Notis 60, 13-03-2009, introduction och inledning, inkl innehållsförteckning på bok av Pim van Lommel, Endless consciousess. A Scientific Approach to the Near-Death Experience. Kommer på engelska 2010, bestseller på holländska.
/GB
UITGEVERIJ TEN HAVE
Non-Fiction Bestseller, 2008
More than 95,000 copies sold
The book has been nominated for ‘The book of the year 2008’ ,
The ‘NS Publieksprijs’
Sold to Harper Collins USA (World English rights)
Sold to Patmos Verlag in Germany
Endless Consciousness, A Scientific Approach to the Near-Death Experience
by Pim van Lommel, cardiologist
In 2001, Dutch cardiologist Pim van Lommel published a famous study of near death experiences (nde’s) in medical journal, The Lancet. Sixty-two of the 344 patients in the Netherlands who had suffered a cardiac arrest in hospital turned out to have had an nde. Van Lommel’s article was a worldwide hit and very controversial.
From that moment on, the phenomenon of Near-Death Experience could no longer be ignored. It is an authentic experience which cannot be reduced to the imagination, psychosis or an oxygen deficiency; people are permanently changed by an nde. In Endless Consciousness, Van Lommel explains how people who are clinically dead can have such a transformative experience. He illustrates his argument with stories of people who have gone through an nde. In van Lommel’s opinion, the current materialistic view of the relationship between the brain and consciousness held by most physicians, philosophers and psychologists is too restricted for a proper understanding of this phenomenon. There are good reasons to assume that our consciousness does not always coincide with the functioning of our brain: consciousness can also be experienced separately from the body.
Pim van Lommel (1943) worked as a cardiologist in the Rijnstate Hospital in Arnhem in the Netherlands from 1977 to 2003. Since 2003 he has lectured all over the world on nde and the relationship between consciousness and brain function.
TABLE OF CONTENTS
1. Introduction
How it started
(Near) death in hospital
Questions about brain function and consciousness
Is there consciousness after death?
The role of science in the study of consciousness
The need for a new approach
Science equals asking questions with an open mind
Endless consciousness
The near-death experience: a bridge between science and spirituality
The book’s structure
2. A near-death experience and its impact on life
3. What is a near-death experience?
Definition of a near-death experience
Circumstances that may give rise to an nde
The frequency of ndes
The elements of an nde according to Moody
Other nde classifications
The five phases of an nde according to Ring
The three main nde categories according to Sabom
The four nde components according to Greyson
The difference between retrospective and prospective scientific studies
The depth of an experience
The twelve elements of an nde, with some striking examples
1. Ineffability
2. A sense of peace and quiet; painlessness
3. Awareness of being dead
4. An out-of-body experience
5a. Being in a dark space
5b. Tunnel experience
5c. Frightening nde
6. Observation of an otherworldly environment
7. Meeting and communicating with deceased persons
8. Encountering a bright light or a being of light
9. Life review
10. Flash forward
11. Presence of a border
12. The conscious return into the body
Empathetic nde
Conclusion
4. Transformed by a near-death experience
Introduction
What are the consequences of an nde?
Studies into transformational processes after an nde
Factors that may affect the process of transformation
Integrating the experience
Positive and negative aspects of transformational processes
An overview of the various changes
Self-acceptance and a changing self-image
Compassion for others
Appreciating life
No more fear of death, and a belief in an afterlife
Reduced piety coupled with increased religious sentiment
Greater spirituality
Physical changes
Enhanced intuitive feelings
Psychological problems following an nde
The effect of time on transformational processes in people with and without nde
Conclusion
5. Near-death experiences in children
Introduction
Scientific research into nde in children
Circumstances that may give rise to an nde report by children
The content of an nde in children
Changes following an nde in childhood
Spontaneous out-of-body experiences
An example of an nde at an early age
6. Research into near-death experiences
Introduction
The development of the scientific research into ndes
The frequency of ndes
The effect of age
Who will experience an nde?
Circumstances that may give rise to an nde
Tentative conclusions about the occurrence of ndes
Theories on the cause and content of an nde
Physiological theories
Oxygen deficiency
An excess of carbon-dioxide
Chemical reactions in the brain
Electrical activity in the brain
Psychological theories
Fear of death
Personality factors
Memory of birth
Dreams
Use of medication
Conclusion
7. The Dutch study into near-death experience
Introduction
The aim of the Dutch prospective study
The organisation
What is the mortality rate of patients with a cardiac arrest?
The longitudinal study
The design of the study
The initial interview
A hidden sign, visible only during an out-of-body experience
The design of the longitudinal study
Findings of the prospective study
Results of the prospective study
Percentage of nde
Identified nde elements
Factors that turned out not to affect the occurrence of nde
Factors that do affect the occurrence of nde
Conclusions of the prospective study
Findings of the longitudinal study
Results of the longitudinal study
Comments on the Dutch study into nde
Comparison with prospective studies into nde in the US and the UK
The American study
The British study 1
The British study 2
Conclusion
8. What happens in the brain during cardiac arrest?
Introduction
The paradox of a clear consciousness when brain function ceases
The cessation of brain activity during a cardiac arrest can be measured
What happens in the brain during a cardiac arrest?
What happens during resuscitation?
Transient and permanent brain damage after a cardiac arrest
Pamela Reynolds’ nde
Conclusion
9. What do we know about brain function?
Introduction
The quest to find consciousness
The reliability of contemporary brain research
Unproven hypotheses
Neurons and electromagnetic fields
The impact of electromagnetic activity on brain function
Magnetic stimulation
Electrical stimulation
Therapeutic effects
Consciousness research through tms
The brain, information storage capacity and memory
Neuroplasticity
The placebo effect and psychotherapy
Cognitive therapy
Meditation
Free will
Summary neuroplasticity
Our brain is not a computer
Conclusion
10. An extensive nde
11. Quantum physics and consciousness
Introduction
Some elements of an nde reconsidered
A brief summary of this chapter
Our classical worldview
Complementarity or wave-particle duality
Entanglement
Non-locality
The new worldview based on quantum physics
What is a wave?
The concept of a field
The hologram
Electromagnetic fields
Fields, frequency and information
The non-local space of probability waves
Consciousness and non-local space
The complementarity of non-local space
Field theories in living systems
Does quantum physics apply to living systems?
Quantum theory, self-organisation and consciousness
Conclusion
12. The brain and consciousness
Introduction
The materialist approach
Near-death experience, consciousness and the brain
The continuity of consciousness
New concepts in science
A new view on consciousness and the brain
Non-local consciousness in non-local space
Complementary theory
A comparison with global communication
The scientific evidence for non-local entanglement of consciousness
The interface between non-local consciousness and the brain
Summary
Potential theories explaining the transition or interface
Linking consciousness and (virtual) photons
The effect of consciousness via the quantum Zeno effect
The transfer of information via quantumspin correlation in the brain
Conclusion
13. The continuity of the changing body
Introduction
dna
A brief summary of this chapter
What exactly is dna?
Epigenetics
The possible function of junk-dna
Biophotons
dna as a source of information for each cell
Non-local transfer of information via dna
dna, heredity and consciousness
Remote communication with cells
Transplanted memory
Conclusions
14. Endless consciousness
Introduction
Our consciousness and ‘reality’
Personal and shared aspects of consciousness
Transpersonal aspects of consciousness
Experiences of changed consciousness
Non-local consciousness
An nde is an aspect of endless consciousness
Other forms of non-local consciousness
Deathbed visions
Experiences of contact with the (non-local) consciousness of deceased persons
Peri-mortal experiences
Post-mortal experiences
Belief in a form of personal afterlife
The continuity of consciousness after physical death
Other forms of non-local exchange of information
Enhanced intuitive sensitivity
Remote viewing (intuitive perception)
Geniality
The effect of consciousness on matter: psychokinesis, telekinesis and teleportation
Conclusion
15. There is nothing new under the sun
Introduction
Nothing new
Mystical experiences as a source of insight into death
The world religions and mystical experiences
Hinduism
Ancient India
Modern India
Tibetan Buddhism
The philosophy of ancient Greece
Ancient Jewish mysticism
Christianity
Islam
A few historical reports on near-death experience
Plato: the vision of Er
An eighth-century report of an nde
A nineteenth-century report of an nde
Two medical reports of a nineteenth-century nde
Conclusion
16. Frequently asked questions
Introduction
Scientific resistance to nde
Reincarnation
Organ donation: what is it ‘essentially’ about?
Penetrating questions
Poor and biased information
When is someone brain-dead?
Does brain death equal death?
A decline in the number of brain-dead donors
Conclusion
17. The practical significance of nde
Support after an nde
nde in hospital
Attempted suicide and suicidal patients
Terminal and palliative care wards
Experiences after death
Views on death in the healthcare sector
Euthanasia and assisted suicide
Conclusion
18. Epilogue
Near-death experience and science
Near-death experience and healthcare
Near-death experience and our image of mankind
Acknowledgments
Glossary
Notes
Bibliography
Index of personal names
1. INTRODUCTION
All science is empirical science, all theory is subordinate to observation; one single fact can be powerful enough to topple an entire system.
Frederik van Eeden, physician and author (1860-1932)[i]
How it started
It is 1969. At the coronary care unit, the alarm suddenly goes off. The monitor shows that the electrocardiogram (ECG) of a patient with a myocardial infarction has become totally flat. The man has a cardiac arrest. Two nurses rush over to the patient who has lost consciousness by now and quickly draw the curtains around his bed. One nurse initiates cardiopulmonary resuscitation, while the other inserts a short tube into his mouth and administers extra oxygen via a mask placed over the unconscious patient’s mouth. The third nurse rushes over with the resuscitation trolley with the defibrillator. The defibrillator is charged, the paddles are covered in gel, the patient’s chest is bared, the medical staff let go of the patient and the bed and the patient is defibrillated. He receives an electric shock to the chest. Without any effect. Cardiopulmonary resuscitation and artificial respiration are resumed and, in consultation with the doctor, extra medication is injected into the drip. Then the patient is defibrillated for the second time. This time, the cardiac rhythm does re-establish itself and more than a minute later, after a spell of unconsciousness lasting some four minutes, the patient regains consciousness, much to the relief of the nursing staff and attendant doctor. That attendant doctor was me. I had started my cardiology training that year.
