The Importance of the Exceptional in Tackling Riddles of Consciousness and Unusual Episodes of Lucidity


  • Michael Nahm Institute for Frontier Areas of Psychology and Mental Health



paradoxical lucidity, dementia, Alzheimer’s disease, neurodegeneration, spiritual and anomalous experiences, near-death phenomena, near-death visions, consciousness, terminal lucidity


The problem of how biochemical processes in the brain give rise to conscious experience is still unanswered. This paper aims at stimulating the debate surrounding this enigma by advocating the study of unusual and anomalous aspects of consciousness. For this purpose, the contents of this paper are organized in three parts. In the first part, I provide a brief overview on unsolved riddles of the mind. These include unusual episodes of lucidity that have been termed terminal lucidity and paradoxical lucidity. Because the use of these terms has sometimes been inappropriate in recent literature, I clarify the basic meanings of these two concepts in the second part. The third part contains suggestions for future research. Specifically, I argue that the field of studies into episodes of lucidity in dementias and the field of studies into end-of-life experiences, such as near-death visions, should engage in an active dialogue in order to build bridges between these disciplines. Such a dialogue will enable a better understanding of the whole spectrum, and thus, possible circumstances, causes and underpinnings of lucid episodes. In sum, this paper argues that the study of lucid episodes such as terminal lucidity, paradoxical lucidity, and related occurrences holds enormous significance for improving our understanding of brain functions and accompanying states of consciousness – from a practice-orientated perspective in the contexts of the dementias and dealing with end-of-life experiences, and from a theoretical perspective in the context of the scientific debate about the nature of consciousness. 


Auyong, D. B., Klein, S. M., Gan, T. J., Roche, A. M., Olson, D., & Habib, A. S. (2010). Processed electroencephalogram during donation after cardiac death. Anesthesia and Analgesia, 110(5), 1428–1432.

Ballard, C., O’Brien, J., Gray, A., Cormack, F., Ayre, G., Rowan, E., Thompson, P., Bucks, R., McKeith, I., Walker, M., & Tovee, M. (2001). Attention and fluctuating attention in patients with dementia with Lewy bodies and Alzheimer disease. Archives of Neurology, 58(6), 977–982.

Barbato, M. (2001). Bispectral index monitoring in unconscious palliative care patients. Journal of Palliative Care, 17(2), 102–108.

Barbato, M., Barclay, G., Potter, J., & Yeo, W. (2017). The moment of death. Journal of Pain and Symptom Management, 53(6), e1–e3.

Beauregard, M. (2007). Mind does really matter: Evidence from neuroimaging studies of emotional self-regulation, psychotherapy, and placebo effect. Progress in Neurobiology, 81(4), 218–236.

Beauregard, M. (2021). Expanding reality: The emergence of postmaterialist science. Hunt.

Bostanciklioğlu, M. (2021). Unexpected awakenings in severe dementia from case reports to laboratory. Alzheimer’s Dementia, 17(1), 125–136.

Brayne, S., Lovelace, H. & Fenwick, P. (2008). End-of-life experiences and the dying process in a Gloucestershire nursing home as reported by nurses and care assistants. American Journal of Hospice & Palliative Medicine, 25(3), 195–206.

Bruhn, J. (2009). Blicke hinter den Horizont: Nahtodeserlebnisse: Deutung – Bedeutung [Glimpses behind the horizon: Near-death experiences: Interpretation – meaning]. Alsterverlag.

Brüntrup, G. (2018). Philosophie des Geistes. Eine Einführung in das Leib-Seele-Problem [Philosophy of mind. An introduction to the mind-body problem]. Kohlhammer.

Chalmers, D. (1995). Facing up to the problem of consciousness. Journal of Consciousness Studies, 2(3), 200–219.

Chalmers, D. (2020a). Idealism and the mind-body problem. In W. Seager (Ed.), The Routledge handbook of panpsychism (pp. 253–273). Routledge.

Chalmers, D. (2020b). Is the hard problem of consciousness universal? Journal of Consciousness Studies, 27(5–6), 227–257.

Chawla, L. S., Akst, S., Junker, C., Jacobs, B., & Seneff, M. G. (2009). Surges of electroencephalogram activity at the time of death: A case series. Journal of Palliative Medicine, 12(12), 1095–1100.

