EP. 112: TERMINAL LUCIDITY AT THE EDGE OF LIFE AND DEATH

May 14

WITH ALEXANDER BATTHYANY, PHD

The Director of the Viktor Frankl Institute discusses the fascinating phenomenon of terminal lucidity — moments when patients at the end of life, even those with severe cognitive impairment, experience a brief return of mental clarity and memory — and what this teaches us about dignity, kindness, and compassion.

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Episode Summary

Terminal lucidity is a mysterious yet well-documented phenomenon in which someone at the end of life—including those who have suffered strokes or other brain injuries, or those afflicted by dementia—suddenly returns with mental clarity and is able to recognize loved ones and engage in meaningful and emotionally rich conversations. It challenges our fundamental understanding and assumptions about the nature of consciousness, brain function in the context of severe illness, and personhood.

In this episode, Alexander Batthyány, PhD, a cognitive scientist and the Director of the Viktor Frankl Institute, offers insights on terminal lucidity from his years of study on this phenomenon from a philosophical, ethical, neurological, and psychological perspective. He is the author of the 2023 book Threshold: Terminal Lucidity and the Border of Life and Death.

Over the course of our conversation, he shares how witnessing terminal lucidity in his grandmother has shaped his life purpose, why he chooses to use the word “soul” in his academic research, the role of spirituality and religion in making sense of terminal lucidity, the limits of our scientific and materialistic understanding of the brain, what terminal lucidity reveals about the dignity and unpredictability inherent in the human condition, and what it ultimately teaches us about kindness and compassion.

Alexander Batthyány, PhD, holds the Viktor Frankl Chair for Philosophy and Psychology at the International Academy of Philosophy in the Principality of Liechtenstein and is Director of the Research Institute for Theoretical Psychology and Personalist Studies at Pázmány University, Budapest. Since 2012, Batthyány is Visiting Professor for existential psychotherapy at the Moscow University Institute of Psychoanalysis, Russia. He is Director of the Viktor Frankl Institute and the Viktor Frankl Archives in Vienna and first editor of the 14-volume edition of the Collected Works of Viktor Frankl. Batthyány has published over fifteen books and articles which have been translated into eleven languages. He lectures widely on philosophical and existential psychology, theory of cognitive science, and the psychology of death and dying.
In this episode, you will hear about:
• 2:31 - The personal experience that drew Dr. Batthyány to study terminal lucidity
• 6:34 - An exploration of human dignity
• 12:26 - The importance of talking and thinking about the human “soul”
• 18:26 - Definition and phenomenology of terminal lucidity
• 23:57 - What is known about brain functioning during episodes of terminal lucidity
• 31:44 - Advice for caregivers, family members, and clinicians if a patient experiences terminal lucidity
• 36:55 - The prevalence of terminal lucidity
• 40:14 - Whether individuals who experience terminal lucidity have insight into their condition
• 42:15 - Why phenomena like terminal lucidity matter
Henry Bair: [00:00:01] Hi, I'm Henry Bair.
Tyler Johnson: [00:00:02] And I'm Tyler Johnson.
Henry Bair: [00:00:04] And you're listening to The Doctor's Art, a podcast that explores meaning in medicine. Throughout our medical training and career, we have pondered what makes medicine meaningful. Can a stronger understanding of this meaning create better doctors? How can we build healthcare institutions that nurture the doctor patient connection? What can we learn about the human condition from accompanying our patients in times of suffering?
Tyler Johnson: [00:00:27] In seeking answers to these questions, we meet with deep thinkers working across healthcare, from doctors and nurses to patients and health care executives those who have collected a career's worth of hard earned wisdom probing the moral heart that beats at the core of medicine. We will hear stories that are by turns heartbreaking, amusing, inspiring, challenging, and enlightening. We welcome anyone curious about why doctors do what they do. Join us as we think out loud about what illness and healing can teach us about some of life's biggest questions.
Henry Bair: [00:01:02] Terminal lucidity is a mysterious yet well documented phenomenon in which someone at the end of life, including those who have suffered strokes or other brain injuries or those afflicted by dementia, suddenly returns with mental clarity and previously lost memory. They are able to recognize loved ones and engage in meaningful and emotionally rich conversations. It challenges our fundamental understanding and assumptions about the nature of consciousness brain function in the context of severe illness and personhood. In this episode, Doctor Alexander Batthyany, a cognitive scientist and the director of the Viktor Frankl Institute, offers his insights on terminal lucidity from years of study on this phenomenon from a philosophical, ethical, neurological, and psychological perspective. Over the course of our conversation, he shares how witnessing terminal lucidity in his grandmother has shaped his life purpose, why he chooses to use the word soul in his academic research, the role of spirituality and religion in making sense of terminal lucidity, the limits of our scientific materialistic understanding of the brain, what terminal lucidity reveals about the dignity and unpredictability inherent in the human condition, and what it ultimately teaches us about kindness and compassion.
Henry Bair: [00:02:24] Alex, thank you so much for joining us and welcome to the show.
Dr. Alexander Batthyány: [00:02:27] Thank you for having me. And I'm looking forward to a nice conversation. Thank you.