Following the successful resuscitation everyone was pleased, except the patient. He had undergone successful resuscitation, yet to everyone’s surprise he was extremely disappointed. He spoke of a tunnel, of colours, of a light, of a beautiful landscape and of music. He was extremely emotional. The term near-death experience (nde) did not yet exist, nor had I ever heard of people having any recollection of the period of their cardiac arrest. Whilst studying for my degree, I had learnt that such a thing is in fact impossible: being unconscious means not being aware, and that applies to people suffering a cardiac arrest or patients in a coma. At such a moment, it is simply impossible to be conscious or to have memories because all brain function has ceased. In the event of a cardiac arrest, a patient is unconscious, he has stopped breathing and he has no palpable pulse or blood pressure.
(Near) death in hospital
The first coronary care units in Dutch hospitals opened in 1966, when cardiopulmonary resuscitation and the administration of extra oxygen, in combination with external defibrillation (an electric shock), proved to be a new and effective method of treating patients with cardiac arrest. Cardiac arrest was and remains the most common cause of death for people with an acute myocardial infarction. In the Netherlands, some 40,000 people die of a cardiac arrest every year. Since the introduction of modern techniques of resuscitation and the establishment of coronary care units, mortality rates as a result of cardiac arrest have fallen sharply and these days it is not uncommon for patients to survive cardiac arrest thanks to resuscitation.
When I was working as a cardiologist the problem of death confronted me on an almost daily basis. As a doctor, one is practically obliged to reflect on all the emotional, philosophical and physiological aspects of life and death. Nevertheless, such reflections only take on real significance when one’s private life is affected by the death of a relative. In my case, the passing of my mother at the age of 62 and that of my brother at the age of 41.
Although I had never forgotten the successfully resuscitated patient from 1969, with his memories of the period of his cardiac arrest, I had never done anything with the experience. This changed in 1986 when I read a book by George Ritchie about near-death experiences with the title Return from Tomorrow.[ii] When suffering double pneumonia as a medical student in 1943, Ritchie had experienced a period of clinical death. At the time, antibiotics such as penicillin were not yet widely used. Following a period of very high fever and extreme tightness of the chest, he passed away: he stopped breathing and his pulse had gone. He was pronounced dead by a doctor and covered with a sheet. But a male nurse was so upset by the death of this medical student that he managed to persuade the attendant doctor to administer an adrenalin injection in the chest near the heart – a most unusual procedure in those days. Having been ‘dead’ for more than nine minutes, George Ritchie regained consciousness, to the immense surprise of the doctor and nurse. It emerged that during his spell of unconsciousness, the period in which he had been pronounced dead, he had had an extremely deep experience of which he could recollect a great many details. At first he was quite unable and afraid to talk about it. Later he wrote his book about what happened to him in those nine minutes. And after graduation, he shared his experiences with medical students in psychiatry lectures. One of the students attending these lectures was Raymond Moody, who was so intrigued by this story that he started looking into experiences that may occur during critical medical situations. In 1975 he wrote the book Life after Life,[iii] which became a global best-seller. In this book Moody first used the term Near-Death Experience (nde).
After reading George Ritchie’s book I kept asking myself how someone can possibly experience consciousness during cardiac arrest and indeed whether this is a common occurrence. That is why, in 1986, I started systematically asking all the patients at my out-patient clinic who had ever undergone resuscitation whether they had any recollection of the period of their cardiac arrest. I was more than a little surprised to hear, within the space of two years, 12 reports of such a near-death experience among just over 50 survivors of cardiac arrest. Since that first time in 1969, I had not heard any other such reports. I had not enquired after these experiences either, because I had not been open to them. But all these reports I was hearing now roused my curiosity. After all, according to current medical knowledge it is impossible to experience consciousness when one’s heart has stopped beating.
During cardiac arrest patients are clinically dead. Clinical death is defined as the period of unconsciousness caused by lack of oxygen to the brain (anoxia) because of the arrest of circulation, breathing or both, as caused by cardiac arrest in patients with an acute myocardial infarction. If, in this situation, no resuscitation is initiated, the brain cells will be irreversibly damaged within five to ten minutes and the patient will nearly always die, even if the cardiac rhythm is re-established later through resuscitation.
Questions about brain function and consciousness
For me it all started with curiosity. With asking questions. With seeking to explain certain objective findings and subjective experiences. The phenomenon of near-death experience raised a number of fundamental questions for me. An nde is a special state of consciousness that occurs during an imminent or actual period of physical, psychological or emotional death. How and why does an nde occur? How does the content of an nde come about? Why does a person’s life change so radically after an nde? I was unable to accept some of the answers to these questions, because they seemed incomplete, incorrect or unfounded to me. I grew up in an academic environment in which I had been taught that there is a reductionist and materialist explanation for everything. And up until that point, I had always accepted this as indisputably true.
After immersing myself in the personal, psychological, social and scientific aspects of near-death experiences, other frequently asked questions became important to me as well: Who am I? Why am I here? Where do I come from? When and how will my life end? And what does death mean to me? Will my ‘life’ go on after death? In all times and cultures, and during every stage of life – among them the birth of a child or grandchild, encounters with death or other serious crises – these essential questions are asked again and again. Questions about the miracle of birth. About the mystery of death. Yet we seldom receive satisfactory answers. Whatever happens in our lives, whatever our personal development, whether we meet with success or disappointment in our lives, or however much fame, power or wealth we acquire, death is inescapable. Everything we gather around us will perish within the not too distant future. Birth and death are a reality during every single second of our lives, because our bodies are undergoing a constant process of death and regeneration.
Some scientists do not believe in questions that cannot be answered, but they do believe in wrongly formulated questions. The year 2005 saw the publication of a special anniversary issue of the journal Science, featuring 125 questions that scientists have so far failed to solve.[iv] The most important unanswered question, What is the universe made of?, was followed by: What is the biological basis of consciousness? I would reformulate this second question as follows: Is there a biological basis of consciousness (at all)? We can also distinguish between both temporary and timeless aspects of our consciousness. This prompts the following question: Is it possible to speak of a start to our consciousness and will our consciousness ever end?
In order to answer these questions, we need a better understanding of the relationship between brain function and consciousness. We shall have to start by examining whether there is any indication that consciousness can be experienced during sleep, coma, brain death, clinical death, the process of dying and, finally, after confirmed death. If the answers to any of these questions are positive, we must look for scientific explanations and scrutinise the relationship between brain function and consciousness in these different situations. This raises a series of other questions that will be addressed in this book:
– Where am I when I sleep? Can I be aware of anything during sleep?
– Can we speak of consciousness when a person is in a coma? A recent article in Science looked at the scientific evidence of awareness in a patient in a vegetative state.[v] This is a form of coma with spontaneous breathing and brainstem reflexes. Brain tests showed that this particular patient’s response to verbal instructions to imagine certain activities, such as playing tennis or walking through one’s home, displayed changes that were identical to changes identified in healthy volunteers carrying out the same instruction. It suggests that the changes that were identified could only be explained by assuming that this patient, despite her vegetative state, had not only understood the verbal instruction, but had also carried it out. The research demonstrated that this coma patient was aware of both herself and her surroundings, but that her brain damage prevented her from communicating her thoughts and emotions directly to the outside world. Likewise, in her book Uit coma,[vi] Alison Korthals Altes describes her observations of staff and family at the intensive care unit during her three-week coma following a serious traffic accident.
– Can we still speak of consciousness when a person has been pronounced brain dead? In his book Droomvlucht in coma[vii] Jan Kerkhoffs tells us about his conscious experiences after neurologists declared him brain dead following complications during brain surgery. It was only because his family had refused organ donation that he could write about his experiences, as much to everyone’s surprise he regained consciousness after three weeks in coma.
– Is brain death really death or does it mark the start of a process of dying that can last anywhere between hours and several days, and what happens to our consciousness during this process of dying?
– Does clinical death equal loss of consciousness? Many of the reports on near-death experience covered in this book suggest that during a cardiac arrest, i.e. during a period of clinical death, people may experience an exceptionally lucid consciousness.
– Can we still speak of consciousness when a person is confirmed dead and the body is cold? I shall look more closely at this final question below.
Is there consciousness after death?
Near-death is anything but the same as death, yet the question is whether research into nde can give us any indication of what happens to consciousness when a person is confirmed dead. We must start by exploring answers to the question whether, and perhaps how, consciousness may be experienced after death. How can we surmise what happens to our consciousness when we are dead? And where do our ideas about death come from? Why would we want to learn more about death, about what being death could mean? The confrontation with death raises urgent questions because death continues to be a taboo in our society. Yet it is ‘dead’ normal for people to die every day. Today, as you are reading this, approximately 375 people will die in the Netherlands. It means that more than 135,000 people die in the Netherlands every year. Worldwide, more than 70 million people die every year. However, because global birth rates exceed mortality rates, the global population continues to increase. On average, 515 babies are born in the Netherlands every day. Dying is just as normal as being born. Yet death has been banished from our society. Increasingly, people are dying in hospitals and care homes, although recent times have shown a trend for dying at home or at a hospice.
What is death, what is life, and what happens when I am dead? Why are most people so afraid of death? Surely death can be a release after a difficult sickbed? Why do doctors often continue to perceive the death of a patient as a failure on their part? Because the patient lost his or her life? Why are people no longer allowed to ‘just’ die of a serious, terminal illness, but are first put on a respirator and given artificial feeding through tubes and drips? Why do some people in the final stages of a malignant disease decide to opt for chemotherapy that may prolong life for a short while, but that may not always improve the quality of their remaining life? Why is our first impulse to prolong life and delay death, at all costs? A doctor usually seeks to keep a patient alive for as long as possible, and this often ties in with the wishes of the patient who, in spite of all the limitations, pain and distress, wishes to stay alive a little longer. Is fear of death the most important underlying cause? And does this fear stem from ignorance of what death might be? Are our ideas about death accurate at all? Is death really the end of everything?
Even medical training pays scant attention to what death might be. By the time they graduate, most doctors have not given death much thought. Throughout your life, 500,000 cells die in your body every second, 30 million every minute and 50 billion every day. These cells are all replaced again on a daily basis, giving you an almost entirely new body every couple of years. Cell death is not the same as physical death. In life, our bodies change constantly, from one second to the next. Yet we do not feel or realise it. What prompts the continuity of this constantly changing body? Cells are building blocks, comparable to the building blocks of a house: but who designs, plans and coordinates the construction of a house? Not the building blocks themselves. This inevitably raises the question: What brings about the construction and coordination of the constantly changing body from one second to the next?
