People experience a state of euphoria during their final moments of life

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“People often look like they are sleeping just after dying, having a neutral facial expression.

But one of my relatives, who had intense pain the hours leading up to his death and lacked access to medical care, had a radiant, ecstatic expression.

For decades, I have wondered whether the last minutes of life can be euphoric. Could dying perhaps trigger a flood of endorphins, in particular in the absence of painkillers?” Göran, 77, Helsingborg, Sweden.

The poet Dylan Thomas had some interesting things to say about death, not least in one of his most famous poems:

“And you, my father, there on the sad height,
Curse, bless, me now with your fierce tears, I pray.
Do not go gentle into that good night.
Rage, rage against the dying of the light.”

It is often assumed that life wages a battle to the last against death.

But is it possible, as you suggest, to come to terms with death?

As an expert on palliative care, I think there is a process to dying that happens two weeks before we pass.

During this time, people tend to become less well. They typically struggle to walk and become sleepier – managing to stay awake for shorter and shorter periods.

Towards the last days of life, the ability to swallow tablets or consume food and drinks eludes them.

It is around this time that we say people are “actively dying”, and we usually think this means they have two to three days to live.

A number of people, however, will go through this entire phase within a day. And some people can actually stay at the cusp of death for nearly a week before they die, something which usually is extremely distressing for families.

So there are different things going on with different people and we cannot predict them.

The actual moment of death is tricky to decipher. But a yet unpublished study suggests that, as people get closer to death, there is an increase in the body’s stress chemicals.

For people with cancer, and maybe others, too, inflammatory markers go up. These are the chemicals that increase when the body is fighting an infection.

You suggest that there may also be an endorphin rush just before someone dies. But we just don’t know as nobody has yet explored this possibility.

A study from 2011, however, showed that the levels of serotonin, another brain chemical that is also thought to contribute to feelings of happiness, tripled in the brains of six rats as they died. We can’t rule out the possibility that something similar could happen in humans.

The technology to look at endorphin and serotonin levels in humans does exist. Nevertheless, getting repeated samples, especially blood, in the last hours of someone’s life is logistically challenging.

Getting the funding to do this research is hard, too. In the UK, cancer research in 2015-2016 was awarded £580m whereas palliative care research was awarded less than £2 million.

There is no evidence suggesting that painkillers such as morphine would prevent endorphins from being produced, however.

Pain isn’t even always an issue when people die. My own observations and discussions with colleagues suggest that if pain has not really been an issue for a person earlier, it is unusual for it to become a problem during the dying process.

In general, it seems like people’s pain declines during the dying process. We don’t know why that is – it could be related to endorphins. Again, no research has yet been done on this.

There are a number of processes in the brain that can help us overcome severe pain. This is why soldiers on the battlefield often don’t feel pain when their attention is diverted.

Work by Irene Tracy at the University of Oxford demonstrates the fascinating power of placebo, suggestion and religious beliefs in overcoming pain. Meditation can also help.

Euphoric experiences

But what could cause a euphoric experience during death, other than endorphins or alternative neurotransmitters? As the body shuts down, the brain is affected.

It is possible that the way in which this happens somehow influences the experiences we have at the moment of death.

The American neuroanatomist Jill Bolte-Taylor has described in a TED talk how she experienced euphoria and even “nirvana” during a near-death experience in which her left brain hemisphere, which is the centre of many rational abilities such as language, shut down following a stroke.

Credit: TED.

Interestingly, even though Bolte-Taylor’s injury was to the left side of her brain, an injury to the right side of the brain can also increase your feelings of being close to a higher power.

I think there is a chance that your relative had a deep spiritual experience or realisation. I know that when my grandfather died he raised his hand and finger as if he was pointing at someone.

My father, a devout catholic, believes that my grandfather saw his mother and my grandmother. He died with a smile on his face, which brought profound reassurance to my father.

The dying process is sacred to Buddhists, who believe that the moment of death provides great potential for the mind.

They see the transition from living to dying as the most important event of your life – that point when you carry Karma from this life into other lives.

That doesn’t mean that religious people generally have more joyful death experiences. I have witnessed priests and nuns become extremely anxious as they approach death, perhaps consumed by concerns about their moral record and the fear of judgement.

Ultimately, every death is different – and you can’t predict who is going to have a peaceful death. I think some of those I have seen die didn’t benefit from a rush of feel-good chemicals.

