On the Journey Toward Understanding, 2003
Introduction
Although there is controversy about the definition
of a NDE, the most common (and narrowest) definition
is that a NDE is a mystical out-of-body-experience
(OBE) that occurs during a cardiac arrest. NDEs
that occur in the hospice setting, however,
do not involve cardiac arrest. They also differ
from those that occur in acute settings by having
an increased frequency of being met by deceased
relatives, the lack of a life review, and the
sense that the NDE helps people prepare for
death rather than to prepare for life. Integration
of the NDE involves assessing value changes
and making appropriate life adjustments. Research
in NDEs has centered on distribution (not related
to sex, religious preference, age, or culture);
veridical perception (confirming sensory input
during NDEs); value changes and adjustment issues;
and possible location of NDEs in the right temporal
lobe. Theories of the origin of NDEs are presented
including the hypoxia theory, drug theory, psychodynamic
theories, and metaphysical theories. Finally,
the possible influence of NDEs and other mystical
experiences on our culture will be explored.
Definition Of A Near-Death Experience
What is an NDE? The definition of a NDE has
been controversial since Dr. Raymond Moody first
coined the phrase in his 1975 book, Life
after Life. A narrow definition includes
an OBE that occurs during a cardiac arrest that
has the features of the 1985 Greyson NDE scale
(cognitive, affective, and transcendental features
with assigned points for individual types of
experiences.) A broad definition includes any
experience that has some features of a NDE (OBE,
mystical encounters, feeling of peace, etc.)
with the physiologic state at the moment being
considered irrelevant. I prefer the narrow definition
found in the 1992 Dictionary of Modern Medicine
which states that a NDE is: "a phenomenon
of unclear nature that may occur in patients
who have been clinically dead and then resuscitated;
the patients report a continuity of subjective
experience, remembering visitors and other hospital
events despite virtually complete suppression
of cortical activity."
My Involvement With NDEs
So how did I get involved in this field? My
"work" with NDEs began when I was
a six-year old child living in a small town
in the Midwest portion of the United States.
The year was 1950 and I had a peritonsillar
abscess that had tracked into my brain producing
meningitis. To this day, I remember the excruciating
head and neck pain as I succumbed to the illness.
The next thing that I remember is being out
of body up in the corner of the room. I did
not feel absolutely any pain, nor did I feel
surprise even though I had nothing in my experience
that would indicate that it was natural to be
out of my body in the corner of the room. I
remember feeling that I was the soul that I
was before I was born and that I was the soul
that I would be when I remembered who I was
in this life, and certainly when I died. I did
not feel like either a boy or a girl, nor did
I feel like a child or a grownup. I was simply
myself at my deepest essence. I felt as though
I was surrounded by God and was entirely at
peace. I then noticed a little girl in a bed
below me. At first, I empathized with her pain
and then I realized that I must be that little
girl, and, with that thought, I was immediately
in my body again. From the moment that the event
happened, I knew at a deep level that it was
perfectly okay and natural. However, it was
many years before I trusted my parents enough
to tell them what I had experienced. I was convinced
that they would be frightened and try to "fix"
me in some way. I knew that I didn't need to
be fixed in any way. From that moment, the possibility
of OBEs seemed perfectly natural to me.
In the ensuing years, my NDE was an important
part of my life, but I never told anyone about
it until I was 42 years old. I felt that my
NDE had been a unique experience that didn't
happen to very many people since no one mentioned
one. Of course, I hadn't mentioned mine to anyone
either. I was profoundly moved in 1989 when
I read Ken Ring's 1984 book, Heading Toward
Omega, and realized that my values were absolutely
the norm among NDErs. My sensitivity to other
people's feelings to the point of literally
feeling them, my interest in spirituality and
disinterest in material possessions, my strong
desire to be of help in the world were all perfectly
standard values of NDErs. Suddenly, my life
made sense to me. It was at that moment that
I vowed to share my story and my knowledge with
other people since they were likely to take
me seriously, not because I was an NDEr with
direct experience, but because I was a successful
physician with a M.D. behind my name.