All bodies function the same on a biochemical and physiological level, yet all people are different. What causes this difference? This difference is not just physical. People have different characters, feelings, moods, levels of intelligence, interests, ideas and needs. Consciousness plays a major role in this difference. This then raises the question: does man equal his body, or does man have a body?
Just over 50 per cent of the Dutch population is fairly certain that death is the end.[viii] These people believe that the death of our bodies marks the end of our identities, our thoughts and our memories, and that death marks the end of our consciousness. In contrast, approximately 40 to 50 per cent of the population believes in some kind of afterlife.[ix] Yet many people never wonder whether their ideas about death are correct – until they are confronted with their own mortality after a death, a serious accident or a life-threatening illness in their family or close circle of friends.
By studying everything that has been thought and written about death throughout history, in all times, cultures and religions, we may be able to form a different or better picture of death. But we may achieve the same on the basis of findings from recent scientific research into near-death experiences. It has emerged that most people lose all fear of death after an nde. Their experience tells them that death is not the end of everything and that life goes on in one way or another. This is what someone wrote to me after his nde:
‘It is outside my domain to discuss something that can only be proven by death. However, for me personally this experience was decisive in convincing me that consciousness endures beyond the grave. Death turned out to be not death, but another form of life.’
According to people with an nde, death is nothing other than a different way of being with an enhanced and broadened consciousness, which is everywhere at once because it is no longer tied to a body.
The role of science in the study of consciousness
According to the philosopher of science Ilja Maso, most scientists generally have the highest opinion of the scientific approach based on materialist, mechanistic and reductionist hypotheses.[x] This attracts most of the funding, achieves the most striking results and is thought to employ the brightest minds. The more a certain vision deviates from this materialist paradigm, the lower its place in the hierarchy, and the less money and status it is accorded. Indeed, experience shows us that a disproportionate percentage of money is spent on the upper echelons of the hierarchy, whereas the lower echelons actually address people’s qualities, needs and problems.[xi] Real science does not restrict itself to materialist and hence limiting hypotheses, but is open to new and perhaps initially inexplicable findings and welcomes the challenge to find an explanation. Maso speaks of an inclusive science that can accommodate ideas that are most consistent with our attempts to learn about subjective aspects of the world and ourselves than the materialist demarcation currently allows.[xii] The psychologist Abraham H. Maslow (1908-1970) offered a fine definition of what such an inclusive science should be:[xiii]
The acceptance of the obligation to acknowledge and describe all of reality, all that exists, everything that is the case. Before all else science must be comprehensive and all-inclusive. It must accept within its jurisdiction even that which it cannot understand or explain, that for which no theory exists, that which cannot be measured, predicted, controlled, or ordered. It must accept even contradictions and illogicalities and mysteries, the vague, the ambiguous, the archaic, the unconscious, and all other aspects of existence that are difficult to communicate. At best it is completely open and excludes nothing. It has no ‘entrance requirements.’
The American philosopher of science Thomas Kuhn (1922-1996) claims that most scientists are still trying to reconcile theory and facts with the routinely accepted (materialist) paradigm, which he describes as essentially a collection of ‘articles of faith shared by scientists’.[xiv] All research results that cannot be accounted for by the prevailing worldview are labelled ‘abnormal findings’, because they threaten the existing paradigm and are therefore seen to violate the expectations raised by the prevailing paradigm. Needless to say, such findings are therefore initially overlooked, ignored, rejected as aberrations or even ridiculed.[xv] Near-death experiences are such abnormal findings. Abnormal findings allow us to adjust existing scientific theories or replace them with new concepts that are capable of explaining these findings. However, it is rare for new concepts to be met and accepted with a great deal of enthusiasm when they do not fit the prevailing materialist paradigm. As such, the words of the psychiatrist Ian Stevenson (1918-2007) still ring true:
‘It’s been said that there’s nothing so troublesome as a new idea, and I think that’s particularly true in science.’
Most of the people who carry out research into consciousness, such as neuroscientists, psychologists, psychiatrists and philosophers, are still of the opinion that there is a materialist and reductionist explanation for consciousness. The well-known philosopher Daniel Dennett believes, and many with him, that consciousness is nothing other than matter,[xvi] and that our subjective experience that our consciousness is something purely personal and differs from someone else’s consciousness is merely an illusion. According to these scientists, consciousness originates entirely from the matter that constitutes our brain. If this were true then everything we experience in our consciousness would be nothing but the expression of a machine controlled by classical physics and chemistry, and our behaviour the inexorable outcome of nerve cell activity in our brain. Obviously the notion that all subjective thoughts and feelings are produced by nothing other than the brain’s activity also means that it is an illusion to believe in free will. This viewpoint has serious implications for concepts such as moral responsibility and personal freedom.
The need for a new approach
‘If you wish to upset the law that all crows are black … it is enough if you prove one single crow to be white.’
William James, psychologist (1842-1910)
When empirical scientific studies discover phenomena or facts that are inconsistent with current scientific theories, these new facts must not be denied, suppressed or even ridiculed, as is still quite common these days. In the event of new findings the existing theories ought to be developed or adjusted, and if necessary rejected and replaced. We need new ways of thinking and new kinds of science to study consciousness and acquire a better understanding of the effects of consciousness. Some scientists, such as the philosopher Chalmers, are more receptive and take consciousness seriously:[xvii] ‘Consciousness poses the most baffling problems in the science of the mind. There is nothing that we know more intimately than conscious experience, but there is nothing that is harder to explain.’ Chalmers has specialised in the problem of consciousness and has written a first-class review of the various theories that seek to explain the relationship between consciousness and the brain.[xviii] A later chapter in this book will consider this review more closely.
In the past, too, new kinds of science developed when prevailing scientific concepts could no longer explain certain phenomena. At the start of the previous century, for instance, quantum physics emerged because certain findings could no longer be accounted for with classical physics. Quantum physics upset the established view of our material world. The slow acceptance of the new insights provided by quantum physics can be attributed to the materialist worldview we have been raised with. According to some quantum physicists, quantum physics even assigns to our consciousness a decisive role in creating and experiencing the physical world as we perceive it. This not yet commonly accepted interpretation holds that our picture of reality is based on the information received by our consciousness. This transforms modern science into a subjective science with a fundamental role for consciousness. The quantum physicist Werner Heisenberg (1901-1976) formulates it as follows:[xix]
‘Science no longer is in the position of observer of nature, but rather recognizes itself as part of the interplay between man and nature. The scientific method … changes and transforms its object: the procedure can no longer keep its distance from the object.’
During an nde, the experience of some aspects of consciousness is comparable, or analogous, with concepts from quantum physics. Of course quantum physics cannot explain consciousness, but in combination with the results and conclusions from research into nde it can contribute to a better understanding of the transition or interface between consciousness and the brain.
Science equals asking questions with an open mind
In my opinion, current science must reconsider its hypotheses about the nature of perceptible reality, because these ideas have led to the neglect or denial of significant areas of consciousness. Current science usually starts from a reality based solely on objective, physical phenomena. Yet at the same time one can (intuitively) sense that besides objective, sensory perception there is a role for subjective aspects such as feelings, inspiration and intuition. Current scientific techniques are incapable of measuring or demonstrating the content of consciousness. It is impossible to produce scientific proof that somebody is in love, or that somebody appreciates a certain piece of music or a particular painting. What can be measured are merely the chemical, electric or magnetic changes in brain activity. The content of thoughts, feelings and emotions cannot be measured. A purely materialist analysis of a living being cannot reveal the content of our consciousness. If we had no direct experience of our consciousness, through our feelings, emotions and thoughts, we would not be able to perceive it. Moreover, people must appreciate that their picture of the physical world is derived and constructed solely from their own perception of physical, quantifiable and reproducible phenomena. There is simply no other way. Thus, every human being creates his own reality on the basis of his consciousness. When someone is in love, the world is beautiful, and when someone is depressed, that very same world is a torment. In other words, the physical, ‘objective’ world is nothing but the picture constructed in our consciousness. People thus preserve their own worldview. This is precisely the kind of idea that the best part of the scientific community has difficulty accepting.
Endless consciousness
On the basis of prospective studies into near-death experiences, recent results from neurophysiological research and concepts from quantum physics, I strongly believe that consciousness cannot be located in a particular time and place. This is known as non-locality. Full and endless consciousness is everywhere in a non-local time and space, where past, present and future are existent and accessible at the same time. This endless consciousness is always in and around us. We have no theories to prove or measure a non-local space and a non-local consciousness in the physical world. The brain and the body merely function as a receiving station to receive a share of our total consciousness and a share of our memories into our waking consciousness. Non-local consciousness encompasses much more than our waking consciousness. Our brains may be compared to both a television set, receiving information from electromagnetic fields and decoding this into sound and vision, and a television camera, converting or coding sound and vision into electromagnetic waves. Our consciousness transmits information to the brain and via the brain receives information from the body and senses. The function of the brain can be compared to a transceiver, with our brain having a facilitating rather than a producing role: it enables the experience of consciousness. In addition, there is increasing evidence that consciousness has a direct effect on the function and anatomy of the brain and the body, with DNA thought to play an important role.
Near-death experience gave rise to the concept of a non-local and endless consciousness and this concept allows us to understand a wide variety of special states of consciousness, such as mystical and religious experiences, deathbed visions, peri-mortem and post-mortem experiences, heightened intuitive feelings, prophetic dreams, remote viewing and the effect of consciousness on matter. Ultimately, one cannot avoid the conclusion that endless consciousness has and always will exist independently from the body. There is no beginning nor will there ever be an end to our consciousness. For this reason we ought to seriously consider the possibility that death, like birth, can only be a transition to another state of consciousness, and that during life the body functions as an interface or place of resonance.
The near-death experience: a bridge between science and spirituality
I hope readers will approach this book with empathy and without prejudice. By making a scientific case for consciousness as a non-local and thus ubiquitous phenomenon, this book can contribute to new ideas about the relationship between consciousness and the brain. I am aware that this book can be little more than a stimulus for further study and debate, because at present we lack definitive answers to the many important questions about our consciousness and the relationship between consciousness and the brain. I have no doubt that in future, too, many questions about consciousness and the mystery of life and death will remain unanswered. However, faced with extraordinary or abnormal findings we must question a purely materialist paradigm in science. A near-death experience is one such extraordinary finding. Although consciousness remains a huge mystery, new scientific theories based on research into nde appear to be helping us answer some of the questions about this mystery. It looks as if a single unusual finding that cannot be explained through widely accepted concepts and ideas is capable of bringing about a fundamental change in science.