Henry Bair: [00:02:31] So, Alex, I was browsing in a bookstore recently when I came across your book, which came out last year titled threshold, Terminal, lucidity, and the Border of Life and Death. It caught my attention because even though terminal lucidity is something I've heard about several times in the hospice setting, it's not something I've ever discussed in my medical training or during my time on the hospital wards. Despite how many times I've taken care of people at the end of life. Your book strives to integrate your personal experiences and those of hundreds of case studies and patients you've interviewed, along with a scientific exploration of terminal lucidity. What drew you to study this phenomenon in the first place?
Dr. Alexander Batthyány: [00:03:12] My own grandmother had a couple of strokes and was cognitively severely impaired. It was almost impossible to talk with her to have a conversation. Yeah. One day displayed a beautifully lucid episode. Yeah. And this happened. I was a student in Vienna, and my grandparents lived in Geneva. And one day my mother calls me and and tells me, call her because we had a conversation. And that was unthinkable for at least a year or so. Yeah. And I called her. And I mean, the moment when you when you heard the click on the other phone on the other side of the phone and you have this very gentle person back again, very kind, very warm as she always was. Yeah. But now was once again able to convey via words, and not only by being present there. I relished it as a beautiful experience. But back then, and that was about 1999, so ten years before the first articles appeared on Terminal Lucidity. That was a wonderful experience. And that's basically it. Yeah. But then ten years later, in 2009, three papers were published on terminal lucidity independently of each other.
Dr. Alexander Batthyány: [00:04:26] And then I knew, of course, this is something, number one, I know that it can happen because I experienced it. Yeah. Now it had a name which was very important, and I think which is very also important for the contemporary debate on it. So often when things happen which are astonishing, which we can't, you know, put in on our landscape, once the country has a name, it's much easier to travel there, so to speak, and to talk about it and to share it. So and then when these when these papers were out, I immediately told my students. And this happened at the end of the term when students are overwhelmed with work anyway. So I always use the last units to talk about things which are not mandatory for exams, but just, you know, to show them how open and wide their fields actually are and to look at lesser known findings. On that very same afternoon, we founded a research group on this topic and started delving into it much more deeply. So there are different reasons.
Henry Bair: [00:05:28] Before you started working on this, what was your academic area of focus?
Dr. Alexander Batthyány: [00:05:33] My field is cognitive science and the theory of it basically, and philosophy of of psychology. And the question of basically of human personhood, which touches many, many areas. But I think one main subject was the mind brain relationship on the one hand and on the other, indeed, the psychology of death and dying, because this is the border area and the litmus test, if you want, where you can see how far do you notions of dignity, of irreducibility, of personhood. This is the testing ground, so to speak, to see how valid our ideas are. Because during lifetime, I mean, there are many conditions which are border areas. Suffering is one of them. Yeah. Also utter joy. And the question of gratitude in this case. And the other side of it is are you there or is it natural for us to be there when somebody is dying? And this tells us a lot about our views. It puts all of it to test.
Henry Bair: [00:06:34] So in many ways, I see that you are sort of perfectly positioned for this because your work is at the intersection of what you said cognitive psychology, neurobiology, a little bit of philosophy as well, which is interesting because early in the book, the first third of the book, before you even talk about terminal lucidity, you show that to talk about the meaning of it or what it tells us about the people who experience it, to be able to understand and have a conversation about that, we first need to have a shared understanding, if you will, of personhood, of self, of human dignity, which I was honestly a little bit pleasantly surprised at how often you use the words like soul in your book. Yeah. And I think a lot of people who are more scientifically minded might think, well, how can you talk and write scientifically about the human soul and about human dignity? These are things that are hard to measure, right? Yes, quantitatively. So I'm curious from your perspective, from your research and your personal experiences, from the conversations you've had with patients and family, what does human dignity even mean, and what does it look like to think and write about it?
Dr. Alexander Batthyány: [00:07:52] I should tell you that the publisher was slightly, I think, angry at me. There was a first version of the book where it wasn't a third on dignity, and the third, but actually 50% of the book. And he gave it back to me and said, you know, we won't sell this. Yeah. And I understand why it's not a criticism. Yeah. The stories, of course, are extremely strong in the sense of there, you see it that you can listen to people, but it seems to me to be important and, you know, scientifically speaking, about the soul, what few people I think many more people know about. But in the popular scientific discourse, maybe not. Materialism. In other words, claiming or the idea, the notion that mind is what the brain does and so on. It's either identical or reducible to, or a product of, and so on, is just one position in the question of the mind body relationship. Mind brain relationship. Yeah. And in proper academia there's a whole lot of people who are interactionists. In other words, they do sincerely think that they have good reasons to say that consciousness can't be reduced to anything unconscious. It's in and of itself an irreducible thing is the wrong word. Entity is the wrong word, but it's irreducible and idealism, which basically puts everything on, on its head. Yeah. And saying that, you know, whatever we measure means that we have a notion of measurement, which is knowledge of measurement. Therefore it's in the mind, and therefore everything is reducible to mind.
