Near-death studies

Near-death studies is a field of psychology and psychiatry that studies the physiology, phenomenology and after-effects of a near-death experience (NDE).

Near-death experience

The Near-death experience is an experience reported by people who have come close to dying in a medical or non-medical setting. The aspect of trauma, and physical crises, is also recognized as an indicator for the phenomenon.^[1] According to sources ^[2][3] it is estimated that near-death experiences are reported by five percent of the adult American population. According to IANDS,^[4] surveys (conducted in USA, Australia and Germany) suggest that 4 to 15% of the population have had NDEs. Some researchers try to study the postulated role of physiological, psychological and transcendental factors associated with the NDE.^[5] These factors come together to form an overall pattern when numerous NDE reports are considered together. It is this pattern that is one of the main objects of interest for Near-Death studies. Among the general characteristics of an NDE we find: subjective impressions of being outside the physical body; visions of deceased relatives and religious figures; transcendence of ego and spatiotemporal boundaries.^[6] Similar traits have been mentioned by other researchers,^[7][8][9] and are also described in an analysis of 613 near-death experiences, gathered by the Near Death Research Foundation.^[10] NDE researchers have also found that the NDE may not be a uniquely western experience. The core experience seems to be similar across cultures, but the details of the experience (figures, beings, scenery), and the interpretation of the experience, varies between cultures.^[7]

NDE-Scale

According to the The NDE-scale ^[11][12] a near-death-experience includes a few, or several, of the following 16 elements:

Table 1: Elements in Greyson's NDE-scale

Elements
1. Time speeds up or slows down.
2. Thought-processes speed up.
3. A return of scenes from the past.
4. A sudden insight, or understanding.
5. A feeling of peace or pleasantness.
6. A feeling of happiness, or joy.
7. A sense of harmony or unity with the universe.
8. Confrontation with a brilliant light.
9. The senses feel more vivid.
10. An awareness of things going on elsewhere, as if by extrasensory perception (ESP).
11. Experiencing scenes from the future.
12. A feeling of being separated from the body.
13. Experiencing a different, unearthly world.
14. Encountering a mystical being or presence, or hearing an unidentifiable voice.
15. Seeing deceased or religious spirits.
16. Coming to a border, or point of no return.

IANDS - Summary of characteristics

Two summaries of characteristics presented by IANDS ^[4][13] confirm many of the same features, but also introduce features not mentioned by Greyson. ^{Note a}

Table 2: IANDS - Summary of characteristics in NDE

Characteristics
1. A sense of peace and well-being.
2. A sense of oneness and interconnectedness.
3. A perception of one’s body from an outside (and usually above) position (Out-of-body Experience).
4. A sense of movement through darkness or a tunnel (A tunnel experience).
5. A movement toward and/or sudden immersion in a powerful light, or an experience of darkness.
6. A feeling of unconditional love, or other intense emotions.
7. Heightened perceptions.
8. A life review.
9. An immersion in a spiritual realm, or world of landscapes.
10. An encounter with spiritual beings, and/or a reunion with deceased loved ones.
11. Knowledge about one’s life and the nature of the universe.
12. A sense of having knowledge of the future.
13. Approaching a border of no return.
14. A decision by oneself or others to return to one’s body.

After-effects

The experience may also involve after-effects. Many of the after-effects are associated with changes in personality and outlook on life, and considered to be beneficial.^{[3][6] [14][15]} Possible after-effects are: enhanced purpose in life, appreciation of life, confidence, self-esteem, reduced fear of death,^[6] greater spiritualism, and greater ecological sensitivity ^[7]

Kenneth Ring has identified a consistent set of value and belief changes associated with people who have had a Near-death experience.^[7] The effects include: greater appreciation of life, higher self-esteem, greater compassion for others, a heightened sense of purpose and self-understanding, desire to learn, elevated spirituality, greater ecological sensitivity and planetary concern, and a feeling of being more intuitive (sometimes psychic). Changes may also include: increased physical sensitivity; diminished tolerance to light, alcohol, and drugs; a feeling that the brain has been "altered" to encompass more; and a feeling that one is now using the "whole brain" rather than just a small part.

