Deep Connections Around Death for an Enriched Life

"Dying isn't a medical issue; it's a part of the human experience." –Shoshana Ungerleider, M.D.

While working in an intensive care unit as a resident, Shoshana Ungerleider found herself confronted with the aftereffects of a death-phobic society. End-of-life discussions were far too uncommon, both inside and outside the ICU. In this high-stakes environment, individuals and families were often forced to make critical decisions about medical care amid crisis and confusion. Ungerleider envisioned a different approach—one where discussions of death weren't viewed as an admission of defeat or tragedy but as an opportunity for open, compassionate conversations about what it truly means to live well until the end.

I spoke with Ungerleider to better understand her perspectives on questions of life and death and her insights on the role of community in enhanced coping as we navigate these frontiers.

Fear of Death

"Young people today don't grow up with a sense that this [death] is a part of life." –Shoshana Ungerleider, M.D.

As a 30-something-year-old psychotherapist, the images I associate with death and dying include a cold hospital bed circled by white curtains. Yet, Ungerleider shares with me that 100 to 150 years ago, people often died in their homes surrounded by friends and family members with ritual and planning. In those days, without the scientific and medical discoveries we have today, no choice was left but to accept that life would end on life's terms. Today, we have lost a cultural understanding of how to face dying.

In conversation, I wonder to myself, among the many ways we are better off today—effective medicines, cleaner water, and information advances to name a few—if this is one exception.

Talk about death is often a taboo in our society. Yet, fear of death runs rampant. Existential anxieties have the potential to interfere with our ability to enjoy life. Research has shown that death anxiety correlates with prolonged grief in bereaved adults (Gegieckaite and Kazlauskas, 2022). Increased fear of death is also linked to a range of mental health difficulties, including depression and anxiety (Gürbüz and Yorulmaz, 2024).

Dr. Shoshana Ungerleider

Source: Courtesy of Shoshana Ungerleider

A Shared Reality

The ability to provide each other with support in this shared reality is key, but, often, we don't talk about these things. Ungerleider expresses that "deep connections" and "normalizing conversations about our mortality" can improve our quality of life. She acknowledges that "it's not always a bad thing to have existential questions" and that "thinking of mortality as being a wake-up call for our lives" can bring meaning to it.

In hopes of addressing this, she founded the nonprofit End Well, whose mission is to "transform how society thinks about, talks about, and plans for the end of life." She discusses a hope to "shift the narrative around death and dying from something that is feared to seeing it as a part of life and a shared experience that we can prepare for and maybe even find meaning in."

Indeed, an analysis of five studies found that having a solid sense of self and meaning in life correlates with a decreased fear of death (Maffly‐Kipp et al., 2024). Allowing ourselves to accept death and discuss it together can give us a way of imagining how we want to spend our lives. Still, often, these conversations are not had. Sometimes, we do this while hoping to protect each other from sadness and other painful emotions that can be sparked, envisioning that such discussions will bring each other down.

Yet, this has not been Ungerleider's experience. Through projects involving social media, creating communities, and an annual large-scale gathering called the End Well Forum bent toward these deep discussions, she shares, "You come to a conference about the end of life, and all small talk goes out the window, You talk about real stuff."

She gleans that discussions around death and other shared collective realities give people opportunities to "live authentically in a transparent way," providing a sense of peace. She shares that approaching community building at the end of life has proved incredibly valuable.

Avoidance grows fear while approaching gives us space to transcend these fears. Building communities surrounding issues of death and dying has the potential to liberate us from the fear of death.

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The Place for Psychotherapy

Ungerleider expresses that "more people are seeking support when they have fears about death that are affecting their day-to-day life and quality of living." Psychotherapy is one option for this. The supportive and validating environment of the therapy room, coupled with meaning-focused approaches, can improve coping.

Existential therapies focus on the shared realities of life, death, freedom of choice, and meaning, which therapists and clients walk through as fellow travelers. Research has suggested that existential therapies can be effective in decreasing death anxieties in aging populations (Sadri Demich and Ramazani, 2016) as well as in alleviating the psychological pain associated with fear of death ignited during the COVID-19 crisis (Sabzevari et al., 2022).

Beyond Therapy

Ungerleider mentions enhancing our connection with the present through mindfulness, meaningful relationships/work/social impact, open dialogue, and seeking professional help as steps people can take in addressing death anxiety. She discusses the target of finding a "legacy," expressing that many people fear "being forgotten or being sort of a speck of dust in this massive, infinite time and space," reflecting that "feeling as connected as we can to the time that we have and what we can be is powerful." She will be hosting a podcast, “Before We Go” beginning in October and looks forward to utilizing this venue to build on this work.

For individuals seeking to build a greater sense of peace with the end of life, the following three strategies are a start:

1. Connect: While conversations about death have traditionally been taboo in American culture, these conversations can be incredibly healing. Find individuals with whom you can discuss your wishes and fears. This could include family, a spiritual leader, or a psychotherapist.
2. Practice presence: Anxiety about the future can be overwhelming. Practice taking moments of mindfulness. Savoring positive experiences and noticing the moment are ways to find peace.
3. Consider the way you wish to live your life: The truth that life on Earth is limited gives us all the more reason to reflect on our values and seek to live our lives in ways that reflect these. Big-ticket items like a visit to another country are just a fraction of this. We can engage in this in simple aspects like how we treat others or ourselves.