Near-death experience

A near-death experience (NDE) is the perception reported by a person who nearly died or who was clinically dead and revived. The experience is somewhat common, especially since the development of cardiac resuscitation techniques. According to a Gallup poll approximately eight million Americans claim to have had a near-death experience (Mauro, 1992). The experience often includes an out-of-body experience.

The phenomenology of the NDE

The phenomenology of an NDE usually includes physiological, psychological and transcendental categories (Parnia, Waller, Yeates & Fenwick, 2001) such as subjective impressions of being outside the physical body (an out-of-body experience), transcendence of ego and spatiotemporal boundaries, and other transcendental experiences (Lukoff, Lu & Turner, 1998; Greyson, 2003).

Typically the experience follows a distinct progression (Mauro, 1992; Morse, Conner & Tyler, 1985; Morse & Perry, 1992; van Lommel et.al, 2001) as summarized in the following points:

• The sudden awareness that one has had a "fatal" accident and not survived.
• An out-of-body experience. A sensation of floating above one's body and seeing the surrounding area.
• Pleasant feelings, calmness. A sense of overwhelming love and peace.
• A sensation of moving upwards through a tunnel or narrow passageway.
• Meeting deceased relatives or spiritual figures.
• Encountering a being of light, or a light (possibly a religious figure, e.g., Jesus Christ / God the Father, Buddha).

• Being given a life review.

• A feeling of being returned to the body, often accompanied by a reluctance to return. A 'core' near-death experience reflects — as intensity increases according to the Rasch scale — peace, joy and harmony, followed by insight and mystical or religious experiences (Lange, Greyson & Houran, 2004). The most intense NDEs involve an awareness of things occurring in a different place or time. Among the clinical circumstances that are thought to lead to an NDE we find such factors as: cardiac arrest, shock in postpartum loss of blood or in perioperative complications, septic or anaphylactic shock, electrocution, coma, intracerebral haemorrhage or cerebral infarction, attempted suicide, near-drowning or asphyxia, apnoea, serious depression (van Lommel et al., 2001).

Near-death research

A significant amount of the research on near-death experiences is co-ordinated through the field of Near-death studies. Among the pioneers of Near-death studies we find Dr. Raymond Moody, who has chronicled and studied many of these experiences in several books (Moody, 1975;1977;1999), and Dr. Kenneth Ring, co-founder and past President of the International Association for Near-death studies (IANDS). Major contributions to the field include the construction of a Weighted Core Experience Index (Ring, 1980) in order to measure the depth of the Near-Death experience, and the construction of the Near-Death Experience Scale (Greyson, 1983) in order to differentiate between subjects that are more or less likely to have experienced a genuine NDE. These approaches include criteria for deciding what is to be considered a classical or authentic NDE. Among the researchers associated with the field of Near-Death Studies we find such names as Bruce Greyson, Michael Sabom, Melvin Morse, PMH Atwater, Yvonne Kason and Peter Fenwick. Most of these researchers tend to emphasize the interpretative and phenomenological dimension of the experience.

Other contributors to the research on Near-death experiences come from the disciplines of medicine, psychology and psychiatry. Neuro-biological factors in the experience has been investigated by researchers within the field of medical science and psychiatry (Britton & Bootzin, 2004; Jansen, 1995; Thomas, 2004). Among the researchers and commentators who tend to emphasize a naturalistic and neurological base for the experience we find the British psychologist Susan Blackmore (1993), and founding publisher of Skeptic magazine, Michael Shermer (1998).

Among the scientific and academic journals that have published, or are regularly publishing new research on the subject of NDE's we find: Journal of Near-Death Studies, Journal of Nervous And Mental Disease, British Journal of Psychology, American Journal of Disease of Children, Resuscitation, The Lancet, Death Studies, and Journal of Advanced Nursing

According to Martens (1994), the only satisfying method to address the NDE-issue would be an international multicentric data collection within the framework for standardized reporting of cardiac arrest events. The use of cardiac arrest-criteria as a basis for NDE-research has been a common approach among the European branch of the research field (Parnia, Waller, Yeates & Fenwick, 2001; van Lommel, van Wees, Meyers & Elfferich, 2001).