However, not all after-effects are beneficial. The literature describes circumstances where changes in attitudes and behavior can lead to psychosocial and psychospiritual problems. ^{Note b [6][16][17]} Often the problems have to do with the adjustment to ordinary life in the wake of the NDE. Another category, so-called distressing, or unpleasant, near-death experiences, has been investigated by Greyson and Bush.^[18]

Explanatory models – A few broad categories

Explanatory models for the phenomenology of the NDE can, according to sources,^[2][19][20] be divided into a few broad categories: psychological, physiological, and transcendental. Psychological theories have suggested that the NDE can be a consequence of mental and emotional reactions to the perceived threat of dying.^[19] These theories also suggest that the NDE might be a product of the imagination or a product of long-buried birth memories; a result of depersonalization or feelings of unreality; or a consequence of different personality features, such as proneness to fantasy ^[2][10]

Physiological theories tend to focus on somatic and biological explanations for the NDE, including neurochemical and neuroanatomical explanations. Among the variables considered are: endorphin levels; serotonin levels; endogenous ketamine-like neurotransmitters; oxygen starvation; altered arterial blood gases with hypoxia; rapid eye-movement (REM) sleep; temporal lobe dysfunction or seizures; compression of the optic nerve by lack of oxygen; and random activation of the dying brain's memory circuits.^{[2][7][10][19][20]} Findings from the field of neurology suggest that “some people have a pattern of brain functioning that allows them to experience NDEs”.^[7] Other findings suggest that NDE's might be a result of sleep and rapid eye movement (REM) processes, or phenomena generated on the border between sleep and wakefullness ^[21]

A third model, sometimes called the transcendental explanation,^[2][7][19] implies that the NDE is a profound event that can not be explained only by using psychological or physiological theories. This model challenges the traditional understanding of the mind-brain relationship by suggesting that it might be possible for consciousness to exist independently of the brain.^[20]

Research in the field of Near-death Studies includes perspectives from all of these three models.^[19] However, differing philosophical and ontological viewpoints exist, and are reflected in the academic debate. Both IANDS, and researchers within the field, have expressed reservations towards explanations that are purely psychological or physiological. Instead they are arguing in favor of explanations that also include transcendental elements.^{[2][4][20][22]} Several NDE-researchers, including Greyson ^[2][12] and Van Lommel,^[20][23] have argued in favor of a re-examination of the current mind-brain model in order to explain many of the features reported by near-death experiencers. Sam Parnia, although an agnostic about the source of subjective NDE-memories, reasons along similar lines. He has expressed the idea that science should be willing to explore whether the brain acts as an intermediary for the mind, and whether the mind has a level of independent functioning beyond the borders of physiology.^[24][25] There are also elements in the transcendental model that reflects a more spiritual view of the NDE. Kenneth Ring has expressed the view that NDE's are a catalyst for spiritual development, and has also described a number of spiritual after-effects related to the NDE.^[7][22] A few researchers, such as Jeffrey Long, have suggested that the NDE might be an opening to after-life dimensions.^[10]

Research - History and background

Individual cases of NDEs in literature have been identified into ancient times.^[26] In the 19th century a few efforts moved beyond studying individual cases - one privately done by Mormons and one in Switzerland. Up to 2005, 95% of world cultures have been documented making some mention of NDEs.^[26] From 1975 to 2005, some 2500 self reported individuals in the US had been reviewed in retrospective studies of the phenomena^[26] with an additional 600 outside the US in the West,^[26] and 70 in Asia.^[26] Prospective studies, reviewing groups of individuals and then finding who had an NDE after some time and costing more to do, had identified 270 individuals.^[26] In all close to 3500 individual cases between 1975 and 2005 had been reviewed in one or another study. And all these studies were carried out by some 55 researchers or teams of researchers.^[26]

