Personality disorders and schizophrenia are the two most disabling mental health conditions, research finds.
The most disabling condition, schizophrenia, is one of the most serious types of mental illness.
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IMPULSE CONTROL
That "voice" is the dorsolateral prefrontal cortex, an area of the brain that handles planning, making choices, and suppressing urges. It coordinates with another region of the prefrontal cortex called the right orbitofrontal cortex, an area involved in regulating emotions. When you encounter a potential reward, these areas of the brain do some quick math to determine whether you'll be better off going for it or putting your energy toward a bigger payoff later.
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LKBC
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Terminal Lucidity
wlker, M. P., Ballard, C. G., Ayre, G. A., Wesnes, K., Cummings, J. L., McKeith, I. G. and O’Brien, J. T. (2000). The clinician assessment of fluctuation and the one day fluctuation assessment scale. Two methods to assess fluctuating confusion in dementia. British Journal of Psychiatry, 177, 252-256.Rare cases of patients with long-term dementia and other severe neurological disorders who exhibit a brief return to mental clarity and full memory shortly before death hold particular significance both for understanding the nature of mind and for terminal patient care. Neglected until recently, the phenomenon of ‘terminal lucidity’ is attracting renewed interest on the part of scientific researchers, particularly in the context of psychical ‘near-death’ phenomena.
History
Early physicians such as Hippocrates, Plutarch, Cicero, Galen, Avicenna, and other scholars of classical times notes that symptoms of mental disorders sometimes decrease as death approaches.1 This was also observed in the nineteenth century: several cases of different aetiology were published in the early medical literature, also in treatises written by authors who proclaimed a Romantic and Post-Romantic understanding of nature, embracing the notion that the human soul is separate from the brain and can survive bodily death.
In the twentieth century, discussions and case reports of terminal lucidity declined and are almost absent in the medical literature of the period. However, some reports continued to be published outside the medical setting. Since the turn of the millennium they have again become more frequent in the medical literature, as a survey of the past 250 years has shown. Case summaries of this survey have been published predominantly by biologist Michael Nahm and colleagues.2 In short, it appears that incidents of terminal lucidity have occurred throughout the history of humanity, on all continents.
Varieties of Terminal Lucidity
As early as 1826, Burdach described two distinct ways in which terminal lucidity can manifest.3 First, the degree of mental derangement can decrease slowly in conjunction with the decline of bodily vitality. Cases of schizophrenia and of affective disorders typically belong to this category, and the process of becoming lucid may take several days or weeks after long years of severe and uninterrupted mental disturbance.
Second, full mental clarity can emerge suddenly just before dying. Among modern cases, those involving Alzheimer’s disease and brain tumors usually belong to this second category. Here, this return of mental clarity often occurs in the last seconds, minutes or hours before the patient’s death. The most astonishing cases of terminal lucidity concern patients who suffered from severe neurologic diseases such as meningitis, tumors, Alzheimer’s disease or strokes – in short, cases in which there is reason to think that the brain’s neuronal circuits were severely impaired or destroyed.