As an afterlife experience

Many commentators see near death experiences as an afterlife experience. This often implies the view that the NDE can not be explained by physiological or psychological causes only, and that consciousness, in some instances, might function independently of brain activity (Rivas, 2003). Some NDE-accounts include elements that, according to some theorists, are most simply explained by an out-of-body consciousness. For example, in one account, a woman accurately described a surgical instrument she had not seen previously, as well as a conversation that occurred while she was understood to be clinically dead (Sabom, 1998). In another account, from a proactive Dutch NDE study [1], a nurse removed the dentures of an unconscious heart attack victim, and was asked by him after his recovery to return them (van Lommel et.al, 2001).

Many people who experience an NDE tend to see it as a verification of the existence of an afterlife (Kelly, 2001). Core NDE experiencers, in particular, tend to be convinced of the reality of the experience as an intimation of the afterlife. This includes those with agnostic/atheist inclinations before the experience. Many former atheists, such as the The Rev. Howard Storm (Rodrigues, 2004) [2] have adopted a more spiritual view of life after their NDEs. Howard Storm's NDE might also be characterized as a distressing near-death experience. The distressing aspects of some NDE's are discussed more closely by Greyson & Bush (1992).

In some instances there might be ambiguity between medical and spiritual facts. There exist reports about, what appears to be, connections between deceased persons and persons who have had an NDE. These visualizations happen over a long period after the NDE. Ken Mullens (1992;1995), who was clinically dead for more than 20 minutes, reported spiritual encounters in his life after his NDE. As he reported, deceased persons he communicated with were often unknown to him, but were connected to people he met at a later point. While many such reports are criticized and discredited by the scientific field they remain a mystery. Since they have no apparent medical or physical explanation they might be said to belong the interpretative and phenomenological dimension of the NDE, as investigated by the field of Near-death studies.

The mathematician John Wren-Lewis (1985), after his NDE, found himself in a more or less permanent state of equanimity, of contact with the void and with no separate existence from the whole.

In support of an after-life interpretation one might point out that neurobiological models often fail to explain NDEs that result from close brushes to death where the brain does not actually suffer trauma, such as a near-miss automobile accident. Regardless of the origin of the phenomenon, the subjective experience of NDEs is well-documented by the field of Near-Death Studies.

As a naturalistic experience

Other commentators see near death experiences as a purely naturalistic phenomenon. According to this perspective the cause of the NDE might be understood as a result of neurobiological mechanisms, related to such factors as anomalous temporal-lobe functioning, epilepsy, compression of the optic nerve (as a cause of the tunnel sensation), chemical changes in the brain related to serotonin and endorphins, and general changes in brain functioning (Mauro, 1992; Britton and Bootzin, 2004). The similarities amongst the experiences of the many documented cases of NDE may be understood to signify that the pathology of the brain during the dying and reviving process is more or less the same in all humans, as suggested by Russian specialist Dr. Vladimir Negovsky (Pravda, 2004).

Among the studies that support a naturalistic interpretation we find the research of Blanke et.al (2002), published in Nature Magazine [3], who found that electrical stimulation on the brain region known as the right angular gyrus repeatedly caused out-of-body experiences to the patient[4]; though the patient did not report seeing her own face, for example. Researchers have largely been unsuccessful in running proactive experiments to establish out-of-body consciousness. There have been numerous experiments in which a random message was placed in a hospital in a manner that it would be invisible to patients or staff yet visible to a floating being, but so far, according to Blackmore (1991), these experiments have only provided equivocal results and no clear signs of ESP.

A well-known scientific hypothesis that attempts to explain NDEs was originally suggested by Dr. Karl Jansen (1995;1997) and deals with accounts of the side-effects of the drug Ketamine. Ketamine was used as an anesthetic on U.S. soldiers during the Vietnam War; but its use was abandoned and never spread to civilian use because the soldiers complained about sensations of floating above their body and seeing bright lights. Further experiments by numerous researchers verified that intravenous injections of ketamine could reproduce all of the commonly cited features of an NDE; including a sense that the experience is "real" and that one is actually dead, separation from the body, visions of loved ones, and transcendent mystical experiences. Ketamine acts in part by blocking the NMDA receptor for the neurotransmitter glutamate. Glutamate is released in abundance when brain cells die, and if it weren't blocked, the glutamate overload would cause other brain cells to die as well. In the presence of excess glutamate, the brain releases its own NMDA receptor blocker to defend itself; and it is these blockers Dr. Jansen (amongst others) hypothesize as the cause of many NDEs.