Research on near-death experiences is mainly limited to the disciplines of medicine, psychology and psychiatry. Interest in this field of study was originally spurred by the research of such pioneers as Elisabeth Kübler-Ross (psychiatrist) and Raymond Moody (psychologist and M.D.), but also by autobiographical accounts, such as the books of George Ritchie (psychiatrist).^[2][27][28] Kübler-Ross, who was a researcher in the field of Thanatology and a driving force behind the establishment of the Hospice System in the United States, embarked upon the study of near-death experiences in the later part of her career.^[29] Raymond Moody, on the other hand, got interested in the subject at the start of his career. In the mid-seventies, while doing his medical residency as a psychiatrist at the University of Virginia, he conducted interviews with Near-Death Experiencers. He later published these findings in the book Life After Life (1976).^[30] In the book Moody outlines the different elements of the NDE. Features that were picked up by later researchers. The book brought a lot of attention to the topic of NDEs,^[7][12] but was also met with a fair amount of scepticism from the scientific community.^[31]

The late seventies saw the establishment of the Association for the Scientific Study of Near-Death Phenomena, an initial group of academic researchers, including John Audette, Raymond Moody, Bruce Greyson, Kenneth Ring and Michael Sabom, who laid the foundations for the field of Near-death studies, and carried out some of the first post-Moody NDE research.^[32] The Association was the immediate predecessor of the International Association for Near-death Studies (IANDS), which was founded in 1981 and which established its headquarter at the University of Connecticut, Storrs.^[33] This group of researchers, but especially Ring, was responsible for launching Anabiosis, the first peer-reviewed journal within the field. The journal later became Journal of Near-Death Studies.^[2]

Bruce Greyson (psychiatrist), Kenneth Ring (psychologist), Michael Sabom (cardiologist) and Melvin Morse (pediatrician) introduced the study of Near-Death experiences to the academic setting, but the subject was often met with academic disbelief,^[34] or regarded as taboo.^[7][35] The medical community has been somewhat reluctant to address the phenomenon of NDEs,^[7][12] and grant money for research has been scarce.^[7] Current research has also experienced scepticism from the medical community, but there are also signs of increased awareness.^[36] However, both Ring and Sabom made contributions that were influential for the newly established field. Ring published a book in 1980 called Life at Death: A Scientific Investigation of the Near-Death Experience. This professional text was followed by a more popular text in 1984 by the title Heading Toward Omega: In Search of the Meaning of the Near-Death Experience.^[31] The early work of Michael Sabom was also bringing attention to the topic within the academic community. Besides contributing material to academic journals,^[37] he wrote a book called Recollections of Death (1982) ^[38] which is considered to be an influential publication from the early days of research.^[32]

Early investigations into the topic of near-death experiences were also being conducted at the University of Virginia, where Ian Stevenson founded the Division of Personality Studies in the late sixties. The division went on to produce research on a number of phenomena that were not considered to be mainstream. In addition to near-death experiences this included: reincarnation and past lives, out-of-body experiences, apparitions and after-death communications, and deathbed visions.^[12][39] Stevenson, whose main academic interest was the topic of reincarnation and past lives,^[40] also made contributions to the field of near-death studies.^[41][42] In a 1990-study, co-authored with Owens & Cook, the researchers studied the medical records of 58 people who believed they had been near death. The authors judged 28 candidates to actually have been close to dying, while 30 candidates, who merely thought they were about to die, were judged to not have been in any medical danger. Both groups reported similar experiences, but the first group reported more features of the core NDE-experience than the other group.^[7][19][41]

Another early contribution to the field was the research of British Neuro-psychiatrist Peter Fenwick, who started to collect NDE-stories in the 1980s. In 1987 he presented his findings on a television-program, which resulted in more stories being collected.^[43][44] The responses from Near-death experiencers later served as the basis for a book published in 1997, "The Truth in the light", co-authored with his wife Elizabeth Fenwick.^[45] Co-operating with other researchers, among others Sam Parnia, Fenwick has also published research on the potential relationship between cardiac arrest and Near-death Experiences.^[5][46][47]