I suspect that reading this book will raise many questions. I am only too aware that some topics in this book may be new or even inconceivable to many readers, especially to those who have never heard of or read about nde. However, the hundreds of thousands of people who have experienced an nde will probably show clear signs of recognition.
An nde is both an existential crisis and an intense lesson in life. People change after an nde as it gives them a conscious experience of a dimension in which time and distance play no role, in which past and future can be glimpsed, where they feel complete and healed and where they experience unlimited knowledge and unconditional love. These life changes mainly spring from the insight that love and compassion for oneself, for others and for nature are major prerequisites for life. Following an nde people realise that everything and everyone is connected, that every thought has an effect on both oneself and the other, and that our consciousness continues beyond physical death. People realise that death is not the end.
People with a near-death experience have been my greatest teachers. My many conversations with them and my in-depth study of the potential significance of an nde have changed my views on the meaning of life and death. There is much to learn from the insights acquired through an nde, although people do not need their own near-death experience to gain new insights into life and death.
In order to accept new ideas in science generally, and about endless consciousness in particular, we need an open mind and abandon a dogmatic approach. And of course this extends beyond science to include all of the topical issues in contemporary Western society. As we open our minds to universal questions about life, death and consciousness our view of humanity may fundamentally change. I sincerely hope that this book can make a valuable contribution to this process.
The book’s structure
A detailed report of an nde and its impact on life may be found in Chapter 2. Following a brief historical overview of the first scientific studies into nde, Chapter 3 gives a detailed account of the twelve universal elements of an nde, illustrated with striking quotes. Chapter 4 discusses the positive life changes people report following an nde during a cardiac arrest lasting only a few minutes. The many problems of the coping process are also addressed. Regrettably, people with an nde are still too often dismissed as dreamers, fantasists, attention-seekers or confused patients. Chapter 5 takes a look at nde in children, because it seems highly unlikely that an nde in young children could be the result of any outside influence. Children recollect the same elements of an nde as adults and are also clearly different from their contemporaries after an nde.
In Chapter 6 I review all scientific explanations for an nde. A satisfactory theory to account for the many facets of the nde must consider both the various circumstances under which an nde can be experienced and the completely different elements that constitute an nde. In Chapter 7 I look in great detail at our own Dutch study into nde among 344 patients who survived cardiac arrest,[xx] and compare the results and conclusions from this study to comparable studies from the USA and the UK.[xxi][xxii][xxiii] These four prospective studies all pointed to the same conclusion, namely that all known elements of an nde were experienced during the period of cardiac arrest, i.e. during the total cessation of blood supply to the brain. How was this possible? Chapter 8 contains a detailed description of what happens in the brain in the event of acute anoxia triggered by the loss of a heartbeat and blood pressure. To supplement this, Chapter 9 looks more closely at the brain’s normal function and the limitation of our current scientific ideas about the relationship between the brain and consciousness.
As an interlude between the preceding, predominantly descriptive chapters, and the subsequent, mainly analytical chapters, Chapter 10 offers an extensive report of two ndes that the person in question underwent several years ago.
Chapter 11 looks at concepts and insights from quantum physics that may help improve our understanding of consciousness. Chapter 12 considers the relationship between the brain and consciousness via a theoretical review and discusses a number of ideas that may be able to provide a scientific explanation for this relationship. Chapter 13 discusses new insights into the potential function of DNA in the continuous changes to our bodies, with DNA thought to play a role as the interface between non-local consciousness and the body, and in the coordination between cells, cell systems, organs and the organism as a whole. Chapter 14 looks closely at the different aspects of non-local or endless consciousness, many of which have been verified by empirical scientific research.
The notion of an endless and eternal consciousness is not new. Chapter 15 features quotations from ancient and medieval writings from Europe and Asia. It offers detailed descriptions of experiences of a heightened and endless consciousness and the notion of a consciousness after physical death. Chapter 16 answers a number of frequently asked questions about research into nde, reincarnation and organ donation. Finally, Chapter 17 will stress that our understanding of nde is not only of theoretical value for our view of humanity, but can also be of great practical use to people working in the healthcare sector as well as to dying people and their families. Everyone ought to be aware of the special experiences that might occur during a period of clinical death, during coma, on a deathbed or after death.
2. A NEAR-DEATH EXPERIENCE AND ITS IMPACT ON LIFE
This is a test to see if you have fulfilled your mission here on earth: if you are still alive, you have not.
Richard Bach, author
I want to begin this book with a report that is representative of a near-death experience (nde) and the difficult process of coming to terms with this experience in later life. This nde was caused by serious complications during a delivery.
***
‘On September 23 I get my first contractions. At that point I am nine months’ pregnant with what we later learn is our second daughter. My whole pregnancy has been a textbook case. After some time my husband and I join the midwife and go to the hospital. I am taken to the delivery room. The midwife listens to the child’s heartbeat through the large wooden horn. The waters break. The delivery room becomes extremely quiet. People are rushing around and talking softly yet urgently with one another. When I ask what is happening neither I nor my husband receive a reply. The contractions stop, but I am feeling fine. Meanwhile, the gynaecologist has joined us, as well as other nursing staff. We don’t know what’s happening. I am told to start pushing. ‘But I have no contractions!’ This does not seem to matter. There is a rattling of tongs, scissors, trays and tissues. My husband passes out, is pulled out of the delivery room and left in the corridor.’
Suddenly I realise I am looking down at a woman who is lying on a bed with her legs in supports. I see the nurses and doctors panicking, I see a lot of blood on the bed and on the floor, I see large hands pressing down hard on the woman’s belly, and then I see the woman giving birth to a child. The child is immediately taken to another room. The nurses look dejected. Everybody is waiting. My head is knocked back hard when the pillow is pulled away. Once again, I witness a great commotion. Swift as an arrow I fly through a dark tunnel. I am engulfed by an overwhelming feeling of peace and bliss. I hear wonderful music. I see beautiful colours and gorgeous flowers in all sorts of colours in a large meadow. At the far end is a beautiful, clear, warm light. This is where I must go. I see a figure in a light garment. This figure is waiting for me and extends her hand. I feel that I am warmly and lovingly expected. We proceed hand in hand to the beautiful and warm light. Then she lets go of my hand and turns around. I feel that I am pulled back. I notice a nurse slapping me hard on my cheeks and calling me.
After some time I realise where I am and also realise that my child is not doing well. Our daughter is not (no longer) alive. How painful is this return! And how I long to go back to … indeed, where to? The world goes on turning.
The medical cause of my nde was the loss of blood that occurred during the delivery. Initially, this loss of blood went unnoticed by the nursing staff. I guess everyone was focusing on the child being born. They only took action at the last moment by pulling the pillow from under my head, giving me blood and … I didn’t see any more. By then I had reached the heavenly paradise.
Once returned from that beautiful world, that beautiful experience, my reception here in this world was cold, frosty and above all loveless. The nurse I tried to share my beautiful experience with dismissed it by saying I would soon receive some more medication so I could sleep soundly and then it would be all over. All over? I did not want that at all. On the contrary, I did not want it to be over. I wanted to go back. The gynaecologist told me I was still young, I could have plenty more children and I should just move on and focus on the future.
I stopped telling my story. Just to find words for my experience was difficult enough, how could words express what I had experienced? But what else could I do? Where could I take my story? What was the matter with me? Had I gone mad?
The only person to whom I could tell my story over and over again was my husband. He listened, asked questions, but didn’t understand himself what I had experienced, what I should make of it or what it was called, and whether I was the only person with such an experience. How pleased I was then, and still am today, that he was such a good listener. My nde did not jeopardise my relationship. And now I know that this is very precious indeed. Speaking of unconditional love! But I did feel as if I was the only person who had experienced such a thing. Not a soul who asked me anything, nobody was interested. To be fair, my case made it even more difficult for people, for how should they react when they were expecting a birth announcement card and received instead a card announcing the baby’s death? For many people this is difficult enough, even without having to listen to an experience like mine.
‘During that time I lived like an automaton. Although I looked after my husband and our first daughter, and walked the dog, my mind was elsewhere. My mind was with my experience. How could I reconnect with it? Where could I hear such beautiful music, see such a beautiful colours, find such gorgeous flowers, see such a beautiful light, experience so much unconditional love? And was I mad for thinking these things? What was the matter with me?
In my undergraduate dissertation I proposed the following key recommendation for healthcare providers: ‘Should I have received just one per cent of all the advice that is currently found in books and articles on nde, I would have been so grateful!’ In 1978 personal support was obviously not of the same high level as it is today, but apart from regular nurses, the gynaecologist and the midwife, I never saw anyone. The family doctor never came to see me, not even after some weeks. He never got in touch with me. Did he simply assume I was doing fine? Neither did I go and see him, for what should I tell him? I had come to the conclusion that my experience was not normal and that it was better to keep silent. My check-up at the gynaecologist revealed no problems. On a mechanical level I was still functioning properly and that was that. No further questions were asked.
And I kept silent.
I spent years dedicated to a silent search. When, eventually, I found a book in the library with a report of an nde, I could hardly imagine that I had had such an experience. Surely it’s impossible? Even I had stopped believing myself. Only very, very gradually did I come to have the courage and the strength to believe myself, to trust my experience, so I could start accepting and integrating it in my life. It was not easy. Over the years I had developed a fairly successful survival strategy, or rather a flight strategy. Fleeing from my feelings, fleeing from myself. I took on more and more work. I also threw myself into sports – running of all things. How symbolical! After all, I was running away from myself and from my nde. Initially this worked out well, also in the eyes of the world: I often found myself crowned the winner, clutching flowers in my hands. But these were not the flowers I was looking for. I was finding it more and more difficult to accept the opinions of others, of colleagues. My inner conflict intensified, I felt at odds with what my feelings told me and with what I knew. Everything became increasingly difficult.