I also found the International Association
of Near Death Studies (IANDS), an organization
that was dedicated to supporting people who
have had NDEs and to furthering knowledge and
research in NDEs. I attended my first conference
in Georgetown, Virginia in 1989 and was incredibly
moved by being in the presence of many other
NDErs and feeling safe to talk about my experience
and how it had influenced my life. When I went
back to Texas, I organized an IANDS support
group for people with NDEs that met monthly
for the next five years until I moved to Colorado.
During that time, many NDErs shared their stories
for the first time in their lives and received
support from people who absolutely knew how
they were feeling. Many people also came with
puzzling mystical experiences that had not occurred
during a time that they were close to death.
They, too, appreciated a venue for sharing all
of who they were. And I learned a lot about
NDEs. To this day, the annual IANDS conference
is a high point of my year where I meet old
and new friends and hear about what is current
with NDEs from the point of view of a near-death
experiencer, a clinician, and someone interested
in research findings.
NDEs In Hospice Patients
In addition to becoming involved with IANDS,
I began speaking with any group who would listen
to me talk about NDEs. This has often included
physician settings. As I gave talks about NDEs,
I became more interested in hospice work and
moved from a family practice setting to a hospice
setting in 1990. From 1990-1994, I worked at
the Hospice at the Texas Center as a hospice
physician who visited patients in their homes
and in the in-patient setting. During that time,
I cared for some 2000 hospice patients. I was
with many of them when they died. What I discovered
is that NDEs are very common in the last few
days of life, but they do differ from NDEs that
occur in the acute setting in several ways.
First, they do not necessarily happen at the
time of acute physiological changes. NDEs in
the acute setting such as in heart attacks are
traditionally seen in the setting of cardiac
arrest. Although cardiopulmonary resuscitation
is not generally done in the hospice setting,
hospice patients nevertheless frequently undergo
NDEs. While encountering deceased relatives
is fairly rare in the acute setting, when hospice
patients have NDEs, they nearly always encounter
deceased relatives. I have never had a patient
encounter someone who is still alive. Occasionally,
I have seen them encounter a deceased relative
that they didn't know was yet deceased. Also,
they frequently encounter deceased relatives
when they are wide-awake and able to converse
in a completely oriented way. I don't technically
call this a NDE since they are completely awake
and oriented. I also don't call it a hallucination
since people who are hallucinating can not respond
to me in an oriented way. For example, they
can not tell me what they had for breakfast
whereas people who are encountering deceased
relatives can stop paying attention to the relative
and focus on my questions. They also give me
coherent correct answers to specific questions
designed to ascertain their orientation and
short term memory. In addition to occurring
in situations where there has not been an acute
physiological shift and in encountering deceased
relatives, hospice patients rarely have a life
review in their NDE. Although they spend much
of the time that they are awake reviewing their
lives, the NDE is markedly devoid of such experiences.
In contrast, in a paper published in 1985, Greyson
reported that life reviews occur in about 25%
of acute setting NDEs. It seems to me that the
purpose of the NDE in the hospice patient is
to prepare them for death and the NDE in the
acute setting is to prepare the NDEr for life.
As to similarities, NDErs in both situations
come back with many questions. If they are assured
that their NDE is perfectly natural given their
circumstances, they can often adapt to what
they have learned in the NDE rather quickly.
Debbie James, a critical nurse from Texas,
did her master's thesis in 1996 on who people
first told about their NDE and how that influenced
their response to the experience. Most people
wanted to talk about it right away, but if they
encountered a skeptical health care person,
they often suppressed talking about the experience
from then on. If they encountered a knowledgeable,
compassionate nurse or doctor, integration of
the experience was much easier. Currently, the
average person takes seven years to integrate
the experience. My belief is that if they encountered
knowledgeable health care providers right after
cardiopulmonary resuscitations, integration
would be much quicker. People would probably
be well on their way to integration after only
a few counseling visits with someone who understands
NDEs and what they require of a person in the
way of changes.
