Beyond Symptom Reduction: The Existential Roots of Psychological Distress

What Terror Management Theory reveals about the mental health crisis

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In March 2020, I was deep in research for my master's program in existential-humanistic psychology when San Francisco became the first city in the mainland United States to issue a shelter-in-place order due to the emerging COVID-19 virus. As the reality of lockdown settled over the city, my tendency to catastrophize was in full swing. As I suspected, we were in it for the long haul. By month 3 of the pandemic, data revealed the scale of what was unfolding: depression symptoms had surged from 6.5% of the population in 2019 to 24.3% by June 2020, while anxiety symptoms jumped from 8.1% in 2019 to 25.5% in those early months.

Suddenly, mortality reminders were everywhere. The theory I'd been studying, Terror Management Theory (TMT), wasn't just academic anymore; it was playing out in real time as the world grappled with an inescapable confrontation with death and fragility. But maybe that's exactly what had drawn me to TMT in the first place—its elegant simplicity: the one thing we can know for sure as humans is that we're going to cease to exist, and that's fucking scary, so of course many people try to avoid thinking about it.

The scale of psychological distress related to COVID-19 was [is] unprecedented, and it was a blessing and a curse to be in grad school during this time. On the one hand, I was studying this emerging crisis through the lens of existential psychology; on the other, it is damn difficult to think critically and creatively when your brain is being melted by a COVID-induced brain fog.

What I discovered in my research shaped how I understand what we all experienced and are, I believe, continuing to experience. Through immersing myself in TMT and the study of human behavior, I’ve come to believe that our unconscious terror of death may be driving much of modern psychological distress. While traditional therapy focuses on symptom reduction, the evidence points to mortality awareness as a hidden engine behind our mental health crisis—and paradoxically, engaging with this awareness directly may hold the key to healing.

Unconscious vs. Conscious Mortality Reminders

Developed by Greenberg, Solomon, and Pyszczynski in the late 1980’s, Terror Management Theory postulates that much of human behavior stems from the tension between our awareness of mortality coupled with our biological drive to survive. When faced with reminders of death—whether through climate change, political upheaval, global pandemics, or other happenings of everyday life—we unconsciously engage psychological defenses to manage the anxiety that results from mortality salience, the term for when death-related thoughts become accessible or prominent in consciousness.

The theory predicts that when our cultural worldviews fail to provide adequate buffers against death anxiety, when our belief systems can’t adequately protect us psychologically, we might experience mortality-related anxiety. It seems likely to me that this is at play in our current mental health crisis. Our hyperconnected world ensures constant exposure to reminders of fragility and impermanence. Endless notifications and feeds of harrowing world-wide news stories deliver a constant stream of salient mortality reminders.

For me personally, this research starts to get especially fascinating during the early 2010's, when scientists discovered something that challenges traditional assumptions about mortality awareness: the conscious consideration of mortality doesn't lead to automatic defenses against death anxiety. Instead, it can "enhance physical health, shift goal priorities, and foster more positive behaviors when individuals are given adequate resources” (Vail et al., 2012).

The crucial distinction appears to be between conscious and unconscious death thoughts. While unconscious mortality reminders often trigger defensive behaviors that are tied to personal worldview and self-esteem—prejudice, materialism, rigid adherence to cultural norms—conscious mortality contemplation can lead to more positive trajectories of terror management. When people consciously engage with mortality, they gain an opportunity to shift from extrinsic, status-oriented goals to intrinsic, personally meaningful ones.

Why Traditional Therapy Falls Short

What emerges from this research challenges fundamental assumptions about mental health treatment. Traditional therapy often falls short because it focuses on symptom reduction without addressing what Irvin Yalom identified as the four fundamental existential givens: death, meaninglessness, isolation, and freedom. We're medicating anxiety without acknowledging that much of it may stem from our unconscious terror of not existing—and without recognizing that anxiety itself can be profoundly beneficial.

As Rollo May distinguished, there's a crucial difference between "normal anxiety" and "neurotic anxiety." Normal anxiety is "the human being's basic reaction to a danger to his existence, or to some value he identifies with his existence," expressed proportionately to real threats (May, 1953). This kind of anxiety serves as "nature's way of indicating to us that we need to solve a problem" and can help individuals "strengthen their consciousness of themselves" to better navigate a frightening world. When we pathologize all anxiety, we lose this vital source of growth and self-awareness.

This may explain why so many people report feeling stuck when using traditional treatment approaches—we're treating the symptoms while the existential roots remain unaddressed. Adam Lewis's work on TMT Integrated Existential Therapy (TIE) offers a different framework, one that encourages clients to confront their mortality within a supportive therapeutic alliance rather than avoiding existential concerns altogether. The goal isn't to eliminate death anxiety but to transform it from unconscious terror into conscious acceptance that facilitates authentic living.

The research suggests that our current mental health crisis isn't just about individual pathology. It appears to be about a collective confrontation with mortality that many (most?) people avoid through numbing and distraction rather than facing consciously. Understandably so, since this is perhaps the most uncomfortable truth we can face.

The Path Forward

We're living through what may be the most existentially challenging period in human history—climate change, global pandemics, political upheaval, and technological disruption that constantly reminds us of our fragility. Steven Pinker would argue I have this backwards. By his data, we're living in the safest, most prosperous, longest-lived era in human history. Violence is down, literacy is up, extreme poverty has plummeted. He's not wrong about the numbers.

But here's what Pinker's optimism may miss: material progress doesn't inoculate us against existential dread. If anything, our unprecedented safety and prosperity may make the anxiety worse. When your great-great-grandmother worried about mortality, it was because cholera was sweeping through town or her crops were failing. Her death anxiety had a clear, addressable target. Today, we've solved many of those concrete threats, but we're left with something more troubling—the pure, undiluted awareness of our finitude without the direct distraction of immediate survival concerns.

The disconnect between material progress and existential distress may be exactly why our responses to the current mental health crisis largely ignore its existential dimensions. Some might argue that existential dread is nothing new—people faced the horrors of two world wars, the Black Death, countless famines and catastrophes. But I'd argue we've never before had this particular perfect storm: multiple overlapping global crises, combined with 24/7 media coverage that ensures we're constantly bombarded with mortality reminders from every corner of the planet. Previous generations might have faced immediate, localized threats to survival, but they weren't simultaneously aware of every earthquake, conflict, and climate disaster happening in real time across the globe.

We keep applying 20th-century solutions to 21st-century problems, treating symptoms that emerge from a fundamentally different kind of suffering than previous generations faced. What we need now, I think, is the courage to embrace the entirety of life—the beautiful, the terrible, and everything in between—rather than numbing ourselves to avoid the most uncomfortable truths. The path forward isn't about eliminating death anxiety, but transforming how we relate to it.

In a world that feels increasingly absurd, turning towards our mortality with conscious intention may be the most radical act of psychological healing available to us.