My body intervened. I went from being overworked and overstrained, from what I felt was a burn-out, into a full-blown depression. I was treated by a psychologist working in the homeopathic tradition. There is no such thing as chance. He was the first healthcare provider who listened to my story, to my experience. He believed it and even considered it normal! But this was more than twenty years after my nde! He suggested that I should sketch the experience or write it down, in any case actively engage with it. With him, I made a fascinating journey into my inner self. Everything was accepted and considered normal. I now realise I am not mad but that my nde has changed me. This is why my fear of death has completely disappeared. This is a marked difference compared to the years prior to my nde, years in which I wrestled with death and with the fear of death. This is why I struggle with the concept of time. Nowadays I always lose track of time, whereas before I lived by the clock. This is why material things are not important to me. This is why the only thing that matters to me is unconditional love. And this is what I had and continue to have with my husband. And yet I recently read in a study that unconditional love is impossible between human beings. And they refuse to believe me! This is why I sometimes feel like an outsider. This is why I am always, especially during holidays, on the lookout for landscapes, for colours and flowers which I have seen but cannot find again. This is why I have a problem with quarrelling – I want to go back to those peaceful surroundings. I am also incapable of picking a row myself.
Having made the journey to my inner self to reach the point where I am now, I am glad I had my nde. I accept it as a beautiful experience, which calms me, which allows me to be myself, with my experience. Life is good now, with my experience. By integrating my nde this world has become a better place. Only since I started accepting and integrating my nde have I come to take some pleasure in life again. My thoughts and feelings are relevant after all, they are not strange or mad; I need them to cut across the chaos to get in touch with my own identity, instead of that of the masses. It does mean, however, that I am still facing the task of spreading awareness of nde among people, and especially among healthcare providers. In my own modest research effort with family doctors in my hometown I was disappointed to learn that many of them still do not know what to do when somebody has had an nde.
But the most important thing to me now is that I can be who I am, with my experiences. I am who I am, no more, but certainly no less either! And that is a good thing.’
E.M.
7. THE DUTCH STUDY INTO NEAR-DEATH
EXPERIENCE
If consciousness be a mere epiphenomenon … we shall of course expect … that consciousness is exclusively linked with the functional disintegration of central nervous elements, and varies in its intensity with the rapidity or energy of that disintegration. And ordinary experience, at least within physiological limits, will support some view like this. Yet now and then we find a case where vivid consciousness has existed during a state of apparent coma … tranquilly and intelligently co-existing with an almost complete abeyance of ordinary vital function … Until this new field has been more fully worked out … we have no right to make any absolute assertion as to the concomitant cerebral processes on which consciousness depends.
F.W.H. Myers, Psychologist (1843-1901)
Introduction
My scientific curiosity into the phenomenon of nde was aroused when I initiated a kind of pilot study in 1986. In my out-patient clinic I asked all patients who had once survived a cardiac arrest whether they had any recollection of their period of unconsciousness. To my surprise, during a two-year period twelve out of the fifty patients (24 per cent) reported an nde, often with extremely poignant details. But unfortunately I was unable to explain how people could have any recollection of the period of unconsciousness caused by a cardiac arrest. After all, according to prevailing scientific opinion consciousness is not at all possible at such a moment. In Chapter 6 I reviewed all the existing explanatory models based on retrospective studies.
The aim of the Dutch prospective study
In order to obtain more reliable data to corroborate or refute the existing theories on the cause and content of an nde, we needed a properly designed scientific study. This was the reason why in 1988 Ruud van Wees and Vincent Meijers, both psychologists who wrote their doctoral theses on nde, and I, a cardiologist with an interest in the subject, started designing a prospective study in the Netherlands. At that point, no large-scale prospective studies into nde had been undertaken anywhere in the world. Our study aimed to include all consecutive patients who had survived a cardiac arrest in one of the participating hospitals. In a prospective study such patients are asked, within a few days of their resuscitation, whether they have any recollection of the period of their cardiac arrest, i.e. of the period of their unconsciousness. All patients’ medical and other data are carefully recorded before, during and after their resuscitation. In other words, this prospective study would only be carried out among patients with a proven life-threatening crisis. All of these patients would have died of their cardiac arrest had they not been resuscitated within five to ten minutes. This kind of design also creates a control group of patients who have survived a cardiac arrest but who have no recollection of the period of unconsciousness.
The organisation
I started giving lectures to nursing staff and doctors at various hospitals, in the hope of securing cooperation to conduct the study into nde in patients who had survived resuscitation at the coronary care units of those hospitals. We finally managed to include ten hospitals in our study, mainly thanks to the efforts of the nursing staff. The coronary care units of the four hospitals where I worked as a cardiologist at the time, and which later merged to form the Rijnstate Hospital in Arnhem/Velp, took part in the study throughout the period of 1988 to 1992, as did the Antonius Hospital in Nieuwegein. Five smaller hospitals participated in the study for a shorter period of time. We terminated a hospital’s participation when it emerged that the pressures of work at a coronary care unit meant it had not been possible to include in the study all consecutive patients after resuscitation. The latter was particularly common when patients had not reported any recollection after their resuscitation. If people without an nde were going to be excluded from the study some of its results would be distorted, among them the answer to the question about the frequency of an nde after a cardiac arrest. We had organised a contact for each hospital as well as a deputy in view of rotas. We also had someone visit the hospitals on a regular basis to monitor the situation. We asked for and received permission from the Ethics Committees of the various hospitals. Patients were always asked whether they wanted to participate, and fortunately they all consented during their initial interview at the hospitals, probably because the question was asked by a nurse or doctor at the patient’s own hospital.
What is the mortality rate of patients with a cardiac arrest?
For every hundred successfully resuscitated patients we were able to include in our study, at least two hundred people died of their cardiac arrest in the same period. Few people realise that at a Coronary Care Unit (CCU) a great many resuscitations are carried out every year and that more than half of these patients do not survive their cardiac arrest. These ‘hard’ facts are corroborated in a study of heart patients by Schwaninger et al.[xxiv] In their investigation into nde in cardiac arrest patients, which was comparable to our study, they encountered 174 resuscitated patients during their research period, of which 119 (68 per cent) died. Of the surviving 55 patients only 30 (17 per cent) could be interviewed. No interviews could be conducted with the other 25 patients because of permanent brain damage at the time the interview was planned. The study by Parnia and Fenwick[xxv] included 220 cardiac arrest patients over a period of one year, of whom 62 per cent died and only 63 patients (28 per cent) could be interviewed.
The longitudinal study
The longitudinal study into life changes was based on interviews after two and eight years with all patients who had reported an nde and who were still alive, as well as with a control group of post-resuscitation patients who were matched for age and sex, but who had not reported an nde. The question was whether the customary changes in attitude to life after an nde were the result of surviving a cardiac arrest or whether these changes were caused by the experience of an nde. This question had never been subject to scientific and systematic research before. The two-year follow-up interviews were coordinated by Ruud van Wees and Vincent Meijers, while the eight-year follow-up interviews were coordinated and conducted by lifespan psychologist Ingrid Elfferich. All the work for our prospective study, including the taped two and eight-year follow-up interviews and their analysis, was carried out by nursing staff and university-educated volunteers, who had been ‘briefed and trained’ by us. We did not receive any subsidies during our ten-year study, as research into near-death experience turned out to be ineligible for financial support from bodies such as the Dutch Heart Foundation.
The design of the study
We had a record of the electrocardiogram, or ECG, for all patients included in our study. An ECG displays the electrical activity of the heart. In cardiac arrest patients this ECG record always displays a normally lethal arrhythmia (ventricular fibrillation) or an asystole (a flat line on the ECG). In the event of resuscitation outside the hospital we were given the ECG done by the ambulance staff.
Following successful resuscitation we carefully recorded the demographic data of all patients, including age, sex, education, religion, foreknowledge of nde and whether or not they had had an earlier nde. They were also asked whether they had been afraid just before their cardiac arrest. Likewise, we carefully recorded all medical information: what was the duration of the actual cardiac arrest? What was the duration of unconsciousness? How often did the patient require resuscitation? What was the exact nature of their cardiac arrhythmia? Was intubation (a tube in the trachea for artificial respiration) needed because of a long-term coma following a difficult resuscitation? Had the patient been resuscitated in or outside hospital? Had the cardiac arrest occurred during electrophysiological stimulation (EPS) during a heart catheterization, when patients are usually defibrillated within fifteen to thirty seconds (through an electric shock to the chest)? Was this the patient’s first myocardial infarction or had the patient had a previous one? What medication, and in what dosage, was administered to the patient before, during and after resuscitation? (In the case of long-term respiration, medication is often extremely strong and may keep the patient in a kind of coma). We also recorded how many days after resuscitation the interview took place, whether the patient was lucid during the interview and whether his or her short-term memory was functioning well.
The initial interview
At the initial interview, usually within five days of resuscitation, the patient was asked only a single, open question: ‘Do you have any recollection of the period of your cardiac arrest?’ If the answer to this question was positive, an initial, unstructured interview was conducted and recorded, preferably by one of the study’s principal researchers, although this was not always possible. One drawback of this method was that, if it was found that the patient had thought ‘he was going to die’, this was recorded as a possible nde with the lowest score (score 1). However, two years later some of the patients with such a minimum score were found not to have had an nde. Likewise, a few patients who had been documented as not having had an nde did report an experience two years on. They had remained silent on their nde so soon after resuscitation. This is a well-known phenomenon. People are extremely reluctant to talk about their extraordinary experience, because they are scarcely able to grasp the experience themselves, and remain silent for fear of being ridiculed or disbelieved.[xxvi] I shall come back to these findings when discussing the results of the longitudinal study.
A hidden sign, visible only during an out-of-body experience
At one of the hospitals in Anhem a ‘hidden sign’ was put on top of the surgical lamp in the resuscitation room, invisible from a normal position. None of the attendant doctors or nurses had been informed of this hidden sign in order to prevent them from influencing patients. I myself never knew which sign (a cross, circle or square, in red, yellow or blue) had been applied by a colleague of mine. Unfortunately, no patients who were resuscitated in this room ever reported an out-of-body experience with perception. Because people are resuscitated everywhere – on the street, in the ambulance, in any CCU room, on the ward, etc. – we had estimated the chances of a ‘hit’ to be relatively low. However, one verified case of out-of-body experience would have been sufficient. Luckily, during our study a nurse told us about the case of the dentures, as described in Chapter 3, although that particular resuscitation room featured no hidden sign.
The design of the longitudinal study
The two and eight-year follow-up interviews were recorded on tape and typed out. This allowed us to compare the content of the nde with the experience as it had been reported to us in hospital directly after the cardiac arrest. Remarkably, after two and eight years patients repeated their nde almost exactly, down to the very last detail. This is nearly impossible in the case of a dream or an invented story. The later interviews were accompanied by Ring’s life-change inventory,[xxvii] which all participants were asked to complete. This inventory features 34 questions about self-image, compassion for others, material and social issues, religious and spiritual matters and attitude towards death. In order to specify their level of transformation, patients were asked to answer these questions on a five-point scale. For the eight-year follow-up, this inventory was expanded with surveys on medical and psychological aspects, drawn up by the Dutch Heart Foundation. These included a list of questions on coping with problems and a questionnaire on feelings of depression. These questionnaires were added for the purposes of qualitative analysis, because so few people were still alive after eight years and the group under investigation had become quite small.