Dr. Alexander Batthyány: [00:09:23] All of these notions are ideas, and they'll never be a way. There can't be a scientific materialism, because in order to know what the world consists of, we'd need to step out of it and look at it. And good luck. How could we do that? Yeah. What some people would say, and I understand where they come from, is that we can only measure material relations and properties. Yeah, but unsurprisingly, if we use material measurement devices, of course, the only thing which will capture are material properties. But to therefore claim that there is nothing but is a philosophy, it's an ideology, it's an assumption. So I thought for a long time, should I use the term soul yes or no? And then I decided, yes, I should, because why hide the fact that there's a whole academic idea on on dualism or, you know, non-materialistic views on, on the person. Yeah. Now, when it comes to dignity. It is important. And maybe I should have pointed out a bit more clearer that we are persons with dignity, so to speak, is independent of the question of sole or not sole. Now, if you want me to define dignity, I'm reminded of Augustine when he was asked to define time and he said, you know, everybody knows what it is, but I can't put it into words. Yeah, but dignity. It's a bit like consciousness. Also, it's very hard to define. I mean, there are volumes, hundreds of them. We are trying to define consciousness and it's very hard. And yet we all know because we bathe in it, we live from it, so to speak.
Dr. Alexander Batthyány: [00:11:02] But for myself, and I'm sorry if this sounds utterly unacademic, but sometimes when I try to live up to what I try to convey in the book. Yeah, and I encounter someone who makes it difficult to see his or her dignity. I try to remind myself that this too, that he or she too once was a child and once was in the arms of his father or his mother, and they saw so much in him or her. And this is dignity. You see what I'm saying? So all of us, no matter you know, what the facade is and how we look like and how we behave, there's something about us which is which we know from ourselves. Here we can feel pain. We know how good it is to be accepted as we are. To be loved, and how even more beautiful it is to love someone or accept other people as they are. Yeah. So and there emerges a type of encounter, which I believe is the point of dignity. Yeah, it's very much a matter of dialog. And it happens not in one person, but when two persons encounter each other or if you go into nature, look at the beauty sometimes of an animal, for example, young and lovable, so to speak. Yeah. And all of this has the taste, the flavor of dignity. But I'm sorry that this is utterly unacademic, but still it does happen. What can we do? Yeah.
Henry Bair: [00:12:26] Yeah, I am absolutely inclined to feel, and if not so much think, but to feel the existence of dignity, especially when you are taking care of people who are ill. Certainly we know that there. I've seen instances when someone is treated within dignity like I recognize it. That's like that is not the right way to treat a human being like in the hospital sometimes. Right? We see that. And on the other hand, we see whether it's in the gentleness with which a nurse takes care of a patient who is shaking in pain, or a family member comforting a child who is at the edge of death or something. You see that it's like everyone, I think. I mean, I can't presume, I can't speak for everyone in the world, but I think most people who see scenes like that would be touched in a way that is indescribable and cannot be captured by words alone. That being said, I do have a question that I think would come to the minds of a lot of people hearing this conversation or hearing what you're saying. And that question is, is a sense of spirituality or religion to you? Do you think it is required for us to talk and think about the human soul?
Dr. Alexander Batthyány: [00:13:36] And that's a good question, since we are also talking personally, I should say that during the work on this topic, my views on religion got stronger, so to speak.
Henry Bair: [00:13:47] Tell us more about that. On this show we love to dive into that aspect of our guests life. To the extent, of course, that you're comfortable with sharing.
Dr. Alexander Batthyány: [00:13:55] Yeah, sure. So I've always I have a very fortunate life circumstances. Yeah. And I always. Thought, even if there's a lot to be grateful for. Yeah, that can't be it. Or let's put it other way, that shouldn't be it. Yeah. So at home, so to speak, that there is more to this life than meets the eye. Yeah. And this I carried with me for a long time, but and I looked in very, very different corners of the world. I mean of the world of ideas, if you want. And briefly before we started the work on turning lucidity or TL for short, I also looked at the near-death experience. And there, of course, you encounter people who, you know, they radiate when they talk about this. Yeah, they radiate a certain knowingness or knowledge or, you know, it's not a belief even. Yeah, they are utterly sure that they touched something beyond this world. And it is very real. Some of them, most of them telling it's much more real than our life here. Yeah. And so that's how they put it. So I knew that this is possible. People can have this certainty, but I didn't have it in that. I mean that's fine. Yeah. I've got a family. I've got enough love, so to speak, in everyday life with two daughters and so on, and my beautiful wife. But then when I studied lucidity, it dawned on me that all this talk about soul when John C Eccles talks about the soul at the end of his life, we had had an interview with him.
Dr. Alexander Batthyány: [00:15:28] He was 92, I think, very elderly gentleman. And Sir John C Eccles, once again Nobel Prize laureate in neurophysiology. And he said after a conversation, he said, you know, there's one thing I would like to tell you. I quote this in the book. There's only one thing which is really important. It's the nature of the self. And then he says, you can't capture it in material terms. So of course it's a pointer towards something else. Yeah, but knowing all of this is one thing, and then encountering so many stories and all the bits and pieces fall into one place and, and therefore there was a certain subtlety on my journey. But when I looked into this, I noticed that my acceptance or even relation to the transcendental grew much stronger. And I almost observed it. Yeah. And my wife told me, do you do you listen to what you're saying? Yeah. And ten years ago you would have said, I wish I believed this and now it comes naturally to you. That's my experience with this. Yeah. But very importantly at least, I believe now that we shouldn't treat ourselves, other people in the world in a kind way only if and because we believe in something beyond this world. So if you are, and there's a beautiful phrase in English, I think is the benefit of doubt in the sense of let others benefit of our uncertainty. So if somebody is unsure about whether there's more, I just remember a student of mine.