Examples in Psychiatric Disorders
Possible affective disorder
A woman diagnosed with ‘wandering melancholy’ (melancholia errabunda) was admitted to an asylum and became manic. For four years, she lived in a continuously confused and incoherent state of mind, without respite. When she fell sick with a fever, she refused to take any medicine. As a consequence her health deteriorated. However, the weaker her body became, the more her mental condition improved. Two days before her death, she became fully lucid. She talked with an intellect and clarity that seemed to surpass her former education. She inquired about the lives of her relatives, and regretted in tears her previous reluctance to take medicine. She died soon thereafter.4
Schizophrenia
A patient with chronic schizophrenia without prior lucid intervals lived for 27 years in an unremitting schizophrenic state, of which the last 17 years were spent in a profoundly regressed catatonic state. Yet after he was struck with a severe organic disease his mental condition started to improve. Although he showed some residual mental idiosyncrasies, his overall behavior had become almost normal shortly before he died.5
Examples in Neurological Disorders
Alzheimer’s disease
A 91-year old woman suffered from Alzheimer's disease for 15 years and was cared for by her daughter. The woman had long been unresponsive and showed no sign of recognizing her daughter or anybody else for five years. One evening, however, she started a normal conversation with her daughter. She talked about her fear of death, difficulties she had with the church, and her family members. She died a few hours later.6
Example involving strokes
A woman aged 91 suffered from two strokes. The first paralyzed her left side and deprived her of clear speech. After a few months, the second stroke rendered her entirely paralyzed and speechless. The daughter who cared for her was one day startled to hear an exclamation from her mother. The old woman was smiling brightly, although her facial expression had been frozen since her second stroke. She turned her head and sat up in bed with no apparent effort. Then she raised her arms and exclaimed in a clear, joyous tone the name of her husband. Her arms dropped again, she sank back and died.7
Relevance to Psi Research
The relevance of terminal lucidity to psi research is twofold. First, cases involving patients with severely destroyed brains (such as in terminal stages of Alzheimer’s disease, tumors or strokes) who become fully lucid shortly before death might provide a pathway to further assess the possibility that the human mind including memory is not entirely generated by the brain, but that the brain functions as a kind of filter or transmitter organ.8
Second, it is not uncommon for terminal lucidity to be accompanied by deep spiritual experiences or so-called ‘deathbed-visions’, as exemplified by the case of the stroke patient above. Such features link terminal lucidity to a number of other end-of-life experiences and also near-death-experiences.9 Given that these types of experiences in near-death states regularly contain psychical aspects, they have long played an important role in psychical research, with the potential to facilitate further study into subliminal layers of the human psyche and provide evidence for post-mortem survival.10
Opportunities and Obstacles to Study
The potential of terminal lucidity as an avenue of research is unfortunately impeded by its very nature: it occurs largely unexpected in terminally ill patients who, in addition, were often confused or non-responsive before. Such patients cannot easily be made subjects of scientific studies or autopsies for ethical and practical reasons. Hence, it is likely that many accounts of terminal lucidity will remain on the anecdotal level. Nevertheless, as with near-death experiences and other end-of life experiences, it is feasible to assess the incidence and varieties of terminal lucidity in prospective and retrospective studies (for example, an approach chosen by Fenwick, Lovelace, and Brayne, 2010).11 Particularly remarkable cases could be documented as thoroughly as possible from a medical perspective; a specific scale to estimate the unusualness and the degree of the observed lucidity could be developed,12 based on existing scales, as a means to judge the fluctuations of mental coherence and memory. It might even be feasible to advance new forms of therapies to improve the access to autobiographic memories in dementia patients.
Future Outlook
Although terminal lucidity will most likely remain challenging to study, it offers the potential to contribute to an enhanced understanding of cognition, memory processing, and the nature of the human mind.
Quite apart from that, a wider knowledge about the phenomenon, and an awareness of its possible occurrence, would give those who attend patients the opportunity to optimally relate to a dying person who has been in a non-responsive condition for an extended period, sometimes years. As it is, this unexpected return of mental clarity and memory often comes as a complete surprise, and since it lasts only a short time, relatives and nurses may miss a last chance to communicate with the dying in a meaningful way unless they are properly prepared.
Michael Nahm
Literature
Burdach, K. F. (1826). Vom Baue und Leben des Gehirns (Vol. 3). Leipzig: Dyk’sche Buchhandlung.
Butzke, F. (1840). Rückblicke auf das klinische Jahr 1838 im Provinzial-Landkrankenhause der Provinz Westpreussen bei Schwetz. Magazin für die gesammte Heilkunde, 14,140-171.
Crooks, V., Waller, S., Smith, T., and Hahn, T. J. (1991). The use of the Karnofsky Performance Scale in determining outcomes and risk in geriatric outpatients. Journal of Gerontology, 46, 139-144.
du Prel, C. (1888) Die monistische Seelenlehre. Reproduced in C. du Prel (1971), Die Psyche und das Ewige. Pforzheim: Rudolf Fischer.
Fenwick, P., Lovelace, H., and 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, 173-179.