Chawla, L. S., Terek, M., Junker, C., Akst, S., Yoon, B., Brasha-Mitchell, E., & Seneff, M. G. (2017). Characterization of end-of-life electroencephalographic surges in critically ill patients. Death Studies, 41(6), 385–392.

Claxton-Oldfield, S., & Dunnett, A. (2018). Hospice palliative care volunteers’ experiences with unusual end-of-life phenomena. Omega, 77(1), 3–14.

Claxton-Oldfield, S., & Richard, N. (2020). Nursing home staff members’ experiences with and beliefs about unusual end-of-life phenomena. Omega, 0030222820981238.

Claxton-Oldfield, S., Gallant, M., & Claxton-Oldfield, J. (2020). The impact of unusual end-of-life phenomena on hospice palliative care volunteers and their perceived needs for training to respond to them. Omega, 81(4), 577–591.

Coons, P. M. (1988). Psychophysiologic aspects of multiple personality disorder: A review. Dissociation, 1(1), 47–53.

Dam, A. K. (2016). Significance of end-of-life dreams and visions experienced by the terminally ill in rural and urban India. Indian Journal of Palliative Care, 22(2), 130–134.

Depner, R. M., Grant, P. C., Byrwa, D. J., LaFever, S. M., Kerr, C. W., Tenzek, K. E., LaValley, S., Luczkiewicz, D. L., Wright, S. T., & Levy, K. (2020). Expanding the understanding of content of end-of-life dreams and visions: A consensual qualitative research analysis. Palliative Medicine Reports, 1(1), 103–110.

Dhanani, S., Hornby, L., Ward, R., Baker, A., Dodek, P., Chamber-Evans, J., Fowler, R., Friedrich, J. O., Gow, R. M., Kutsogiannis, D. J., Mcintyre, L., Momoli, F., Morin, K., Ramsay, T., Scales, D., Writer, H., Yildirim, S., Young, B., Shemie, S., & Canadian Critical Care Trials Group and in collaboration with the Bertram Loeb Chair and Research Consortium in Organ and Tissue Donation. (2014). Vital signs after cardiac arrest following withdrawal of life-sustaining therapy: A multicenter prospective observational study. Critical Care Medicine, 42(11), 2358–2369.

Dhanani, S., Young, B., & Shemie, S. (2014). The authors reply. Critical Care Medicine, 42(10), e682–e683.

Driesch, H. (1926). Grundprobleme der Psychologie. Ihre Krisis in der Gegenwart [Basic problems of psychology. Its crisis in the present]. Reinicke.

Driesch, H. (1927). On the methods of theoretical psychical research. Journal of the American Society for Psychical Research, 21(2), 65–77.

Driesch, H. (1951). Lebenserinnerungen [Memoirs]. Reinhardt.

du Bois-Reymond, E. (1872). Über die Grenzen des Naturerkennens [On the limits of knowing nature]. Veit.

Eldadah, B. A., Fazio, E. M. & McLinden, K. A. (2019). Lucidity in dementia: A perspective from the NIA. Alzheimer’s & Dementia, 15(8), 1104–1106.

Fenwick, P., Lovelace, H., & Brayne, S. (2010). Comfort for the dying: Five year retrospective and one year prospective studies of end of life experiences. Archives of Gerontology and Geriatrics, 51(2), 173–179.

Gambrell, M. (2005). Using the BIS monitor in palliative care: A case study. The Journal of Neuroscience Nursing: Journal of the American Association of Neuroscience Nurses, 37(3), 140–143.

Gardner, H. (1976). The shattered mind: The person after brain damage. Vintage.

Gilmore-Bykovskyi. A., Block, L., Benson, C. & Griffin J. M. (2021). The importance of conceptualizing and defining episodes of lucidity. Journal of Gerontological Nursing, 47(4), 5.

Grant, P. C., Depner, R. M., Levy, K., LaFever, S. M., Tenzek, K. E., Wright, S. T., & Kerr, C. W. (2020). Family caregiver perspectives on end-of-life dreams and visions during bereavement: A mixed methods approach. Journal of Palliative Medicine, 23(1), 48–53.

