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Do People Suddenly Gain Clarity About Life Just Before Dying?

A small number of cognitively challenged or dementia patients become lucid — for the first time in years — just before dying

The percentage of people who suddenly become lucid on the point of death may be small but their stories are remarkable. The best known case was that of Anna Katharina Ehmer (1895–1922) who, due to mental disabilities, lived in a psychiatric institution called Hephata in Germany for most of her life (from 1896 to 1922). She

… allegedly never spoken a single word during her life. Yet, she was reported to have sung dying songs for a half hour before she died. The case was reported by the head of this institution and by its chief physician. We consider it difficult to evaluate the authenticity of the case definitively in retrospect. Nevertheless, there are similar cases and a variety of other anomalous brain-related findings we consider worth investigating. Studies into such anomalous cases might improve our concepts of human brain functioning and of mental processing in persons with mental disabilities, and might be of special value for the dying, the bereaved, and caretakers.

Nahm M, Greyson B. The death of Anna Katharina Ehmer: a case study in terminal lucidity. Omega (Westport). 2013-2014;68(1):77-87. doi: 10.2190/om.68.1.e. PMID: 24547666.

In a 2018 article, Zaron Burnett III recounts that no one was expecting that: “The doctors and hospital staff who witnessed Anna’s concertina for Death were rendered speechless themselves; some sobbed in bewilderment; others felt they’d witnessed a miracle of the soul.”

A fluke? But it’s not that rare. In 2018, nurse educator Marilyn Mendoza wrote a pair of articles for Psychology Today on such cases, noting researchers Alexander Batthyány’s (and Michael Nahm’s) efforts to gather data:

So far, the response rate to the questionnaire he distributed has been limited. While the results are in no way definitive, out of the 227 dementia patients tracked, approximately 10 percent exhibited terminal lucidity. From his literature review, Nahm has reported that approximately 84 percent of people who experience terminal lucidity will die within a week, with 42 percent dying the same day.

Marilyn Mendoza, “Why Some People Rally for One Last Goodbye Before Death” at Psychology Today (October 10, 2018)

She also offers a more recent instance:

Nahm gives the example of a 91-year-old woman who suffered from Alzheimer’s disease for 15 years:

“The woman had long been unresponsive and showed no signs of recognizing her daughter or anyone for the previous five years. One evening, she started a normal conversation with her daughter. She talked about her fear of death, difficulties she had with the church and family members, and then died a few hours later.”

Marilyn Mendoza, “Why Some People Rally for One Last Goodbye Before Death” at Psychology Today (October 10, 2018)

Mid-twentieth century palliative care pioneer Elisabeth Kübler-Ross (1926–2004) apparently noted the same thing in some patients: “‘We observed that these patients with dementia and so on, they suddenly lighten up, or they become clear again shortly before this.” Such episodes can last anywhere from a few minutes to several days.

Terminal lucidity might easily be dismissed as the fond imagination of the bereaved, except for two things: We mainly notice it when the dying person had not been capable of such feats beforehand. That is, a usually lucid person who dies soon after saying something lucid won’t attract much attention. But when a person’s multi-year mental fog lifts just before death, we seek some explanation. Second, as Mendoza has noted, it’s not even that rare.

The term terminal lucidity was first coined by German biologist Michael Nahm who studies the phenomenon. He and psychiatrist Bruce Greyson, author of After (2021), define terminal lucidity in a paper as

… the unexpected return of mental clarity and memory shortly before the death of patients suffering from severe psychiatric and neurologic disorders

Nahm M, Greyson B. The death of Anna Katharina Ehmer: a case study in terminal lucidity. Omega (Westport). 2013-2014;68(1):77-87. doi: 10.2190/om.68.1.e. PMID: 24547666.

