Stafford Betty talks about "Terminal Lucidity" in Chapter 9. It's basically when people who have no way to speak or think due to a severe loss of brain function (i.e. advanced Alzheimer's disease) suddenly recover their cognitive abilities and say good to bye to loved ones. Shortly afterwards, they die. Apparently, due to palliative care (morphine and sedatives), these cases have become rarer, but they still happen.I wonder about people who have brain diseases (like Alzheimer and such) or who suffered a severe stroke, and whose consciousness has started to recede/leave their body while the body continues to hang on. They're clearly 'not there' anymore; they even see or hear stuff that nobody can see or hear (they see people in the house, even talk to them, or try to pick up stuff on the floor that is 'not there', for ie).
Here's an excerpt:
An elderly woman never speaks, no longer recognizes her loved ones when they come to visit, and shows no expression. By the looks of her, she is a human vegetable. And she’s been this way for over a year. Her brain’s cerebral cortex and hippocampus—necessary for memory, thought, language, and normal consciousness—are severely shrunk. Her brain bears little resemblance to a healthy one.
Yet something utterly astonishing is about to happen. As reported by both the nursing staff of her care unit and her family members, “Unexpectedly, she calls her daughter and thanks her for everything. She has a phone conversation with her grandchildren, exchanges kindness and warmth. She says farewell and shortly thereafter dies.”
Similar cases have been scattered side notes in the medical literature, but recently a small body of researchers, such as Bruce Greyson, Professor of Psychiatry and Neurobehavioral Sciences at the University of Virginia, and biologist Michael Nahm in Freiburg, Germany, have begun to take a careful look at the phenomenon and agreed to call it terminal lucidity, or TL. Professor Alexander Batthyany, who teaches cognitive science at the University of Vienna, is currently running a large-scale study of the phenomenon–-the first of its kind. He is sending out detailed questionnaires to caregivers of Alzheimer’s victims, mostly nurses and medical doctors, and as the questionnaires trickle in, new mysteries arise as fast as older ones are clarified. The case cited above comes from Batthyany’s database.
Almost all brain scientists have assumed up until now that a severely damaged brain makes normal cognition impossible. But Batthyany’s preliminary results, presented at the 2014 IANDS (International Association for Near-Death Study) Annual Congress in Newport, California, suggests that normal cognition, or lucidity, does occur in spite of a severely damaged brain—not often, but in about 5-10% of Alzheimer’s cases. And only when death is very near. This has led him to wonder how terminal lucidity—which he describes as “close to a miracle, given what we know about brain function and cognition”—can occur. What is actually going on during those amazing moments? We know that there is no observable change in the brain—the cerebral cortex doesn’t suddenly grow billions of new neurons—so what accounts for TL?
Conventional brain science has no explanation. It has long assumed that as the brain goes, so goes the mind; for the brain is what gives rise to the mind, it claims. The return of mental clarity and memory in a brain ravaged by Alzheimer’s is not supposed to happen. Yet it does in some cases.
When we broaden our horizon, we discover that terminal lucidity is not unique to Alzheimer’s patients but occurs in other conditions. In 2007 Dr. Scott Haig, an assistant clinical professor of orthopedic surgery at the Columbia University College of Physicians and Surgeons, described a case in a lung cancer patient, David, whose brain had been destroyed by the cancer following metastasis. The term “terminal lucidity” hadn’t been invented yet (it wouldn’t be until 2009), but what he described in Time Magazine fit the paradigm perfectly:
[David] stopped speaking, then moving…. The cerebral machine [the brain] that talked and wondered, winked and sang, the machine that remembered jokes and birthdays and where the big fish hid on hot days, was nearly gone, replaced by lumps of haphazardly growing gray stuff. Gone with that machine seemed David as well. No expression, no response to anything we did to him. As far as I could tell, he was just not there. But just before his death, with his family surrounding him, he became lucid. A nurse on the floor witnessed the event:
He woke up, you know, doctor—just after you left—and said goodbye to them all. Like I’m talkin’ to you right here. Like a miracle. He talked to them and patted them and smiled for about five minutes. Then he went out again, and he passed in the hour.
Dr. Haig didn’t use unscientific language like “miracle” to portray what had happened, but he didn’t back away from saying what really happened either. He described David’s mind as “uncloaked.” It had somehow loosened itself from the brain:
…it wasn’t David’s brain that woke him up to say goodbye that Friday. His brain had already been destroyed. Tumor metastases don’t simply occupy space and press on things, leaving a whole brain. The metastases actually replace tissue. Where that gray stuff grows, the brain is just not there…. What woke my patient that Friday was simply his mind, forcing its way through a broken brain, a father’s final act to comfort his family.
If consciousness, or the “mind,” is separated from the brain at death, then the mind is free to go its own way. The dead brain has no claim on it.
Some of the most striking cases of terminal lucidity take us back to the 19th and early 20th centuries, when, surprisingly, there was far more readiness to investigate the phenomenon than in the later 20th. No one has delved into these old cases more thoroughly than Dr. Nahm. Not only did he invent the term “terminal lucidity”; his lengthy historical survey of TL written for The Journal of Near-Death Studies is, at present, the gold standard for anyone interested in TL. His analysis of its causes are even more important. (As of this writing, TL is such a new field that no one has yet written a book devoted exclusively to it.)
Here is a typical case, from 1921. A man had been housed in an insane asylum (the term used for a mental hospital in earlier times) for many years. One day the man’s brother got a telegram from the asylum’s director, saying that his brother wanted to speak to him.
He immediately visited his brother and was astonished to find him in a perfectly normal mental state. On leaving again, the director of the asylum decently informed the visitor that his brother’s mental clarity is an almost certain sign of his approaching death. Indeed, the patient died within a short time. Subsequently, an autopsy of the brain was performed, to which [the brother] was allowed to attend. It revealed that the brain was entirely suppurated and that this condition must have been present for a long time.
The author of the article asks: ‘‘With what, then, did this brainsick person think intelligibly again during the last days of his life?’’
The most extraordinary early case of terminal lucidity comes from Friedrich Happich, the director of a German asylum from 1913 up to the mid-1930s. Peter Ringger summarizes the event:
One of the most disabled patients of Happich’s asylum was Käthe. From birth on, she was seriously retarded and never learned to speak a single word. She could only utter animal-like voices; her bodily abilities did not exceed uncontrolled spasms. It never seemed that she took notice of what was happening around her even for a second. One day, Happich was called to immediately visit Käthe by a physician and psychiatrist of the asylum, Dr. Wittweber. Käthe was ill with tuberculosis and she was about to die. When entering the room, Happich was stunned. He continues: ‘‘We did not believe our eyes and ears. Käthe, who never spoke one word, entirely mentally disabled from birth on, sang the dying songs to herself. Specifically, she sang ‘Where does the soul find its home, its peace? Peace, peace, heavenly peace!’ over and over again. For half an hour she sang. Then, she quietly died. Her face, up to then so stultified, was transfigured and spiritualized. Like myself and the present nurse, the physician had tears in his eyes. He stated repeatedly: ‘I cannot explain this in medical terms. If demanded, I can prove by autopsy that … from an anatomical perspective, thinking could not have been possible.’’’
Nahm is especially impressed by this case, for “there was no return of previously available faculties but, rather, the emergence of a qualitatively new bodily skill, namely speaking. To my knowledge, no materialistic theory of psychology or neurology to date could account convincingly” for such a case: “brain physiology is of only minor importance.”