Talking to compassionate, knowledgeable health
care providers is also crucial in the hospice
setting. In our hospice, NDEs were a part of
the daily report. We found that about half of
the patients on our in-patient unit either had
a NDE or encountered deceased relatives while
fully conscious, or both. The knowledge of the
common frequency of NDEs helped all of the hospice
in- patients (whether they had a NDE or not),
to die more peacefully. We invariably noticed
that a person became much more peaceful after
a NDE.
Integration Of The NDE
So what does integration entail? First of
all, it requires that people acknowledge that
we are more than the physical bodies that we
have considered being machine-like in their
function. There are other dimensions beyond
the three dimensions that we usually confine
ourselves to. Second, people who have had NDEs
realize that we are here to learn how to love
in the universal sense. If we are not behaving
in a loving manner, we are not fulfilling our
function here. That may call for some very big
changes in how a person lives their lives. Next,
people with NDEs usually have voracious appetites
for learning. At an IANDS conference in Philadelphia
in 2000, Tom Sawyer talked about barely reading
any books before his NDE and reading a book
every day or two after it. He is fairly typical
in that respect. People also are interested
in the universality of spirituality, not necessarily
in particular religions. They have no fear of
death, although they may still have a fear of
dying in pain or with other uncontrollable symptoms.
They also have minimal interest in material
possessions. This often creates problems in
families, especially if the NDEr was an excellent
provider who had enjoyed a job that was not
particularly helpful to other people before
the NDE.
How are NDEs currently being accepted in the
medical profession? The last twenty years has
seen a burgeoning interest in NDEs in the United
States, and, indeed, in the world. NDE has become
a household word; NDE books are bestsellers;
NDEs are commonly discussed on talk shows; and
are prominently featured in movies. The medical
profession has lagged behind the general public
in the United States in their understanding
of NDEs. Many doctors are skeptical, I believe,
for two reasons. First, there is little controlled
research on the topic. Second, and probably
more paramount, is that understanding of the
NDE requires a paradigm shift in their understanding
of how a body works. According to the ideas
of Dr. Larry Dossey as described in Reinventing
Medicine, the mechanical era of medicine (Era
I) was ushered in with the discovery of the
germ theory and antibiotics. Medicine has made
great strides with advanced techniques in surgery
and with new medications, but the concept of
the body as a machine can take us only so far.
This led to Era II and mind-body medicine that
began in the 1950's with the discovery of the
placebo effect. The body does behave like a
machine, but the mind influences the machine.
Clearly, what a person thinks influences how
their body responds. Many doctors were still
having difficulty grasping the concept of mind-body
medicine when Era III medicine began in the
1970's with the hospice movement, NDEs, and
healing at a distance. Nonlocal influences and
"eternity" medicine were now shown
to influence the body as well as the mind. Many
doctors have yet to embrace this concept, although
there are many studies now to support various
aspects of Era III medicine. Because of the
required paradigm shift, accepting NDEs as a
reality is a far cry from learning about a new
medication that is efficacious and it is no
wonder that physicians are having difficulty
enlarging their views of medicine to accept
it. However, since they are basically scientists,
I feel that their acceptance is inevitable.
Research that is presented in peer-reviewed
journals will assistance the acceptance process
significantly.
Research In NDEs
What are the types of research that have been
done with NDEs? The original research primarily
involved looking at NDEs in different populations.
Melvin Morse (1986) studied the pediatric population
that was resuscitated through Operation Airlift
Northwest. He found that 1/3 of children who
were resuscitated remembered a NDE. He also
found that children who were very ill, but not
ill enough to be resuscitated, did not have
similar experiences. He found that if children
received more medications during the resuscitation,
they were less likely to remember the NDE than
were children who had received fewer drugs.