All findings of the prospective study and the longitudinal study underwent statistical processing to identify significant differences, with P≤0.05.
Findings of the prospective study
The Dutch study was published in The Lancet in December 2001.[xxviii] Within four years, between 1988 and 1992, 344 successive patients who had undergone a total of 509 successful resuscitations were included in the study. In other words, all the patients in our study had been clinically dead. Clinical death is defined as the period of unconsciousness caused by lack of oxygen in the brain (anoxia) because of the arrest of circulation, breathing or both, as caused by cardiac arrest in patients with an acute myocardial infarction. If, in this situation, no resuscitation is initiated, the brain cells will be irreversibly damaged within five to ten minutes and the patient will always die. People who survived a difficult resuscitation outside hospital were significantly younger, and only twelve patients survived a cardiac arrest lasting more than ten minutes. Statistics show that ultimately only ten per cent of people with a cardiac arrest outside hospital will leave hospital alive, because of the frequent occurrence of irreversible brain damage leading to brain death and, finally, death.
Table 7.1 features the recorded data of the 344 patients in our study.
Table 7.1 Recorded data of the
344 patients in the study
| Number of resuscitations | 509 |
| Mean age | 62 years |
| Number of men | 73% |
| Number of women | 27% |
| Religion | 72% |
| Secondary education | 66% |
| Foreknowledge of nde | 57% |
| Previous nde | 4% |
| Fear of death | 2% |
| First myocardial infarction | 86% |
|
Resuscitation in hospital Cardiac arrest < 2 minutes Regained consciousness < 5 minutes |
234 patients (68%) 190 patients (81%) 187 patients (80%) |
|
Resuscitation outside hospital Cardiac arrest > 2 minutes Unconscious > 10 minutes |
110 patients (32%) 88 patients (80%) 62 patients (56%) |
| Unconscious for more than 1 hour | 104 patients |
| Artificial respiration in long-term coma | 12% |
| Short-term memory defect | 41 patients |
Results of the prospective study
Percentage of ndes
If patients reported memories from the period of unconsciousness, the experiences were scored according to a certain index, the wcei, or “weighted core experience index”. For more information on this, please refer to Chapter 3. The higher the number of elements reported, the higher the score and the deeper the nde. Our study found that 282 patients (82 per cent) had no recollection of the period of their unconsciousness, whereas 62 patients – 18 per cent of the 344 patients – reported an nde. Of these 62 patients with memories, 21 patients had some recollection; having experienced only some elements, they had a superficial nde with a low score. 18 patients had a moderately deep nde, 17 patients reported a deep nde and 6 patients a very deep nde (see Table 7.2).
Table 7.2 Classification of the 344 patients according to (wcei)
depth of nde
| wcei score |
number
|
|
| 1. no recollection | 0 | 282 (82%) |
| 2. some recollection | 1-5 | 21 (6%) |
| 3. moderately deep nde | 6-9 | 18 (5%) |
| 4. deep nde | 10-14 | 17 (5%) |
| 5. very deep nde | 15-19 | 6 (2%) |
62 patients (18 per cent) reported memories (nde)
When comparing these numbers with results from retrospective studies, the much lower percentage of ndes is conspicuous; it is a consequence of the prospective design of the study and the fact that we looked at a much older group of patients. Only 12 per cent of patients had an experience with a score of six or more (a moderately deep, a deep and a very deep nde). This is known as a core experience, because in retrospective studies this score of six marked the cut-off point for defining a recollected experience as an nde. Calculating the percentage of nde on the basis of the number of resuscitations, we are left with only 5 per cent. Women, who were on average older, reported a significantly deeper nde, as did people who had been resuscitated outside hospital and patients who had been extremely fearful prior to their cardiac arrest.
Another striking finding was that people with a deep nde, and especially those with a very deep nde, were significantly higher (P≤ 0.0001) to die within thirty days of their cardiac arrest, even though medically they were no different from the other patients. I cannot offer an adequate explanation for this. However, it is possible that after a deep or very deep nde people had lost their fear of death so completely they were able to ‘let go’ and leave their bodies. We know that people can exercise a certain control over the time of their death. If a family is very sad to see mother or father die and is observing a weepy 24-hour deathbed vigil as it were, this person will be unable to ‘let go’. Unless, that is, the family is momentarily absent – indeed the dying patient will usually die at that precise moment. And when someone is dying, but waiting for a daughter to come over from Australia, then this person will not die until the daughter has arrived several days later – thus defying all medical opinion. Anyone working in a hospital or hospice has come across cases like this.
Identified nde elements
Which nde elements were reported in our study, and what was the frequency of these elements? (See Table 7.3)
Table 7.3 Frequency of nde elements in
the 62 patients
| Awareness of being dead | 31 | (50%) |
| Positive emotions | 35 | (56%) |
| Out-of-body experience | 15 | (24%) |
| Moving through a tunnel | 19 | (31%) |
| Communication with ‘the light’ | 14 | (23%) |
| Observation of colours | 14 | (23%) |
| Observation of a ‘celestial landscape’ | 18 | (29%) |
| Meeting with deceased friends and relatives | 20 | (32%) |
| Life review | 8 | (13%) |
| Presence of a border | 5 | (8%) |
Half of the patients with an nde were aware of being dead and had positive emotions, 30 per cent had a tunnel experience, observed a celestial landscape or met with deceased persons, approximately a quarter had an out-of-body experience, communication with ‘the light’ or perception of colours, 13 per cent had a life review and 8 per cent experienced the presence of a border. In other words, all the familiar elements of an nde were reported in our study, with the exception of a frightening or negative nde.
Factors that turned out not to affect the occurrence of nde
Are there any reasons why some people do but most people do not recollect the period of their unconsciousness? In order to answer this question we compared the recorded data of the 62 patients with an nde to the data of the 282 patients without an nde (see Table 7.4). To our big surprise we did not identify any significant differences in the duration of the cardiac arrest, no differences in the duration of unconsciousness and no differences in whether or not intubation was necessary for artificial respiration in seriously ill patients who remained in a coma for days or weeks after a complicated resuscitation. Nor did we find differences in the thirty patients who had a cardiac arrest during electrophysiological stimulation (eps) in the catheterization laboratory and whose heart rhythms were always re-established via defibrillation (an electric shock) within fifteen to thirty seconds. So we failed to identify any differences between the patients with a very long or a very brief cardiac arrest. The degree or gravity of the lack of oxygen in the brain (anoxia) appeared to be irrelevant. Likewise, it was established that medication played no role. Most patients suffering a myocardial infarction receive morphine-type painkillers, while people who are put on a respirator following complicated resuscitation are given extremely high doses of sedatives. A psychological cause such as the infrequently noted fear of death does not affect the occurrence of an nde either, although it did affect the depth of the experience. Whether or not patients had heard or read anything about nde in the past made no difference either. Any kind of religious belief, or indeed its absence in non-religious people or atheists, was irrelevant and the same was true for the standard of education reached (see Table 7.4).
Table 7.4 Factors that did not affect the occurrence of nde
| 1. Duration of cardiac arrest | N.S. |
| 2. Duration of unconsciousness | N.S. |
| 3. Intubation (complicated resuscitation) | N.S. |
| 4. Induced cardiac arrest (eps) | N.S. |
| 5. Medication | N.S. |
| 6. Fear of death | N.S. |
| 7. Foreknowledge of nde | N.S. |
| 8. Religion | N.S. |
| 9. Education | N.S. |
N.S. = not significant
Factors that do affect the occurrence of nde
Factors that do affect the frequency of an nde are an age below 60 and a first myocardial infarction; in the latter case the patients were also younger than the mean age of 62. If patients required several resuscitations during their stay in hospital, the chances of an nde report were greater. Remarkably, we found that all patients who had had an nde in the past also reported significantly more frequent ndes in our study (see Table 7.5).
Table 7.5 Factors influencing the occurrence of nde
|
More frequent nde: |
|
| 1. Age below 60 | P = 0.012 |
| 2. First myocardial infarction (younger!) | P = 0.013 |
| 3. More than one resuscitation in hospital | P = 0.029 |
| 4. Previous nde | P = 0.035 |
|
Less frequent nde: |
|
| Lasting memory defects | P = 0.011 |
| P is the degree of statistical significance | |
| P≤0.05 denotes a significant difference |
A complicated resuscitation can result in a long coma and most patients who have been unconscious on a respirator for days or weeks are more likely to suffer short-term memory defects as a result of permanent brain damage. The longer the coma, the greater the risk of these so-called cognitive defects,[xxix] which also occur after severe concussion or a stroke and which may wipe hours, days and sometimes even weeks from a patient’s memory. These patients reported significantly fewer ndes in our study (see Table 7.5). This suggests that a good memory is essential for remembering an nde.
Conclusions of the prospective study
The possible causes for the occurrence of nde we have mentioned so far, i.e. a physiological or medical explanation (anoxia), a psychological explanation (fear of death) or a pharmacological explanation (medication), could not be corroborated by this first large-scale prospective study into nde.
We were particularly surprised to find no medical explanation for the occurrence of an nde. All the patients in our study had been clinically dead and only a small percentage reported an enhanced consciousness with lucid thoughts, emotions, memories, and sometimes perception from a position outside and above their lifeless body while doctors and nursing staff were carrying out resuscitation. If there were a physiological explanation, such as a lack of oxygen in the brain (anoxia), for the occurrence of this enhanced consciousness, one might have expected all patients in our study to have reported an nde. They had all been unconscious as a result of their cardiac arrest, which caused the loss of blood pressure and the cessation of breathing and all physical and brain-stem reflexes. Likewise the gravity of the medical situation, such as long-term coma after a complicated resuscitation, failed to explain why patients did or did not report an nde, except in the case of lingering memory defects. The psychological explanation is doubtful because most patients did not experience any fear of death during their cardiac arrest as it occurred so suddenly they failed to notice it. In most cases they were left without any recollection of their resuscitation. This is borne out by Greyson’s study,[xxx] which only collected the subjective data of patients after their resuscitation and showed that most patients did not even realise they had had a cardiac arrest. This is similar to fainting. When people regain consciousness they have no clear idea of what happened. A pharmacological explanation could be excluded as well, as the medication had no effect on whether or not patients reported an nde.
