By Kiera Laehy

Humans possess a unique capacity to contemplate our mortality and imagine a world that continues without us. However, in contemporary Western culture, the prospect of our own or a loved one's death, however inevitable, is often perceived as a traumatic loss that instills fear and dread. We avoid discussing death with loved ones. We have few rituals or practices aimed at preparing us emotionally, during life, for our own or a loved one's death. Since our brains are hard-wired for survival, this aversion is a natural consequence of our innate drive to safeguard our existence. Although people almost universally wish for a long and healthy life, sometimes we face a prognosis that life will be cut short, and this is experienced physiologically as the mortal threat that it is. The brain's default stress response, often called the "fight-or-flight" response, is designed to enhance our ability to confront imminent threats to survival (Caldwell, 2018). When endured over weeks, months, or even years, the stress response takes a toll on both mind and body. However, understanding the concept of neuroplasticity—the brain's ability to change in response to experiences—opens the door to creating a different physiologic and emotional experience around death with reduced distress and a sense of peace and acceptance.

 Often, we are unprepared to cope with unexpected news of our own or a loved one's impending demise, and this can cause a range of distressing emotions, including shock, anger, fear, and grief. Neurologically, we go into survival mode; the brain's limbic system will signal the "fight-or-flight" response, summoning the sympathetic nervous system to high alert to overtake or evade the perceived threat to survival (Shulman, 2018). Our amygdala releases a cascade of hormones and inflammatory agents, increasing heart rate and respiration as it prepares us to save ourselves (LeWine, 2024). This physiologic response can negatively impact our ability to sleep, eat, think clearly, and function in daily tasks, compounding distress, fear, and grief. Although the fight-or-flight state is well adapted for confronting acute and short-lived threats, enduring chronic stress for long periods is harmful, emotionally and physically. "The distress caused by an overactive amygdala reflects the price of inheriting an evolutionary primitive mechanism that prioritizes survival over the quality of life" (Diamond and Zoladz, 2017). Confronting death in this state will diminish the quality of life during the precious time that remains, and prolonged stress impairs our ability to cope with the diagnosis. 

Because the brain is plastic, we can consciously override fear and stress reactions triggered in the limbic system and cultivate alternate neuronal pathways that promote tranquility and reduce fear. As noted above, neuroplasticity refers to the brain's ability to reorganize neural connections based on experiences. Depending on habitual thought patterns and actions, neuroplasticity can either enhance or degrade brain function (Kolb & Whishaw, 1998; Davidson & McEwen, 2012). Low to moderate stress levels can enrich brain connections in the cerebral cortex, the uniquely human part of our brains responsible for cognition, reasoning, and executive functioning, where strong connections improve memory and reduce fear responses. Acute stress or severe chronic stress does the opposite, strengthening the neuronal connections in the limbic brain and resulting in increased anxiety and fear (Shulman, 2018). Usually, the limbic brain and cerebral cortex are in a state of balance, with the limbic surveilling for threats without being overactive and the frontal cortex allowing for cognitive functions such as reasoning and judgment (Shulman, 2018). This study teaches us that even when facing death, it is possible to engage in habits that will produce positive connections in the brain's cerebral cortex and override fear and distress produced in the amygdala. 

How individuals perceive death as either the ultimate threat or an inevitable part of life ultimately shapes the rewiring of neural connections related to this concept. Hebb (1949) proposed that "neurons that fire together wire together," highlighting a fundamental aspect of neuroplasticity where repeated activation of neural circuits establishes default responses. As noted, such circuits that default to fear and anxiety will produce negative physical and emotional impacts. Chronic stress and persistent negative thoughts associated with death can lead to hyperactivity in the amygdala, heightening anxiety and fear responses. These physiological reactions, in turn, increase the brain's sensitivity to stressors (Roozendaal et al., 2009). Those who allow the limbic system to drive their responses to a death prognosis will default to more fear and stress, with weakened cognitive functions carried out by neurons in the prefrontal cortex. Decision-making, attention, and impulse control would all be negatively impacted (Arnsten, 2009). Additionally, chronic stress can hinder neurogenesis in the hippocampus, impacting memory and mood regulation (McEwen et al., 2015), among other harmful consequences. 