Critics of Jansen's hypothesis point out that although some aspects of the experience may be similar, not all NDEs exactly fit the ketamine experience; and that while it might be possible to chemically simulate the experience, this does not refute the possibility that spontaneous NDEs have a spiritual component. As Dr. Jansen himself notes:

Claims that NDE's must have a single explanation (e.g. Ring, 1980), or that a scientific theory must explain all of the experiences ever given the name of NDE (e.g. Gabbard and Twemlow, 1989) are difficult to justify (Jansen, 1995). Indeed Dr. Jansen's own shifting perspective on the c

onclusions to be drawn from the ketamine-NDE analogy has been notable. He started out as an unequivocal debunker of the notion that NDE's are evidence of a spiritual (or at least transnormal) realm. But with time he has developed a more agnostic hypothesis: that ketamine may in fact be one particularly powerful trigger of authentic spiritual experiences - of which near-death may be another. In each case, according to Jansen's more recent pronouncements, all we can say is that the subject gets catapulted out of ordinary 'egoic' consciousness into an altered state - we cannot comfortably rule out the possibility that the 'worlds' disclosed in these 'trips' have ontological status. Latterly, therefore, Jansen's position appears closer to thinkers like Daniel Pinchbeck (2002), who has written a book on hallucinogenic shamanism, and other names like Carl Jung, Ken Wilber and Stanislav Grof, than to thinkers like Susan Blackmore or Nicholas Humphrey, who represents a sceptical position.

Related to the findings of Jansen we find the work Strassman (2001) who induced near death experiences (in addition to some different naturally-occurring altered states of being) in a clinical setting by injecting subjects with DMT, a powerful psychedelic tryptamine. Because DMT is a chemical that is produced endogenously in the human pineal gland it might be relevant to the study of NDE's and other mystical, religious, and transpersonal experiences. Related to the findings of Jansen we also find the theory of Shawn Thomas (2004), director of Neurotransmitter.net, who has suggested that the neurotransmitter agmatine is the key substance involved in near-death experiences [5].

It is generally accepted that some people who reported NDEs were shown to have approached the clinical boundary between life and death. However, in support of a naturalistic interpretation of NDE's one might argue that it is not shown that the experiences themselves took place in any time other than just before the clinical death, or in the process of being revived. In altered states of consciousness such as this and during dream states or under the influence of drugs, the subjective perception of time is often dilated.

Spiritual and psychological after-effects

NDE subjects often report long-term after-effects, and changes in worldview, such as increased interest in spirituality, greater appreciation for life, increased interest in the meaning of life, increased empathic understanding, decrease in fear of death, higher self-esteem, greater compassion for others, heightened sense of purpose and self-understanding, desire to learn, greater ecological sensitivity and planetary concern, a feeling of being more intuitive or psychic (Mauro, 1992; van Lommel et.al, 2001). Greyson (2003) notes that Near-death experiences are associated with enhanced purpose in life, appreciation of life and with reduced fear of death, but also with adverse effects, such as posttraumatic stress symptoms. Some subjects also report internal feelings of bodily energy and/or altered states of consciousness similar to those associated with the yogic concept of kundalini (Greyson, 2000).

Greyson (1983) developed The Near-Death Experience Scale in order to measure the after-effects of a near-death experience. Researchers have pointed out that the aftermath of the experience can be associated with both positive and healthy outcomes related to personality and appreciation for life, but also a spectrum of clinical problems in situations where the person has had difficulties with the experience (Orne, 1995). These difficulties are usually connected to the interpretation of the experience and the integration of it into everyday life. The near-death experience as a focus of clinical attention, and the inclusion of a new diagnostic category in the DSM-IV called "Religious or spiritual problem" (American Psychiatric Association, 1994 - Code V62.89), is discussed more closely by Greyson (1997) and Lukoff, Lu & Turner (1998).

Simpson (2001) notes that the number of people that have experienced an NDE might be higher than the number of cases that are actually reported. It is not unusual for near-death experiencers to feel profound insecurity related to how they are going to explain something that the surrounding culture perceives as a strange, paranormal incident.

