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A near-death experience (NDE) is the perception reported by a person who nearly died or who was clinically dead and revived. They are somewhat common, especially since the development of cardiac resuscitation techniques, and are reported in approximately one-fifth of persons who revive from clinical death. The experience often includes an out-of-body experience.

The phenomenology of an NDE usually includes physiological, psychological and transcendental factors (Parnia, Waller, Yeates & Fenwick, 2001) such as subjective impressions of being outside the physical body (an out-of-body experience), visions of deceased relatives and religious figures, transcendence of ego and spatiotemporal boundaries and other transcendental experiences (Lukoff, Lu & Turner, 1998; Greyson, 2003). Typically the experience follows a distinct progression, starting with the sensation of floating above one's body and seeing the surrounding area, followed by the sensation of passing through a tunnel, meeting deceased relatives, and concluding with encountering a being of light (Morse, Conner & Tyler, 1985).

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. The most intense NDEs involve an awareness of things occurring in a different place or time (Lange, Greyson & Houran, 2004).

Contents 1 Near-Death Research 2 As an afterlife experience 3 As a naturalistic experience 4 Clinical Implications 4.1 Implications for health professionals 4.2 Implications for the dying patient 4.3 Implications for family and friends 5 Spiritual and psychological after-effects 6 See also 7 References 7.1 Personal experiences 7.2 Fiction 8 External links

Near-Death Research

Dr. Raymond Moody is recognized as the father of NDE research. He has chronicled and studied many of these experiences in several books (Moody, 1975;1977;1999). Another early pioneer is 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. Well-known researchers in the field who support a moderate view, or sympathize with aspects of the after-life view are Kevin Williams, Bruce Greyson, Michael Sabom, Melvin Morse, PMH Atwater, Yvonne Kason, Sam Parnia, Peter Fenwick, Jody A. Long and Jeffrey P. Long. Much of this research is co-ordinated through the field of Near-Death Studies.

Among the researchers who support 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). The possibility of altered temporal lobe functioning in the near-death experience is suggested by Britton & Bootzin (2004). In this study Near-Death experiencers were also found to have altered sleep patterns compared to subjects in the control group. Dr. Rick Strassman 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. This is significant because DMT is produced endogenously in the human pineal gland and may be the chemical that causes natural NDE's (and other mystical, religious, entity contact and transpersonal experiences). This research is described in his book DMT - The Spirit Molecule (2001).

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, and some 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).

However, researchers have 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.

Regardless of the origin of the phenomenon, the subjective experience of NDEs is well-documented by the field of Near-Death Studies, and follows certain patterns:

• It is generally accepted that some people who reported NDEs were shown to have approached the clinical boundary between life and death. However, 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.
• Those who report NDEs typically respond by a major change of life perspective and direction, generally away from self-orientation toward outward orientation, or what they call "a more loving life". 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. Many former atheists have adopted a more spiritual view of life after NDEs, for example Howard Storm (Rodrigues, 2004) [2] and George Rodonaia. Howard Storm's NDE might be characterized as a distressing near-death experience. The distressing aspects of some NDE's are discussed more closely by Greyson & Bush (1992).
• 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. Few experiencers tend to view the NDE as a brain hallucination. The tendency to explain the experience in terms of a materialistic model is usually offered by non-experiencers [3].

As a naturalistic experience

Other commentators see near death experiences as a purely naturalistic phenomenon. For example; a Swiss study (Blanke. et.al, 2002), published in Nature Magazine [4], found that electrical stimulation on the brain region known as the right angular gyrus repeatedly caused out-of-body experiences to the patient[5]. According to this perspective the etiology of the NDE is understood as a result of neurobiological mechanisms, related to such factors as epilepsy and brain stimulation. 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 in his book Clinical Death As Seen by Reanimator (Pravda, 2004). However, this model fails 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.

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. Shawn Thomas, director of Neurotransmitter.net, has suggested that agmatine is the key substance involved in near-death experiences [6].

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 conclusions 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, Jansens 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 (two particularly high-profile materialist skeptics).

Ultimately, the hallucination theory is one which is very convincing to materialists, and very unconvincing to the vast majority of NDE experiencers[7].

Clinical Implications

Current scientific research strongly suggests that near-death experiences occur at the time of dying and are not unconscious secondary falsifications after the fact. As 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. The following points are adapted from Morse (1991) and Morse & Perry (1992):

Implications for health professionals

1. Death-related visions can play a role for us in alleviating our own guilt, lack of control, and spiritual/social isolation when dealing with death and dying.

2. Death-related visions can relieve us 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 our patients.

3. Ultimately, we may see a decreased need for irrational adherence to rules and policies that reflect our own need to impose control and order on the process of dying, instead of focusing on patient care needs.

4. 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.

