Existential Anxiety
An exploration of the universality of
existential anxiety and its potential
implications in the work of music-
thanatology
Academic Research Paper
Michal Sterling
Lane Community College Music Thanatology Training Program
Portland, Oregon
March, 2015
1
Copyright © 2015 Michal Sterling
All Rights Reserved

Acknowledgments
Thank you to my teachers, mentors, family and friends who have loved and supported me as I
have worked through my deepest fears and anxieties in the course of my training to become a
music-thanatologist.
I was blessed with the most supportive class who created a safe space to explore these fears
without judgement. I am so grateful for the Class of 2015.
A special mention and thank you to Raya Partenheimer for the energy and love she put into
editing my paper and helping me to relay my thoughts with more strength and clarity. Thank
you also to the music-thanatologists who contributed to shaping this paper by completing the
questionnaire I sent out in late 2014.
And finally very deep gratitude to the patients and families who have allowed me to be
present at such a sacred time in their life.
Introduction
“This is the terror: to have emerged from nothing, to have a name,
consciousness of self, deep inner feelings, an excruciating inner yearning for life
and self-expression – and with all this yet to die.”
1
“You do realise you have widespread disease that’s incurable?” were the words I heard
from my oncologist after my questions made it clear to him my ignorance to the seriousness
of my prognosis. Thyroid cancer is one of the most curable forms of cancer and although I
knew it had spread to my lymph glands and my lungs, I still imagined that I would somehow
be spared. Hearing the word ‘incurable’ quickly jolted me out of my denial, exposing
existential anxiety I had long since repressed and launching an ever evolving search for
meaning.
Before going any further I would like to clarify what I mean by existential anxiety and
how it can be distinguished from neurotic anxiety and normal anxiety. Existential
philosophers have varying definitions of existential anxiety but for the purpose of this paper I
relate to the following definitions:
2
2

Existential anxiety– the inevitable unease or malaise that comes from awareness of yourself,
your freedom and the finitude of human existence.
3
Neurotic anxiety– Anxiety of sufficient severity to be deemed clinical; that is, indicative of a
pathological, not a normal state. Psychiatric classifications specify that the anxiety can be
diffuse, may involve attacks of panic, and is not attributable to real danger.
4
Normal anxiety– anxiety that occurs when a person reacts appropriately and proportionately
to the events in everyday life.
5
Since my diagnosis eight years ago, I have moved between these different states of
anxiety, and regressed back into periods of denial and repression. Prior to starting Music-
Thanatology training in 2013 I felt like I had done a lot of work coming to terms with my
mortality, even experiencing moments of unintentional self righteousness which surfaced as
pity for those around me who still appeared to be in the depths of denial or the grip of
existential anxiety. It wasn’t until I entered the internship phase of my training and began
offering music at the bedside that all of a sudden my self imaginings were exposed as just
that. I realised that I had never truly applied death to myself. I was no more immune to the
fear of death than the people I had previously imposed my judgement on. A period of
neurotic anxiety followed. I experienced multiple panic attacks and began desperately
seeking a story that would once again have me believing in my own immortality. During
these periods of anxiety I suffered harsh self judgement in the face of deeply held beliefs
about what is acceptable and unacceptable. I have always been admired for my resilience and
I began to identify with this as a positive character trait. To find myself in the grip of
debilitating anxiety was a blow to my self esteem. A necessary blow perhaps, which put me
on this path of exploration with the aim of better understanding existential death anxiety as
part of the human condition. My exploration is bound to continue beyond the pages of this
3