Dr. Alexander Batthyány: [00:17:05] So I used to be in Moscow. I had a visiting professorship. Now it's impossible because of political reasons. But there I tried to teach people in the house, work in the hospice here. And one of them one day came to me and said, you seem to believe in dignity and the meaning of life and all these things. Yeah. And he said, what can I do? I don't. And when I go there and treat my patients under my care and I wish good morning to them, I know it's not a good morning. He told the story. So there was this patient with pancreatic cancer. And he took care of her. Wishing her good morning every morning. But in the end he knew, let's say, a week or two weeks and she will be gone. What is good at this morning? And I try to convey to him, the nihilist maybe doesn't believe in meaning for him or herself, but for others we should. We should treat them as if. There was meaning and freedom with all the dignity, because then it emerges. There are certain things such as freedom, for example, which may be there. But if we don't utilize them, if we don't realize them, they could as well not be there. Yeah. And once we tune in to the tune of dignity, so to speak, then it emerges you. I don't know whether I can convey this, but.
Henry Bair: [00:18:26] Yeah, it is pretty hard to convey. And, you know, given that I personally I am a practicing resident physician and I deal with the life or death situations that you describe often. And a lot of our audience members are clinicians or future doctors, future nurses. I definitely want to revisit this concept later on in the conversation, and hear some of what other advice you might have for us, but for now, I do want to talk about terminal lucidity. And, you know, we've been having such a wonderful, rich conversation about your personal experiences, and we've been talking about human dignity and the soul from a more humanistic lens. I'd like to sort of take an interlude, if you will, and talk about terminal lucidity, but talk about the more scientific aspects, because this is exactly what your book does about part way through. Right? So can you tell us what exactly is happening in moments of terminal lucidity?
Dr. Alexander Batthyány: [00:19:20] The first thing which happens is something utterly unexpected, namely that persons who had severe brain disorders such as dementias, one of the dementias which are believed to be irreversible. What happens is that some of them we don't know precisely how many one prospective studies suggest. Anything between 6 to 8% or so do regain their memory, their ability to access their own biography, their ability to communicate. Yeah. And suddenly you put it in the word of the observers. They are back again. They lose it. Yeah. So terminal means it's towards the end. And this usually not always but usually happens, let's say anything between 48 hours to a few minutes before this person is going to die. And lucidity means he or she is back again. Yeah. And in the full sense, back again. Such as my grandmother. Yeah. It's not that she was slightly better. We talked about memories at the Geneva Lake. Even I had forgotten. Yeah. And then remembered. Yeah, yeah.
Henry Bair: [00:20:23] Although to be clear though, this this happens not just with patients with dementia, right? Oh, yeah. This can happen to anyone at the end of life. Right? A lot of people towards the end of life, they're a little bit, as we say, they're not really themselves because, you know, they're sort of they might be very weakened from their illness. But even in those cases, you do see instances when they have a surge of maybe I don't know what you want to call it, like energy or vitality. And that's what you're talking about, right?
Dr. Alexander Batthyány: [00:20:49] Yes, yes and no. Because the energy itself here, if somebody is really forgetful or let's say deluded, then only vitality would mean that he's much stronger, deluded, and he would share more of his delusions. Yeah. The point of lucidity is that not only are there and some of our informants tell us, my grandfather looked ten years younger suddenly, and the eyes were glowing once again. But this is the vitality aspect, which is known, but not as mysterious as the fact that somebody who is thought to have permanently lost his capacity for coherent verbal communication, for access to memory, and so on, suddenly regains all of these functions and in a strong way, because we conducted a study and we are still collecting cases and about 80 to now it's 85% do have really a full comeback. So not a slight, you know, in dementia or other brain disease. This is waxing and waning and it comes and goes. But the further advance the disease is the lesser it happens or the ceiling is so low that if it happens it wouldn't make much of a difference. Yeah. But what we see is that people do come back, but they come back for a very short time because it can take anything between most of the cases, around five, six hours, and they have beautiful conversations with their relatives. Once they overcome the shock that the person who they thought they would never be able to speak normally again with, yeah, shares memories. They sometimes order things which had to be done.
Dr. Alexander Batthyány: [00:22:29] I've got this art historian who, when he already had dementia, borrowed a few very valuable books from his from his colleague. He was he wasn't unable to read the captions, but he could at least relish the pictures. Yeah, but then he he declined. And he said on his deathbed, please return these books to my colleague because, yeah. So they try to put order in their lives before they leave. Yeah. And some things which need to be said are said. So it's very, very heartwarming. Yeah. And one of the reasons also why I tried to highlight this is, you know, there's a study by Peter Fenwick of London, about 80% of caregivers and also relatives are unprepared and they don't know how to handle this. But given that there's a time window of a few hours, yeah, it better be. Not that we waste them with being confused, but to relish the gift which which you are handed at this very moment. Yeah. So it's like if there's a beautiful song on the radio which has been. You never knew. How does it sound? Like, you know, what's the name of the group if it comes in the radio? Listen. Yeah. And later on we can reflect on, you know, what was this song? Yeah. And this is a bit like it's. It's a life event. It's a one time event. Yeah. As I said, it's mostly internal cases, so there won't be a rewind of it. Yeah. And therefore we try also to make people aware that this can happen.
