May 2006 Article of the Month
This month's article selection is by Chaplain John Ehman,
University of Pennsylvania Medical Center-Penn Presbyterian, Philadelphia PA.
Athappilly, G. K., Greyson, B. and Stevenson, I. [Department of Psychiatry, University of Illinois-Chicago]. "Do prevailing societal models influence reports of near-death experiences? A comparison of accounts reported before and after 1975." Journal of Nervous and Mental Disease 194, no. 3 (March 2006): 218-222.
SUMMARY: This study sought to assess whether accounts of near-death experiences (NDEs) have been influenced by the "prevailing societal model" [p. 219] of those experiences that was set out in 1975 by Raymond A. Moody, Jr., MD, PhD, in his book, Life After Life--The Investigation of a Phenomenon: Survival of Bodily Death and, in the process, to test a "plausible expectancy hypothesis...that these transcendental experiences are shaped by the dying individual's cultural and personal constructs" [p. 218]. The authors note at the outset recent research suggesting that 12%-18% of cardiac arrest survivors report "transcendental experiences in near-death settings" [p. 218] and that the current Diagnostic Statistical Manual-IV code for "Religious or Spiritual Problem" was developed in part to address these kinds of experiences. However, the question is how much Moody's popular model may have come to shape accounts.
Moody coined the term near-death experience and identified fifteen common characteristics in reports from over a hundred Americans who had "experienced 'clinical death' and were subsequently revived" [quote taken from Life After Life (2001), as cited on Moody's web site, www.lifeafterlife.com]. The authors summarize:
These 15 features, which have come to define near-death experiences both among the academic community and in the popular imagination, were (1) ineffability, difficulty describing the experience linguistically; (2) hearing the news of their death from medical personnel, family, or others; (3) overwhelming feelings of peace; (4) noise, variously described as beautiful music or as unpleasant buzzing or ringing; (5) a tunnel or dark enclosed space; (6) a sensation of being out of the body, sometimes accompanied by apparent perception of the physical body from an external location, and sometimes accompanied by a sense of a distinct, nonphysical body with different properties and senses; (7) meeting nonphysical beings, sometimes unidentified but sometimes identified as deceased acquaintances or religious figures; (8) a "Being of Light," often described as a loving entity manifesting as a supernaturally brilliant light; (9) a life review, sometimes under the guidance of the "Being of Light" and sometimes accompanied by a sense of judgment; (10) a border or limit demarcating the boundary between terrestrial and postmortem life; (11) coming back, variously described as making a decision to return to life or as being sent back involuntarily; (12) telling others, and often receiving negative responses to recounting their experience; (13) effects on lives, often described as renewed focus on spirituality, increased appreciation for life, and love for others; (14) new views of death, specifically decreased fear of death and belief in postmortem survival; and (15) corroboration, in which family and/or medical personnel verify the experiencer's knowledge of events that was unlikely to have been acquired through normal perception. [pp. 218-219].
Since this model has come to define near-death experiences (at least in American/Western culture) since 1975, Athappilly and her colleagues compared 24 accounts collected between 1961 and 1974 to 24 accounts collected between 1984 and 2002. The demographic matching was quite close.
The pre-1975 and post-1975 groups were matched identically on gender, race, cultural background, and condition leading to the near-death event. They did not differ significantly on age at the time of the experience, closeness to death as reported by the participant, religion at the time of the experience, religious tradition of the participant's family of origin, or on marital status, education, or employment at the time of the experience. Both groups were predominantly female, and overwhelmingly Caucasian, of European background, and Christian. [p. 220]
If accounts of near-death experiences are shaped by cultural and psychosocial factors, then one would expect a greater frequency of Moody's characteristic features in the later group, but that was not the case. Only one of the fifteen features, that of a tunnel experience, occurred more often in the second group. Results are summarized well in a table on p. 221.
The authors qualify the finding of more tunnel descriptions in the post-1975 by pointing to research that suggests that this feature may not be central to near-death experiences, after all [--see p. 221]. They conclude generally that their findings "suggest that the prevailing societal conception of NDEs does not significantly influence the phenomenology of these experiences, and by implication cast doubt on the expectancy hypothesis that the content of NDEs is shaped largely by cultural and psychosocial constructs" [pp. 221-222]. They address appropriately, in closing, limits of the study.