paper, but to date the process has been both profoundly humbling and deeply comforting.
___________________________
Existential anxiety is part of the universal human experience. It drives us to seek out
and defend death denying cultural constructs that alleviate the anxiety associated with the
awareness of our own mortality. I believe that bringing awareness of this aspect of the human
condition will be helpful to music-thanatologists by encouraging the cultivation of trait
mindfulness and reducing defensive responses to existential threat.
Through my research I have encountered many differing perspectives on the subject
of death anxiety but when I discovered the works of cultural anthropologist, Ernest Becker
and philosopher, Stephen Cave, I was captivated. Much of what they articulate resonates with
me at this time. Stephen Cave’s ideas are linked to Ernest Becker’s through the Terror
Management Theory which was proposed by social psychologists Jeff Greenberg, Tom
Pyszczynski, and Sheldon Solomon and inspired by Ernest Becker’s writings.
6
I will offer an
overview of their central ideas throughout the course of this paper.
Ernest Becker believed in the universality of the fear of death which is perhaps why I
am drawn to his ideas.
7
There is comfort in the belief that I am not isolated in my struggle to
look death in the face. Many people are unable to identify the presence of death anxiety in
their lives due to the many indirect ways it can manifest itself but Becker maintains that no-
one is free of it.
8
He brings awareness to the unconscious desire that drives human behaviour,
the desire to transcend death, whether that be physically or symbolically.
9
In his book, The
Denial of Death, Becker talks to the undeniable biological argument.
10
Like animals we have
survival instincts, fear responses that are necessary to our survival.
11
He argues that as such a
highly sensitive species it would be reasonable to assume that the fear responses of animals
4

would not only still exist in humans but be magnified.
12
What separates human beings from
animals is the ability to think abstractly, giving us what Becker calls a symbolic identity.
13
Cultures and societies are set up to provide opportunities for us to develop a symbolic
identity. Our name, our occupation, our beliefs and interests, anything that sets us apart as
individuals makes up this symbolic identity. This provides us with a sense of value or self
esteem that allows us to separate ourselves from others, whose mortality we acknowledge
more comfortably than our own, and leads to what is known in the world of modern
psychology as the existential paradox.
14
Becker refers to this existential paradox as “the
condition of individuality within finitude”.
15
He says “Man is literally split in two: he has an
awareness of his own splendid uniqueness in that he sticks out of nature with a towering
majesty, and yet he goes back into the ground a few feet in order blindly and dumbly to rot
and disappear forever”.
16
This is a uniquely human dilemma. Our intelligence allows us to
think abstractly. We are capable of reflection and contemplation, transporting ourselves back
in time and projecting ourselves into the future through our imagination.
17
We are self
conscious beings and it is this consciousness of self that prevents us from living blissfully
unaware of our fate.
18
Philosopher, Stephen Cave, says “We are therefore blessed with
powerful minds yet at the same time cursed, not only to die, but to know that we must”.
19
So how do we live with this terror? How is it that we ultimately know we will die yet
we are not “twitching blobs of biological protoplasm completely perfused with anxiety and
unable to effectively respond to the demands of [our] immediate surroundings”?
20
Is it
possible that even in the face of undeniable evidence, deep down we do not really believe we
will die? I have spent a lot of time reflecting on what it means to contemplate my own death
and come to the conclusion that I am not capable of perceiving this. Neurologist and
Psychotherapist, Sigmund Freud wrote “It is indeed impossible to imagine your own death;
5

and whenever we attempt to do so we can perceive that we are in fact still present as
spectators.”
21
When I first read this I found myself revelling in this simple realisation. I have
many times imagined my death, the funeral that would follow and my family’s grief but only
now realise that in the imagining of these things I have not in fact imagined my death at all.
In these imaginings I still exist with the same consciousness that I possess in life.
Intellectually I know I must die but I cannot conceive of this as it is completely outside of my
human experience.
22
It seems that the the fear of death is so profound and overwhelming that we cope by
convincing ourselves of our own immortality, despite the concrete evidence that we are all
going to die.
23
This explains why eight years after my diagnosis I still find myself wracked
with anxiety when I am put in a position where rationality wins out and I am unable to deny
that death applies to me. I referred to one such situation earlier when I spoke of entering my
music-thanatology internship. Prior to this I had never been at the bedside of anyone who was
dying and so never been witness to the moment of death. In the first three months of my
internship I was present for four transitus vigils. I was awed by these moments and at the
same time struck by just how modestly these people died. They were people I could relate to,
and they had taken their last breath. It seemed to me that just like that, they were gone.
I wasn’t aware at the time just how acutely these experiences affected me but not too
long after, I found myself becoming hyper aware of my breath, as if I subconsciously thought
each one could be my last. I think the closest I came to the experience of nothingness was in
the moments just before I would fall asleep. I strongly resisted this, sometimes snapping
awake very suddenly as if to stop myself from simply drifting away into nonexistence. It’s as
if the idea of my own death had shifted from the realm of possibility to the realm of
inevitability and this was indeed terror inducing. In order to move through this anxiety I had
6