Grant, P. C., Levy, K., Lattimer, T. A., Depner, R. M., & Kerr, C. W. (2021). Attitudes and perceptions of end-of-life dreams and visions and their implication to the bereaved family caregiver experience. The American Journal of Hospice & Palliative Care, 38(7), 778–784.

Greyson, B., Kelly, E. F., & Dunseath, W. J. R. (2013). Surge of neurophysiological activity in the dying brain. Proceedings of the National Academy of Sciences, 110(47), E4405–E4405.

Greyson, B., van Lommel, P., & Fenwick, P. (2022). Commentary: Enhanced interplay of neuronal coherence and coupling in the dying human brain. Frontiers in Aging Neuroscience, 14, 899491.

Kellehear, A., Pogonet, V., Mindruta-Stratan, R., & Gorelco, V. (2011). Deathbed visions from the Republic of Moldova: A content analysis of family observations. Omega, 64(4), 303–317.

Kelly, E. W. (2007). Psychophysiological influence. In E. F. Kelly, E. W. Kelly, A. Crabtree, A. Gauld, M. Grosso, & B. Greyson (Eds.), Irreducible mind: Toward a psychology for the 21st century (pp. 117–239). Rowman & Littlefield.

Kerr, C. W., Donnelly, J. P., Wright, S. T., Kuszczak, S. M., Banas, A., Grant, P. C., & Luczkiewicz, D. L. (2014). End-of-life dreams and visions: A longitudinal study of hospice patients’ experiences. Journal of Palliative Medicine, 17(3), 296–303.

Klein, S., Kohler, S., Krüerke, D., Templeton, A., Weibel, A., Haraldsson, E., Nahm, M., & Wolf, U. (2018). Erfahrungen am Lebensende: Eine Umfrage bei Ärzten und Pflegenden eines Spitals für anthroposophisch erweiterte Medizin [Experiences at the end of life: A survey among physicians and nurses at a hospital for anthroposophically extended medicine]. Complementary Medicine Research, 25(1), 38–44.

Krall, S., Nahm, M. & Waldrich, H.-P. (2021). Hinter der Materie. Hans Driesch und die Natur des Lebens [Beyond matter. Hans Driesch and the nature of life]. Graue.

Lee, D. R., McKeith, I., Mosimann, U., Ghosh-Nodial, A., Grayson, L., Wilson, B., & Thomas, A. J. (2014). The dementia cognitive fluctuation scale, a new psychometric test for clinicians to identify cognitive fluctuations in people with dementia. American Journal of Geriatric Psychiatry, 22(9), 926–935.

Levy, K., Grant, P. C., Depner, R. M., Byrwa, D. J., Luczkiewicz, D. L., & Kerr, C. W. (2020). End-of-life dreams and visions and posttraumatic growth: A comparison study. Journal of Palliative Medicine, 23(3), 319–324.

Lim, C.-Y., Park, J. Y., Kim, D. Y., Yoo, K. D., Kim, H. J., Kim, Y., & Shin, S. J. (2020). Terminal lucidity in the teaching hospital setting. Death Studies, 44(5), 285–291.

Macleod, A. D. (2009). Lightening up before death. Palliative and Supportive Care, 7(4), 513–516.

Mashour, G. A., Frank, L., Batthyany, A., Kolanowski, A. M., Michael Nahm, Schulman-Green, D., Greyson, B., Pakhomov, S., Karlawish, J. & Shah, R. C. (2019). Paradoxical lucidity: A potential paradigm shift for the neurobiology and treatment of severe dementias. Alzheimer’s & Dementia, 15(8), 1107–1114.

Masman, A. D., van Dijk, M., van Rosmalen, J., Blussé van Oud-Alblas, H. J., Ista, E., Baar, F. P. M., & Tibboel, D. (2016). Bispectral index monitoring in terminally ill patients: A validation study. Journal of Pain and Symptom Management, 52(2), 212-220.e3.

Moody, R. (2010). Glimpses of eternity. Guideposts.

Morita, T., Naito, A. S., Aoyama, M., Ogawa, A., Aizawa, I., Morooka, R., Kawahara, M., Kizawa, Y., Shima, Y., Tsuneto, S., & Miyashita, M. (2016). Nationwide Japanese survey about deathbed visions: “My deceased mother took me to heaven.” Journal of Pain and Symptom Management, 52(5), 646-654.e5.