COMMENT: Chaplains often hear patients' accounts of near-death experiences, sometimes prefaced by comments like, "I've never told this to anyone before," or "Maybe you'll think I'm crazy, but once...." Caution and apprehension, as well as a sense of great personal significance, seem to surround these testimonies. For my own part, I cannot remember a single instance when a report of a near-death experience was said by a patient to be widely known by family or friends. I usually feel as though I'm being entrusted with a precious and powerful secret. I have also wondered whether a chaplain's access to this kind of information might permit research in the area. More than 20 years ago, a survey of clergy regarding NDEs was published in The Journal of Pastoral Care, "to stimulate further research and discussion on [this] topic of interest to pastoral counselors" [--see Royce, p. 42, cited under Related Items of Interest, §III, below], but it is nevertheless a topic seldom discussed, much less researched, by chaplains. The task of bringing such important reports of experience to light need not be confused with some agenda to assess their accuracy or determine the "reality" of what they describe. Chaplains may be in an especially good position to invite people to share such experiences, to think about how those experiences may be offered safely for patients, and to understand how to respond when those offerings call further for pastoral care.
Suggestions for the Use of the Article for Discussion in CPE:
This month's article easily raises for CPE students the potent question of the basis of near-death experiences. It may be interesting to note differences between the positions of those students who have heard of NDEs first-hand from patients (or perhaps experienced NDEs themselves) and those who consider the topic more abstractly. Because the piece is brief, it could be paired with a second article to steer discussion in particular ways--see the various Related Items of Interest, below. For a discussion of the potential mystical insight of NDEs into an afterlife, a complementary article could be Kelly, Greyson and Stevenson's "Can experiences near death furnish evidence of life after death?" For a broader overview of NDEs and theories about them, including spiritual perspectives, choose French's "Near-death experiences in cardiac arrest survivors." And, for a discussion particularly of pastoral issues, use one of the two articles noted below from the Journal of Pastoral Care. Students may be well served by a discussion of appropriate pastoral responses to patients' sharing about NDEs. Finally, the article could lead into a book discussion of Moody's Life After Life.
Related Items of Interest:
I. Recent studies, cases, and reviews from the health care literature:
Brayne, S., Farnham, C. and Fenwick, P. "Deathbed phenomena and their effect on a palliative care team: a pilot study." American Journal of Hospice and Palliative Care 23, no. 1 (January-February 2006): 17-24. [This small pilot study analyzed interviews with "five nurses, three doctors, and one support worker" (p. 18) who had much experience with patients in the hours before death and at the time of death. Among the findings, deathbed experiences--such as visions comforting to the dying--seem to be quite varied, they occur relatively frequently and are probably underreported, patients and relatives may share these experiences more with nurses than with doctors, and the question of whether these experiences are hallucinations is a salient concern. Participants appeared to view these phenomena as clinically significant, such as "a prognostic indicator for nearing death" (p. 20), and to be instrumental events in patients' processes of reconciliation. The interviewees also indicated that their exposure to deathbed phenomena was personally affecting to them as health care providers. Recommendations include issues of pastoral care, caregiver support, and supervision.]
Ethier, A. M. "Death-related sensory experiences." Journal of Pediatric Oncology 22, no. 2 (March-April 2005): 104-111. [This is a review not of near-death experiences but rather of a potentially related phenomenon of death-related sensory experiences (DRSEs): "a spiritually transforming experience occurring with the appearance of a messenger beyond the visible observable universe to guide a dying person through the dying process" (--from the abstract) The article pays special attention to the pediatric context.]