I can think of a number of younger people in my care, for example, who found it difficult to accept that they were dying. They had young families and never settled during the dying process.

Those I have seen who may have had an ecstatic experience towards the end of their lives were generally those who somehow embraced death and were at peace with the inevitability of it. Care may be important here – a study of lung cancer patients who received early palliative care were found to be happier and lived longer.

I remember one woman who was getting nutrition through her veins. She had ovarian cancer and was not able to eat. People fed like this are at risk of serious infections.

After her second or third life-threatening infection, she changed.

The sense of peace emanating from her was palpable. She managed to get home from hospital for short periods and I still remember her talking about the beauty of sunsets. These people always stick in my mind and they always make me reflect on my own life.

Ultimately, we know very little about what happens when someone is dying. After 5,000 years of medicine, we can tell you how you die from drowning or a heart attack, but we don’t know how you die from cancer or pneumonia. The best we can do is describe it.

My research is focused on trying to demystify the dying process, understand the basic biology and develop models predicting the last weeks and days of life.

In time, we may also get to research the role endorphins play in the last hours of life and actually get to answer your question definitively.

It is possible that we experience our most profound moment in the murky hinterland between life and death. But that doesn’t mean we should stop raging against the dying of the light. As the Swedish diplomat Dag Hammarskjöld put it:

“Do not seek death. Death will find you. But seek the road which makes death a fulfilment.”


In research on humans’ relationship to the natural world, spirituality is key to understanding people’s emotions and the meaning of nature to them (Fredrickson and Anderson, 1999). Stokols (1990)maintains that it is a central element of environmental experience. Spirituality can be defined as “an individual’s inner experience and/or belief system, that gives meaning to existence, and subsequently allows one to transcend beyond the present context,” in Kamitsis and Francis’s (2013, p. 137) words.

In recent years, spirituality research has peaked in association with research on transcendent experiences (Levin and Steele, 2005Yaden et al., 2017) in relation to wellbeing (Yaden et al., 2017), health (Levin and Steele, 2005), and other aspects.

It has, further, opened up a specific line of research on feelings of awe, which researchers have undertaken experimentally (Piff et al., 2015) as well as phenomenologically (Bonner and Friedman, 2011), building on Keltner and Haidt (2003) pioneering contribution.

Various studies have examined what elicits this sort of transcendent emotion, as well as its effects. They all emphasize that nature is a principal source for people to “experience a sense of spirituality” (Kamitsis and Francis, 2013, p 236).

However, there is not a consensual definition about these spiritual and transcendent experiences to nature, being more difficult a quantitative approach (Joye and Bolderdijk, 2015).

This study presents an instrument and a definition to measure spiritual responses elicited by nature, a particular transcendent emotions, that we propose to call sublime emotion toward nature.

Sublime experience has been defined as a mix of emotions – arousal, pleasure, and vitality – together with feelings of awe in nature, which is perceived as powerful, vast, and complex (Bodei, 2008/2011). According to Van Elk et al. (2016), “sublime is experienced as boundlessness that can eventually overwhelm or even destroy the observer” (p.11). Those authors recognize that sublime emotion can be evoked by the imposing natural world, and that it resembles the feeling of awe.

Edmund Burke (1757/2005), in his essay on “the sublime and beautiful” published in 1757, defined the sublime as an emotion mainly characterized by feelings of amazement and fear, and to a lesser extent admiration, respect, and reverence.

Burke adds that sublime emotion means experiencing passions painful or delicious, terrible or pleasurable, depending on a person’s proximity to real danger. It is triggered by the experience of subjugation to something greater than oneself, such as nature, the divine, or the institutionalized power of kings, and is associated with awe and “a connection with terror” (p. 97).

Likewise, Burke describes the sublime in terms of privation, “the void, darkness, solitude, and silence” (p. 101); vastness, unimaginable smallness, majesty, the unknown, the notion of the infinite that elicits “delightful horror” (p. 103).

According to Kant (1764/2008), sublime is an emotion that presupposes the soul’s excitability. It can manifest as “the terrifying sublime,” which is those emotions that are accompanied by a degree of horror or melancholy; “the noble,” which is related to quiet admiration; or “the splendid,” which is a sense “of beauty that extends to the plane of the sublime” (p. 32). He includes a sense of dread and respect as yet another property of the sublime.