As research in the field progressed both Greyson and Ring developed measurement tools that can be used in a clinical setting.^[11][48] Greyson has also addressed different aspects of the NDE, such as the psychodynamics of the experience,^[49] the varieties of NDE,^[3] the typology of NDE's ^[50] and the biology of NDE's.^[51] In addition to this he has brought attention to the near-death experience as a focus of clinical attention,^[17] suggesting that the aftermath of the NDE - in some cases - can lead to psychosocial and psychospiritual problems. Morse and colleagues ^[8][52] have investigated near-death experiences in a pediatric population. They found that children report NDE's that were similar to those described by adults. Morse later published two books, co-authored with Paul Perry, that were aimed at a general audience: Closer to the light: learning from children’s near-death experiences (1990)^[53] and Transformed by the light: the powerful effect of near-death experiences on people’s lives (1992).^[7] Research has also entered into other fields of interest, such as the mental health of military veterans. Goza studied NDE's among combat veterans. She found, among other things, that combat soldiers reported different, and less intense near-death experiences, compared to NDErs in the civilian population.^[54][55]

Pim van Lommel (cardiologist) was one of the first researchers to bring the study of NDE's into the area of Hospital Medicine. In 1988 he launched a prospective study that spanned 10 Dutch hospitals. 344 survivors of cardiac arrest were included in the study.^[20][56] 62 patients (18%) reported NDE. 41 of these patients (12%) described a core experience. The aim of the study was to investigate the cause of the experience, and assess variables connected to frequency, depth, and content.^[9] Another large, 30-month study, conducted at University of Virginia Hospital in 2001, involving 1,595 people, found that 10 percent of cardiac-arrest patients reported near-death experiences.^[35] The implications of cardiac arrest has also been investigated by other researchers. In a study from 2001 Parnia and colleagues found that 11.1% of 63 cardiac-arrest survivors reported memories of their unconscious period. Several of these memories included NDE-features. ^{Note c [5]}

In 2008 the University of Southampton announced the start of a new research-project named The AWARE (AWAreness during REsuscitation) study. The study was to be co-ordinated by the University of Southampton, but included collaboration with 25 medical centres within the UK, mainland Europe and North America. The object of the study was to study the brain, and consciousness, during cardiac arrest, and to test the validity of out of body experiences and reported claims of lucidity (the ability to see and hear) during cardiac arrest.^[35][57][58] The project is still in progress, and release date for the results is still not decided.^[59] Recently, the work of Jeffrey Long has also attracted attention to the topic of NDE's in both the academic, and the popular field.^[10][60][61] In 2010 he released a book, co-authored with Paul Perry, called Evidence of the Afterlife: The Science of Near-Death Experiences. In this book Long presented results from research of more than 1,300 near-death experiences from around the world.^[62][63][64]

Psychometrics – Measuring the NDE

Several psychometric instruments have been adapted to near-death research. Ring developed the Weighted Core Experience Index in order to measure the depth of NDE's,^[11] and this instrument has been used by other researchers for this purpose.^[65] The instrument has also been used to measure the impact of near-death experiences on dialysis patients.^[66] According to some commentators^[2] the index has improved consistency in the field. However, Greyson notes that although the index is a pioneering effort, it is not based on statistical analysis, and has not been tested for internal coherence or reliability.^[11] Ring also developed an instrument called the Life Changes Inventory (LCI) in 1984, in order to quantify value changes following an NDE. The instrument was later revised and standardized, and a new version, the LCI-R, was published in 2004.^[67]