Kelly, E. F., Crabtree, A., and Marshall, P. (eds.) (2015). Beyond Physicalism. Toward reconciliation of science and spirituality. Lanham, MD: Rowman & Littlefield.
Kelly, E. F., Kelly, E.W., Crabtree, A., Gauld, A., Grosso, M., and Greyson, B. (2007). Irreducible Mind: Toward a Psychology for the 21st Century. Lanham, MD: Rowman & Littlefield.
Lee, D. R., McKeith, I., Mosimann, U., Gosh-Nodial, A., Grayson, L., Wilson, B. and 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, 926-935.
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, 453-478.
Nahm, M. (2012). Wenn die Dunkelheit ein Ende findet. Terminale Geistesklarheit und andere Phänomene in Todesnähe. Amerang: Crotona.
Nahm, M. (2013). Terminale Geistesklarheit und andere Rätsel des menschlichen Bewusstseins. In: Serwaty A, Nicolay J (eds). Nahtoderfahrung und Bewusstseinsforschung. Goch: Santiago; pp. 78-134.
Nahm, M., and Greyson, B. (2009). Terminal lucidity in patients with chronic schizophrenia and dementia: A Survey of the Literature. Journal of Nervous and Mental Disease, 197, 942-944.
Nahm, M., and Greyson, B. (2013-2014). The death of Anna Katharina Ehmer. A case study in terminal lucidity. Omega, 68, 77-87.
Nahm, M., Greyson, B., Kelly, E. W., and Haraldsson, E. (2012). Terminal lucidity: A review and a case collection. Archives of Gerontology and Geriatrics, 55, 138-142.
Noyes, M. (1952). A true account of a beautiful passing. Light, 72, 65.
Rivas, T., Dirven, A., and Smit, R. H. The Self Does Not Die. Durham, NC: IANDS Publications.
Schag, C. C., Heinrich, R. L. and Ganz, P. A. (1984). Karnofsky performance status revisited: Reliability, validity, and guidelines. Journal of Clinical Oncology, 2, 187-193.
Turetskaia, B. E. and Romanenko, A. A. (1975). Agonal remission in the terminal stages of schizophrenia (in Russian, transl. M.H. Pertzoff). Korsakov’s Journal of Neuropathology and Psychiatry, 75, 559-562.
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St Augustine said ‘What then is time? If no one asks me, I know what it is. If I wish to explain it to him who asks, I do not know.’
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Both Hīnayāna and Māhayāna Buddhism ascribe a great many terrestrial miracles to Shakyamuni Buddha in his lifetime. Both expect the arrival of Maitreya Buddha in the future, who will usher into the next age of the world, and renew the teaching when it has been depleted. Maitreya is the Messiah of the oriental tradition. Both schools of thought accept that a Buddha does not arise independently, but awakens over innumerable lifetimes of religious training. A being in the process of becoming a Buddha is a bodhisattva. Maitreya is now a bodhisattva, just as Shakyamuni was.
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D SHAI
Losers and failures have the greatest chance. Sufferers who can’t get rid of their suffering.
I work with people, and the only one who gets the message of liberation is one who is in a wheelchair and has to endure pain that will never end.
For it is in the end of attempting to avoid hell that liberation is. Freedom is that which does not need to be free of anything to be free. There is no bondage. It’s an incredible illusion. The desire for something other than what is, is the suffering. Who is the one who needs it to be different? Everyone so believes that there can’t be liberation with pain, that liberation must be from pain. Yuddhishthira, in the Mahabrat, sat in hell and was quiet, with no desire to escape. That is why he was liberated, transcending both the attachment to heaven and the need to avoid hell.
Buddha said life is suffering. No one wants to hear this, however, for if they did, they would not seek a way out. And just in case you seek a way out and think you found it, he tells you, “everything is impermanent.” So whatever came, will go. If your freedom depends on something that came, then it’s a second-hand freedom. The gourmet meal you ate yesterday is shit today.
Don’t count on anything to save you, but question who needs saving. For that which you are is a freedom that is not merely the opposite of bondage, but a freedom that knows neither freedom nor bondage. It is a freedom that doesn’t need a pleasant experience in order to be free. It is free also from needing to avoid pain.