Findings of the longitudinal study
Two years later, 19 of the 62 patients with an nde had died and six declined to be interviewed, leaving 37 patients with an nde for the second interview (see Table 7.6). Of the 17 patients with a low score, seven remained unchanged, four had the lowest score 1 with only positive emotions, while in retrospect six patients turned out not to have had an nde after all. After the initial conversation these six people had been classified as a potential nde with score 1 because ‘they had had the feeling they were dying’. However, this turned out not to have been an nde during the in-depth interview two years later. Following the second interview these six people were grouped with the patients without nde (see Table 7.6). In order to put together a control group of patients who survived a cardiac arrest without nde, but who were matched for age and sex, we approached a total of 75 patients before we found 37 people prepared to participate in a second interview. This group turned out to contain four more patients who had had an nde after all, two with a low score and two with a core experience. Following the second interview, these four patients were grouped with the people with an nde (see Table 7.6). The first post-resuscitation interview had probably been too soon for them to be able or prepared to talk about their nde.[xxxi]
Table 7.6 The number of patients interviewed during the 1st, 2nd and 3rd
phase of the study
|
344 patients |
||
| With nde | Without nde | |
|
1st phase (1988-1992) |
62 patients (18%) | 282 patients (82%) |
|
2nd phase (1991-1993) |
37 (-6+4) = 35 patients 19 died (31%) 6 decline |
37 (+6-4) = 39 patients 38 died or declined
|
|
3rd phase (1997-1998) |
23 patients 11 died 1 no interview |
15 patients 20 died 4 no interview |
Thus we were able to interview a total of 74 patients during the two-year follow-up: 35 patients with a nde affirmed by the second interview and 39 patients without nde (see Table 7.6). Eight years later we approached the same patients for a third interview. Of the people with an nde 11 had died, while of the 24 patients who were still alive one person could not participate because of memory defects. So in the end we were able to conduct third interviews with 23 patients with an nde. Of the people without nde we could interview only 15 after eight years. 20 patients had died and four were unable to participate in the third interview for reasons including dementia. We were therefore able to compare the patterns of change after two and eight years in 23 patients with an nde and in 15 patients without an nde (see Table 7.6).
Results of the longitudinal study
As mentioned, the later interviews were conducted using a standardised inventory featuring 34 life-change questions.[xxxii] Among the 74 patients who consented to be interviewed after two years, 13 of the total of 34 factors listed in the questionnaire turned out to be significantly different for people with or without an nde (see Table 7.7). The second interviews showed that in people with an nde fear of death in particular had significantly decreased while belief in an afterlife had significantly increased. We also identified significant differences between people with and without nde with respect to a number of social and religious factors such as showing one’s emotions, accepting others and a more loving attitude to life as well as more love and compassion for oneself and others. Other differences pertained to a greater involvement in the family, a greater interest in spirituality and the purpose of life and greater appreciation for ordinary things, coupled with a reduced interest in money, possessions and social norms (‘keeping up appearances’). We then compared these 13 factors, which had been so significantly different between the two groups with and without nde after two years, in the same patients after eight years (see Table 7.7).
It struck us that after eight years the people without nde were also undergoing unmistakable processes of transformation. Nevertheless, clear differences remained between people with and without nde, although by now these differences had become a little less marked. We were also surprised to find that the processes of transformation that had begun in people with an nde after two years had clearly intensified after eight years. The same was true for the people without nde. In summary, we could say that eight years after their cardiac arrest all patients had changed in many respects, showing more interest in nature, the environment and social justice, displaying more love and emotions and being more supportive and involved in family life. Nevertheless the people who had experienced an nde during their cardiac arrest continued to be clearly different. In particular, they were less afraid of death and had a stronger belief in an afterlife. We saw in them a greater interest in spirituality and questions about the purpose of life, as well as a greater acceptance of and love for oneself and others. Likewise, they displayed a greater appreciation of ordinary things, whereas their interest in possessions and power had decreased. People without nde showed a marked drop in interest in spirituality and an increase in fear of death (see Table 7.7).
Table 7.7 How the significant differences between people with and without nde changed after two and eight years
| After two years | After two years | After eight years | After eight years | |
| Life-change inventory |
nde n = 23 |
No nde n = 15 |
nde n = 23 |
No nde n = 15 |
| Social attitude | ||||
| 1. Showing one’s feelings | +42 | +16 | +78 | +58 |
| 2. Acceptance of others | +42 | +16 | +78 | +41 |
| 3. More loving and empathetic | +52 | +25 | +68 | +50 |
| 4. Understanding others | +36 | +8 | +73 | +75 |
| 5. Involvement in family | +47 | +33 | +78 | +58 |
| Religious attitude | ||||
| 6. Understanding the purpose of life | +52 | +33 | +57 | +66 |
| 7. Sense of inner meaning of life | +52 | +25 | +57 | +25 |
| 8. Interest in spirituality | +15 | -8 | +42 | -41 |
| Attitude to death | ||||
| 9. Fear of death | -47 | -16 | -63 | -41 |
| 10. Belief in life after death | +36 | +16 | +42 | +16 |
| Other | ||||
| 11. Interest in meaning of life | +52 | +33 | +89 | +66 |
| 12. Understanding oneself | +58 | +8 | +63 | +58 |
| 13. Appreciation of ordinary things | +78 | +41 | +84 | +50 |
The table contains the percentages of all positive [(+1) and (+2)] and
negative changes [(-1) and (-2)] after two and eight years for the same
patients with and without nde. For example: the possible answers to the question
‘Are you interested in spirituality?’ included: strongly increased (+2), somewhat
increased (+1), no change (0), somewhat decreased (-1) and strongly decreased
(-2). After two years 15 per cent of people with an nde scored +1 or +2;
after eight years this percentage with interest in spirituality had increased
to 42 per cent. Meanwhile 8 per cent of the people without nde scored -1 or -2
after two years; this percentage for interest in spirituality fell further to -41 per cent after eight years.
The later interviews show the nde to be an experience that provides new insight into everything that is important in life: compassion, unconditional love and acceptance of oneself (including acceptance of one’s negative qualities), as well as of others and nature. In most cases, fear of death had disappeared. The conversations also revealed that people had acquired enhanced intuitive feelings after an nde, along with a strong sense of connectedness with others and with nature. Or, as many of them put it, they had acquired ‘paranormal gifts’. The sudden occurrence of this enhanced intuition can be quite problematic, as people suddenly have a very acute sense of others, which can be extremely intimidating, and also experience clairvoyance, prophetic feelings and visions. This intuitive sense can be quite extreme, with people ‘sensing’ feelings and sadness in others, or having the sense of knowing when someone will die – which usually proved to be accurate. People said it felt ‘as if they had become another person, but with the same identity’. As already mentioned in Chapter 4, the integration and acceptance of an nde is a process that may take many years because of its far-reaching impact on people’s pre-nde understanding of life and value system. Finally, it is quite remarkable to see a cardiac arrest lasting just a few minutes give rise to such a lifelong process of transformation.
Comments on the Dutch study into nde
Thanks to The Lancet’s global press release our Dutch prospective study into nde attracted a great deal of attention in December 2001. The study not only made the front pages of all major newspapers in Europe, the US, Canada and Australia, but was also front-page news in countries such as Russia, China, India, Sri Lanka, Japan, Brazil and Argentina. Our group of researchers never anticipated this huge interest. I was forced to reschedule appointments at my out-patient clinic for several days in order to satisfy all the requests for interviews with national and international newspapers, radio and television. We received hundreds of e-mails with positive responses from people who had had an nde and who felt this study gave them support and recognition. We also received feedback from doctors who had experienced an nde themselves and who had never been able to discuss it with colleagues. Dr. Pam Kircher, a GP and practising doctor at a hospice (an institution for terminal care) in the US, published the following comment:
‘Van Lommel’s article in The Lancet is a landmark that should be read by every doctor. It reports on the largest prospective study to ask people about ndes after a cardiac arrest. Equally important, the study followed people for eight years after their nde. I would encourage readers to obtain the complete Lancet article to share with your doctor. You will be doing your family doctor a great favor. I believe that the findings in Van Lommel’s study challenge hospitals to ask people about their ndes after a cardiac arrest.’
Dr. Jeffrey Long, another doctor, wrote:
‘On behalf of all people with an nde I congratulate Van Lommel for his excellent research.’
Feedback from scientific and medical circles, however, was mixed and at my own hospital I received not only many positive reactions but also some more cautious ones, with some colleagues never even mentioning the publication.
Since 2001 the study has not only been repeatedly cited in scientific articles and books and in science programmes on radio and television, other publications also feature frequent references to the Dutch study. Our Dutch study into nde was the reason Professor Janice Holden awarded me the ‘Bruce Greyson Research Award’ on behalf of the IANDS (the International Association of Near-Death Studies) in the US in September 2005. And in September 2006 the President of India, Dr. A.P.J. Abdul Kalam, awarded me the ‘Life Time Achievement Award’ in New Delhi following a lecture I presented on our study at the World Congress on Clinical and Preventive Cardiology 2006.
As far as I am aware no negative comments were published in any scientific journals, with the exception of the mildly critical commentary in The Lancet itself. I did, however, receive some extremely critical comments in the Netherlands from Dr. C. Renckens, gynaecologist and chair of the Dutch Association against Quackery. As well as linking our study into nde with
‘multiple personality disorder, chronic fatigue syndrome, fibromyalgia and “alien abduction syndrome”’
he described me as:
‘a failed prophet with the personality of a pre-morbid quack.’
In Belgium I received some blunt comments from Professor W. Betz, professor of family medicine in Brussels and a member of Skepp (the Belgian study group for the critical evaluation of pseudo-science and the paranormal). Professor W. Betz’s initial response to our study appeared in an article in HP/De Tijd on 29 December 2001:
‘When scientists start spouting nonsense, someone must warn the public.’
According to the magazine, he was
‘livid’, ‘this is just post-modern deception.’
And he labelled the study as
‘pseudo-science’, ‘nonsense’, ‘a veritable cult’, ‘Van Lommel belongs to a sect’ [and associated the study with] ‘astral bodies, the paranormal and graphology’.