Unlike the prevailing theories at the time,
drugs seemed to block the memory of the NDE,
not facilitate the experience.
Osis and Haraldsson (1977) found that NDEs
were common when people came close to death
in India. NDEs were reported from a myriad of
cultures and a variety of countries. In the
Gallup Poll in 1982, 8,000,000 Americans reported
NDEs. In that poll, NDEs occurred in approximately
1/3 of the people who reported cardiopulmonary
resuscitations. There was no difference between
the frequency of NDEs in women and men, in people
who knew about NDEs and those who did not, in
people who were religious, and those who were
not. In short, it seemed to be a random event
with the only common denominator being a cardiac
arrest.
The next level of research was to look at the
changes that occur in people who have NDEs.
Kenneth Ring (1984) reported on an in-depth
psychological questionnaire that was give to
143 people with NDEs. They reported the changes
in their values that I have already discussed.
PMH Atwater (1999) did similar studies in children
and found them to have the same values found
in adult NDErs. She also found them to be wise
beyond their years. They often have problems
integrating their experience if the significant
adults in their lives don't take their NDEs
seriously.
Other studies in the dying and grieving population
have found that people frequently have ADC (after
death communications) from loved ones (Guggenheim,
1995). Although that is not strictly a NDE,
it is an interesting related phenomenon that
is very common.
What are the questions that are currently being
explored by researchers in the area of NDEs?
One area that has seemed promising is the study
of corroborative NDEs (a phrase coined by Harold
Widdison). People with NDEs frequently report
the awareness of visual, auditory, and/or touch
sensations that they could not be aware of in
their unconscious state and/or from the viewpoint
of their body. In fact, at the July 2001 IANDS
conference in Seattle, Washington, Dr. Jeff
Long reported that in 100 NDEs entered on his
web site (www.nderf.org), 53 of them had corroborative
types of NDEs. However, these were personal
reports, not the results of research that involved
controls. Studies to date under controlled conditions
have not produced significant results. Dr. Jan
Holden (1990) designed an experiment in Illinois
where there were signs on the ceiling where
cardiac arrests were fairly likely, but no cardiac
arrests occurred during the time of her experiment.
Madeline Lawrence had similar disappointing
results. When Dr. Sam Parnia (2001) initiated
a yearlong study in England, he, too, had no
significant outcome. This is largely due to
the fact that although NDEs are common in people
with cardiac arrests, cardiac arrests themselves
are infrequent and nearly always unexpected.
During a research panel discussion at the IANDS
conference, Dr. Bruce Greyson discussed the
value of research in electrophysiologic labs
where people with severe arrythmias are stimulated
to create the arrythmias under very controlled
conditions in order to determine if they need
an implanted ventricular defibrillator that
will function when arrythmias are present. He
felt that the manufacturers of defibrillator
implants would be supportive of NDE experiments
because they are trying to make inroads into
hospitals since these implants will be widely
used in the next five years and companies would
like to be a well-known name in individual hospitals.
Dr. Jan Holden is currently designing another
study of veridical perception (identifying objects
that are not in the field of vision of the eyes
of the unresponsive person) at the University
of North Texas. She plans to insert colorful
flashing messages in places where people might
see them if they are out of their bodies during
surgery.
Another interesting line of research is looking
at areas of the brain that might be involved
in NDEs. A graduate student at the University
of Arizona, Willoughby Brittain, is currently
obtaining EEGs during sleep of controls as well
as people who have had NDEs in the past. She
postulates that NDErs may have temporal lobe
activity that differs from controls.
Theories About The Origins Of NDEs
What have been the theories about the origins
of NDEs? The original idea about NDEs in the
medical field that still prevails today is that
NDEs are the result of oxygen deprivation. Oxygen
deprivation alone does not create profound life-style
and value changes in people who do not also
undergo a NDE. Also, oxygen deprivation could
in no way explain how people frequently see
and hear things outside of their visual and
auditory range during the time that they are
having a NDE.