Morris, P. & Bulman, D. (2020). Lucidity in the context of advanced neurodegenerative disorders: A concept analysis. Journal of Gerontological Nursing, 46(12), 42–50.

Morris, P. & Bulman, D. (2021). The importance of conceptualizing and defining episodes of lucidity. Journal of Gerontological Nursing, 47(4), 6.

Muthumana, S. P., Kumari, M., Kellehear, A., Kumar, S., & Moosa, F. (2010). Deathbed visions from India: A study of family observations in northern Kerala. Omega, 62(2), 97–109.

Nahm, M. (2009). Terminal lucidity in people with mental illness and other mental disability: An overview and implications for possible explanatory models. Journal of Near-Death Studies, 28, 87–106.

Nahm, M. (2011). Reflections on the context of near-death experiences. Journal of Scientific Exploration, 25(3), 453–478.

Nahm, M. (2012). Wenn die Dunkelheit ein Ende findet. Terminale Geistesklarheit und andere Phänomene in Todesnähe [When darkness comes to an end. Terminal lucidity and other phenomena near death]. Crotona.

Nahm, M. (2013). Terminale Geistesklarheit und andere Rätsel des menschlichen Bewusstseins [Terminal lucidity and other enigmas of human consciousness]. In A. Serwaty & J. Nicolay (Eds.), Nahtoderfahrung und Bewusstseinsforschung (pp. 78–134). Santiago.

Nahm, M. (2017). Terminal lucidity. Psi Encyclopedia of the Society for Psychical Research.

Nahm, M. (2021). Hans Drieschs Beschäftigung mit der Parapsychologie [Hans Driesch‘s interest in parapsychology]. In S. Krall, M. Nahm, & H.-P. Waldrich (Eds), Hinter der Materie: Hans Driesch und die Natur des Lebens [Behind matter: Hans Driesch and the nature of life] (pp. 127–143). Graue Edition.

Nahm, M. (2022). Terminal lucidity versus paradoxical lucidity: A terminological clarification. Alzheimer’s & Dementia.

Nahm, M. & Greyson, B. (2009). Terminal lucidity in patients with chronic schizophrenia and dementia: A survey of the literature. Journal of Nervous and Mental Disease, 197(12), 942–944.

Nahm, M. & Greyson, B. (2014). The death of Anna Katharina Ehmer: A case study in terminal lucidity. Omega, 68(1), 77–87.

Nahm, M. & Haraldsson, E. (2009). Geistige Klarheit von psychisch kranken Menschen kurz vor dem Tod [Lucidity in people with mental illness shortly before death]. Tattva Viveka, 40, 70–75.

Nahm, M., & Weibel, A. (2020). The significance of autoscopies as a time marker for the occurrence of near-death experiences. Journal of Near-Death Studies, 38(1), 26–50.

Nahm, M., Greyson, B., Kelly, E. W. & Haraldsson, E. (2012). Terminal lucidity: A review and a case collection. Archives of Gerontology and Geriatrics, 55(1), 138–142.

Ney, D. B., Peterson, A. & Karlawish, J. (2021). The ethical implications of paradoxical lucidity in persons with dementia. Journal of the American Geriatrics Society.

NIH (2020) RePORTER. [2021 Oct 08]

Norton, L., Gibson, R. M., Gofton, T., Benson, C., Dhanani, S., Shemie, S. D., Hornby, L., Ward, R., & Young, G. B. (2017). Electroencephalographic recordings during withdrawal of life-sustaining therapy until 30 minutes after declaration of death. Canadian Journal of Neurological Sciences, 44(2), 139–145.

Nosek, C. L., Kerr, C. W., Woodworth, J., Wright, S. T., Grant, P. C., Kuszczak, S. M., Banas, A., Luczkiewicz, D. L., & Depner, R. M. (2015). End-of-life dreams and visions: A qualitative perspective from hospice patients. American Journal of Hospice & Palliative Care, 32(3), 269–274.

Osis, K., & Haraldsson, E. (1977). Deathbed observations by physicians and nurses: A cross-cultural survey. Journal of the American Society for Psychical Research, 71(3), 237–259.

Osis, K., & Haraldsson, E. (2012). At the hour of death. White Crow Books.

