of one’s own death and is apparently very common. Why is it interesting? Because there are so many layers to it.

Firstly, thanatophobia is a form of anxiety. It’s a phobia, which is classed as anxiety. It comes with physical anxiety symptoms such as shortness of breath, increased heart rate, muscle tension, nausea, dizziness etc etc. It can be associated with panic attacks. It’s a fear of something which is at once inevitable but also quite unlikely at any given moment in time. The person is afraid of something which they know is definitely going to happen, but they have no way of knowing when.

Thanatophobia also has an existential, even theological component. If someone is afraid of death, what do they fear? The actual fear must relate to the person’s beliefs about death. What do they think is going to happen to them when they die and why is it so frightening.

Here’s a range of possible beliefs about death:
– nothing happens, you cease to exist (materialist view)
– you may go to heaven or hell, depending on some kind of judgment of your actions in this life (Judeo-Christian view)
– reincarnation (Hindu, Buddhist)
– some people believe in ghosts, or spirits of the dead who somehow just float around the earthly plane making a nuisance of themselves

For those who believe the first option, a fear of death is not very rational. After all if you don’t exist, what does it matter? You won’t be suffering. For Christians, and similar viewpoints, a fear of death could be related to some kind of guilt. You feel you have done wrong and you are going to hell. In that case all that is required is to repent and you’ll be forgiven – easy.

Those who believe in reincarnation may be afraid of their own karma. They may have done wrong and fear a horrible next life. It’s understandable. It’s also understandable for those who believe in spirits or ghosts to feel afraid. Who would want to be floating around forever, feeling cold and scaring people?

I get the feeling that most people with this fear haven’t quite worked out their own beliefs yet. They may be searching, and the fear could be a healthy sign that they are moving towards some kind of spiritual growth.

Some writers (like Elisabeth Kubler-Ross, Victor Frankl and also in the Tibetan Book of Living and Dying) emphasise the need to confront one’s own mortality in order to grow or really be able to live well. Death is a necessary step on the road to rebirth in a number of ways, some of which are symbolic. There’s a cycle.

Fear of death could also be related to other problems. It could be due to narcissism (fear of one’s own nonexistence) or fear of the unknown. It could also be related to a death-wish as sometimes we fear what we really desire.

I don’t have thanatophobia and I’m frankly quite unconcerned about the whole thing. I don’t fear death and I don’t pretend to know what is going to happen to me there. I have some kind of faith that tells me it will be OK. But I find the whole thing very interesting.