Terminal Lucidity, ‘the last goodbye’

I think it is safe to say that a correlation between normal brain function and mental processing capacity is generally assumed. Mental processing embraces all that people can do with their minds including the capacity for thinking, decision-making, perception, emotion and memory recall. The correlation suggests that if a person’s brain function deteriorates their mental processing capacity will too. This may generally hold true but certain exceptional end-of-life experiences challenge this. Terminal lucidity is one such experience.
So what exactly is terminal lucidity? In essence, it is the unexpected return of mental clarity and memory, shortly before death, in patients suffering from severe psychiatric and neurological disorders. Among these neurological disorders are meningitis, brain tumours and strokes, as well as the condition I have chosen to focus on in this blog, Alzheimer’s disease.
You may well be personally familiar with this incredibly challenging neurodegenerative condition. My own father suffered with this disease and I felt such deep sadness, tinged with an unwanted sense of resignation, as I witnessed the slow but relentless destruction of his memory and thinking skills. Of him. Some of my clients living with loved ones who have Alzheimer’s think of it as ‘the loss of their loved one before they are gone’. They share with me that they are grieving for a living person. Others speak of their experience with Alzheimer’s as the ‘total absence’ of their loved one, an absence that is associated with years of no recognition, no memory, no responsiveness and no reactive communication. But for some, terminal lucidity changes this.
Shortly before death, at a time when the brain is at its most compromised, the Alzheimer’s patient who experiences terminal lucidity has a sudden surge – one that brings a bright demeanour; clear, coherent and consistent thinking; the renewed ability to communicate; as well as the capacity to remember and recognise loved ones. The dying Alzheimer’s patient briefly returns as the person their loved ones remember – clear thinking, communicative and with memory seemingly intact. A gentleman in his 80s, for example, who had been suffering with Alzheimer’s for many years, unexpectedly became animated, engaged in communication and clearly remembered the family member he was speaking to. He said that he wanted to say goodbye as he thought he was going to die soon. Thirty six hours later he slipped away.
Dr Rudolph Tanzi, a Harvard Alzheimer’s disease specialist, describes it this way:
“Terminal lucidity happens, even in Alzheimer’s patients who are barely conscious, who are barely responsive… we hear about it all the time. How, suddenly, a patient can, just before death, say their goodbyes to their loved ones, remembering their names, maybe recalling an event after a decade or so of not learning, of having lost first their short-term memory and then their long-term memory… Well, it is a complete mystery. But it is undeniable that it happens, and it is amazing”.
Alzheimer’s disease is a progressive neurological disorder and at the time when the patient is nearing the end of their life significant, irreversible destruction of the brain has taken place. The brain has been compromised beyond any meaningful form of neuronal generation. It is because of this neurophysiological damage that terminal lucidity is regarded as unusual or ‘amazing’. It is also because of this that family members and loved ones, those who are with the patient as they near the end of life, do not expect the changes that terminal lucidity brings. They do not expect such a remarkable period of revival.
Medical professionals and loved ones bear witness to the extraordinary, yet observable, phenomenon of terminal lucidity. However, quite how these severely neurologically compromised, end-of-life patients return as the person the family remembers, engage and communicate with their loved ones, and say their last goodbye shortly before slipping away remains unexplained.
Further research in this area is needed both to understand the mechanisms and processes involved in terminal lucidity, as well as to heighten awareness of this phenomenon. Creating awareness may assist those who are with loved ones when terminal lucidity unexpectedly occurs to be better prepared for it, and to cope with these experiences more easily. Remarkable as this phenomenon is, it is not necessarily easy for family members to deal with. Some loved ones suggest that they found the experience unnerving or overwhelming. Others share that their loved one seemed as if they were ‘back to normal’ and they assumed their loved one had recovered from their illness. They felt disappointed that this was not the case. Many, however, say that they are very grateful, and always will be, for a connected farewell filled with special moments and the last goodbye.
Through my Foundation, the Transformative End-of-Life Experiences Research Foundation (TELERF), I am currently investigating terminal lucidity as an experience and its impact on families, caregivers and medical professionals. If you have directly witnessed this phenomenon, or if you have personally experienced terminal lucidity in a loved one, please consider sharing this with me. Feel free to connect with me at elaine@telerf.com if you are willing to do so. I look forward to hearing from you.

• Dr Elaine L Finkelstein is a registered clinical psychologist and a registered occupational psychologist. She is a chartered psychologist (UK) and an associate fellow of the British Psychological Society. Elaine is also the founder of the Transformative End-of-Life Experiences Research Foundation. The author of this blog is not dispensing medical or psychological advice, or prescribing the use of any technique as a form of treatment for physical, medical or psychological problems. The advice of an independent physician or mental health professional, either directly or indirectly is required for this. The intent of the author is only to offer information of a general nature to help you in your quest for emotional and spiritual well-being. In the event that you use any of the information in this blog for yourself, which is your right, the author assumes no responsibility for your actions.

COPYRIGHT NOTE: The author of this article, Elaine L Finkelstein owns the copyright over this blog and the Trade Marks: Transient-Death Experience, Shared Transition Experience and Nothing to Fear. Dying, Death and Beyond. You may contact her at web@elainefinkelstein.com. Elaine L Finkelstein grants readers permission to copy and distribute this column and distribute it free of charge, provided that copies are distributed for educational and non-profit use, no changes or revisions are made, all copies clearly attribute the article to its author and include its copyright notice and the author’s email address web@elainefinkelstein.com.