[ADDED 1/22/11]: Fenwick, P. and Brayne, S. "End-of-life experiences: reaching out for compassion, communication, and connection-meaning of deathbed visions and coincidences." American Journal of Hospice and Palliative Medicine 28, no. 1 (February 2011): 7-15. [(Abstract:) A recent study shows that the greatest fear for many Britons is to die alone. More than half the complaints received by the UK National Health Service (NHS) concern end-of-life care, with an emphasis on spiritual matters. Much has been written on the spiritual needs of the dying, but many doctors and nurses still find this a difficult area to approach. They lack the confidence and/or training to recognize or discuss spiritual aspects of death and dying or to affirm the spiritual needs of the dying person. Our end-of-life experience (ELE) research suggests that deathbed visions (DVs) and deathbed coincidences (DCs) are not uncommon, and that the dying process appears to involve an instinctive need for spiritual connection and meaning, requiring compassionate understanding and respect from those who provide end-of-life care]
French, C. C. "Near-death experiences in cardiac arrest survivors." Progress in Brain Research 150 (2005): 351-367. [This is a broad review of near-death experiences and the spiritual, psychological and organic theories about them, with an overview of research related to cardiac arrest survivors.]
Greyson B. "Incidence and correlates of near-death experiences in a cardiac care unit." General Hospital Psychiatry 25, no. 4 (July-August 2003): 269-276. [This is a good and recent introduction to the subject by a premier researcher of near-death experiences. The study here indicated that 10% of patients with cardiac arrest and another 1% of other cardiac patients. Spiritual interpretation of NDEs is noted on p. 274.]
[ADDED 10/3/07]: Greyson, B. "Near death experience: clinical implications." Revista de Psiquiatria Clinica 34, suppl. 1 (2007): 49-57. [Available online from the journal via www.scielo.br/scielo.php?script=sci_issuetoc&pid=0101-608320070007&lng=en&nrm=iso.]
[(Abstract:) Background: When some people come close to death, they report a profound experience of transcending the physical world that often leads to spiritual transformation. These “near-death experiences” (NDEs) are relevant to clinicians because they lead to changes in beliefs, attitudes, and values; they may be mistaken for psychopathological states, although producing different sequelae requiring different therapeutic approaches; and because they may enhance our understanding of consciousness. Objectives: This literature review examined the evidences regarding explanations proposed to explain NDEs, including expectation, birth memories, altered blood gases, toxic or metabolic hallucinations, and neurochemical and neuroanatomical models. Methods: The literature on NDEs of the past 30 years was examined comprehensively, including medical, nursing, psychological, and sociological databases. Results: NDEs typically produce positive changes in attitudes, beliefs, and values, but may also lead to interpersonal and intrapsychic problems. These problems have been compared to various mental disorders, but are distinguishable from them. Various therapeutic strategies have been proposed to help experiencers with problematic aftereffects, but have not been tested yet. Conclusions: The mystical consciousness and higher mental activity during NDEs, when the brain is severely impaired, challenge current models of brain/mind interaction and may occasionally lead to more complete models for the understanding of consciousness.]
[ADDED 8/10/06]: Greyson, B. "Near-death experiences and spirituality." Zygon 41, no. 2 (June 2006): 393-414. [This is a good overview of the phenomenon of Near Death Experiences, with an extensive bibliography.]
Greyson, B. "Posttraumatic stress symptoms following near-death experiences." American Journal of Orthopsychiatry 71, no. 3 (July 2001): 368-373. [In this study of 194 people who claimed to have come close to death (148 who claimed near-death experiences and 48 who did not have such experiences), the NDE group indicated significantly greater Post-Traumatic Stress than the non-NDE group, but with a distinctive pattern: "although [NDE] experiencers do report more intrusive thoughts and memories of their close brush with death than comparison-group participants, they do not report greater efforts to avoid thoughts or reminders of that event" (p. 371).]
Kelly, E. W., Greyson, B. and Stevenson, I "Can experiences near death furnish evidence of life after death?" Omega: The Journal of Death and Dying 40, no. 4 (1999–2000): pp. 513–519. [The authors consider cases of near-death experiences that, taken together and in terms of key features, may "provide convergent evidence that warrant our taking seriously the idea that consciousness may survive death" (p. 518).]