Henry Bair: [00:23:57] So I've read your book. I've seen the studies. I've read the first hand descriptions, numerous accounts of people who've observed this. The documentation of this at least is really robust. And yet my training in medicine and and in how the mind works is so strong. Part of me still finds it so hard to believe this is even possible. I mean, when we're talking about people with Alzheimer's or other kinds of dementia or, you know, as you mentioned, your grandmother, vascular dementia, these are neurons. These are cells actually destroyed. And we know from studies that once destroyed neurons don't come back. That's by definition, neurons don't grow back in the brain. And so my belief that this damage is permanent and irreversible is so strong that I still can't believe part of me is like, how is this even possible? And yet I know it does happen. So can you tell us, based off of some other research that we've done, what is actually happening in the brains of people experiencing terminal lucidity?
Dr. Alexander Batthyány: [00:24:55] Yes. I mean, your disbelief... I do know I have to smile because I remember when this was still a very young field of study, the BBC, the British Broadcasting Corporation, one of the journalists, interviewed me and we talked about this. And when he switched off the microphone, he told me, but you don't want to tell me that this really happens. So in other words, now you can tell me. Yeah. But I mean by now it's well documented. But what's happening in the brain? It's a very good question. And the answer currently is we don't know why, because when it happens, it's spontaneous. It's an episode of unexpected. Clearly from the clinical pictures. Unexpected. Meaningful, spontaneous. We don't know what causes it, and therefore it's very hard to predict it. And therefore it's even harder to study it. Because if a patient, let's say, who has been gone for a long time, suddenly returns, you don't want to interfere. When the relatives are standing there and say, look, take him to the lab and see what's happening in his or her brain. What we do know for sure from older cases is anatomical studies tell us that there was no regrowth of neurons. And the idea that neurons regrow in an orderly fashion in such a brief time, at the point when, evolutionarily speaking, it makes the least sense because this patient is going to die anyway. It's terminal. No. It's very, very unlikely. I think what is possible but very, very unlikely. What's more likely is that it might inform us about a different model of the mind-brain relationship.
Dr. Alexander Batthyány: [00:26:37] And I know that this is also not unbelievable, but hard to believe. But Bruce Greyson, who's a professor of psychiatry in Virginia, and he came up with what I think is an interesting proposal, at least. Yeah. Namely, that so often in the history of science, we believe that we know something because we repeatedly observe the phenomenon. But as soon as we go to the outer limits, so to speak, when things in physics are very, very small or objects are very, very large, or they move in a very, very fast way, then, for example, the omnipresence and omni validity of Newtonian physics, everyday physics here no longer applies. And he says, so when we go to the extremes, the boundary conditions, new relations, new properties, new phenomena emerge. Now death and dying is an extreme condition. And perhaps that might be a key towards why people in near death, internal acidity, do suddenly display what seems to be a certain independence of mind on brain, or why, during the near-death experience, people. Which is also not overly conducive. Speaking of, you know, oxygen circulation in the brain, why they not only experience something, but very, very complex thoughts. They have insight when they come back and they have memories, and they have a very orderly experience at a time when you wouldn't expect it under normal circumstances, if you wish. So maybe that's a key.
Henry Bair: [00:28:12] Yeah. I've never thought about it in the way of the analogy that you mentioned with physics. It's true, right? Like Newtonian physics holds in like daily circumstances. But when things get very fast or when you zoom down to really slow, Newtonian physics breaks down and you have to use quantum mechanics. And then we know that if you go even smaller, push it even more to the extreme, then even that breaks down. And we have currently no unifying theory of everything, right? I've never thought about the human experience and the biology of it in those terms. But again, I'm not saying that there is a way that we can eventually reduce even terminal lucidity or life and death to just biology and neuroscience. Maybe we'll never get there, I don't know, but it's just fascinating that we do see this breakdown of empirical quantitative understanding in other realms as well.
Dr. Alexander Batthyány: [00:29:00] Yes. And of course, we know how dependent the mind is on the brain. I mean, the whole phenomenon of terminal lucidity accepts that our mind functioning is very, very dependent on brain functioning. And we know this when we are tired and the fever gets drunk, whatever happens, how do we reconcile this with the fact that suddenly when you expect that, you know, the brain shuts down, the person is dying? Yeah. Now a person who's already severely impaired is dying. Yeah. So why do you see the very opposite of what you expect? Yeah. It's not closing down. It's living. You're reliving once again. It's returning once again. Yeah. And Rayson's proposal I think is interesting that it would. I hope my book is just a drip, a drop in the ocean. It's hopefully one chapter in trying to rekindle a debate which in the philosophy departments is fairly strong, namely, you know, what is consciousness and within consciousness, what is self consciousness? And within that what is personhood? In other words, you know, a continuum of collecting memories and the experience of a lifespan and so on and materialism so far.
