I have been running a program at the Anxiety and Phobia Center for the last ten years for people suffering from health anxiety. These people represent a number of different diagnostic categories: hypocondriasis, somatization disorder, obsessive-compulsive disorder etc. Essentially, they are people who worry too much about their health. Most typically, someone (usually a young person) worries about having an obscure medical condition with few obvious symptoms, but which has the potential to be fatal. Some common examples include brain or pancreatic cancers or AIDS. Often they have been tested repeatedly for these conditions and have been told repeatedly that the tests are negative and that, in fact, they have no reason to be concerned about these illnesses. They worry, nevertheless. When I ask them what they are really afraid of (what it would mean to them to have cancer, for example) they usually say they are afraid of dying. Actually, they divide into two groups, those who are afraid of the process of dying and those who are afraid of being dead. Different people have somewhat different ideas of death, but there are two almost universal fears that underlie the fear of death (as the fear of death could be said to underlie the fear of illness):
1 The fear of helplessness and
2. The fear of being all alone
The person afraid of dying often imagines himself in a hospital, unable to move away from a hospital bed, becoming weaker and weaker, alone at night, unable to reach doctors or nurses, left alone after visiting hours, to an increasing extent all alone, and unable to do anything.
The person afraid of being dead imagines himself buried in a grave unable to move, all alone and helpless.
The fear of getting a fatal illness does not respond to repeated reassurance. It does, however, respond to treatment of the underlying fears. Someone who learns that the important people in his life will respond to his wishes, (or listen to them, at least) will feel less helpless and less alone. In short, the fear of death (which is, after all, not universal) depends on how successfully people live their lives. There are specific things someone may do to feel more closely connected to people and less vulnerable. In the short run, however, fear of each particular illness must be addressed even if it is followed, as it usually is by the fear of another. A number of do’s and don’ts are important and I will mention them in future blogs. I discuss these strategies in detail in my book, “Worried Sick?” and in the handbook.
In my next blog I will explain why the great majority of old people are not afraid of dying. There are three reasons.