[ADDED 7/6/07]: Lai, C. F., Kao, T. W., Wu, M. S., Chiang, S. S., Chang, C. H., Lu, C. S., Yang, C. S., Yang, C. C., Chang, H. W., Lin, S. L., Chang, C. J., Chen, P. Y., Wu, K. D., Tsai, T. J. and Chen, W. Y. [Division of Nephrology, Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan]. "Impact of near-death experiences on dialysis patients: a multicenter collaborative study." American Journal of Kidney Diseases 50, no. 1 (July 2007): 124-132, +132.e1-2 (supplementary data). [This is a cross-sectional study of 710 dialysis patients at 7 centers in Taiwan. (From the abstract:) MEASUREMENTS: Greyson's NDE scale, Royal Free Questionnaire, 10-Question Survey, Ring's Weighted Core Experience Index, and Beck Depression Inventory. RESULTS: 45 patients had 51 NDEs. Mean NDE score was 11.9 (95% confidence interval, 11.0 to 12.9). Out-of-body experience was found in 51.0% of NDEs. Purported precognitive visions, awareness of being dead, and "tunnel experience" were uncommon (<10%). Compared with the no-NDE group, subjects in the NDE group were more likely to be women and younger at life-threatening events. Both frequency of participation in religious ceremonies and pious religious activity correlated significantly with NDE score in patients with NDEs (P < 0.01 and P = 0.01, respectively). The NDE group reported being kinder to others (P = 0.04) and more motivated (P = 0.02) after their life-threatening events than the no-NDE group. …CONCLUSIONS: NDE is not uncommon in the dialysis population and is associated with positive aftereffects. Nephrology care providers should be aware of the occurrence and aftereffects of NDEs. The high occurrence of life-threatening events, availability of medical records, and accessibility and cooperativeness of patients make the dialysis population very suitable for NDE research.]
Lange, R., Greyson, B. and Houran, J. "A Rasch scaling validation of a 'core' near-death experience." British Journal of Psychology 95, pt. 2 (May 2004): 161-177. [The authors test the concept of a "core near-death experience," working from Bruce Greyson's 1983 Near-Death Experience Scale (given in an appendix, on pp. 176-177). The analysis supports the use of Greyson's scale. The authors clearly presuppose that readers have advanced knowledge of statistics, but for serious researchers in this area, the article would be quite valuable.]
For the more on the Near-Death Experience Scale, see: Greyson B. "The Near-Death Experience Scale: construction, reliability, and validity." Journal of Nervous & Mental Disease 171, no. 6 (June 1983): 369-375. [This is the original presentation of Greyson's 16-item scale that has been used clinically to differentiate between near-death experiences and organic brain syndromes and non-specific stress responses. The scale is intended to be useful also in distinguishing unequivocal claims about NDEs from qualified or questionable claims.]
Lopez, U., Forster, A., Annoni, J.-M., Habre, W., and Iselin-Chaves, I. A. "Near-death experience in a boy undergoing uneventful elective surgery under general anesthesia." Pediatric Anesthesia 16, no. 1 (January 2006): 85-88. [This is a brief case report, illustrated with quotes from the patient. Analysis of the event is made solely in physiological terms. The significance of the case is that it raises the question of how frequently NDEs may occur under general anesthesia for common surgeries.]
Parnia, S., Waller, D. G., Yeates, R. and Fenwick, P. "A qualitative and quantitative study of the incidence, features and aetiology of near death experiences in cardiac arrest survivors." Resuscitation 48, no. 2 (February 2001): 149-156. [From the text, p. 154: "The data suggests that in this cardiac arrest model, the NDE arises during unconsciousness. This is a surprising conclusion, because when the brain is so dysfunctional that the patient is deeply comatose, the 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 88.8% of patients in this study) or at best a confusional state if some brain function is retained. Even if the unconscious brain is flooded by neurotransmitters,...this should not produce clear, lucid remembered experiences, as those cerebral modules which generate conscious experience and underpin memory are impaired by cerebral anoxia."]
Simpson, S. M. "Near death experience: a concept analysis as applied to nursing." Journal of Advanced Nursing 36, no. 4 (November 2001): 520-526. [This is a general and practical article, introducing nurses to the concept of near-death experiences and outlining clinical implications. The authors cite studies that suggest a quite high incidence of NDEs and emphasize how the phenomenon may be underreported due to patients' hesitancy to talk about it. Case examples are presented.]