Bodei (2008/2011) defines the sublime as an experience of simultaneous fear and pleasure. According to his analysis, nature inspires sublime emotion. First, “horrid places” (p. 19) such as “oceans, deserts, mountains, untamed jungles, and volcanoes have qualities that awaken fear, fright, and goosebumps” (p.19). Second, cosmic nature, the “planet that, floating, navigates through the void, through immense dark spaces” (p. 27), fills people with anguish, uneasiness, shock, and terror as they confront concepts they cannot rationally understand – like death, the infinite, and limitless expansion.

Johnson (2002), on the other hand, posits the sublime as one of various spiritual feelings that emerge during wilderness contact. He defines it as “the awesome power of wild nature and its indifference to human concerns” (p.29), and suggests there is a need for empirical research to test the spiritual benefits of wilderness exposure.

Recent interest in transcendent emotions has built on important historical contributions from Psychological Science. William James (1902/19861890/1950) refers to spiritual identity as a sense of oneness with all things, and he connects it to a mystic experience – a sort of spiritual, religious experience that is typically ineffable, true, transitory, passive, and brought about by a perceived higher power. Nature evokes these feelings because “it seems to have a peculiar power of awakening such mystical moods” (James, 1902/1986, p. 385). James adds that mystical experiences provoked by nature are cited in works of art, including and especially Walt Whitman’s poetry (James, 1902/1986), which conveys a sense of interconnectedness and oneness between the entire universe and the personal, private sphere.

Maslow (1964), too, studied human emotions related to self-transcendence and self-realization, in terms of his famous concept of peak experience. Emotional response during a peak experience is described as a constellation of intense feelings, associated with terms like “wonder, surprise, awe, amazement, reverence, humility and surrender before the experience as before something great” (Maslow, 1999, p.89). Self-perception transcends the self, and what emerges is a sense of oneness with the broader universe. Similarly, it is associated with positive emotions like self-realization, and impulses toward honesty and goodness.

A third point of conceptual support for investigating transcendent emotions is flow experience. Csikszentmihalyi (2014) defines this as a person entering a state of absorption, full attention, and abstraction in a personally fulfilling activity that brings him or her closer to a positive state – for instance, a state of utter joy, a sense of balance and self-sufficiency in life, etc. Seligman and Csikszentmihaly (2000) link flow experience to spirituality as a Positive Psychology tool to “move individuals toward better citizenship” (p. 5).

Mystical experience, peak experience, and flow are all psychological processes related to transcendent emotions (Yaden et al., 2017). Several studies offer empirical support that nature prompts transcendent emotional reactions. Talbot and Kaplan (1986) argue that wonder and awe are among people’s emotional reactions to direct contact with wilderness, along with a feeling of oneness with nature (see also Hartig and Evans, 1993).

Williams and Harvey (2001) conducted a study to discover types of transcendent emotions produced in the forest, in the state of Victoria in southeast Australia. Among others measures, they adapted the Hood (1975) mysticism scale to measure “the transcendent nature of the experience” (p. 251) and defined transcendent emotions in the forest as intense positive mood, unity, absorption, and timelessness. Through cluster analysis, they determined that transcendent emotion is defined by feeling small and insignificant while also experiencing deep flow. Feeling small is marked by a high level of fascination and novelty, low belonging, and feelings associated with awe, wonder, and humility toward the natural world. Meanwhile deep flow is defined by feelings of belonging and relaxation in the forest.

Seamon (1984) analyzes Wordsworth poems (1770–1850) from a phenomenological perspective, concluding that spiritual emotions denote a profound sense of belonging with nature and refer to positive, pleasant feelings like joy, exaltation and the sublime feeling in particular. He mentions a heightened emotion feeling, which he describes as a sense of inner peace that suspends the individual in a deep, inner spiritual state; hard to explain rationally with words, it is best understood through lived experience.

Vining and Merrick (2012), on the other hand, propose studying environmental epiphanies as “highly significant and meaningful experiences that shift the fundamental self-nature relationship” (p. 506). Vining and Merrick lay out five types of environmental epiphany: aesthetic, intellectual, realization, awakening, and connectedness epiphanies. The latter is described in terms of spiritual and mystic qualities, and the experience of becoming one with nature. It even involves physical sensations (numbness or tingling) that can change a person’s perception of where s/he is.

