Why are some people happy when they are dying?

Simon Boas, who wrote a candid account of living with cancer, passed away on July 15 at the age of 47. In a recent BBC interview, the former aid worker told the reporter: “My pain is under control and I’m terribly happy – it sounds weird to say, but I’m as happy as I’ve ever been in my life.”

It may seem odd that a person could be happy as the end draws near, but in my experience as a clinical psychologist working with people at the end of their lives, it’s not that uncommon.

There is quite a lot of research suggesting that fear of death is at the unconscious centre of being human. William James, an American philosopher, called the knowledge that we must die “the worm at the core” of the human condition.

But a study in Psychological Science shows that people nearing death use more positive language to describe their experience than those who just imagine death. This suggests that the experience of dying is more pleasant – or, at least, less unpleasant – than we might picture it.

In the BBC interview, Boas shared some of the insights that helped him come to accept his situation. He mentioned the importance of enjoying life and prioritising meaningful experiences, suggesting that acknowledging death can enhance our appreciation for life.

Despite the pain and difficulties, Boas seemed cheerful, hoping his attitude would support his wife and parents during the difficult times ahead.

Boas’s words echo the Roman philosopher Seneca who advised that: “To have lived long enough depends neither upon our years nor upon our days, but upon our minds.”

A more recent thinker expressing similar sentiments is the psychiatrist Viktor Frankl who, after surviving Auschwitz, wrote Man’s Search for Meaning (1946) in which he lay the groundwork for a form of existential psychotherapy, with the focus of discovering meaning in any kind of circumstance. Its most recent adaptation is meaning-centred psychotherapy, which offers people with cancer a way to improve their sense of meaning.

How happiness and meaning relate

In two recent studies, in Palliative and Supportive Care and the American Journal of Hospice and Palliative Care, people approaching death were asked what constitutes happiness for them. Common themes in both studies were social connections, enjoying simple pleasures such as being in nature, having a positive mindset and a general shift in focus from seeking pleasure to finding meaning and fulfilment as their illness progressed.

In my work as a clinical psychologist, I sometimes meet people who have – or eventually arrive at – a similar outlook on life as Boas. One person especially comes to mind – let’s call him Johan.

The first time I met Johan, he came to the clinic by himself, with a slight limp. We talked about life, about interests, relationships and meaning. Johan appeared to be lucid, clear and articulate.

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

When I asked him what his concerns were, he burst into tears. He said: “That I won’t get to celebrate my birthday next month.” We sat quietly for a while and took in the situation. It wasn’t the moment of death itself that weighed on him the most, it was all the things he wouldn’t be able to do again.

Johan arrived at our third meeting supported by a friend, no longer able to grip the crutches. He told me that he had been watching films of him cycling with his friends. He had concluded that he could watch YouTube videos of others cycling around Mont Blanc. He had even ordered a new, expensive mountain bike. “I’ve wanted to buy it for a long time, but was tightfisted,” he said. “I may not be able to ride it, but thought it would be cool to have in the living room.”

For the fourth visit, he arrived in a wheelchair. It turned out to be the last time we met. 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 were to get out of this alive, I would like to volunteer in domestic care services – one or two shifts a week,” Johan said. “They work hard and it gets crazy sometimes, but they make such an incredible contribution. I wouldn’t have been able to get out of the apartment without them.”

My experience of patients with life-threatening disease is that it’s possible to feel happiness alongside sadness, and other seemingly conflicting emotions. Over a day, patients can feel gratitude, remorse, longing, anger, guilt and relief – sometimes all at once. Facing the limits of existence can add perspective and help a person appreciate life more than ever.