Terror; the Worm at the Core

Physicians should be hopeless. Not that they should be mean, give up, or so brutally honest that all that remains is the maw of the grave. Rather, they should believe in the spirit and strength of each man and woman. If healers are honest, positive and supportive, patients can deal with even horrible situations.   Each doctor’s calling is to help patients cope, not offer blind, baseless hope.


Terror Management Theory (TMT) is the concept that all human behavior is driven by the fear of death. We all want to live, are conscious we will die, and spend every moment of life desperately coping with eternity.


Developed from the early twentieth century writings of Psychoanalyst Otto Rank, and the 1973 Pulitzer Prize winning book, “The Denial of Death,” by Ernest Becker, TMT proposes that what we love, what we hate, what we create, what we destroy, and how we look at the world, is built on our terror of mortality. We are always trying to deal with death by finding some piece of immortality in our daily life.


The Worm at the Core; On the Role of Death in Life,” by Solomon, Greenberg and Pyszczynski, is an important book and a major advance in this critical conversation. The authors have spent the last 30 years performing over 500 experiments evaluating the TMT hypothesis. They have studied at length, in a wide range of populations and conditions, what happens when a person is reminded or stimulated to think about death. In Worm, they have now brought that critical research together. Their news is not good. Any thought about death alters our behavior in ways that do not say good things about what it means to be human.


Their studies show that Judges reminded of mortality, met out punitive justice. Individuals who think about death, crave wealth and power. The more we are concerned about death, the more we become violent, even if being violent would in no way direct way protect us. We follow irrational leaders, if they offer a cause or dominating worldview that gives the possibility of immortal purpose.   Our views of intimacy are twisted; even considering carnal relations increases death-related thoughts and actions.


Written for a broad audience, a mix of stories and science, Worm is a long awaited analysis advancing and supporting Becker’s theories. It blends hard behavioral research, sociology, psychological theory and anthropology. Worm should be required reading for leaders, planners, and anyone seriously trying to understand mankind’s behavior. Its ideas are vital, if we are to prepare for the future. Fear of death drives us all. Perhaps man’s greatest paradox and flaw is that we destroy each other and ourselves because we are terrified that death will destroy us.


Those who study TMT fall, broadly, into two categories; those that believe man is a doomed species, who will never be able to cope with his terror, and those who believe there is “hope.”   The authors conclude that mortal fear is the greatest threat to man, but we must and can “come to terms with death.” They note that the worm in the apple’s core, first sampled as in the Garden of Eden, must be recognized and accepted. We must understand the hold death terror has on each of us and build meaning with “courage, compassion and concern for future generations.”


This brings us back to my patients. I have seen, through a long career, the strength and power of individuals to understand their illness, when given support and honest information. Even at the end-of-life, I have witnessed transcendent moments of wisdom, sharing, forgiveness and love. Fear, ignorance and loneliness do indeed threaten every man and woman. Nonetheless, I believe that the greatest hope is our remarkable, powerful and nearly infinite ability, to contemplate, communicate and cope.




The Worm at the Core; On the Role of Death in Life

Sheldon Solomon, Jeff Greenberg, Tom Pyszczynski

Random House, New York    2015 274P


  • Elaine Nwcomb
    Thank you Dr.Salwitz, for letting me know of another tool to put in my advocate bag. I am ordering this book today.
  • meyati
    I'm not scared of death. I'm scared of the extreme pain caused by cancer, and how I haven't been given anything to control pain in trauma. They don't care that I vomit and shake, faint-while I'm covered with dog bites. They give me lidocaine to for stitches then I'm on my own. Things like that- I'm allergic to acetaminophen-can't take Oxy-and they call me a dope addict. I've torn up scripts for oxy and asked them what dope addict does that? They say that they don't care.
  • D Someya Reed
    I haven't read this book (but now plan to) so my comments may be premature. However, I don't believe that all of our lives and all that is in them can be reduced to: 1. I'll do 'this' today because I could die tomorrow. 2. I'll do 'that' today so I won't die tomorrow. I would hate to think that every selfless and/or heroic act of ultimate sacrifice (ending in death) is solely motivated by a sense of immortality in the history books and a fear of death so strong that the hero feels that this is as good a time as any to get it over with (that is, die and face the fear). And if fear of death is so motivational of all things then why would test subjects need to be reminded or stimulated to think of it? Isn't it always there? How could this be done without bias? Is 500 subjects a good sampling to represent over 7 billion? There is supposed to be a section(s) in the book on coming to terms with death but if this fear is as ingrained in us as they appear to claim won't that simply be avoidance? Perhaps they explain all this. Guess I'll find out when I read the book. But I have to think, if fear of death is so pervasive in our societies as well as our psyches shouldn't I be afraid to read the book? Perhaps my grandfather was on to something when he said, "You don't smoke, drink or cuss. Are you from this planet?" Actually, they were traits of my dad's that I just didn't want to share. See now I'm thinking how would a son wanting to be the opposite of his alcoholic, abusive father be motivated by fear of death? Especially when one of the father's favorite expressions was "I put you on this Earth, I can take you off." Seems the safer, less fear-inducing route would have been to be just like him; though, in my opinion, that didn't work out so well for my older brother who was (like him) but then surpassed him. Perhaps someone reading this post is thinking I simply had a "death wish." Not that I recall. Though I have to admit that I did see saving the world from those who would destroy it even though it meant surrendering it to those whom you may not have wanted to have control of it (James Franciscus and Charlton Heston in 'Beneath the Planet of the Apes') to not be a bad way to go. But, hey, I was a kid. When my father learned he was dying, he said that of all of his children (there were a lot of us which I likened to army-style living) I was the only one of whom he was proud. Not because of anything I did exactly but more because of what I chose not to do. At the time, he was certainly aware of his mortality. I wonder how Becker and the authors of “The Worm at the Core; On the Role of Death in Life” would incorporate this into their research? How would such a statement be motivated by fear of death as one is dying? But then I'm not a fan of 'reductionism' especially taking the complexities of all of our lives and reducing them to any single element be that fear or otherwise. I do tend to believe, from the sum of experiences, that the simplest answer is usually the correct one but this fear of death motivation as the single answer just seems too narrow of thinking. Similar, perhaps, to the conclusions and misconstruing of the Stanford Prison Experiment that each of us has some dark, evil, sadistic person at our core based on some people's fear of the authority and others strong domination tendencies along with others sense of detachment when doling out punishment. Shockingly, this book is available at our small Ag town library. I have to ask the librarians how they came to choose this book for their collection.
  • jill mckenzie
    Great post! I always find it interesting how being human we self obsess and intellectualize our wonderful existance and end of life. Stage 4 grade 2 infiltrating ductal carcinoma. Fear of death? I fear pain and not having control over my life..but think death is part of life. I just have to much I want to do and a son I love so I just do not want to. Book sounds like a keeper!

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