There is no current medical explanation for the phenomenon:

In essence, terminal lucidity is a mysterious flash of life and vitality that occurs in people just before they die. It’s most remarkable in people who have dementia, Alzheimer’s, meningitis, brain damage, strokes or were in a coma. There’s no known medical explanation for where this sudden surge of vitality and functionality comes from. In large part because as suddenly as it comes, within a few hours or even a day or two, it fades and the person dies, taking any answers with them.

Zaron Burnett, “Terminal Lucidity: The Researchers Attempting to Prove Your Mind Lives On Even After You Die” at Medium/Mel Magazine (September 26, 2018)

One researcher of such experiences, University of Vienna cognitive scientist professor Alexander Batthyány, holds the Viktor Frankl Chair of Philosophy, Psychology, at the University of Liechtenstein. He became interested in near-death phenomena through his contact with Frankl, a mid-twentieth century psychiatrist and Auschwitz survivor who stressed the importance of meaning in life, via a clinical approach called logotherapy. Batthyány finds it hard to account for terminal lucidity in terms of the “adaptation for survival” of a human animal:

“What we observe with near-death experiences is that they’re enormously ordered, structured, clear thinking and very elaborate experiences. Which, evolutionarily speaking, they’re not very adaptive, yeah? Quite on the contrary. A near-death experience keeps a person much more peaceful than perhaps they should be when they’re defending against an aggressor like death.”

Zaron Burnett, “Terminal Lucidity: The Researchers Attempting to Prove Your Mind Lives On Even After You Die” at Medium/Mel Magazine (September 26, 2018)
Closeup of hand female caregiver holding oxygen mask with cute child patient in hospital bed or home,little girl putting inhalation,doctor or nurse intensive care,health care,support,help concept

Some findings from research on the topic are quite interesting, for example:

➤ If it is a religious experience, it doesn’t seem to play favorites:

That said, there has been one important finding to emerge from his data — terminal lucidity occurs for atheists and believers at the same rate. “I would’ve thought maybe religious people are more, you know, willing to see the unexpected. But the unexpected — if it does come — comes no matter who you are or what you believe,” Batthyány concludes with a satisfied lift in his voice.

Zaron Burnett, “Terminal Lucidity: The Researchers Attempting to Prove Your Mind Lives On Even After You Die” at Medium/Mel Magazine (September 26, 2018)

One of Batthyány’s mentors, as he told Burnett, was John Beloff, (1920–2006) an atheist who nonetheless believed in survival after death. He himself is uncertain what he believes and would only say “the more you look into — not necessarily the evidence, but into the stories of the ones who witness terminal lucidity — it’s hard not to believe them. But frankly, I don’t know. I really don’t know.”

➤ Terminally lucid persons tend to focus on “reminiscing, preparations, last wishes, body concerns, such as hunger or thirst, as well as an awareness of their impending death.”

➤ Sometimes, that last burst of lucidity is a disappointment for survivors. Mendoza explains, “Family members often view this as a miracle, and as a result, often expect that their loved one will make a full recovery, only to discover that death is not far behind.”

As she points out, more study of that last burst may help us understand dementia better and point the way to treatments:

This research has the potential to “eventually point to novel mechanisms underlying cognitive decline, identify potential preventive or therapeutic approaches for individuals with dementia, offer more effective strategies for caregivers, and perhaps even expand our understanding of the nature of personhood and consciousness.”

Marilyn Mendoza, “Terminal Lucidity Revisited — The mystery continues” at Psychology Today (September 30, 2019)

Zaron Burnett concludes that “As we rule out physical causation, we’re left with few explanations other than the radical Cartesian notion of Dualism,” as we try to understand terminal lucidity.

Actually, while dualism is unpopular in many quarters, it isn’t all that radical. There are a number of varieties of dualism other than the Cartesian one. Dualism is just a corollary of the observation that some things we experience, like information, are immaterial by their very nature, yet they are just as real as material ones.


You may also wish to read: Your mind vs. your brain: Ten things to know


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Do People Suddenly Gain Clarity About Life Just Before Dying?