[ADDED 8/23/07]: van Lommel, P., van Wees, R., Meyers, V. and Elfferich, I. "Near-death experience in survivors of cardiac arrest: a prospective study in the Netherlands." Lancet 358, no. 9298 (December 15, 2001): 2039-2045. [(Abstract:) BACKGROUND: Some people report a near-death experience (NDE) after a life-threatening crisis. We aimed to establish the cause of this experience and assess factors that affected its frequency, depth, and content. METHODS: In a prospective study, we included 344 consecutive cardiac patients who were successfully resuscitated after cardiac arrest in ten Dutch hospitals. We compared demographic, medical, pharmacological, and psychological data between patients who reported NDE and patients who did not (controls) after resuscitation. In a longitudinal study of life changes after NDE, we compared the groups 2 and 8 years later. FINDINGS: 62 patients (18%) reported NDE, of whom 41 (12%) described a core experience. Occurrence of the experience was not associated with duration of cardiac arrest or unconsciousness, medication, or fear of death before cardiac arrest. Frequency of NDE was affected by how we defined NDE, the prospective nature of the research in older cardiac patients, age, surviving cardiac arrest in first myocardial infarction, more than one cardiopulmonary resuscitation (CPR) during stay in hospital, previous NDE, and memory problems after prolonged CPR. Depth of the experience was affected by sex, surviving CPR outside hospital, and fear before cardiac arrest. Significantly more patients who had an NDE, especially a deep experience, died within 30 days of CPR (p<0.0001). The process of transformation after NDE took several years, and differed from those of patients who survived cardiac arrest without NDE. INTERPRETATION: We do not know why so few cardiac patients report NDE after CPR, although age plays a part. With a purely physiological explanation such as cerebral anoxia for the experience, most patients who have been clinically dead should report one.]
II. Articles from the Journal of Near-Death Studies, published by the International Association for Near-Death Studies (www.iands.org):
Morris, L. L. and Knafl, K. "The nature and meaning of the near-death experience for patients and critical care nurses." Journal of Near-Death Studies 21, no. 3 (February 2003): 139-167. ["The sample included 12 patients who experienced an NDE and 19 nurses who cared for patients who experienced NDEs. This study highlighted the emotional aspects of the NDE. Patients described how the NDE transformed their lives and nurses reported how their experiences with patients changed them personally and professionally." (--from the abstract)]
Schwaninger, J., Eisenberg, P. R., Schechtman, K. B. and Weiss, A. N. "A prospective analysis of near-death experiences in cardiac arrest patients." Journal of Near-Death Studies 20, no. 4 (2002): 215-232. [Thirty patients who had survived cardiac arrest at Barnes Jewish Hospital were interviewed, and 23% reported NDEs during their recent hospitalization and 13% more reported NDEs during an earlier life-threatening event. "The experiences were most frequently characterized by ineffability, peacefulness, painlessness, lack of fear, detachment from the body, and no sense of time or space. Significant differences were noted in the follow-up psychosocial assessment between patients who experienced an NDE and those who did not with regard to personal understanding of life and self, attitudes toward others, and changes in social customs and religious/spiritual beliefs. Of importance, patients reported it was beneficial to receive psychosocial support before hospital discharge after having an NDE. The results suggest that NDEs are fairly common in cardiac arrest survivors. The experiences consisted of a number of core characteristics and changed psychological, social, and spiritual awareness over both the short and long term." (--from the abstract)]
III. Two articles from the Journal of Pastoral Care:
Nelson, H. R "The near death experience: observations and reflections from a retired chaplain." Journal of Pastoral Care 54 no 2 (Summer 2000): 159-166. [The author reflects on two decades of interest in near-death experiences, in light of Moody's model, and offers thoughts on biblical spirituality and pastoral practice.]
Royse, D. "The near-death experience: a survey of clergy's attitudes and knowledge." Journal of Pastoral Care 39, no. 1 (March 1985): 31-42. [This is a report on a survey of 174 clergy. Among the findings: 45% of the sample had read Mood's Life After Life, and reports of NDEs to clergy were not rare and were seldom "hellish" in tone, and "near-death experiencers tend to be come more religious and their fear of dying lessened" (--from the abstract). The authors note a variety of responses indicating attitudes of clergy toward NDEs and pastoral counseling around the experiences.]