Fear Of Death Sometimes Indicates A Healthy Prognosis

In American culture, the fear of death is often defused with comedy. American television abounds with examples of hypochondria as the basis for jokes.

In the NBC hit comedy Parks and Recreation, for example, the character Chris was born with an inherited blood disorder that was expected to claim his life in infancy. As adult, he is in superb physical condition but he did suffer lasting effects — he is a germaphobe who frequently expresses his fear of death.

In the science fiction series Star Trek Voyager, the character Ensign Kim was constantly concerned about catching contagion on the new planets Voyager explored. When Kim ran a program the Emergency Medical Hologram (a computer-generated holograph that interacted with the crew in the capacity of a doctor) had written for the holodeck, he commented "Even my holodeck character is a hypochondriac."

Comedian Woody Allen has made a career from his hypochondria. Tens of millions of Americans have enjoyed reruns of the Andy Griffith Show, which featured a character who felt her life depended on her placebo (sugar) pills. And the rock group The Who immortalized the lines:

"Doctor, thanks for seeing me today, I'm glad 
I've got every sickness there is to be had 
I had whooping cough last month 
And today I've got the mumps 
And tomorrow I'll catch chicken pox as well."

Fear of Death Really Isn't Funny

Americans deal with their fears of death by laughing at them. But how does that change when the fear of death is well-founded? Is it best to ignore a fear of death, to tell one's friend and families and even strangers about one's fear of death, or is a sense of doom of any real relevance to health outcomes?

Psychology experts tend to be dismissive of "ex consequentia" reasoning, the kind of thinking that results in conclusions along the lines of "I must be sick, because I am anxious." (Having said that, anxiety disorders are real illnesses, so there's some truth to this.) When people know they are sick, however, on the basis of medical diagnosis, and they feel that they are facing disastrous consequences, fear of death takes on an entirely different meaning.

Predictive Value of Fear of Death

It turns out that a fear of death or a sense of impending doom is highly predictive of future health. People who have a well-founded fear that they are going to die soon may have a dramatically greater chance of survival or a dramatically reduced chance of survival, and the difference between the two outcomes is not hard to understand. The importance of a sense of impending doom is especially useful in predicting outcomes in heart disease.

Fear of Death In Heart Disease

Studies from all over the world have found that a fear of death is an indication of a healthy outcome in heart disease, especially in persons who have been diagnosed with atherosclerosis or who have had a heart attack, at least when people have the option of seeking medical treatment.

Sense of Impending Doom Leads to Seeking Effective Treatment

A Chinese study of patients who were already previously diagnosed with cardiovascular disease who had a sense of possible death found that they were 14 times more likely to seek admission to hospitals that could perform percutaneous cardiovascular interventions to put stents into clogged arteries than if they did not have a sense of impending doom. Patients who did not have a sense of imminent death were more likely to seek treatment with herbal medicine or medications. In other words, when you're scared that you're about to die, and that's actually a real risk, you are also more likely to do something that may reduce the real risk of dying. That step can, in turn, contribute to proving you wrong.

Sense of Impending Doom Leads to Cooperation with Treatment

A Japanese study of patients who survived a condition known as cardiac tamponade (the accumulation of fluid around the heart, interfering with its ability to beat) were highly likely to have used the terms and phrases "I am anxious," "I am discouraged," "I am depressed," or to have expressed a fear of death to their doctors. In this study, 89 percent of cardiac tamponade survivors, but a significantly smaller number of patients who later died of the disease, let their doctors know they were afraid they would die. Patients who are scared of death are more likely to be compliant with treatment recommendations. This, too, reduces their risk of death.

Cardioprotective Genes Also Trigger Fear Response

And on a very basic level, genes that help the heart overcome congestive heart failure also induce a fear response, at least in laboratory experiments with genetically engineered mice. Scientists at the European Molecular Biology Laboratory in Italy have found that genes that activate the release of two heart-protective hormones,  insulin growth factor isoform (mIGF-1) and the NAD+-dependent protein deacetylase (SIRT1), normalize blood pressure, but also increase evasive reactions to potentially dangerous stimuli. It is as if the mouse begins to protect its life once its heart is healthy enough to continue it.

At a very basic level, healthy hearts enable the body to respond to healthy fears. And at the level of choices in medical care, fear inspires heart patients to get the treatment they need--and even in developing countries, they usually do.

When is fear of death not an predictor of future health? People who don't have options don't benefit from fear. If care simply is not available, fear of death does not make life better. But when there are options for healthcare, a fear of death may be an ironically healthy kind of hypochrondria.