to find a story that would convince me that it was safe to die. In his book Immortality,
Stephen Cave, refers to these stories as immortality narratives.
24
He says “Each one finds
some way of resolving the Mortality Paradox, some way of convincing us that, contrary to
appearances, we really will live on, that bodily death is either not inevitable or not what it
seems, that we are right to believe in the impossibility of our extinction”.
25
He believes that
within every culture at least one immortality narrative exists.
26
These immortality narratives
vary greatly but all have one thing in common. They offer some form of reassurance as to
why death is not something to be feared or seen as final.
27
Stephen Cave proposes that all
immortality narratives fit into one of four kinds.
28
Stephen Cave refers to the first immortality narrative as ‘Staying Alive’.
29
This is an
age old immortality narrative that we have all certainly become acquainted with at some point
in our lives, whether through myths and legends, a historical perspective or a more modern
scientific approach.
30
As the name suggests this narrative is based on the premise of defying
death altogether and being granted eternal life.
31
You only have to turn on the television
nowadays to be bombarded with advertising for various products that claim to postpone the
normal aging process. The dream of finding a magical elixir of life can be traced back to the
earliest recorded cultures and it seems that many still hold out hope for a scientific
breakthrough that will guarantee eternal life and therefore an escape from the perpetual fear
of death.
32
The second of the immortality narratives is the ‘Resurrection’ narrative.
33
Possibly the
most widely known resurrection story is that of Jesus Christ when he rose from the dead after
being crucified. This act of resurrection was interpreted as a sign of God’s intention to grant
mankind immortality.
34
John 3:16 in the King James version of the bible says “For God so
loved the world, that he gave his only begotten Son, that whosoever believeth in him should
7

not perish, but have everlasting life.”
35
The resurrection story appears in various forms in
many religious traditions and in modern day science.
36
Stephen Cave uses cryonics as an
example of the modern day resurrection story.
37
Cryonics involves preserving the body at
very low temperatures to ensure the body is still intact if scientific advances ever make
resurrection possible.
38
This is an expensive procedure and the financial commitment implies
a genuine belief in this possibility. However, this is not the most optimistic of futuristic
resurrection beliefs. With the digital age comes a multitude of predictions including the
possibility of digitizing your psychological identity so you can be resurrected in the form of a
virtual person.
39
The third immortality narrative is the ‘Soul’ narrative.
40
This relates to the commonly
held belief that we have a soul that is immaterial and unlike the physical body in that it is not
vulnerable to decay and death.
41
Many believe that the soul encompasses our true essence or
self and that it transcends physical limits.
42
This narrative is comforting to many because fear
of death is often associated with the fear of losing the individual self or consciousness.
43
The
soul narrative addresses the mortality paradox by strengthening feelings of individual
significance.
44
Rather than seeing ourselves as mere mortals, dissolving back into nature like
all other animals, the soul narrative boosts our self esteem and sense of value and meaning in
the world by offering each one of us a personal connection with the divine.
45
The fourth and final immortality narrative is the ‘Legacy’ narrative.
46
This narrative is
widely subscribed to in conjunction with other immortality narratives, and by those who find
the previous three immortality narratives unconvincing. The legacy narrative is associated
with a belief that we can live on in the symbolic world.
47
Stephen Cave makes a distinction
between cultural and biological legacy.
48
The idea of cultural immortality inspires many to
seek out some form of heroism.
49
This perceived heroism can be acquired through the
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systems set up by society that allow us to feel we are contributing to something meaningful
and lasting. Something that will outlive us and leave our mark on the world.
50
The desire to
leave behind a cultural legacy is not necessarily negative and has contributed to many
positive developments and contributions. I often think about my call to music-thanatology in
these terms and question if it is my own selfish desire that brings me to the bedside. However
I have come to believe that if my subconscious desire for heroism collides with my desire to
do my best to ease someone’s passage then this cannot be perceived as a negative response to
existential anxiety. The second part of the legacy narrative is the biological immortality
narrative or the notion that we live on through our children.
51
Albert Einstein wrote “Our
death is not an end if we can live on in our children, for they are us; our bodies are only
wilted leaves on the tree of life”.
52
The Staying Alive, Resurrection, Soul, and Legacy narratives all serve to satisfy our
desire for immortality and act as antidotes to the fear of death.
53
I appreciate that Stephen
Cave acknowledges, “that they are motivated by deep-seated aspects of the human condition
tells us nothing about whether or not these narratives are true”.
54
I believe it is important to
recognise this when exploring this subject in order to avoid using the awareness of this theory
as just another way to separate ourselves from others. Even if we are able to understand these
behaviours on an intellectual level, it will not eliminate the need for an immortality narrative
of our own.
Given that none of us are immune to the influence of existential anxiety in our lives,
how can we avoid allowing this to negatively affect our service as music-thanatologists? Is it
possible to maintain an open heart and a loving, non judgemental presence when confronted
with the reality of death? We all need a way to control the terror that accompanies the
awareness of morality. Terror Management Theory emerged from the belief that human
9

