Familiar ideas are, for better or worse, frequently recycled and resold in new packaging. One such case is Terror Management Theory (TMT), which I recently read about in the Journal of Clinical Oncology. The article’s author, Daniel Rayson, an oncologist in Halifax, Nova Scotia, wrote about how patients respond to terminal disease. He reports a case of a medical resident who, after dealing with a patient with terminal cancer, wrote the following note: “She reports excellent energy, she is smiling all the time … obviously in denial.”
Rayson writes that his attention was piqued by the young physician’s assumption of denial. He goes on to discuss other cases in which patients dealt with imminent death in ways that that resembled denial, though the patients surely understood, at least on some level, that they were terminal. Where is the upbeat response coming from? And should it be criticized?
Rayson cites Terror Management Theory—a branch of social psychology that grew out of the work of the cultural anthropologist Ernest Becker, whose 1973 book, The Denial of Death, saw the evolution of culture as a human adaptive tendency to ignore or deny the inevitability of death. As Rayson summarizes: “TMT attempts to explain why we continue to give meaning to our thoughts, actions, and emotions despite the fact that at some point, mostly not of our own choosing, death will simply shut us and everything we know, down.”
We are all in denial, according to TMT; otherwise we couldn’t carry on productive lives. Rayson’s point is that terminal patients are in some ways in more need of the coping skills that we, whose deaths are (presumably) not imminent, use every day.
Rayson’s views echo the age-old philosophical idea about the need to prepare for and face death. Montaigne said “to live is to prepare to die,” which would seem to be the opposite of TMT—and the responses of some of Rayson’s patients. But then, the point is not to prescribe how an individual might deal with death. Some people may cope best by acknowledging it, and thus savoring life more fully. Some may find that thinking about death unflinchingly helps them eliminate some of its terror. Others may deal best with death by carrying on as they always have—ignoring it, even when it seems to be staring them in the face.
I don’t much like buzzwords and acronyms, and TMT seems particularly incongruous given the profound subject it is addressing. But terminology aside, I can’t really argue with the content of the theory. We manage our expectations in order to live a happy life, and that would include managing our knowledge that our life is finite.