Taking an empirical and especially qualitative approach, Cousins et al. (2009) studied people’s emotional states while contemplating wild animals. They feel transcendent emotions they describe as awe and wonder, which mix emotional responses like “epiphany and joy with mortal fear” (p. 1075) when they are in the wilderness, or while contemplating large mammals in the wild.

Kamitsis and Francis (2013) conducted a study of 190 participants, concluding that spirituality mediated the effects of nature exposure and nature connectedness on psychological wellbeing.

The literature indicates that, like Kamitsis and Francis (2013)found, transcendent emotions are positively associated with greater exposure and connectedness to nature. Of those emotions, awe is among the most extensively empirically examined to date (Joye and Bolderdijk, 2015).

Keltner and Haidt (2003) seminal study defines awe as a prototypical emotion in which a person feels disoriented, afraid, small, humble, and confused. It is prompted by stimuli perceived to be quite vast; to process a thing or place with such grandeur requires perceptual accommodation (Keltner and Haidt, 2003). Joye and Bolderdijk (2015) define awe as a “highly intense emotion that is triggered by vast and overwhelming phenomena, leading to increased spirituality, and to feelings of oneness with, and caring for others” (p. 2). They conclude that awe as a variable mediates the effect on mood, improving mood when someone is exposed to images of amazing, awesome natural landscapes, as opposed to depictions of nature in everyday spaces. Similar results have been reported about awe in appraisals of gigantic buildings (Joye and Dewitte, 2016). Awe has even been referred to as one thing people feel when they see planet Earth from space (Yaden et al., 2016).

Awe has been linked to other positive emotions that human beings experience (Maslow, 1964Keltner and Haidt, 2003). Nisbet et al. (2009) believe the awe variable may relate to positive emotions, and recommend studying it in relation to wellbeing and connectedness with nature. Shiota et al. (2007) administered a survey of open-ended questions to 60 psychology students, concluding that the following events most often elicit awe: exposure to nature (27%) and exposure to art or music (20%). Those authors conclude that awe is a more intimate expression than happiness, and that it is only provoked by positive, not negative, events that inspire horror and fear (storms and natural disasters, among other phenomena).

Awe has been defined as a positive – as well as complex – emotion, and several recent studies have examined its effects. It has a demonstrated impact on perception of one’s body (Van Elk et al., 2016), and of time (Rudd et al., 2012). Additionally, Piff et al. (2015) research has identified two effects of awe: diminishment of the individual self; and increased prosocial behavior. Other studies have shown that awe has effects on the genesis of spiritual intentions (Van Cappellen et al., 2013). Hinds and Sparks (20082011) investigations associate it with Eudaimonia, a type of psychological wellbeing associated with feelings of inner peace, happiness, vitality, and satisfaction with life. Awe, considered a sort of affective state, loaded onto the Eudaimonia factor along with other affective states – emotional connection, contemplation, serenity, vitality, sense of freedom, empathy, and freshness. Awe was related to being (or remembering being) in the jungle, mountains, and large valleys; and to a lesser extent being in the forest, river, ocean, or at the beach.

Altogether, these studies highlight some of the most important psychological benefits of awe. Yet as Bonner and Friedman (2011)point out, “awe lacks a consensual and precise meaning” (p. 222). It might be part of a broader concept of spiritual, transcendent emotions (Ashley, 2007), the sublime experience toward nature, as the present study proposes.

For better clarification, as Table 1 clearly conveys, sublime emotion as described by Burke (1757/2005) and Bodei (2008/2011) has a similar meaning to Maslow (1964) peak experience, and sense of awe as defined by Kant (1764/2008)Keltner and Haidt (2003)Haidt (2003)Shiota et al. (2007), and Cousins et al. (2009),. The definitions agree that awe, a property proposed as part of the conception of sublime emotion, is accompanied by an experience that overwhelms the self and human understanding, triggering a devotional reaction. Maslow (1964) goes further, arguing that these experiences and emotions relate to other psychological variables, like intrinsic, universal values that everyone and every culture have for wilderness experience.

Table 1

Summary of Basic Content Referenced about Sublime and Transcendent Emotion.