Dr. Alexander Batthyány: [00:30:13] Is strong in the sense that it would be a very neat explanation of everything. But the problem is, it doesn't explain a lot at the moment. It's only a promise that one day it will be possible. Yeah. And otherwise we only collect many, many correlations between brain events and mental events. But that alone isn't a theory. It's, you know, it's an ever growing catalog of inventory of mind and brain going together under normal circumstances. Yeah. And this is why death and dying is so interesting. I mean, there are many reasons why death and dying should be interesting to us because we all are mortals. But next to that, philosophically speaking, yeah. Why we should have a look. Because this is the very point where this would be possible. In principle, the brain and mind go different ways. Wow. Yeah. The only I mean, birth would be the other end, but nobody would start. I mean, it's a bit more difficult, but that it's possible. Yeah. And the few indications which we do have is something happens which is not precisely predicted by materialism.
Henry Bair: [00:31:16] Yeah, exactly. And you know, to your point about the materialism versus I don't know what the opposite of materialism is.
Dr. Alexander Batthyány: [00:31:22] Non reductionism because I mean there are different schools like idealism tells us, you know, matter basically is mind and therefore materialism is idealism. And so there are different ideas. Dualism tells us that, you know, next to the human body we've got a human soul, not only God, but are actually but let's say non reductionism.
Henry Bair: [00:31:44] Sure. Yeah. Speaking of this debate, you know, I can't help but feel that at least my understanding of personhood and self is almost exclusively tied to my memories, my experiences, and my relationships with other people. I mean, without my memories, without my relationships, I don't know if I am me anymore. And to the extent that my body is a component of that identity, it's only a component because my body allows me to have those relationships and to have those experiences, all of which are intangible there in my brain now. But those memories, I can't remove them and study them objectively, like from a third person perspective. Right. So it's interesting that you said that one of the things that caregivers often say is that they're back, like they as in the personhood of the patient, if only momentarily, it is back. Yes. That's a really fascinating perspective. Um, earlier you said that one of the reasons you wrote this book was because a lot of people you feel don't know what to do when this happens, when the person is back. Yes. Well. What would be your advice then, for the caregivers, for the family members, for clinicians? Now that we know this phenomenon exists, they can recognize it when they see it. Okay. What next?
Dr. Alexander Batthyány: [00:33:04] The answer must be simple. For the simple reason that it can't be in nature, I hope. At least not yet. That you need someone like me to tell you what to do because you know it should be enough, so to speak. What I believe is that just be there and don't question. Enter the relationship. You know, what's happening is, um. And that I always found astonishing. Even my grandmother told me I've been very tired for the past few months. And that was a very kind understatement of being almost not there. Yeah, yeah. And that was it this once. And then she wanted to move and to say thank you for being such wonderful grandchildren. My brother and me. And I thankfully had the sense of telling her, you know, thank you for being such a, you know, wonderful grandparent in Geneva and how warm and how and we just relished the moments. And the question what's happening? And so on. This can come later. Yeah. One informant. So one relative who was in severe dispute with his grandfather, told me on the spot, I decided I will forgive him. And later on, when he's gone, I will work it all out. Yeah, but let's say the benefit of doubt, of generosity in this case. Yeah, because he is here right now. Yeah.
Dr. Alexander Batthyány: [00:34:24] And I don't want to carry with me the wound of not being kind at the time when it was the last time to be kind. And I mean, these are all the wisdom teachings, all wisdom of elderly people or of wise people. Yeah. Condense in this very moment. So it's nothing new. It's something which we all know. And you don't even need to read a book. Just if we ask ourselves what would we like it to be when it's our time to go, let's imagine that we, you know, our window opens once again for a few hours. What would we like to have? Yeah. So people are holding hands. One of them, a patient, asked for chocolates and her granddaughter said, I never in my life saw somebody relish and celebrate a piece of chocolate, as she did celebrate her last piece of chocolate. Yeah. So it's all very humane in a way, in a human and humane in a sense. And there's a wonderful saying by Martin Heidegger. And Heidegger was a complicated person, politically speaking. But Heidegger said one thing, which I try to remember every time I see someone I find difficult or not difficult. Yeah. Namely, wherever humans are, metaphysics happens. Wherever a human being is not even doing something, but just being someone. Yeah, means we are the exception.
Dr. Alexander Batthyány: [00:35:42] If you look at this vast universe here and we don't know, is there life out there? Is there conscious, self conscious? But we do know here now that there are about 8 billion, I think, cells running around, all of them with their own dreams and hopes and experiences and I think vast knowledge and experience and wisdom. Yeah. And if we then zoom in into a patient room where somebody is having term lucid episode, relish this because this is unique and somehow is entrusted to you because you are the one who's there during his or her last hours. And I think with this awareness, we should be both grave and light grave in the sense this is really unique and light in the sense of, you know, every day people die and there are eight billions of them. And. It's like in music when you have two tones in the harmonize, it's on the one sense. It's very grave and the one sense is just a beautiful encounter. And then it's fine. Yeah, but if people get shocked and wonder, why do you come back and you know, they want to discuss, that's not the time that can come later. And and it takes a time then afterwards to come to terms with having witnessed such an episode.
Henry Bair: [00:36:55] Yeah. Experience first. The understanding can come later. That is, uh, so valuable I think in many instances in healthcare. So. Yeah. So remind me again, I guess to your best estimate amongst all patients at the end of life, how prevalent is terminal lucidity?
