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Why Do We Lose Rational Behavior During Times of Intense Trauma?

I received a letter from a man who had been very ill. During some of that time he was delusional, confused, disoriented and agitated. His family has told him that during the time of his illness he was mean, uncooperative, a really nasty person. He is now puzzled by how he could possibly be that person they described. 

As people approach death in the weeks, days, and even hours they can experience the same behavior this gentleman described. It has the medical name of terminal agitation.

Why do we say and do what we say and do during times of intense trauma? I’m not a psychologist, but it seems to me that during these times (which can be from either illness or approaching death) we tend to lose touch with all the “conditioning” we have experienced in our life. Instructions on how to do and say the “correct things,” how to be socially correct, are gone.

Our base nature comes out when we are in pain, other worldly, and on high doses of all kinds of medications.  We are unconsciously expressing the terrible situation we were in. Our everyday “manners” are of no importance here.

When a person is in an agitated state either in recovery or approaching death the “governor” is off. The training, thinking switch is off. The survival, get me out of here switch is on.

When the end of life is approaching, the line between this world, this reality and another reality, is thinned. The person has one foot in both worlds. I think with pain medications, intense physical pain, dehydration, the body malfunctions (even when death is not approaching or is approaching but is later reversed) we slip out of this world and into another. 

What we watchers consider rational behavior is generally gone. Unlike the movies, where the person says “I love you, take care of the children” closes their eyes and dies. In real life a dying person breathes strangely, talks about and to people we can’t see or hear, often shows fear, restlessness, agitation, and yes, may say angry, “mean” words. All of this is the normal, natural part of being very sick and possibly dying.

Something More… about Why Do We Lose Rational Behavior During Times of Intense Trauma?

I believe that knowledge reduces fear and that in our society there is a considerable lack of knowledge about the normal, natural dying process. I have a compilation of my most popular blog articles that address the many facets of the normal, natural way that people die.  They are called, Knowledge Reduces Fear: A Resource for End of Life Education  and Knowledge Reduces Fear Volume 2: A Resource for End of Life Education . For more on pain management at end of life please consider, Pain at End of Life: What You Need to Know About End of Life Comfort and Pain Management .

Originally Published on

Barbara Karnes Registered Nurse

Barbara Karnes, RN Award Winning End of Life Educator, Award Winning Nurse, NHPCO Hospice Innovator Award Winner 2018 & 2015 International Humanitarian Woman of the Year

While at the bedside of hundreds of people during the dying process, Hospice Pioneer Barbara Karnes noticed that each death was following a near identical script. Each person was going through the stages of death in almost the same manner and most families came to her with similar questions. These realizations led Barbara to sit down and write Gone From My Sight, "The Little Blue Book" that changed the hospice industry.

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