NEWPORT BEACH, Calif.—Occasionally, just before death, people with Alzheimer’s disease or dementia who’ve been completely incoherent for many years will seem to return suddenly to their senses. Their memories, personality, and entire mind—so long shrouded by the disease that loved ones had lost hope of their return—shine forth in a final blaze. This phenomenon is known as terminal lucidity.
Some say it refutes the philosophical argument that the “soul” is merely a function of the brain.
The late philosopher Paul Edwards made his “Alzheimer’s Argument Against the Soul” in 1995. He used the example of “Mrs. D.” Mrs. D was a kind and generous lady, often helping others. Alzheimer’s drastically changed that. “All her elegance was gone. She no longer recognized her children, and then in the advanced stage, became extremely aggressive. She who always helped others and was kind to others suddenly started to beat up other elderly patients,” quoted Robert Mays, a near-death experiences researcher. Mays gave a presentation on terminal lucidity at the International Association for Near-Death Studies (IANDS) 2014 Conference on Aug. 30, on behalf of Dr. Alexander Batthyany, a professor in the cognitive science department at the University of Vienna.
Edwards argued that the case of Mrs. D shows the mind or soul does not exist separately from the brain. When the brain is damaged, the person’s mind is damaged. Mrs. D was kind when her brain was functioning, but her personality disappeared when her brain ceased to function properly, proving that the brain creates the mind.
Batthyany said that Edwards makes an “intuitively compelling” argument. But terminal lucidity may suggest the mind is not destroyed with the brain, Batthyany said.
If the mind were dependent on parts of the brain for existence, it is hard to see how a whole person—a person who can make connections between this memory and that, a person who can calmly and rationally interact with others and perform coherent actions—could return. If parts of the brain were so badly affected by the disease, one would expect only a fragmented individual to remain.
Batthyany asks whether Edwards’s argument would be as compelling if the loss of cognition were only temporary. What if Mrs. D were in a state of drug-induced confusion or some dream state with effects similar to Alzheimer’s? Would it make a difference in how Edwards viewed the case if Mrs. D’s mind returned to normal functioning and her personality remained intact?
In terminal lucidity, it almost looks as if the mind distances itself from a diseased brain, if only briefly, and close to the actual dying process, said Batthyany. When one reads such reports, one cannot help but get the impression that the mind is also hidden behind and constrained by the brain, he said: “Much like the moon eclipses the sun, the brain eclipses the self.”
The Data
Further studies need to be done on terminal lucidity to understand the phenomenon and all of its implications, Batthyany said. In a survey of 800 caregivers, only 32 responded. These 32 caregivers had cumulatively cared for 227 Alzheimer’s or dementia patients. About 10 percent of these patients had a sudden and brief return to lucidity. However, these caregivers were self-selected, warned Batthyany. The low response rate may well mean that the phenomenon is rare, and that we received replies primarily from those who had witnessed terminal lucidity in their dying patients. Currently, we do not know how often the phenomenon really takes place. Most people with dementia still die with dementia. Yet cases of terminal lucidity have a lasting impact on those witnessing them.
A caregiver was quoted as saying: “Before this happened, I had become fairly cynical about the human vegetables I cared for. Now, I understand that I am caring for nurslings of immortality. Had you seen what I saw, you would understand that dementia can affect the soul, but it will not destroy it.”
Studies carried out by Michael Nahm and Bruce Greyson, including one published in the Journal of Nervous and Mental Disease in 2010, are based on analyses of recorded cases from 100 years ago or earlier. More current information is needed, Batthyany said.
‘Thanks for Everything’
A few cases were cited in Batthyany’s presentation, including the following: “An elderly woman with dementia, almost mute, no longer recognizes people, non-expressive. Unexpectedly one day, she called her daughter and thanked her for everything ... [she] had a phone conversation with the grandchildren, exchanged kindness and warmth, and said farewell, and shortly afterwards, she died.”
In another case study, the patient was mute and disoriented and hadn’t seemed to notice or understand when her husband, whose name was Urs, died. A few months after her husband’s death, she sat up in bed, stretched out her hand, and said, “Urs! Yes, yes, ready.” She died shortly afterward.
Though this case was somewhat ambiguous, Batthyany said, it was nonetheless untypical of hallucinatory delusions sometimes observed in Alzheimer patients in that it was calm, orderly, and based on traces of memory that hadn’t been observed in the patient in a long time. It also showed a similarity to many near-death experiences, in which people who have brushes with death or who die for a few moments before being resuscitated often report seeing loved ones who help them “cross over.” Near-death experiencers also often report hovering above their physical bodies, seeing beings or scenes in the afterlife, feelings of euphoria, et cetera.
A Philosopher’s Take
As he seeks further scientific data, Batthyany considers also the words of philosophers. He quoted Spinoza: “You can have light without shadow, but you cannot have shadow without light.”
Lucidity, the mind’s normal state, is the light. Dementia and confusion are the shadows.
Batthyany also said: “You can have truth without error, but you cannot have error without truth.” Error is a deviation, as dementia and Alzheimer’s are deviations from the brain’s normal functioning. There may yet be a true mind or a light shining behind the distorted shadows of the disease.
Batthyany closed on a cautionary note. Terminal lucidity research is a very young field, and it would be premature to draw strong conclusions from the little data currently available. We still do not know what is happening and how it is possible that some of these patients who have been lost for years return to cognitive lucidity in the presence of severe brain pathology. Batthyany’s research also shows that terminal lucidity episodes tend to be relatively brief (between 30 minutes and 2 hours) and are therefore easy to miss. The only strong conclusion so far seems to be that we should never cease giving attention to dying patients—whether demented or not—as end-of-living experiences such as terminal lucidity have deep impact and give warm consolation to family, friends, and caregivers, whatever the wider implications may be.
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