Dr. Alexander Batthyány: [00:37:12] Well, we try to figure it out and it's a bit difficult, but I think. An educated guess would be anything between six to perhaps 15%, I think. Now, it's important to know that it tends to be very brief, and I often wonder how often it takes place without being observed because nobody is there. Yeah, right. So I also point this out in the book. It means that it's not a majority. And for those who are listening to this or reading this, and the newspaper reports sometimes are a bit, you know, glorifying it. Unfortunately, most people with dementia will die with dementia, not with a lucid episode. And then, you know, sometimes I receive emails from people telling me, you know, I'm sitting here at the deathbed of my father who had dementia. Iphone is my smartphone is on video function. I'm just waiting for the lucid episode. What should I do? And I tell them, you know what, be there exactly in this kind and welcome his being as he or she is at this very moment. But don't expect it. We can't demand it. I mean, we all were children, and there were times when we demanded or hoped that our parents would give us a certain Christmas gift or a gift. Birthday gift. Yeah. We can't demand the gift. We can expect it. We can hope for it. We can pray for it if you feel like. But it's not that we can demand it. And I don't want to raise hopes which are going to be disappointed. Yeah, but if somebody is with the patient in the hope that he or she returns, this hope is also something really beautiful to remember later on. So it's nothing wrong. Yeah.
Speaker4: [00:38:51] Yeah, I almost wonder... I mean, this is.. I don't know if we can ever I guess there is a way to find this out through video recording. But setting that aside, I do wonder if this phenomenon happens because there are people that observe it. Do you feel like that could be possible?
Dr. Alexander Batthyány: [00:39:06] Yeah. I mean, we asked in our questionnaire, which we send out. Yeah. Do you think anything played a role? You know, something. And the majority of the persons told us where the patient died. I think they think that was the trigger, so to speak. And it when it when it comes to relatives being around, it's difficult to say because very often the nursing home will call and say, physiologically speaking, he or she is going to die soon. And then relatives come and tell happens, but we don't know what causes what, so to speak. Yeah, I have a few cases where things happened, like the patient was lying, their eyes open, the nurse entered and let's say opened the window and suddenly the patient. Thank you very much, nurse. And this patient didn't talk for a year. Yeah. So he or she must have been lucid before, because otherwise she wouldn't have noticed that they opened the window. Right, right. And then the nurse was, of course, shocked, but aware enough to sit down and hold hands. And, you know, is there something you would like to tell me? And then beautiful conversation came.
Henry Bair: [00:40:14] Wow. Do patients do individuals experiencing terminal lucidity? Are they aware that they're back and that for a long time they have not been there or have not been?
Dr. Alexander Batthyány: [00:40:25] Well, some of them are. Some of them, yeah, the majority in my case collection, which covers about 420 cases. Now the majority does no, such as my grandmother told me I was very tired. Yeah. What I find even more astonishing is not only that they have the memories back, which, given their pre lucid state, is fairly remarkable, but quite a number are knowing that they're going to die. And how do they know? I have no idea. Yeah. But they say like last words. And there was one who who whose sister also had dementia. And he had only one urgent wish when he talked to his daughter. Please make sure that my sister is well taken care of. Yeah. And she loves whatever to eat. And that she's getting what she can't express. I can tell you what she needs. Now. Just imagine this person, I think for one and a half years was almost mute. Yeah. And then suddenly came back and to display this amount of self-transcendence, not to care about oneself, but about his sister. So you have even very complex cognitive function, if you wish.
Henry Bair: [00:41:33] Yeah. So much there to think about.
Dr. Alexander Batthyány: [00:41:36] You mentioned videos. I've got one beautiful video about a what must have been a very lovely couple and loving couple. Yeah. And he had a comeback. So a lucid episode. Yeah. And they used to love eating and the first thing he did and then she, she took out her phone and videoed it. He made a grocery list and the grocery list. He said, I want some steaks. And the way he wrote it, almost like writing a poem, it was so the enthusiasm of, of, you know, of having, being able to choose what to eat. Yeah. So yeah. Video I do have a few video recordings from, from relatives who recorded the patient. Yeah.
Henry Bair: [00:42:15] Beautiful. For. So in the last few moments we have here, I want to close in a way similar to how you close your book. The last chapter of your book is Why It matters. So let's say that someone who's very skeptical, okay, they acknowledge that this happens, but then they point out, okay, doesn't happen to the vast majority of people, right? The vast majority of people do not experience this. Yes. And let's say this person is he's also a materialist. He's like, okay, like this does happen. But fundamentally, I still feel like we're just atoms and molecules and bags of chemicals that float around. So to someone like that, to someone who says doesn't happen very often and I'm still not sure about like fundamentally if the underlying mechanisms would be any different from our previous materialistic understanding of the world. Right. To someone like that, what would you say? Why does this all matter? Why does it matter that we think about it, that we study it, that we embrace it?