He describes nde as ‘a hallucination’ and tries to refute the published out-of-body experience with the account of the dentures by hinting at a lack of integrity on the part of both the nurse who wrote the report and us, the authors of the article. He writes:
‘enthusiastic researchers, absolutely convinced of being in the right, are only too keen to “help” the victim of an nde retrieve his memories.’
He suggests that patients ‘can be talked into an nde’, even years after a cardiac arrest. In an interview in Belgian magazine Humo he describes our study as ‘complete nonsense’, and claims that ‘the publication lacks any kind of cohesion’. Prof. Betz concludes his comments by saying:
‘Imagine there were any truth in Van Lommel’s claims … admit it, wouldn’t that be most peculiar?’
Comparison with prospective studies into nde in the US and the UK
One American[xxxiii] and two British studies[xxxiv] [xxxv] into cardiac arrest patients, featuring the same prospective research design as our Dutch study,[xxxvi] found near-identical percentages of nde after a successful resuscitation. However, none of these four studies, comprising a total of 562 patients, was able to produce a definite scientific explanation for the occurrence of nde (see Table 7.8).
Table 7.8 Four prospective studies into nde in cardiac patients
|
Dutch study (2001): 344 patients 18% nde: 12% nde score of 6 or higher, 6 % score of 1-5 American study (2003): 116 patients 15.5% nde: 9.5% nde score of 6 or higher, 6% score of 1-5 British study 1 (2001): 63 patients 11% nde: 6.3% nde score 6 of higher, 4.8% score of 1-5 British study 2 (2006): 39 patients 23% nde: 18% nde score of 6 or higher, 5% score of 1-5
Conclusions of the four studies into a total of 562 patients: 1. The same percentage of nde is found to occur during cardiac arrest. 2. There is no physiological or psychological explanation for nde. 3. An nde occurs during the cardiac arrest. 4. During a cardiac arrest all brain function ceases.
|
The American study
As part of Bruce Greyson’s prospective study in the US,[xxxvii] a total of 1,595 patients were interviewed at the cardiac ward of a university hospital. It emerged that 5 per cent of these patients had once had an nde. Without a cardiac arrest, however, an nde occurred in only 1 per cent of the heart patients. The comparative study included only 116 cardiac arrest patients, of whom 9.5 per cent reported an nde with a score of 6 or higher, and 6 per cent an nde with a low score. A total of 15.5 per cent of the patients who had survived a cardiac arrest reported an nde according to our more liberal criteria. This study also identified a younger mean age for people with an nde. The medical files were not systematically analysed for physiological, psychological and pharmacological factors. Diagnoses such as ‘clinically dead’, ‘close to death’ or ‘not in immediate danger’ were not based on objective criteria, but were made by the patients themselves. This is why so few people in the study were described as ‘clinically dead’, since it transpired that most patients were unable to recollect their resuscitation. Likewise, the diagnoses ‘unconscious’, ‘reduced consciousness’ and ‘normal consciousness’ were made by the patients themselves. So unfortunately this study recorded predominantly subjective and very few objective medical data. In his conclusion, Greyson writes that “no one physiological or psychological model by itself could explain all the common features of an nde. The paradoxical occurrence of a heightened, lucid awareness and logical thought processes during a period of impaired cerebral perfusion raises particular perplexing questions for our current understanding of consciousness and its relation to brain function. A clear sensorium and complex perceptual processes during a period of apparent clinical death challenge the concept that consciousness is localized exclusively in the brain.”
The British study 1
The British prospective study by Sam Parnia and Peter Fenwick[xxxviii] included 63 patients who, over a period of one year, had survived a cardiac arrest at Southampton hospital. Four patients (6.3 per cent) reported an nde and three patients (4.8 per cent) had an experience with a low score, bringing the total nde according to our more liberal criteria to 11 per cent. The only objective data that were recorded were arterial blood gases (O2 and CO2, see Chapter 6) and medication. The number of patients in this study was too small for statistical analysis. Significantly, hidden signs had been affixed near the ceilings of the patient rooms in the coronary care unit. But unfortunately, just as in our study, none of the patients had an out-of-body experience coupled with perception of one of these signs. According to the authors the report suggests that the nde occurs during the period of unconsciousness. This is a surprising conclusion, in their view, because “when the brain is so dysfunctional that the patient is deeply comatose, those cerebral structures, which underpin subjective experience and memory, must be severely impaired. Complex experiences such as are reported in the nde should not arise or be retained in memory. Such patients would be expected to have no subjective experience, as was the case in the vast majority of patients who survive cardiac arrest, since all centres in the brain that are responsible for generating conscious experiences have stopped functioning as a result of the lack of oxygen.”
Another, frequently cited explanation might be that the observed experiences occur during the early phases of the cessation or during the recovery of consciousness. Parnia and Fenwick, however, claim that the verifiable elements of an out-of-body experience during unconsciousness, such as patients’ reports on their resuscitation, render this extremely unlikely.
The British study 2
Over a period of four years Penny Sartori carried out an even smaller study into nde in the UK.[xxxix] Only 1 per cent of the 243 patients who survived their stay at intensive care reported an nde. Her study, however, focused on 39 cardiac arrest patients, of whom 18 per cent reported an nde and 5 per cent only an out-of-body experience without any of the other nde elements, bringing the total to 23 per cent according to our more liberal nde criteria. Sartori notes that only two patients with a deep nde reported their experience ‘spontaneously’; the other ndes were reported during the purposive interviews. As mentioned earlier, this would seem to be the result of the great reluctance to discuss this extremely profound experience. Her study also included three patients with an nde who died very soon after their cardiac arrest, something we also encountered in our study. This study, too, featured hidden signs that were not seen during an nde. There was, however, a patient with an extremely detailed out-of-body account, of which many aspects proved to be correct upon inquiry.[xl] Sartori asked a control group of people who had been successfully resuscitated but who had not reported an nde to describe their own resuscitation and this resulted in a great many fundamental mistakes. The study by cardiologist Sabom came to a similar conclusion.[xli] In Sartori’s study the medication or arterial blood gases (O2 and CO2), recorded in a number of patients, failed to provide an explanation for whether or not patients experienced an nde. This study was also too small for statistical analysis. Sartori concludes that “according to mainstream science, it is quite impossible to find a scientific explanation for the nde as long as we ‘believe’ that consciousness is only a side effect of a functioning brain.” The fact that people report lucid experiences in their consciousness when brain activity has ceased is, in her view, difficult to reconcile with current medical opinion.
Conclusion
‘Although the content of consciousness depends in large measure on neuronal activity, awareness itself does not …To me, it seems more and more reasonable to suggest that the mind may be a distinct and different essence.’
Wilder Penfield, Neurosurgeon (1891-1976)
Only the large-scale Dutch study allowed for statistical analysis of the factors that may determine whether or not an nde occurs. It thus ruled out the aforementioned possible physiological, psychological and pharmacological explanations for the occurrence of an nde. Our study was also the first to include a longitudinal component with interviews after two and eight years, which allowed us to compare the processes of transformation between people with and without an nde. We identified a distinct pattern of change in people with an nde and revealed that integrating these changes into daily life is a long and arduous process. Cardiac arrest patients without nde also change over time, but these changes are different in many respects.
On the strength of the four prospective studies among cardiac arrest survivors, we reached the inevitable conclusion that they experienced all the aforementioned nde elements during the period of their cardiac arrest, during the total cessation of blood supply to the brain. Nevertheless, the question how this could be possible remains unanswered.
Scientific studies into the phenomenon of nde point up the limitations of our current medical and neurophysiological ideas about the various aspects of human consciousness and the relationship between consciousness and memories on the one hand and the brain on the other. The prevailing paradigm holds that memories and consciousness are produced by large groups of neurons or neural networks. For want of evidence for the aforementioned explanations for the cause and content of an nde the commonly accepted, but never proven concept that consciousness is localised in the brain should be questioned.
After all, how can an extremely lucid consciousness be experienced outside the body at a time when the brain has momentarily stopped functioning during a period of clinical death? What exactly happens when the supply of blood to the brain ceases? And what do we really know about normal brain function? The next chapter will look at these important questions in more detail.
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[xi] Maso, I.
[xii] Maso, I.
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[xv] Kuhn, Th. S.
[xvi] Dennett, D. (1991). Consciousness explained. Little, Brown and Co., Boston, London.
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[xviii] Chalmers, D.J. (2002). Consciousness and its Place in Nature. In: Philosophy of Mind: Classical and Contemporary Readings. Oxford University Press. Also at: http://consc.net/papers/nature.html
[xix] Heisenberg, W. (1958). Physics and Philosophy. Harper and Row, New York.
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[xxi] Greyson, B. (2003). ‘Incidence and correlates of near-death experiences in a cardiac care unit.’ Gen Hosp Psychiatry 25, 269-276.
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[xxiv] Schwaninger, J., Eisenberg, P.R., Schechtman, K.B., & Weiss, A.N. (2002). ‘A prospective analysis of near-death experiences in cardiac arrest patients.’ Journal of Near-Death Studies 20, 215-232.
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[xxvi] Hoffman, R.F. (1995). ‘Disclosure habits after near-death experience: influences, obstacles and listeners selection.’ Journal of Near-Death Studies 14, 29-48.
[xxvii] Ring, K. (1984). Heading Toward Omega: In Search of the Meaning of the Near-Death Experience. New York: Morrow.
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[xxix] Sauve, M.J., Walker, J.A., Massa, S.M., Winkle, R.A., Scheinman, M.M. (1996). ‘Patterns of cognitive recovery in sudden cardiac arrest survivors: The pilot study.’ Heart Lung 25 (3), 172-81.
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[xxxi] Hoffman, R.F.
[xxxii] Ring, K.
[xxxiii] Greyson, B.
[xxxiv] Parnia, et al.
[xxxv] Sartori, P. (2006). ‘The Incidence and Phenomenology of Near-Death Experiences.’ Network Review (Scientific and Medical Network) 90, 23-25.
[xxxvi] Lommel, P. van.
[xxxvii] Greyson, B.
[xxxviii] Parnia, et al.
[xxxix] Sartori, P. (2006). Network Review.
[xl] Sartori, P., Badham, P., Fenwick, P. (2006). ‘A Prospectively Studied Near-Death Experience with Corroborated Out-of-Body Perception and Unexplained Healing.’ Journal of Near-Death Studies 25 (2), 69-84.
[xli] Sabom, M.B. (1982). Recollections of Death: A Medical Investigation. New York: Harper & Row.