Life is pain anyway. Your pleasurable experiences confirm the existence of pain. You cannot separe them off. But because you believe you can hold on to pleasure, you suffer. You create need, desire (who needs to hold on to pleasure?). You want life to be a certain way. The way it is is never lastingly satisfying. And I tell you also that it will never be. True satisfaction is that which doesn’t need to seek any satisfaction. Life is satisfaction. Already as it is. But when you need something from it, you always feel something is missing. I tell you it’s already complete as it is. It will never be more or less complete. Just stop demanding it to be different.
Those who have failed enough give up. They see the truth of Buddha and the wisdom of Yuddhishthira. This is hell, welcome. When will you accept this and stop trying to dress up hell as heaven? In a surrender that no one does, there may be a flash that you may not even recognize, in which hell turns into something else, just like it is told in the Mahabarat, because the desire to avoid is gone. It’s inexplicable, beyond the mind. In that split of the split second of no longer fighting for “better” and “more” - you just can no longer remember why you thought what is needed to be escaped.
It’s not logical. The mind will say, “of course there are things that need to be escaped.” But, I tell you, in the absence of two, there is no one who can suffer. You have to be different from what is, commentating on it, judging it, to suffer. When you are what is, then what is is what is. There’s just no idea that it’s not good, not right, needs to be different. No one is left to ask, “Why is it this way? it really shouldn’t be!”
So the person who fails to find lasting peace and satisfaction - and is honest about it - he will find that it cannot be found. And in his total failure will be his salvation. All of his ideas will be swallowed by failing him. For each idea that promises salvation will fail. Until, somehow, you are left naked, without any ideas - including that there is one in bondage who needs salvation.
There is no need for freedom (what you call “enlightenment”). The belief in that need drives everyone absolutely insane. You are not trapped in what is. It’s just what is. See this, and there is no need to be free from it. That is freedom - the absence of a need to be free from anything.
If you cannot be free in hell, then what kind of freedom is it anyway? That is why this is your chance.
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P FOLEY
No. Wise people fully understand the nature of suffering. It is not witnessing suffering that causes deep sadness, but not knowing why suffering exists, what is its meaning, what is it’s nature. Those who are wise, know. They understand. Having understood, they accept.
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SW N PURI
Thanks a lot for this question….
It depends on how the Self is experienced for the first time.
Sri Kunju Swami was a well known and an ardent devotee disciple of Bhagavan Sri Ramana Maharshi. When he was in the vicinity of Sri Ramana Maharshi, he would feel that he was Self realised…
Sri Kunju Swami….
This was because of the power of presence or the sannidhi of Sri Ramana Maharshi. In his powerful presence, the latent vasanas or tendencies of the mind would be in abeyance for the time being. As a result, seekers did experience the Self, that intense peace and stillness.
After a few days, when Kunju Swami went back to Kerala, he noticed that what he had experienced in Sri Ramana Maharshi's presence started fading away and he was back to square one!
Later when he mentioned this to Sri Ramana Maharshi, Maharshi replied that what Kunju Swami experienced was due to the power of presence or sannidhi; and if that experience has to become permanent, then the eradication of vasanas or what is also known as vasana kshaya was an absolute must!
Due to the merits of some past lives, one may experience the Self…for the time being, the vasanas would appear to be subdued. But it will resurface again and the experience of the Self would fade away. And the doership would remain intact as long as the experience of the Self is not 24/7.
It's only when the experience of the Self becomes permanent that the doership and the sense of agency go away for good; and the earlier motivations from a limited perspective no longer holds true for such a Self-realised person.
If such a person happens to be in, say, some business, the business will continue but the motive to make more and more profits disappear completely. He/she will remain satisfied with what comes.
A higher power takes over the life of such a person and looks to all his/her needs. He/she just becomes a tool in the hands of that higher power.
Sri Nisargadutta Maharaj was in beedi buisness, and after his enlightenment too, the same business continued, Maharaj also continued smoking his beedis. But the profit making motive was totally gone!
Thanks for reading
Nirvritananda
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BATTEN D TRGDY
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