Greyson ^[11] developed The Near-Death Experience Scale. This 16-item Scale was found to have high internal consistency, split-half reliability, and test-retest reliability ^[6][11] and was correlated with Ring's Weighted Core Experience Index. Questions formulated by the scale address such dimensions as: cognition (feelings of accelerated thought, or "life-review"), affect (feelings of peace and joy), paranormal experience (feelings of being outside of the body, or a perception of future events) and transcendence (experience of encountering deceased relatives, or experiencing an unearthly realm). A score of 7 or higher out of a possible 32 was used as the standard criterion for a near-death experience.^[6] The scale is, according to the author,^[6][11] clinically useful in differentiating NDEs from organic brain syndromes and nonspecific stress responses. The NDE-scale was later found to fit the Rasch rating scale model.^[68] The instrument has been used to measure NDE's among cardiac arrest survivors,^[5] coma survivors,^[69] out-of-hospital cardiac arrest patients/survivors,^[70][71][72] substance misusers,^[73] and dialysis patients.^[66]

In the late 1980s Thornburg developed the Near-Death Phenomena Knowledge and Attitudes Questionnaire.^[74] The questionnaire consists of 23 true/false/undecided response items assessing knowledge, 23 Likert scale items assessing general attitudes toward near-death phenomena and 20 Likert scale items assessing attitude toward caring for a client who has had an NDE.^[75] Knowledge and attitude portions of the instrument were tested for internal consistency. Content validity was established by using a panel of experts selected from nursing, sociology, and psychology.^[74] The instrument has been used to measure attitudes toward, and knowledge of, near-death experiences in a college population,^[76] among clergy,^[77] among registered psychologists,^[74] and among hospice nurses.^[75]

Greyson has also used mainstream psychological measurements in his research, for example The Dissociative Experiences Scale;^[78] a measure of dissociative symptoms, and The Threat Index;^[79] a measure of the threat implied by one's personal death.

Research Organizations and Academic locations

The field of near-death studies includes several communities that study the phenomenology of NDE's. The largest of these communities is IANDS, an international organization based in Durham, North-Carolina, that encourages scientific research and education on the physical, psychological, social, and spiritual nature and ramifications of near-death experiences. Among its publications we find the peer-reviewed Journal of Near-Death Studies, and the quarterly newsletter Vital Signs.^[13][80] The organization also maintains an archive of near-death case histories for research and study.^[81]

Another research-organization, the Louisiana-based Near Death Experience Research Foundation, was established by radiation oncologist Jeffrey Long in 1998.^[10][60][82] The foundation maintains a web-site, also launched in 1998, and a database of more than 1.600 cases, which is currently the worlds largest collection of Near-death reports. The reports come directly from sources all across the world.^[60][62]

A few academic locations have been associated with the activities of the field of Near-death Studies. Among these we find the University of Connecticut (US),^[22] Southampton University (UK),^[57] University Of North Texas (US) ^[54] and the Division of Perceptual Studies at the University of Virginia (US).^[12]

Conferences

IANDS holds conferences, at regular intervals, on the topic of Near-Death Experiences. The first meeting was a medical seminar at Yale University, New Haven (CT) in 1982. This was followed by the first clinical conference in Pembroke Pines (FL), and the first research conference in Farmington (CT) in 1984. Since then conferences have been held in major U.S. cities, almost annually.^[83] Many of the conferences have addressed a specific topic, defined in advance of the meeting. In 2004 participants gathered in Evanston (IL) under the headline: "Creativity from the light".^[27] A few of the conferences have been arranged at academic locations. In 2001 researchers and participants gathered at Seattle Pacific University. ^[84] In 2006 the University of Texas MD Anderson Cancer Center became the first medical institution to host the annual IANDS conference. ^[85]

The first International Medical Conference on Near-Death Experiences was held in 2006.^[20] Approximately 1.500 delegates, including people who claim to have had NDEs, were attending the one-day conference in Martigues, France. Among the researchers attending the conference were anaesthetist and intensive care doctor Jean-Jacques Charbonnier, and pioneering researcher Raymond Moody.^[86]

Important publicatons

IANDS publishes the quarterly Journal of Near-Death Studies, the only scholarly journal in the field. The Journal is cross-disciplinary, is committed to an unbiased exploration of the NDE and related phenomena, and welcomes different theoretical perspectives and interpretations that are based on scientific criteria, such as empirical observation and research.^[87] IANDS also publishes Vital Signs, a quarterly newsletter that is made available to its members and that includes commentary, news and articles of general interest.