5. What to do and say?

a) Analyze your spiritual beliefs and feelings about death. Dismissing a patient’s vision of the afterlife as “hallucinations” can often reflect our own religious beliefs and values.

b) When in doubt, do and say nothing.

c) 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.

d) 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.

e) 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.

f) Resist the urge to have all the answers or interpret the experiences. The whole point is to give up control to the dying and family.

6. Recognize that near death experiences may make death more attractive to those considering suicide. Those who have attempted suicide and have had near death experiences return to life with the firm conviction that suicide is not a solution.

Implications for the dying patient

1. The near death experience validates the patient’s own psychical experiences and can restore control and dignity to the process of dying.

2. The knowledge that the process of dying is not painful or scary, but spiritual and wonderful, can be comforting.

3. 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.

4. If the dying patient has had spiritual visions, these can be used to interpret the process of dying for them. There is no need to dismiss such visions or intuitions as drug induced experiences or hallucinations. They often contain seeds of healing.

5. For patients who have not had death-related visions, guided imagery or fantasy can often serve the same purpose.

6. Knowledge of near death experiences can reverse the isolation and neglect of the dying. People will 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.

Implications for family and friends

1. Research on near death experiences validates a variety of death-related visions. The knowledge that NDEs are “real“ events 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.

2. 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 75% 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.

3. 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.

4. Death related visions can 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.

5. 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.

6. Family and friends can find comfort in knowledge that those last moments of life are serene and peaceful in spite of the reality of the dehumanization and seeming torture of critical care medicine.

7. 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.

8. Death-related visions can give faith and confidence to survivors to trust their own spiritual intuitions and reaffirm their religious faith.

Spiritual and psychological after-effects

NDE subjects often report long-term after-effects, and changes in worldview, such as an increased interest in spirituality, an increased interest in the meaning of life, increased empathic understanding and a decrease in fear of death (van Lommel et.al, 2001). 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. This research notes that the aftermath of the experience is 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.

See also

• Near-Death Studies
• Alister Hardy
• Beyond and Back

References

• American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders, fourth edition. Washington, D.C.: American Psychiatric Association (Code V62.89, Religious or Spiritual Problem).
• Blackmore, Susan (1991) Near-Death Experiences: In or out of the body? Skeptical Inquirer, 16, pp. 34-45
• Blackmore, Susan (1993) Dying to live: Science and Near-Death Experiences. London: Harper Collins.
• Blanke, Olaf et.al (2002) Stimulating illusory own-body perceptions. The part of the brain that can induce out-of-body experiences has been located. Nature, Vol. 419, 19 September, 2002
• Britton WB, Bootzin RR. (2004) Near-death experiences and the temporal lobe. Psychol Sci. Apr;15(4):254-8. PubMed abstract PMID 15043643
• Greyson, B. (1983) The Near-Death Experience Scale: Construction, reliability, and validity. Journal of Nervous and Mental Disease, 171, 369-375.
• Greyson B. (1997) The near-death experience as a focus of clinical attention. Journal of Nervous and Mental Disease. May;185(5):327-34. PubMed abstract PMID 9171810
• Greyson, B. (2000) Some neuropsychological correlates of the physio-kundalini syndrome. Journal of Transpersonal Psychology, 32, 123-134.
• Greyson, Bruce (2003) Near-Death Experiences in a Psychiatric Outpatient Clinic Population. Psychiatric Services, December, Vol. 54 No. 12. The American Psychiatric Association
• Greyson, Bruce & Bush, Nancy E. (1992) Distressing near-death experiences. Psychiatry, Feb;55(1):95-110.
• Jansen, Karl L. R. (1995) Using ketamine to induce the near-death experience: mechanism of action and therapeutic potential. Yearbook for Ethnomedicine and the Study of Consciousness (Jahrbuch furr Ethnomedizin und Bewubtseinsforschung) Issue 4 pp55-81.
• Jansen, Karl L. R. (1997) The Ketamine Model of the Near Death Experience: A central role for the NMDA Receptor. Journal of Near-Death Studies Vol. 16, No.1
• Kelly EW. (2001) Near-death experiences with reports of meeting deceased people. Death Stud. Apr-May;25(3):229-49
• Lange R, Greyson B, Houran J. (2004) A Rasch scaling validation of a 'core' near-death experience. British Journal of Psychology, Volume: 95 Part: 2 Page: 161-177
• Lukoff, David, Lu, Francis G. & Turner, Robert P. (1998) From Spiritual Emergency to Spiritual Problem - The Transpersonal Roots of the New DSM-IV Category. Journal of Humanistic Psychology, 38(2), 21-50
• Martens PR. (1994) Near-death-experiences in out-of-hospital cardiac arrest survivors. Meaningful phenomena or just fantasy of death? Resuscitation. Mar;27(2):171-5. PubMed abstract PMID 8029538
• Morse M., Conner D. and Tyler D. (1985) Near-Death Experiences in a pediatric population. A preliminary report, American Journal of Disease of Children, n. 139 PubMed abstract PMID 4003364
• Morse, Melvin (1990) Closer to the Light: Learning From the Near-Death Experiences of Children. New York: Villard books
• Morse, Melvin & Perry, Paul (1992) Transformed by the Light. New York: Villard books
• Moody, R. (1975) Life After Life: The Investigation of a Phenomenon - Survival of Bodily Death. New York: Bantam
• Moody, R. (1977) Reflections on Life After Life: More Important Discoveries In The Ongoing Investigation Of Survival Of Life After Bodily Death. New York: Bantam
• Moody, R. (1999) The Last Laugh: A New Philosophy of Near-Death Experiences, Apparitions, and the Paranormal. Hampton Roads Publishing Company
• Orne RM. (1995) The meaning of survival: the early aftermath of a near-death experience. Research in Nursing & Health. 1995 Jun;18(3):239-47. PubMed abstract PMID 7754094
• Parnia S, Waller DG, Yeates R, Fenwick P (2001) A qualitative and quantitative study of the incidence, features and aetiology of near death experiences in cardiac arrest survivors. Resuscitation. Feb;48(2):149-56. PubMed abstract PMID 11426476
• Pinchbeck, Daniel (2002) Breaking Open the Head: A Psychedelic Journey into the Heart of Contemporary Shamanism. Broadway Books, trade paperback, 322 pages
• Pravda (2004) Reanimators try to grasp the afterlife mystery. Pravda article 21.12.2004. (Article translated by: Maria Gousseva)
• Ring K. (1980) Life at death. A scientific investigation of the near- death experience. New York: Coward McCann and Geoghenan
• Rodrigues, Linda Andrade (2004) Ex-atheist describes near-death experience. Standard Times, Page C4, January 31, 2004
• Shermer, Michael (1998) Why People Believe Weird Things: Pseudoscience, Superstition, and Other Confusions of Our Time. New York: W.H. Freeman & Company
• Sabom, Michael (1998) Light & Death: One Doctor's Fascinating Account of Near-Death Experiences. Grand Rapids, Michigan: Zondervan Publishing House
• Simpson SM. (2001) Near death experience: a concept analysis as applied to nursing. Journal of Advanced Nursing.Nov;36(4):520-6. PubMed abstract PMID 11703546
• Strassman R. (2001)DMT - The Spirit Molecule. Rochester, VT: Park Street Press
• van Lommel P, van Wees R, Meyers V, Elfferich I. (2001) Near-Death Experience in Survivors of Cardiac Arrest: A prospective Study in the Netherlands. Lancet, Dec 15;358(9298):2039-45.

