The Enigma of Terminal Lucidity

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Last year, I received a phone call telling me that my mother was seriously ill and would probably pass away in the next few hours. I rushed to the hospital and found my mum deeply unconscious, in a seemingly comatose state, completely unresponsive. I was told that she had dangerously low sodium levels and that her liver and kidneys were failing.

I sat with her for a few hours. Her condition seemed stable so I went home for some sleep, returning the next morning. Throughout the day, there was no seeming improvement or deterioration. It didn’t surprise me that my mum was proving more resilient than the doctors expected, as she had always been physically tough.

But the second morning, when I arrived back at the hospital, something had changed. The nurse told me with a look of surprise, “You mum is getting better.” I found her sitting up with her eyes open, breathing more strongly. I asked her how she was and she shrugged her shoulders and replied, “Not great, Steven.” I played some of her favorite songs on my computer, and to my surprise, she started singing along softly. She moved her legs and feet in rhythm to the songs. She drank some water and had some soup, for the first time since she had been in hospital.

The doctor told me, “It doesn’t seem possible – your mother is dangerously ill but somehow she seems to be getting better. We’ll wait a few hours and if she’s still like this, she can return to the nursing home.”

My mum remained alert for the next two hours or so. Then she fell asleep and didn’t wake up again. She returned to a comatose state and died early the next morning.

Terminal Lucidity

It’s by no means uncommon for people who are close to death to experience a brief surge of mental clarity and energy. In 2009, Michael Nahm and Bruce Greyson coined the term “terminal lucidity” for the phenomenon, although other terms have been used, such as “end of life rallying” or “pre-mortem surge.”

Most strikingly, terminal lucidity may happen to people who have suffered severe cognitive impairment for many years, perhaps due to dementia, a stroke or meningitis. People who have long been immobile and unresponsive may become agile and alert. People with dementia may regain their memory and other mental faculties, surprising their relatives by recognising them, remembering details, and speaking coherently. According to Nahm and Greyson, 43% of people who experience this brief lucidity die within a day, while 84% pass away within a week.

Recorded cases of terminal lucidity date back to ancient times. As Michael Nahm has noted in another article, “Hippocrates, Plutarch, Cicero, Galen, Avicenna, and other scholars of classical times noted that symptoms of mental disorders decrease as death approaches.” Nahm also cites a case reported by an early 19^th century physician, of a man who had been a catatonic invalid for 28 years but regained his awareness and the power of speech during the day before his death. The same physician describes the case of a man who was deaf-mute and never learned to speak coherently. However, shortly before his death he began to talk clearly.

In a similar but more recent example, Nahm cites the case of a 91-year old woman who had suffered from Alzheimer's for 15 years, For the last five years, she had been unresponsive, showing no sign of recognizing anyone. But one evening, she became more alert and started talking normally to her daughter, discussing her fear of death and her relationships with other members of the family. A few hours later, she died.

The above cases are more dramatic than my mum’s, but they demonstrate the same essential phenomenon: a strange surge of vitality shortly before death which restores mental faculties and physical strength. Then the vitality and clarity disappear, as mysteriously as they arose.

Explaining Terminal Lucidity

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Understanding Children’s Near-Death Experiences

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There is no explanation for terminal lucidity, at least as yet. From a medical point of view, it seems to make little sense. How can people whose brains are badly damaged become fully conscious again, demonstrating a level of alertness that they only possessed before their illness or injury? How can people who are so severely ill that they are close to biological death experience a powerful surge of energy, regaining physical agility and strength?

These questions must remain open. However, one intriguing aspect of terminal lucidity is what it suggests about human consciousness. Although many people assume that consciousness is produced by the brain, terminal lucidity seems to contradict this. If it were the case, how would it be possible for severely damaged brains to produce normal consciousness? That would be like a broken television producing clear images.

Along with other anomalous phenomena such as near-death experiences (which I have discussed previously in this blog), terminal lucidity suggests that human consciousness may have a more complex and mysterious source. According to the philosophical approach that I term “panspiritism,” consciousness exists beyond the human brain, as a fundamental and universal quality. The brain’s role is not to produce consciousness, but to transmit it, so that universal consciousness becomes our own internal consciousness. In these terms, terminal lucidity is equivalent to a last powerful surge in the transmission of consciousness, before the brain ceases to function as a transmitter, as physical death occurs.