Dr. Alexander Batthyány: [00:43:07] Yeah. The last chapter of this book is basically a call not to believe something, but to do something differently. And it doesn't matter. So sometimes within the religious field or spiritual people think that they can accuse materialists of being, you know, very hard, you know, having a very hard heart, whatever, you know, being very cold blooded and so on. And that's not true because I know so many nurses and people and medical colleagues and psychologists who are extremely kind, but they don't believe in any soul or whatever. And it can't be that our kindness and our warmth and our humaneness depends on what we believe, what who we are and what we send out comes long, long, long before what we believe. Yeah. And I mean, look into history now. I consider myself, as I told you now, a religious person. But I do know that my colleagues in history weren't very kind people. Yeah. I mean, how many atrocities happened in. So if it was that simple, my God, I would say let's do mission. But it's not that simple. Yeah. So our humaneness doesn't depend on what we believe. It depends on what we see in another person. Yeah. And what we see in ourselves. And to those who are undecided what TL means and what it conveys to us about the nature of personhood and so on. No problem. I really and I also am very I don't forward a a a ready set theory on what happens. Yeah. What is clear, however, is it's not what we believe, it's what we do.
Dr. Alexander Batthyány: [00:44:47] And then once again, look at what these stories are telling us and not telling us about the soul and so on, but about about the human person at the end, about the fact that 15% can surprise us with utterly unexpected behavior. Yeah, but what they are saying, the warmth which is shared in the hospital room and the hospice room. Yeah, all of this need not only happen in the last moments, it can happen also before. Yeah. And so often when medical doctors, when relatives and so on. You know, when it comes to death and dying, it can be all very fearful or it can be very understanding. We are all very vulnerable. We are all, you know, we never know about tomorrow, where we where we are going to be. And this should allow us a certain softness, a certain kindness. Yeah. We are all in the same boat no matter what we believe. Yeah. And no matter what we think about human person. But look at us how we treat ourselves. Look at how we treat. I mean, while we are talking, I'm sorry to say, but children are turning blind because they don't have the nutrients, which we would have. Yeah. And we have the capacity now. Yeah. And nature is destroyed and we destroy ourselves with unkindness and being overly competitive and being. And we hurt ourselves. We are. So we created such, such an enormously cold and hard world.
Dr. Alexander Batthyány: [00:46:13] Yeah. And most of us don't like it. So why not change it? And you know, if ten you know, if a crowd is running in one direction, it's the wrong direction. One alone would be a bit too little to to, you know, to turn around. But 1015 it has to grow our and that's the important part. It's not a teaching which has to be spread. It's only listening once again to ourselves, to our hearts, I mean, and then we would see all of us. Yeah. And funnily enough, most often materialists, because they tend to be more skeptical, don't accept the givens of society and so on. If they looked and said, okay, no matter what the world consists of, what are we doing with it and ourselves? Yeah. And then I think that's the silent revolution of the heart, which doesn't need a leader, which doesn't, because we all have our own hearts and conscience and so on. Yeah. And this is what I try to convey, that we all know what we are missing. Yeah. And also others are missing it. Yeah. And once again, the injustice in this world. Yeah. Needs no further argument. And the suffering in this world, even the rich industrial countries. Yeah. If you look on the street and see these empty faces running around for money so that they can live. Yeah, rather than live and share and so on. I know this sounds a bit idealistic, but it's true nonetheless. Yeah.
Henry Bair: [00:47:41] Yeah. No, the thing is, I can't help but think that if a part of us is to believe that at least a significant component of who we are exists in memories and relationships, then even after a loved one dies, they still live on like they are never really dead because they're still there with you. And you know, these moments of terminal lucidity and the opportunity to be kind when that happens allows us to build a legacy that we can carry with us forward into the future.
Dr. Alexander Batthyány: [00:48:10] Right? Definitely. Yes.
Henry Bair: [00:48:12] Yeah. So that's such a beautiful message, and it is an encouraging call for all of us to embrace the mystery. Just because we don't understand it does not mean it's not meaningful. Yeah.
Dr. Alexander Batthyány: [00:48:23] Thank you for pointing out. Yeah, yeah. I also I told the publisher the condition to, to write this book. Was that like the subtitle is on the border of life and Death. Life must be in the title. So this book is not only about death. Yeah. It's very, very, very much about life. But sometimes I tell myself even. Yeah, don't look for teachings. Look at your own heart. And then we know what others also need. Yeah. Why the pain that comes enough pain from disease and catastrophes which we don't can, can control. But if people hurt people, it's unbelievable actually. Yeah. How this can happen. It's so unbelievable.
Speaker5: [00:49:03] Yeah. Well, you know, with that we want to thank you again so much, Alex, for coming on the show, for sharing your work. This is something that I agree with you. I think we should all be aware of it all. Be ready for it. And I'll, um, be conscious and think about what it can teach all of us. So thank you very much for your your humane stories, your insightful wisdom. And I look forward to, you know, the upcoming work that you do in this field.
Dr. Alexander Batthyány: [00:49:27] Thank you for having me.
Henry Bair: [00:49:32] Thank you for joining our conversation on this week's episode of The Doctor's Art. You can find program notes and transcripts of all episodes at the doctor's Art. Com. If you enjoyed the episode, please subscribe, rate and review our show available for free on Spotify, Apple Podcasts, or wherever you get your podcasts.
Tyler Johnson: [00:49:51] We also encourage you to share the podcast with any friends or colleagues who you think might enjoy the program. And if you know of a doctor, patient, or anyone working in healthcare who would love to explore meaning in medicine with us on the show, feel free to leave a suggestion in the comments.
Henry Bair: [00:50:05] I'm Henry Bair.
Tyler Johnson: [00:50:06] And I'm Tyler Johnson. We hope you can join us next time. Until then, be well.