Death is something that, in one way or another, therapists encounter almost daily in their work. Death and the fear of death can overpower and paralyses individuals. These are conscious emotions but sometimes they also affect the sub-consciousness of the individual, and they may be expressed in the dependence on another person, by an unhealthy attachment, or, on the contrary, by the search for oneoff sexual encounters intended to blot out the thought of mortality by the “intensity” of the present moment. Miloš Raban observes that if we want sexuality to regain its transcendental dimension, we need to integrate the awareness of death into it [1]. The fear of death brings anxiety into human sexuality, undermines trust in relationships, and can be expressed in various selfish forms of behaviour. This results in the loss of the most important aspect of the relationship, i.e., the potential for love to become free and joyful, and in that way to resist the assault of death. The person paralysed by fear of death, as it were, seeks to confirm his independence by proving himself superior to nature, or on the contrary, retreats and tries to merge with another force.

Yalom considers denial to be the primary way in which people try to transcend death, and he shows that this may be expressed in a range of maladaptive forms, such as the desire for power. The individual tries to avoid his fear and feeling of limitation by enlarging his self and his sphere of influence. According to Yalom there is some evidence that people who choose occupations concerned with death (soldiers, doctors, priests, employees of funeral parlours) are partly motivated by a need to control their anxiety about death [2].

In psychotherapy it is acknowledged that the issue of death may evoke what is known as a “liminal” or “boundary” situation, i.e., something that may initiate a radical shift in the view on life, and the restructuring of the individual’s values in life, or, it may be a source of anxiety that cripples the individual. Yet, even such an individual can look for, and eventually find, meaning in his situation. Thus, after a few months of therapy a person, who is at first completely paralysed by the prospect of his life partner’s death due to cancer, can come to terms with the situation, and the fear of death can be reduced by turning to the possibility of living a life that is meaningful in the here and now. In short, life cannot be postponed to another time. Many people with a terminal diagnosis only live life to the fullest in the period when they are seriously ill. Some cancer patients actually say, “What a pity that I had to wait for my body to give out before I learned to live…” [3] this testimony brings us back to life, to its beauty in spite of all losses. It shows that in the final phase of life, life itself becomes more intense.

Death leads us to put trivialities into perspective, and let them go. It helps us to say goodbye to the ballast, the deposits in our life which can become a sort of routine, and offers us a chance to jettison everything we want to clear out of our lives. Often we live in accordance with the expectations of others. Death actually leads us to our inner selves, to our core, to what we really are. It inspires us to turn to others, to an enlarged perception of others and ourselves, and in fact to a more intensive relationship to ourselves [4]. Joseph Campbell argues that the individual discovers the meaning in his life only when he is dying. Everything that forces us to awaken, that makes us aware of what we value in life – the importance of our own authenticity and living according to our own values - is again and again clarified when an individual is dying [5].

In psychotherapeutic practice the therapist often meets people who do not know how to recognize what is essential. Some think that the most important thing is their career, or sexual attractiveness and suchlike. Psychotherapy employs various methods to encourage such people to distinguish the important from the secondary. One of these is dis-identification. It involves a patient writing down an answer to the question “Who am I?” on eight different cards, and then arranging them in the order of importance. Then the patient has to consider which cards are the most dispensable. All cards are supposed to be discarded one by one [2]. The objective of this exercise is to teach us not to cling to all that surrounds us but rather develop a clear awareness of who we are; to make us realize that we are neither a teacher, nor a parent, nor an eternal helper, and in this way we should find the essential ground of our own self. It is precisely in this situation, of being thrown back on the very basis of his self, that a dying person finds himself or herself.