Others in the medical profession feel that
NDEs are the result of drugs that are given
to extremely ill people. However, people receiving
the same amount and type of drugs do not all
report NDEs. Also, these events occur during
car accidents and near-drownings, long before
any medications are given. As I have already
described earlier in this paper, my work with
hospice patients has definitely convinced me
that these kinds of experiences do not have
any thing to do with the hallucinations that
are commonly seen in adverse reactions to medications.
Also, the experiences seem independent of medication
adjustments in hospice patients.
From a psychodynamic perspective, Dr. Bruce
Greyson discussed several theories in a chapter
in Varieties of Anomalous Experience. Noyes
and Kletti (1977) suggested that NDEs might
be a dissociative phenomenon as a response to
the fear of death. Ken Ring (1992) suggested
that NDEs often occur to encounter-prone individuals,
people that have high absorptive capacities.
Greyson (2000) suggested that NDEs have some
features in common with PTSD (Post-Traumatic
Stress Disorder.) The 1994 DSM IV (Diagnostic
and Statistical Manual of Mental Disorders)
included a category of "other conditions
that may be a focus of clinical attention."
Although they had considered NDEs as possibly
falling into the "Spiritual or religious
problem" category, they realized that while
many NDErs might need counseling to adjust to
their newfound values, they rarely called it
a "spiritual problem." Rather, a new
interest in spirituality was considered to be
a blessing by most NDErs.
At a conference of the International Association
of Near Death Studies in Seattle Washington
in July 2001, Dr. Melvin Morse suggested that
NDEs and other mystical experiences might well
dwell in the deep right temporal lobe of the
brain. He based his theory on several supporting
findings. First, Wilder Penfield had stimulated
parts of the brain in the mid-20th century.
He found that when he stimulated the right temporal
lobe, people tended to have mystical experiences.
When a study was done with experienced meditators,
they were found to have intense right temporal
lobe activity per EEG when they were meditating.
That meditators do frequently have mystical
experiences while they are meditating is a further
support of the theory. People with temporal
lobe tumors do often have mystical-like experiences
as well. Dr. Morse's theory is that we are "hard-wired
for God." Although this is a plausible
theory, it has yet to be proven with controlled
studies. Perhaps Willoughby Brittain's current
study will support Dr. Morse's theory.
While the above theories are of great interest
to clinicians and researchers, most NDErs believe
that some part of them did separate from their
bodies and did have contact with the after-life.
While I acknowledge that the right temporal
lobe may be stimulated during the experience,
I feel that the reality of the experience (described
as "realer than real" by most NDErs)
and the profound aftereffects of the experience
create a meaning of the experience that far
exceeds the explanation as to how it came to
occur.
The Meaning Of NDEs
What is my opinion after a lifetime as a NDEr
and twelve years in fieldwork of talking to
NDErs both in the acute and hospice settings?
There is no doubt in my mind about the value
of a NDE. As we become more and more successful
at cardiopulmonary resuscitation, we will have
more and more people in the world who have had
a NDE. These people are changing our culture
with their emphasis on love, knowledge, and
spirituality. In the United States, there is
a burgeoning interest not only in NDEs, but
also in spirituality, mystical paths, and simplicity.
As a NDEr, I am totally supportive of these
changes in our culture.
I believe that most people have had some kind
of mystical experience. That might be a NDE,
a detailed portension of an upcoming event,
a visit from a deceased relative, an out of
body experience while lying down, or any of
a myriad of mystical types of experiences. My
plea is for everyone to share what they are
experiencing with each other. I believe that
it would change our perception of reality overnight.
In the way that Galileo changed our perception
from a flat world to one that was spherical
and Einstein showed us that energy could be
converted to matter and vice versa, I believe
that NDEs and other mystical and paranormal
experiences will show us that there are dimensions
to our world that only our physicists are currently
dreaming of. We are all experiencing these dimensions
right now and all it takes to include it in
our paradigm of the world is for us to share
our experiences with each other!
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