Arthur Koestler’s Dialogue with Death is an unusual, even unique, book in that it’s the experience of a professional writer who expects at any moment to be shot. It provides unique insights into how proximity to death feels, although there are clearly doubts about how much Koestler’s experiences apply to those close to death in less dramatic circumstances.

Koestler, who had written a book describing how the Fascists in the Spanish Civil War tortured and summarily executed Republican prisoners, was captured by the Fascists when they captured Malaga. He might have been shot instantly but wasn’t. He had, however, been condemned to death by a kangaroo court, although he didn’t know it at the time. He was transferred to a prison in Seville, where every night he heard the telephone ring at 10pm precisely to announce who was to be shot that night. Over the next three hours he heard a warder with a priest with a bell moving from cell to cell giving prisoners the last rites and taking them to be shot. Hundreds were shot, and Koestler never knew when it would be his turn.

I say Koestler heard these sounds every night, but actually with a remarkable effort of will he managed to sleep through the sounds after a while. He forced himself to wake at 3am and then stay awake until 9.30pm, when he would fall into a deep sleep that would carry him through the terrible hours.

He also showed an astonishing strength of will in not drinking for eight days and not eating for even longer. He did this to produce real symptoms and so fool the prison doctor that he had a heart condition. He wanted to be transferred to the prison hospital, where he expected to have extra privileges. But the prison doctor prided himself on spotting ever more sophisticated forms of malingering, seeing it as a failure to admit anybody to the hospital, and decided that Koestler had been drinking ether. As a consequence Koestler lost rather than gained privileges.

The book is packed with wisdom (quotes on death here), and Koestler is lyrical on how being able to read and write can make life bearable, even when in a condemned cell. But it’s his dialogue with death that makes the book, which, as Koestler observes, lacks a climax. The climax could, of course, have been his execution.

Koestler subscribes to Freud’s idea that we cannot imagine our own deaths, even when it may be moments away.

“Of course everyone knows that he must die one day. But to know is one thing, to believe another…”

He doesn’t believe that any human, including Socrates, has ever died consciously.

“I fancy there must be some mathematic relationship; one’s disbelief in death grows in proportion to its approach. I don’t believe that since the world began a human being has ever died consciously. When Socrates, sitting in the midst of his pupils, reached out for the goblet of hemlock, he must have been at least half convinced that he was merely showing off. He must have seemed to himself to be rather bogus and have secretly wondered at his disciples’ taking him so seriously. Of course he knew theoretically that the draining of the goblet would prove fatal; but he must have had a feeling that the whole thing was quite different from what his per-fervid, humourless pupils imagined it; that there was some clever dodge behind it all known only to himself.”

Koestler thinks that the mind can split, with one part knowing that death is close but another part cool and aloof as though observing a stranger.

“That dream-like feeling of having one’s consciousness split in two, so that with one half of it one observes oneself with comparative coolness and aloofness, as though observing a stranger. The consciousness sees to it that its complete annihilation is never experienced. It does not divulge the secret of its existence and its decay. No one is allowed to look into the darkness with his eyes open; he is blindfolded beforehand. This is why situations lived through are never so bad in reality as in imagination. Nature sees to it that trees do not grow beyond a certain height, not even the trees of suffering.”

Koestler attempted and contemplated suicide. The attempt showed him how powerfully we cling to life.

“At this moment I was really convinced, that it was only out of laziness and apathy that I did not commit suicide. Of course I was deceiving myself again. The instinct of self-preservation, shrewd and indestructible as it is, assumes the most subtle masks. That morning it had presented itself in the toga of Socrates, who, calm and collected, reaches out for the draught of hemlock. The mask had served its purpose; it had helped the mind through a crucial moment. Now it appeared in a new garb; that of St. Simeon Stylites, who squats on his column and lets the worms devour him.”

And the contemplation allowed him a state of calmness. Others, including Sylvia Plath and William Styron, have described how contemplation of suicide can bring relief from suffering; and those who kill themselves are regularly described, often with surprise, as being calm immediately before killing themselves. These observations help me understand how the legalisation of assisted suicide suicide can bring great benefits with only a small number actually acting on the option.

“The fact that I had made a decision [to kill himself] which I regarded as final filled me with utter contentment. I became really cheerful, and the barometer rose at an astonishing rate. I was very proud of this Olympian frame of mind, and, true to the penny novelette, thought: nothing has power to move him who has done with life. It was not until much later, in Seville, when I and a fellow prisoner, also condemned to death, were discussing the various forms of fear, that I understood the secret of this magic metamorphosis: namely, that by coming to a sham decision to take my life I had simply snatched for myself twelve untroubled hours. My state of Olympian calm was not, as I thought, the result of the decision itself, but of my having set a time limit of twelve hours. Up till now I had counted hourly on hearing the oily voice calling out my name; now, by a wishful inference, I took it for granted that the twelve hours’ respite which I had given myself would be respected by the outside world. This was why I was so cheerful.”

Koestler was every day with people about to be shot, and he makes the observation, useful to all but especially to doctors and medical students, that what you say to a person close to death matters little, it’s tone and gesture that matter, human contact.

“Only much later, in Seville, did I learn the simple fact that in such cases [talking to a man who has been badly beaten up and is about to be shot] the content of what one says matters little, and the tone and gesture everything; thus, in the prison in Seville three of us managed to lull to death in this way a little Militiaman who was more afraid even than most people of execution. He knew that we were lying, and we knew that he knew it; and yet he was comforted, and swallowed our words like a drug.”

Back home in London after his experience Koestler notes that he never felt as free as when he lived close to death.

“Often when I wake at night I am homesick for my cell in the death-house in Seville and, strangely enough, I feel that I have never been so free as I was then. This is a very strange feeling indeed. We lived an unusual life on that patio; the constant nearness of death weighed down and at the same time lightened our existence. Most of us were not afraid of death, only of the act of dying; and there were times when we overcame even this fear. At such moments we were free—men without shadows, dismissed from the ranks of the mortal; it was the most complete experience of freedom that can be granted a man.”

Death, I believe, has many upsides.

Richard Smith was the editor of The BMJ until 2004.

Competing interest: None declared.