Logotherapy and existential analysis uses Frankl’s conception of values, which he divides into creative, experiential and attitudinal. As it is rare for a dying person to be able to realize creative and experiential values, he turns to spiritual, attitudinal values. Viktor Frankl writes about the case of a young woman whom he met as a fellow-prisoner in a concentration camp. The woman knew that she would soon die, but was still cheerful: “I am grateful to fate for treating me so harshly, because in my earlier life as a citizen I was too spoilt and had little in the way of spiritual ambitions. This tree here is my only friend in my solitude”, she said, and pointed through the window. Outside stood a chestnut tree just about to blossom [6]. Frankl tells us without sentiment that this is a story testifying to human greatness, to immense inner power. Another example that Frankl uses to demonstrate the realization of attitudinal value is the story of a young man who was in hospital as a result of an inoperable, very advanced spinal tumour. He had been unable to work in his profession for a long time because of the crippling effects of the disease. He no longer had any chance to implement creative values, but he could implement experiential values. He spent his time in spiritually stimulating conversations and reading good books. As time went by, however, his paralysis worsened and he could not hold a book in his hand. He was forced to turn to attitudinal values. In his case the value was expressed in how bravely he bore his suffering while still being able to encourage the other patients. The day before his death he asked his doctor to give him morphine in the evening so that the doctor would not have to get up in the middle of the night to give him another dose [7]. These true stories show the importance of the role of attitudinal values in terminally ill people, and the possibility of their development. They are also examples of the frequency with which the issue of death appears in psychotherapy.

The death of a loved one intensifies awareness of death. For many people, not only in therapeutic practice, the death or a threat to the life of a loved one means confrontation with their own death. You start to look for the meaning of what you are living through.

How is death perceived in the present days? Most people live to be seventy or more but a not insignificant proportion of the Czech population is still dying before being fifty. Every year roughly six thousand people younger than fifty die in the Czech Republic. Olga Nešporová has researched the ways people explain the differences in the length of human lives. She thought that she would be able to divide respondents into two groups according to whether they believed length of life to be pre-ordained by fate, or just a matter of chance. The religious faith of respondents turned out to be an important parameter. Believers were strikingly more likely to favor either the idea of fate or the idea of chance as determining longevity, while non-believers mostly did not see fate and chance as separate categories [8]. Some Catholics formulated their beliefs about the length of life in these terms: “… everybody gets a certain number of years that he or she lives here on earth. If we believe in an eternal mind that created this world, then we, Catholics, definitely believe that the length of our lives is pre-ordained” [8].

More than half the non-believing respondents (17 out of 30) believe that the way we live has no influence on how we die. Moreover, a fifth of them emphasize their own conviction that death is not fair. In other words, these respondents do not see a moral life and a “good death” as causally related. The most frequent view taken by the non-believers is that there is no direct relationship between what a person has done in his life and the way he dies. This can be illustrated by a typical answer from such a respondent to the question whether death or the way that a person dies is related to the way in which he or she has lived: “I don’t really think so. I think you can basically live as you wish, and death just comes. It’s fair, I mean death is fair, in the sense that no matter whether we live in wealth, poverty; in sin or virtuously, whether someone steals, and another doesn’t steal – death simply comes, and we are all equal in that, and that’s it. I don’t think the way people die is connected with the way we live. I believe that people, who have never hurt anyone and so on throughout their lives, can still have a painful death, being bedridden and the end being bad. So, I think death is fair in the sense that it comes to everyone, but I don’t see justice in the way it comes to one or another” [8].

From the conversations with the non-believers it was clear that many of them had not tried to find an explanation for the things that happen around them – I mean the relationship between dying and its deeper nature, or possible patterns in the relationship between the life and the death. One reason was the fact that most of the non-believers were unconvinced of the existence of any such simple and universally valid rules and relationships. It was the believers who were more likely to see an either/or dichotomy between fate and some rational connection between the life and the death. It is interesting to point out that Olga Nešporová in her research only encountered reference to the original sin of Adam and Eve as explanation for death among Jehovah’s Witnesses; none of the Catholic or Protestant respondents mentioned this spontaneously [8].

In her book Marie Svatošová considers the spiritual needs of dying people in detail. She herself says that it is hard to take a correct and neutral standpoint with regard to people who think differently. What she means here is not a different view about religion, but an overall different kind of thinking. In perspectives on death or at death, religious and non-religious views may often intersect and overlap [9].

Another woman, a Catholic, interpreted the course of life in a way similar to the non-believing woman cited earlier: “It’s simply that we are born, we have a candle and we die […] what are to happen will happen and we can’t prevent it in any way [8].

In this place we ought to point out that the understanding of dying and death can change in people who were originally not religiously oriented. For example, in a hospice where we held conversations with dying people it was clear that religious matters, issues of life after death, and the existence of “Someone” had become relevant to them [10]. Marie Svatošová also notes that among some people, the imminence of death may lead to the accentuation of spiritual needs [11].