behaviour is predominantly influenced by this need.
55
However, the immortality narratives we
adopt will only continue to ease our existential angst if we feel a level of certainty about
them. When we are faced with others who have differing beliefs this can bring up questions
about the validity of our own beliefs. A common response to this is to cling even more tightly
to our own beliefs and reject or attempt to convert those that threaten our truth.
56
Terror
Management Theory has generated hundreds of studies, providing empirical research that
supports the theory that when people are reminded of their own death, they are more likely to
have an increased sense of certainty surrounding their own worldview.
Jeff Greenberg, Tom Pyszczynski, and Sheldon Solomon, who proposed Terror
Management Theory, developed the concept of mortality salience to test their theories.
57
Mortality salience is “a psychological state in which thoughts of one’s death are prominent,
or salient, in the individual’s conscious mind”.
58
Findings substantiate Terror Management
Theory’s view that mortality salience results in a negative bias towards those with dissimilar
cultural worldview’s and a positive bias towards those who share a similar cultural
worldview.
59
This is known as worldview defense.
60
“People who do not share our
cultural/religious assumptions (stories/fictions) are a big problem, since by their very
existence they cast doubt on the absolute certainty of our truth (revealing its fiction nature to
us) and thus expose us again to the repressed anxiety they function to allay in the first
place.”
61
As Music-Thanatologists we are serving people who subscribe to a broad range of
cultural and religious belief systems and my hope is that in bringing awareness to our
vulnerability to worldview defense, that there is less likelihood of a defensive response when
mortality is salient.
62
This is especially relevant in this line of work as it could be presumed
that mortality salience commonly presents itself when offering music at the bedside of the
10

dying. However subtle the impact of this may be, I believe it’s important that we do our best
to eliminate any possible attitude of bias that may arise at the bedside.
If these attitudes/biases are so deeply ingrained in our being, how do we go about
counteracting them? A series of studies by social psychologists Niemiec, Brown, Kashdan,
Cozzolino, Breen, Levesque-Bristol, and Ryan (2010) conclude that trait mindfulness can
reduce defensive responses to existential threat.
63
“That is, some individuals can readily
maintain awareness of their feelings, sensations, and environment, called trait mindfulness.
When individuals exhibit trait mindfulness, they process information about themselves in a
balanced, considered, and insightful manner. Because of this mindset, feelings of anxiety are
not as likely to initiate a series of defensive responses.”
64
Mindfulness, as defined by the Merriam-Webster online dictionary, is “the practice of
maintaining a nonjudgmental state of heightened or complete awareness of one’s thoughts,
emotions, or experiences on a moment-to-moment basis”.
65
Mindfulness as a “state of mind”
can develop into a “trait of mind” with practice.
66
The more we incorporate deliberate
mindfulness practice into our lives, the more likely it is that we will become mindful
individuals, able to maintain a more naturally mindful state throughout the day. The purpose
of mindfulness meditation is not to experience the benefits of being mindful only while
meditating, but to strengthen mindfulness as a more enduring trait.
67
When mindfulness
becomes a trait it becomes one of the characteristics that makes up our personality.
68
I think
we can probably all identify people in our lives who seem easily distracted and less attentive
as compared to others who we might describe as being grounded and more present. For some
this quality of mindfulness is innate but thankfully it is also something that can be developed,
as it exists in all of us to some extent.
69
We must start with intentionally practicing
mindfulness, through meditation or other practices that promote mindfulness, as well as
11