One of the first introductions to the field of Near-death studies was the publication of a general reader: The Near-Death Experience: Problems, Prospects, Perspectives. The book was published in 1984 and was an early overview of the field.^[88] In 2009 Praeger Publishers published the The handbook of near-death experiences: thirty years of investigation, a comprehensive critical review of the research carried out within the field of Near-death Studies.^[26][89] 2011 marked the publication of Making Sense of Near-death Experiences: A Handbook for Clinicians. ^[90] The book is a multi-author text which describes how the NDE can be handled in psychiatric and clinical practice.^[91]

Criticism and Sceptical views

Skepticism towards the findings of Near-death Studies, and the validity of the near-death experience as a subject for scientific study, has been widespread. Both scientists and medical professionals have, in general, tended to be skeptical.^{[7][24][36][92]} Skeptics have remarked that it is difficult to verify many of the anecdotal reports that is being used as background material in order to outline the features of the NDE.^[7][10] Acceptance of NDE's as a legitimate topic for scientific study has improved, but the process has been slow.^[12][36]

Internet Infidels paper editor, and commentator, Keith Augustine has criticized near-death research for oversimplifying the role of culture in afterlife beliefs. He has also exposed weaknesses in methodology, paucity of data, and gaps in arguments. Instead of a transcendental model of NDE's, which he does not find plausible, he suggests that NDE's are products of individuals' minds rather than windows into a transcendental reality.^[93][94] His criticism has been answered by Greyson^[94] who suggests that the materialist model favored by Augustine is supported by even fewer data than the "mind-brain separation model" favored by many researchers within the field of Near-death studies.

But criticism of the field has also come from commentators within its own ranks. In an open letter to the NDE-community Ring has pointed to the "issue of possible religious bias in Near-death studies". According to Ring the field of Near-death studies, as well as the larger NDE-movement, has attracted a variety of religious and spiritual affiliations, from a number of traditions, which makes ideological claims on behalf of NDE-research. In his view this has compromised the integrity of research and discussion.^[32]

The findings of NDE-research has been contested by several writers in the fields of Psychology and Neuroscience. Neuroscientist Susan Blackmore ^[10] has contested the findings of NDE-research, and has instead argued in favour of a neurological explanation. Psychologist Christoper French has also expressed sceptical views, implying that the NDE "could just be the brain trying to make sense of what is a very unusual event".^[24] Other researchers have also stated that there is nothing paranormal about near-death experiences, with the suggestion that their cause have a neurophysiological or psychological basis.^[95]

See also

• IANDS
• Near-death experience
• Transpersonal psychology
• Parapsychology
• Bruce Greyson
• Pam Reynolds' NDE

Notes

a.^ Elements not mentioned by the NDE-scale or by IANDS, but mentioned in other summaries (Mauro, 1992; van Lommel et.al, 2001: Table 2) include: "An awareness (or sense) of being dead" and "observation of colours".

b.^ The diagnostic label of "Religious or spiritual problem" is included in DSM-IV under the category of "Other conditions that may be a focus of clinical attention". See American Psychiatric Association (1994) "Diagnostic and Statistical Manual of Mental Disorders", fourth edition. Washington, D.C.: American Psychiatric Association (Code V62.89, Religious or Spiritual Problem).

c.^ Reported memories were assessed by the Greyson NDE Scale.

References

External links

• The International Association for Near-Death Studies, Inc.
• University of Virginia Health System - Division of Perceptual Studies
• Links to 290 online NDE Scientific Papers

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