The perception of death through the eyes of contemporary religious believers

Whether or not religious, everyone recognizes that death unquestionably means the end of a person in his form up to that point on Earth. Not just a view of death itself, however, but of what happens or does not happen after death, is implicated in the kinds of meaning and significance that every person variously attributes to his life. Religion, which gives death a particular meaning, still plays a key role in the formation of these ideas among the believers. For someone who genuinely believes in the existence of a merciful God, who welcomes you with open arms, and a life continuing after death, death and dying has a different context than it does for someone who does not. In the Czech society one can encounter a range of basic meanings attributed to death among believers. The most frequent include: death as a transition, watershed or turning-point; death as a part of life; death as the most important moment of life; death as a purely bodily matter; death as an unnatural matter [8]. Death as a turning-point, a watershed, is the most view most often mentioned. The Christian conception of death is the theme of Tomáš Halík’s book “Last Things” in the Christian Tradition [12].

Members of the traditional mainstream churches – Catholics and Protestants alike- are the most likely to refer to death as a turning-point. One respondent for example said: “Death as such is just a moment, a turning point, a transition from one state of being to another.” Similar views were voiced by another respondent: “It is certainly true that death is part of life, that it is the culmination of life or a kind of turning-point in life.” Another female respondent said, “For me death probably means a turning-point, and I don’t have much of a clear idea about it. In death I see a parting, which I can’t somehow get beyond mentally, but at the same time something new, a breakthrough” [8].

Hope among the very ill is closely bound up with faith in God, but conversations with patients showed that it is hard to assess the depth of faith of individuals. Patients who are believers express a conviction that there is “Someone” here, that the suffering gives meaning to their illness and helps them to uncover spiritual values [10].

From the testimony of the people interviewed by Olga Nešporová it emerges that religious believers see death not as a definitive state, but as a transition to something new, another form of existence somewhere else, a certain continuation. This involves a sense of the overcoming of death; for Christianity death does not have the last word. The idea of the overcoming of death is perhaps the most vividly represented in the gospel text on the raising of Lazarus. Respondents in the study cited suggested a kind of “resurrection of the dead”, i.e., the granting of an eternal blissful communion with God. For members of the Hare Krishna movement, for example, death was the most important, key moment of life. In answer to a question on the meaning of life one said, “Death is essentially very important, the most important moment in the life of every human being. And death is actually the most important point, because it is the decisive point; in the moment of death the nature of our future destiny is decided…” Another member of this movement also understood death as a crucial moment and said in the interview, “That is what it is about, that death is the crucial moment. Life is like a preparation for death, where everything that we have done throughout our lives is clearly projected. The time when a person leaves the body is the time he thinks about that the most, and his future life will correspond to it; it is there that he will go” [8]. For Hare Krishna believers, then, death has huge meaning, just as for Catholics and Protestants. The Jehovah’s Witnesses take a distinctively different view. They see death as unnatural and as a punishment for Adam and Eve’s disobedience to God’s command. Other believers see death for the most part neutrally, as necessary and inevitable, and some believers say that they fear death itself less than dying.

In the Christian context we should add that the funeral service asserts that the last things be guided by hope in the continuation of another life [12].

The perception of death among non-believers

Olga Nešporová talked to both believers and non-believers. In her analysis of the answers of non-believers it emerged that most of them did not think about death as such in an abstract way and, in fact, they attributed no specific meaning to it. These people neither had made any very clear assessment of death nor had they set it in the context of life. Most often they said that death was “a natural part of life”. They emphasised that death was a natural thing that simply belongs to life. Another aspect that was mentioned was the age at which a person dies. Today death is regarded as more natural, the later the point at which it occurs. As one respondent said, “I think death is a natural part of life. And mainly, when a person gets sick and dies young, or children die, that’s bad. But when an old person dies, then that’s somehow natural” [8].

It was characteristic of the views expressed by non-believers as opposed to believers in the conversations that the former attributed no special meaning to death. They apparently did not try to explain death in any way and some of them seemed to have consigned death to the margins of their thinking and not to consider it at all. They often said that they saw no specific meaning to death and had no idea of what meaning it ought to have. The only thing that they were able to say was the general sentiment that “death is part of life and no-one escapes it”. A minority of these respondents had thought about death in connection with the death of loved ones. For them death meant above all the loss of loved ones and the resulting pain. This approach was mainly to be found among those who had already experienced the death of parents or siblings and had been deeply affected by it. In some testimonies we find the idea of justice and inevitability of death. In a way this is a kind of reassurance of the self about the naturalness of death and an attempt to give it some positive feature, here justice [8].