working at remembering to be mindful throughout the day, continuously bringing ourselves
back to the present moment with non-judgemental awareness.
70
This practice will cultivate
and strengthen the “trait” of mindfulness.
Terror management theory suggests that if death denying aspects of our cultural
worldview, and our feeling of significance within this world view, alleviate anxiety then it’s
likely that we would strongly defend our worldview when mortality is salient.
71
This
defensive response to mortality salience has proven to result in negative reactions towards
those whose worldview differs from our own and favoritism towards those whose worldview
validates our own.
72
However, Niemiec, Brown, Kashdan, Cozzolino, Breen, Levesque-
Bristol, and Ryan hypothesized that trait mindfulness could curb the affects of mortality
salience and result in less defensive responses.
73
Research supports their hypothesis. Niemiec,
Brown, Kashdan, Cozzolino, Breen, Levesque-Bristol, and Ryan undertook a series of studies
that measured for levels of trait mindfulness.
74
Participants who reported high levels of trait
mindfulness “did not evoke defense mechanisms to circumvent existential anxiety.”
75
With the development of trait mindfulness we are less likely to respond habitually and
more likely to approach our lives and our work with tolerance, non-judgemental awareness
and a deeper level of compassion. I believe that as music-thanatologists it is particularly
important that we identify the ways in which existential anxiety presents itself in our lives.
We are accountable to the patients and families we work with and with this accountability
comes a responsibility to remain mindful of our attitudes, biases, cultural influences and
anything that could affect our offering of a loving and compassionate presence at the bedside.
Our shared existential concerns bind us together as a human race and my hope is that this
paper will encourage a recognition of the universality of the fear of death and a deeper
exploration of this aspect of the human condition.
12

1Becker,The Denial of Death, Foreword by Sam Keen
2Iacovou,What is the difference between existential anxiety and so called neurotic anxiety
3Ibid.
4Marshall,“A Dictionary of Sociology”
5Iacovou,What is the difference between existential anxiety and so called neurotic anxiety
6Moss, “Terror Management Theory”
7Becker,The Denial of Death,Chapter 2
8Ibid.
9Ibid.
10Ibid.
11Ibid.
12Ibid.
13Ibid.,Chapter 3
14Ibid.
15Ibid.
16Ibid.
17Ibid.
18Ibid.
19Cave,Immortality,Chapter 1
20Ibid.
21Ciraulo,World Philosopher on Death,167-174
22Cave,Immortality,Chapter 1
23Ibid.
24Ibid.
25Ibid.
26Ibid.
27Ibid.
28Ibid.
29Ibid.,Chapter 2
30Ibid.
31Ibid.
32Ibid.
33Ibid.,Chapter 4
34Ibid.
35Bible Hub, “John 3:16”
36Cave,Immortality,Chapter 5
37Ibid.
38Alcor Life Extension Foundation, “What is cryonics”
39Cave,Immortality,Chapter 5
40Ibid.,Chapter 6
41Ibid.
42Ibid.
43Ibid.
44Ibid.
45Ibid.
46Ibid.,Chapter 8
47Ibid.
48Ibid.
49Ibid.
50Becker,The Denial of Death, Foreword by Sam Keen
51Cave,Immortality, Chapter 9
52Ibid.
53Ibid.,Chapter 10
54Ibid.,Chapter 1
55Moss, “Terror Management Theory”
56The Ernest Becker Foundation Website,“16 Central Ideas of the Theory of Generative Death Anxiety”
57Darity, Jr,“Salience, Mortality”
58Ibid.

59 Moore,General and Personal Mortality Salience and Nationalistic Bias
60 Moss, “Terror Management Theory”
61 The Ernest Becker Foundation Website,“16 Central Ideas of the Theory of Generative Death Anxiety”
62 Moss, “Terror Management Theory”
63 Niemiec, Kashdan, Breen, Brown, Cozzolino, Levesque-Bristol, Ryan,Being Present in the Face of Existential
Threat
64 Moss, “Terror Management Theory”,Mindfulness
65 Merriam-Webster, “Mindfulness”
66 Walsh, “Mindfulness: State and Trait”
67 Ibid.
68 Ibid.
69 Ibid., “Mindfulness in general essays”
70 Ibid.
71 Niemiec, Kashdan, Breen, Brown, Cozzolino, Levesque-Bristol, Ryan,Being Present in the Face of Existential
Threat
72 Ibid.
73 Moss, “Terror Management Theory”
74 Ibid.
75 Ibid.

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