Clinical implications

Near-death experiences has many clinical implications for health professionals, for the dying patient and for family and friends.

Implications for health care professionals

For health care professionals, it is not necessary to take sides in the debate concerning the objective reality of these spiritual experiences. Simply the knowledge that they are a normal and natural part of the dying process has profound implications for those who work with death and dying. The ability to feel at ease in discussing the paranormal is an essential element of the bedside manner of all those who work with critically ill patients.

Death-related visions can play a role for health care professionals in alleviating their own guilt, lack of control, and spiritual/social isolation when dealing with death and dying. They can also can relieve health care personnel of responsibility and the need to always be in control, always have the right answer, the right dose of medicine, etc. when confronted with the deaths of patients. Death-related visions or the use of guided imagery with the dying can result in increased bedside related activities, conversations about death and dying, touching, holding, and simply sitting: all of which can reverse the social isolation of the dying. Ultimately, health care personnel may see a decreased need for irrational adherence to rules and policies that reflect their own need to impose control and order on the process of dying, instead of focusing on patient care needs.

It might be suitable for health care professionals to analyze their own spiritual beliefs and feelings about death. Dismissing a patient’s vision of the afterlife as “hallucinations” can often reflect their own religious beliefs and values. It might also be important to recognize that most death-related events are not dramatic visions of an afterlife, but might be simple feelings and intuitions. Patients are often troubled if they don’t have a dramatic vision of another life. It might also be suitable to encourage discussion among family and friends. Often death-related visions and their significance only become evident when several family members report having the same experience at the same time. A professional, being willing to validate the experience as normal and natural, can often give the family permission to trust their instincts and beliefs. Family members often perceive comatose patients as “stuck in the tunnel”. Others want to know why their child or spouse did not “choose” to return to them. These issues must be addressed in an individual manner (Morse, 1991; Morse & Perry, 1992).

Implications for the dying patient

The near death experience validates the patient’s own psychical experiences and can restore control and dignity to the process of dying. The implication that the process of dying is not painful or scary, but spiritual and wonderful, can be comforting. Comatose patients often are able to hear and see what is going on around them and can emotionally process conversations. Often they subjectively perceive themselves to be floating on the ceiling and perceive themselves to have a bird’s eye view of their own deathbed or resuscitation. If the dying patient has had spiritual visions, these can be used to interpret the process of dying for them. For patients who have not had death-related visions, guided imagery or fantasy can often serve the same purpose. Knowledge of near-death experiences can reverse the isolation and neglect of the dying. People might want to visit to hear about pre-death visions or to work with guided imagery with the dying. The old-fashioned deathbed scene crowded with friends and relatives may be resurrected (Morse, 1991; Morse & Perry, 1992).

Implications for family and friends

Research on near-death experiences validates a variety of death-related visions. The knowledge that NDEs are being studied as "real" phenomena can bring new meaning to a peaceful smile before death, a faraway look in the eyes, or simple and brief statements such as “the Light, the Light” that might otherwise be missed. Frequently, friends and family members have post-death visions and intuitions that can be properly interpreted in light of this new scientific information. For example, Dr. Therese Rando states that 75percent of grieving parents have post death visions of their deceased child. Simply restating that most parents will see their child again after death, without using a medical term such as “hallucinations,” can bring enormous comfort and can give parents “permission” to interpret the event in their own way. Death related visions can serve to restore a sense of control and order to the universe, which is particularly important in dealing with untimely deaths or the death of a child. They can also promote healthy grieving and decrease the incidence of pathological grief, by decreasing guilt and a sense of personal responsibility that can interfere with normal grieving. Also, death related visions generate a sense of meaning for death, even if that meaning is elusive. For example, a pre-death vision of a child’s accidental death can allow parents to feel there is some meaning to the death. This can convert a senseless tragedy to a “senseful” one, which is helpful in preventing pathological grief. Family and friends can find comfort in knowledge that those last moments of life may be serene and peaceful. Knowledge that it is now scientifically possible to entertain the survival hypothesis can give hope for eventually being reunited with the dying. This can be extraordinarily comforting to many. Death-related visions can give faith and confidence to survivors to trust their own spiritual intuitions and reaffirm their religious faith (Morse, 1991; Morse & Perry, 1992).
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