In the case of people in the hospice it was obvious that in serious illnesses faith played an important role. People who before coming to the hospice had not considered themselves believers were finding different values and often thinking about God [10]. Among people who were not seriously ill the situation was different.

The reason why the majority of non-believers found it very difficult to speak of the meaning of death was that they did not speak about it much with other people. Among non-believers death is often marginalised as a theme and even taboo. One female respondent said, “Mainly I think that in my generation, whether in school or anywhere else, nobody ever said anything about it. It’s like that. So for example I might read, or someone might tell me, that when his mother or grandmother died they had still had her at home and said goodbye to her, but in my time….well these people are taken to hospital and they die there. So you don’t say goodbye to them or anything. I think we weren’t brought up to do that; we are not at all familiar with it. With death” [8]. This remark shows that death still tends to be pushed out of consciousness and thought of as something not to be talked about or reflected on – a taboo.

Overall the interview results supported the findings of various sociologists to the effect that in modern society there is a great deal of denial about death.

In the depths of our hearts the fear of death appears to be a fear of void, of non-being, of non-living out our lives to the fullest, of the nothingness of our life task. For therapeutic work, it is important to make people realize that the transience of life increases our joy of living. Limits in the joy increase the value of the joy; limits in the time of life increase its preciousness.

Viktor Frankl always claimed that it is the possibilities which are the only truly ephemeral aspects of life. They are not spared of ephemerality and thus saved until they are implemented. For therapeutic practice, it is therefore important to lead people to make decisions. The individual often already knows what is good and right, but without that step of “decision” it is hard to fill up the life. Therefore, good therapists encourage their clients not to fear making decisions as long as they have their life in their hands. Fear of death is nurtured by the experience of non-lived out life. Living to the fullest is conditioned by our realization that our life is finite. Another very important aspect in the psychotherapeutic practice is forgiveness. Leading individuals to forgiveness in life is sometimes a long but meaningful process. The aspect of forgiving oneself is a process that happens within time, and it is important that the person would get close to his or her inner self, and to experience the feeling of affection to themselves) and of the joy of being and living. Therapist’s patience is the key issue in this process.

Of course, the approach to death and dying is conditioned by the culture of the country. The Czech Republic is a country, which is affected by 40 years of communism, which is still obvious in the way the issues of death and dying are addressed by the society. Denial of any spiritual facet of human nature and orientation to life without selftranscendence took their toll as is evident in the way of life of the people nowadays. Death is displaced and perceived as a loss. It is taken as a kind of evil and in terms of materialism, death is the final end.

In every culture there is a specific approach to dealing with death, with loss. It may be more or less solid framework, linked with the core of understanding, with spiritual beliefs, with expectations, and etiquette. Death evokes strong emotions; for example the Americans mourned openly at the death of President Kennedy or Dr. Martin Luther King, not only as individual members, but also as a community. Another example of how a culture deals with loss and suffering is Bali. In Bali suffering is seen as something harmful that needs to be overcome by laughter. It illustrates that although tears of sadness are a common symptom, it is not a universal constant. Another example of differences in cultural dealing with loss is the Middle East. Women are supposed to wail, scream, beat their chests or collapse into each other’s arms when they deal with death.

It is obvious that every culture has its own way of coping with loss. In terms of psychology, life and death merge together, death is part of life, because we think about it during our lives and thus we actually get ready for it. If we blocked death out of our inner life, we would lose what makes life meaningful - the responsibility for the present moment, the realization of each moment that has its boundaries.

Existential analysis offers a wide variety of ways as to how a person can seek meaning, and although it is not easy, it teaches us that it is possible to find meaning at all times. Whether in terms of creative, experiential attitudinal values that we take up facing the givens. Life, facing the time limitation caused by the unavoidable death, has one more meaning – the time itself is perceived differently, there is a shift in values from the ones of status, career, wealth etc., to those of freedom and love. The notion of death makes life more valuable.