Neuroplasticity demonstrates the brain's remarkable ability to override default pathways and offers hope for experiencing death with less fear and greater peace. Mindfulness practices, such as meditation, offer a promising approach. Meditation is a powerful yet often overlooked tool for coming to terms with mortality. Meditation fosters neuroplasticity in ways that can mitigate the impact of stress on brain function (Davidson & McEwen, 2012). By strategically utilizing mindfulness, individuals can develop a more adaptive response to thoughts of death, potentially reducing chronic stress and its detrimental effects on cognitive function and emotional well-being. Meditation practices cultivate present-moment awareness, increase a sense of conscious connection to the now, promote the ability to detach from undesired emotions, and potentially facilitate acceptance and peace around the prospect of death. Studies indicate that meditation can modulate brain activity, promoting relaxation and reducing anxiety (Lazar et al., 2000). For instance, functional MRI studies demonstrate that mindfulness meditation alters neural responses in regions associated with stress regulation, enhancing emotional coping mechanisms (Zeidan et al., 2011). Moreover, mindfulness-based interventions have shown decreased psychological distress and improved the quality of life in patients preparing for surgery or managing life-threatening illnesses (Johns et al., 2015). Neuroimaging has also demonstrated that mindfulness meditation can alter neural connectivity patterns in areas related to emotion regulation, self-control, and self-awareness (Figure 1) (Tang et al., 2015; Fox et al., 2014). By strengthening neural pathways that support mindfulness and emotional resilience, meditation provides individuals facing mortality with a framework to confront existential uncertainties calmly and with acceptance. This analysis of meditation aligns with philosophical traditions that emphasize embracing life's impermanence as an intrinsic aspect of the human journey. 

In addition to meditation, emerging research demonstrates the potential of specific psychedelic agents, such as Psilocybin, also known as "magic mushrooms," in fostering acceptance and reducing fear of death. Studies show that Psilocybin can induce profound, mystical experiences that can lead to lasting changes in attitudes toward death and dying (Griffiths et al., 2016). Studies have found that psilocybin-assisted therapy can significantly reduce anxiety and depression in patients with life-threatening illnesses, providing them with a sense of peace and acceptance regarding their mortality (Figure 2) (Griffiths et al., 2016). Neuroimaging studies reveal that Psilocybin affects brain regions associated with emotional processing, often resulting in decreased activity in the default mode network (Figure 3, and 4) (Carhart-Harris et al., 2012), linked to the sense of self and ego. 

This framework of acceptance and resilience is beautifully illustrated in Gustav Klimt's painting "Death and Life," which is a stunning portrayal of mortality and acceptance (Figure 5).  In this artwork, death, depicted as the Grim Reaper gazing at life, symbolizes the inevitable cycle of life and death. The portrayal of individuals of all ages illustrates life's continuous and interconnected nature. Looking at death without fear, the woman in the top left embodies acceptance, a theme in line with philosophical and spiritual traditions acknowledging death as a natural part of existence. By presenting death not as a menace but as an integral component of existence, the painting encourages viewers to embrace the beauty of life while accepting its impermanence. This depiction resonates with the idea that practices such as meditation and using Psilocybin in a therapeutic setting can foster acceptance and tranquility in the face of mortality. Just as Klimt's painting suggests a cyclical and accepting view of life and death, modern neuroscience and psychological interventions provide tools for individuals to navigate their own existential journeys. These tools can help people achieve a state of acceptance and serenity, much like the woman in Klimt's painting who looks at death without fear. This holistic approach to coping with mortality gracefully demonstrates the timeless wisdom of accepting life's impermanence while fully embracing its moments of beauty and joy.

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