Personal experiences

• Embraced by the Light by Betty Eadie (1992). One of the most detailed near-death experiences on record.

• Saved by the Light by Dannion Brinkley. Brinkley's experience documents one of the most complete near death experiences, in terms of core experience and additional phenomena from the NDE scale.

Fiction

• In Passage, a 2001 novel by Connie Willis, the principal storyline centers around a researcher who has developed a technique for inducing an experience very much like a natural NDE. By studying the effects and comparing them with real NDEs, she hopes to find a biological basis for NDEs.

• The novel Fearless (1993) by Rafael Yglesias is about an architect that survives a planecrash. His Near-Death experience starts a period of fearlessness and existential concerns which puts him in conflict with both his family and the surrounding culture. The book was later adapted to the screen by director Peter Weir, starring Jeff Bridges as the main character, Max Klein. See Fearless.

• The movie Flatliners (1990) is about a group of medical students who wanted to study the Near-Death experience. One of them each time would voluntarily die clinicaly and then his or her fellow students would use their practical knowledge to revive them. But their experiment begins to go awry.

External links

• Kluwer Academic Publishers - Journal Of Near-Death Studies
• The International Association for Near-Death Studies, Inc
• University of Virginia Health System - Division of Personality Studies
• University Of Wales, Lampeter - The Alister Hardy Society Religious Experience Research Centre
• University of Southampton News Release - Research body will shed more light on near death experiences
• University Of Wales, Lampeter - Press Releases: A Near Death Experience?
• Susan Blackmore - Near-Death Experiences: In or out of the body? Article from Sceptical Inquirer, 1991
• The North Texas Daily - Discovering secrets of near-death
• PMH Atwater - Near-death researcher
• Critique of Susan Blackmore's "Dying to Live"
• CSICOP Online - "Have You Seen 'The Light?'"
• Karl Jansen - "The Ketamine Model of the Near Death Experience"
• Karl Jansen - "Using ketamine to induce the near death experience"
• Near-Death Experience Research Foundation (NDERF)
• Near-Death Experiences and the Afterlife
• Crank.net page on NDEs
• The Campaign for Philosophical Freedom - The secular scientific case for survival after death
• Spiritualtravel.org - Short article describing the weaknesses of some of the current scientific explanations for near-death experience

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