The Death of Anna Katharina Ehmer A Case Study in
The Death of Anna Katharina Ehmer A Case Study in
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ABSTRACT
77
food, fouled herself day and night, uttered an animal-like sound, and slept.
In all the time she lived with us, we have never seen that she had taken notice
of her environment even for a second. We had to amputate one of her legs,
she wasted away. (Ringger, 1958, p. 219)
Wittneben maintained that these phenomena indicate that there are always
possibilities to influence brain cells positively in these patients, be it by the use of
medical or pedagogical means. In this publication, he referred to such cases to
support the concept of his therapy outlined in the section about his life and work.
Six years later, in a talk for the Arbeitsgemeinschaft für eugenische Fragen
[Working Group for Eugenic Questions] in 1932, Happich used the following
words to describe his experiences with patients close to dying:
For me, the most mentally deranged idiot is not inferior to normal persons
in the deepest sense. I have lived through various virtually shattering experi-
ences, some of which I have experienced together with the chief physician of
our institution, Dr. Wittneben. These experiences have shown me that even
the most miserable imbecile leads a hidden inner life which is just as valuable
as my own inner life. It is only the destructed surface that hinders him to
show it to the outside. Often in the last hours before death, all pathological
obstructions fell away and revealed an inner life of such beauty, that we could
only stand in front of it, feeling shaken to the core. For somebody who has
witnessed such events, the entire question of legally controlled euthanasia
is completely finished. (Trost, 1983, pp. 9-10)
dying!” When we entered the room together, we did not believe our eyes and
ears. Käthe, who had never spoken a single word, being entirely mentally
disabled from birth on, sang dying songs to herself. Specifically, she sang
over and over again “Where does the soul find its home, its peace? Peace,
peace, heavenly peace!” For half an hour she sang. Her face, up to then
so stultified, was transfigured and spiritualized. Then, she quietly passed
away. Like myself and the nurse who had cared for her, the physician had
tears in his eyes. (Ringger, 1958, p. 220)
DISCUSSION
It is difficult to evaluate the available reports concerning the death of Käthe,
as they are essentially historical. We cannot exclude the possibility that both
Happich and Wittneben, who were in constant friendly contact, simply invented
this case to support their personal agendas. For example, when Wittneben first
wrote about terminal lucidity in 1926, he used the cases he had allegedly witnessed
as conceptual support for the diagnostic and therapeutic method he had developed.
84 / NAHM AND GREYSON
persons. In particular, cases of Käthe’s kind raise questions about current concepts
of brain functioning. With regard to meningitis, we found three other reports
of terminal lucidity. Other cases involved strokes, advanced stages of dementia
including terminal stages of Alzheimer’s disease, and brain abscesses and tumors
(Nahm, 2009; Nahm & Greyson, 2009; Nahm et al., 2012). Among 100 consecutive
hospice deaths, Macleod (2009) reported six cases of terminal lucidity, of which
three involved central nervous system metastases or primary malignancy.
Often, terminal lucidity occurred only moments, minutes, or hours before
death. Like Käthe’s case, some of the reports that involve notable damage of
brain tissue seem to challenge currently prevailing models about the mind and its
relation to the brain’s anatomical fine structure. Systematic studies into such
cases might add to other anomalous brain-related findings that at present seem
difficult to explain. We maintain that such anomalies are of special interest, because
they might eventually lead to an improvement of our understanding of human
brain functioning.
Comparable anomalies that appear problematic include complex consciousness
and memory under conditions of severe brain malfunction (Greyson, Kelly, &
Kelly, 2009), the sudden remission of cerebral palsy in a 60-year-old man docu-
mented in a prospective study on near-death experiences (Sartori, 2008; Sartori,
Badham, & Fenwick, 2006), the apparent intactness of memory and personality
characteristics in a 35-year-old man who underwent hemispherectomy after a
malignant brain tumor had developed (Bell & Karnosh, 1949), and above-average
intelligence in hydrocephalic persons with only limited amounts of cortical brain
tissue, which in addition displays a different anatomical structure compared to
normally developed brains (Jackson & Lorber, 1984; Lorber, 1983). As Treffert
wrote of the savant syndrome, we hold that no model of brain functioning,
particularly of memory, will be complete until it can include and account for these
remarkable conditions (Treffert, 2006, p. 3).
Thus, specific and large-scale studies that address the question of deathbed
cognitive function of persons with mental disabilities are indicated. Such studies
might result in findings that improve our understanding of human mental
functioning and lead to enhanced treatment of persons with severe mental
disabilities. Moreover, studying anomalous end-of-life experiences would lead
to an increasing familiarity with them among healthcare providers and those
caring for terminally ill persons. Recent surveys have shown that many care-
takers would like to learn more about unexpected and anomalous end-of-life
experiences to be better able to deal with them, and recommended pertinent
training modules in their education (Brayne, Lovelace, & Fenwick, 2008;
Fenwick, Lovelace, & Brayne, 2010). In conclusion, increased familiarity with
such experiences would be important for the dying, for those who care for them,
for the bereaved, and ultimately, for all those who are confronted with dying in
one way or another.
86 / NAHM AND GREYSON
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