Owen, A. M. (2017). Into the grey zone. A neuroscientist explores the border between life and death. Guardian Books.

Parnia, S., Spearpoint, K., de Vos, G., Fenwick, P., Goldberg, D., Yang, J., Zhu, J., Baker, K., Killingback, H., McLean, P., Wood, M., Zafari, A. M., Dickert, N., Beisteiner, R., Sterz, F., Berger, M., Warlow, C., Bullock, S., Lovett, S., … Schoenfeld, E. R. (2014). AWARE-AWAreness during REsuscitation-a prospective study. Resuscitation, 85(12), 1799–1805.

Peterson, A., Clapp, J., Harkins, K., Kleid, M., Largent, E. A., Stites, S. D. & Karlawish, J. (2022). Is there a difference between terminal lucidity and paradoxical lucidity? Alzheimer’s & Dementia.

Peterson, A., Clapp, J., Largent, E. A., Harkins, K., Stites, S. D. & Karlawish, J. (2021). What is paradoxical lucidity? The answer begins with its definition. Alzheimer’s & Dementia.

Rady, M. Y., & Verheijde, J. L. (2014). Persistent activity on lectrocardiography and electroencephalography after acute circulatory arrest: Implications for non-heart-beating organ donation. Critical Care Medicine, 42(10), e681–e682.

Renz, M., Reichmuth, O., Bueche, D., Traichel, B., Mao, M. S., Cerny, T., & Strasser, F. (2018). Fear, pain, denial, and spiritual experiences in dying processes. The American Journal of Hospice & Palliative Care, 35(3), 478–491.

Ring, K. (2007). Letter to the Editor. Journal of Near-Death Studies, 26(1), 70–76.

Rivas, T., Dirven, A., & Smit, R. (2016). The self does not die. Verified paranormal phenomena from near-death experiences. International Association for Near-Death Studies.

Santos, C. S. D., Paiva, B. S. R., Lucchetti, A. L. G., Paiva, C. E., Fenwick, P., & Lucchetti, G. (2017). End-of-life experiences and deathbed phenomena as reported by Brazilian healthcare professionals in different healthcare settings. Palliative & Supportive Care, 15(4), 425–433.

Schlumpf, Y. R., Reinders, A. A. T. S., Nijenhuis, E. R. S., Luechinger, R., van Osch, M. J. P., & Jäncke, L. (2014). Dissociative part-dependent resting-state activity in dissociative identity disorder: A controlled FMRI perfusion study. PloS One, 9(6), e98795.

Schreiber, T. P. & Bennett, M. J. (2014). Identification and validation of premortem surge. Journal of Hospice & Palliative Nursing, 16, 430–437.

Shared Crossing Research Initiative. (2021). Shared death experiences: A little-known type of end-of-life phenomena reported by caregivers and loved ones. American Journal of Hospice & Palliative Care, 38(12), 1479–1487.

Shared Crossing Research Initiative. (2022). The spectrum of end-of-life experiences: A tool for advancing death education. Omega, 302228211052342.

Strasburger, H., & Waldvogel, B. (2015). Sight and blindness in the same person: Gating in the visual system. PsyCh Journal, 4(4), 178–185.

Treffert, D. A. (2010). Islands of genius: The bountiful mind of the autistic, acquired, and sudden savant. Kingsley.

Treffert, D. A., & Christensen, D. D. (2005). Inside the mind of a savant. Scientific American, 293(6), 108–113.

van Lommel, P. (2021). The continuity of consciousness. A concept based on scientific research on near-death experiences during cardiac arrest.

Vicente, R., Rizzuto, M., Sarica, C., Yamamoto, K., Sadr, M., Khajuria, T., Fatehi, M., Moien-Afshari, F., Haw, C. S., Llinas, R. R., Lozano, A. M., Neimat, J. S., & Zemmar, A. (2022). Enhanced interplay of neuronal coherence and coupling in the dying human brain. Frontiers in Aging Neuroscience, 14, Article 813531.




How to Cite

Nahm, M. (2022). The Importance of the Exceptional in Tackling Riddles of Consciousness and Unusual Episodes of Lucidity. Journal of Anomalous Experience and Cognition, 2(2), 264–296.



Theoretical and methodological papers