Why are some people happy when they are dying?

Simon Boas, who wrote a candid account of his life with cancer, died on July 15 at the age of 47. In a recent BBC interviewthe former aid worker told the reporter: “My pain is under control and I am extremely happy. It may sound strange to say, but I am the happiest I have ever been in my life.”

It may seem strange that someone can still be happy when the end is near, but in my experience as a clinical psychologist working with people at the end of their lives, this is not that unusual.

There is a fair amount of research that suggests that fear of death is unconsciously central to being human. William James, an American philosopher, called the knowledge that we must die “the worm at the core” of the human condition.

But one study in Psychological science shows that people approaching death use more positive language to describe their experience than people who only imagine death. This suggests that the experience of dying is more pleasant, or at least less unpleasant, than we might imagine.

In the BBC interview, Boas shared some insights that helped him accept his situation. He mentioned the importance of enjoying life and prioritizing meaningful experiences, and suggested that acknowledging death can increase our appreciation for life.

Despite the pain and difficulties, Boas appeared cheerful and hoped his attitude would support his wife and parents in the difficult times ahead.

Boas’ words are reminiscent of those of the Roman philosopher Seneca, who advised that: “Whether we live long enough does not depend on our years or days, but on our intellect.”

A more recent thinker who expresses similar sentiments is the psychiatrist Victor Frankl who, after surviving Auschwitz, wrote:Man’s Search for Meaning” (1946), in which he laid the foundation for a form of existential psychotherapy, focusing on discovering meaning in every circumstance. The most recent adaptation is meaning-focused psychotherapy, which offers people with cancer a way to improve their sense of meaning.

How Happiness and Meaning Relate

In two recent studies, Palliative and supportive care and the American Journal of Hospice and Palliative CarePeople approaching death were asked what happiness meant to them. Common themes in both studies were social connections, enjoying simple pleasures like being in nature, having a positive mindset, and a general shift in focus from seeking pleasure to finding meaning and fulfillment as their illness progressed.

In my work as a clinical psychologist I sometimes meet people who have the same view of life as Boas, or who eventually arrive at it. One person comes to mind, let’s call him Johan.

The first time I met Johan, he came to the clinic alone, with a slight limp. We talked about life, interests, relationships, and meaning. Johan seemed bright, clear, and articulate.

The second time he came with crutches. One foot was starting to falter and he couldn’t trust his balance. He said it was frustrating to lose control of his foot, but he still hoped to cycle around Mont Blanc.

When I asked him what his worries were, he burst into tears. He said, “Not being able to celebrate my birthday next month.” We sat quietly for a while, taking in the situation. It wasn’t the moment of death itself that weighed most heavily on him, it was all the things he would no longer be able to do.

Johan arrived at our third meeting, supported by a friend who could no longer hold on to the crutches. He told me that he had been watching movies of himself cycling with his friends. He had decided that he could watch YouTube videos of other people cycling around Mont Blanc. He had even ordered a new, expensive mountain bike. “I’ve been wanting to buy one for a long time, but I was cheap,” he said. “I may not be able to ride it, but I thought it would be cool to have it in the living room.”

For the fourth visit he arrived in a wheelchair. It turned out to be the last time we saw each other. The bike had arrived; he had it next to the couch. There was one more thing he wanted to do.

“If by some miracle I get out of here alive, I would like to volunteer in home care, one or two shifts a week,” Johan said. “They work hard and it can be crazy sometimes, but they make such an incredible contribution. Without them, I wouldn’t have gotten out of the apartment.”

My experience with patients with life-threatening illnesses is that it is possible to feel happiness alongside sadness and other seemingly contradictory emotions. In the course of a day, patients may experience gratitude, remorse, longing, anger, guilt, and relief, sometimes all at once. Facing the limitations of existence can add perspective and help one appreciate life more than ever.

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