TermDefinitionAuthor (s)
Sublime emotionEmotion characterized by astonishment, awe, fear, respect and admiration. Feeling a mix of terror and pleasure that becomes a “delightful horror” if no real danger is perceived. Stimuli that trigger it include natural and non-natural places with particular features and properties, qualities of human frailty, the infinite, eternity, and certain works of art. This is distinct from “beauty.”Burke (1757/2005)
The sort of feeling that stirs the soul, whether due to surprise, terror, reverence, magnificence, trembling, or respect. Kant added certain personal characteristics to the sublime stimuli earlier proposed by Burke.Kant (1764/2008)
Sublime emotion toward natureExperiencing fear and pleasure in a wilderness perceived as powerful. In a mix of awe, humility, self-transcendence, joy, sadness, enthusiasm, and connection with the whole universe. This is produced by “horrid” landscapes as well as superhuman dimensions like eternity, infinity, and the ineffable.Bodei (2008/2011)
Self-transcendencePeak experience. A larger-than-life experience of self-realization characterized by a mix of spiritual emotions like enlightenment, awe, reverence, humility, happiness, wonder, and connection to the universe, among others.Maslow (1964)
Flow experience. Achieving harmony and balance in consciousness by engaging in creativity and focused attention on a process of authentic personal growth. This entails deep enjoyment of life and attainment of happiness.Csikszentmihalyi, 2014
Feeling of aweAn emotional experience characterized by fear, vulnerability, humility, disorientation, inspiration, and renewal; and in contrast, sensing a higher power, beauty, and justice, among other things.Keltner and Haidt (2003) Shiota et al. (2007)
A mix of emotional states – epiphany, joy, mortal fear, vitality, humility, vulnerability, respect, and sensing a connection with all of nature – elicited by nature’s mystery, power, savagery, and unpredictability.Cousins et al. (2009)

The aforementioned studies share an interest in transcendent and spiritual emotions, highlighting the importance of one in particular within the empirical literature: awe. However, many authors have suggested (Bonner and Friedman, 2011, among others) there is a need to precisely define the content of this complex emotion. Moreover, we need to institute measures of awe that can be compared. For example, Joye and Bolderdijk (2015) maintain that:

We have probed for awe and awe related emotions by using only one item. This underscores the need to develop a validated scale –or any other measurement instrument- that is capable of accurately capturing the occurrence of this complex emotional state, and of associated emotions and states (Joye and Bolderdijk, 2015, p. 7).

This study endeavors to propose an instrument to measure transcendent emotions, including precisely the content referred to until now as part of awe.

This study aims to help establish transcendent and spiritual contents related to nature, and proposes the sublime as a unifying feeling that encompasses awe and positive and pleasurable emotions within a single construct.

To date, there is no empirical assessment of wilderness experience that includes emotional responses of awe, positive and pleasurable emotions, and epiphany within the same construct. Based on the Bethelmy (2012) conceptual definition, the sublime emotion toward nature is defined as a transcendent, spiritual emotion involving epiphany and a mix of heightened fear (awe) and pleasurable emotions, like wellbeing and others, provoked by a stimulus of impressive and frightful qualities in the experience with nature. The objective, therefore, is to create an operational definition of sublime emotion toward nature and design a reliable and valid instrument to measure it.

Instrument creation followed Kerlinger and Lee (2000) and Abad et al. (2011) recommendations, which maintain that instruments, in addition to being reliable, should have good indicators of discriminant and predictive validity. We expect that this operational measure of sublime emotion toward nature will yield good reliability indexes, one indication of internal consistency. Furthermore, the contents (items) of the sublime emotion scale should differ from other measures of similar emotional content, like love and care for nature (Perkins, 2010), connectedness with nature (Mayer and Frantz, 2004), and transcendent emotion (Williams and Harvey, 2001) – though it has certain elements in common with those variables – if we are to conclude that the scale has content and construct validity (Kerlinger and Lee, 2000Abad et al., 2011).

Love and care for nature (Perkins, 2010), connectedness with nature (Mayer and Frantz, 2004) and environmental intention (Amérigo et al. (2012) are selected because these measures content items about the emotions to nature and affinity and connectedness to nature related to environmental intention and behavior. For example, love and care for nature 2010) was significantly related with connected with nature and environmental behavior (see Perkins, 2010).

Another characteristic of a good operative definition is the explanatory power as an indicator of predictive validity (Kerlinger and Lee, 2000Abad et al., 2011). Previous results indicate that emotions toward nature have a predictive power over environmental behaviors (Grob, 1995) and even a mediating role (Corraliza and Bethelmy, 2011). Therefore, the relation of the new measurement of sublime emotion toward nature with other variables of the environmental intention and behavior is explored as an indicator of predictive validity.


Source:
The Conversation

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