Abstract
In Dutch prospective studies on near-death experiences (NDE) in survivors of cardiac arrest, 18% of the 344 included patients reported such an experience of enhanced consciousness during the period of unconsciousness, during clinical death, during a transient functional loss of the cortex and the brainstem. An NDE seems to be an authentic experience which cannot be simply reduced to oxygen deficiency, imagination, fear of death, hallucination, psychosis, or the use of drugs, and people appear to be permanently changed by an NDE during a cardiac arrest of only several minutes duration.
Introduction
A near-death experience (NDE) can be defined as the reported memory of a range of impressions during a special state of consciousness, including a number of unique elements such as an out-of-body experience, pleasant feelings, seeing a tunnel, a light, deceased relatives or a life review, and a conscious return into the body. Many circumstances are described during which NDEs are reported such as cardiac arrest (clinical death), shock after loss of blood (childbirth), coma caused by traumatic brain injury or stroke, near-drowning (children) or asphyxia; also in serious diseases not immediately life-threatening, during isolation, depression or meditation, or without any obvious reason. Similar experiences to near-death ones can occur during the terminal phase of illness and are called “deathbed visions” or “end-of-life experiences.”
So-called “fear-death” experiences are mainly reported after situations in which death seemed unavoidable like serious traffic or mountaineering accidents and “shared-death” experiences are reported by bystanders at the moment of death of a close relative. The NDE is usually transformational, causing enhanced intuitive sensitivity, profound changes of life-insight and the loss of fear of death. The content of an NDE and the effects on patients seem similar worldwide, across all cultures and all times. However, the subjective nature and absence of a frame of reference for this ineffable experience lead to individual, cultural, and religious factors determining the vocabulary used to describe and interpret this experience.1 Near-death experiences occur with increasing frequency because of improved survival rates resulting from modern techniques of resuscitation and from new therapies for patients with cerebral trauma. According to a recent random poll in the U.S. and in Germany, about four percent of the total population in the western world have experienced an NDE. 2,3 Thus, about nine million people in the U.S., about two million people in the United Kingdom and about 20 million people in Europe should have had this extraordinary conscious experience. A NDE seems to be a relatively regularly occurring, and, to many physicians, an inexplicable phenomenon and hence an often ignored result of survival in a critical medical situation. After all, according to current medical knowledge it is impossible to experience consciousness during cardiac arrest or deep coma.
Until quite recently there was no prospective and scientifically designed study to explain the cause and content of an NDE, all studies had been retrospective and very selective with respect to patients. Based on these incomplete retrospective studies, some believed the experience could be caused by physiological changes in the brain as a result of lack of oxygen (cerebral anoxia), other theories encompass a psychological reaction to approaching death, hallucinations, dreams, side effect of drugs, or just false memories. So properly designed prospective studies in survivors of cardiac arrest are necessary in order to obtain more reliable data to corroborate or refute the existing theories on the cause and content of a NDE. We needed to know if there could be a physiological, pharmacological, psychological or demographic explanation why people experience enhanced consciousness during a period of cardiac arrest.
The Dutch Prospective Study on NDE in Survivors of Cardiac Arrest
In 1988 a prospective study was initiated in the Netherlands.4 At that point, no large-scale prospective study into NDEs 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 ten participating Dutch hospitals. This prospective study would only be carried out among patients with a proven life-threatening crisis. All of these patients would have died of 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. 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. We always collected a record of the electrocardiogram during the cardiac arrest of all patients included in our study. The advantage of this prospective study design was that all procedures were defined in advance and no selection bias could occur. Within four years, between 1988 and 1992, 344 successive patients who had undergone a total of 509 successful resuscitations were included in the study. All the patients in our study had been clinically dead and in the first stage of the process of dying. The Dutch study was published4 in the Lancet in December 2001.
Results of the Dutch Prospective Study
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.”5 The higher the number of elements reported, the higher the score and the deeper the NDE. We found that 282 patients (82%) had no recollection of the period of their unconsciousness, whereas 62 patients - 18% of the 344 patients - reported a NDE. Of these 62 patients with memories, 21 patients (6%) had some recollection; having experienced only some elements, they had a superficial NDE with a low score. Because of the prospective design of the study, we also included these patients. And 42 patients (12%) reported a core experience: 18 patients had a moderately deep NDE, 17 patients reported a deep NDE and six patients a very deep NDE. The following elements were reported: half of the patients with a NDE were aware of being dead and had positive emotions, 30% had a tunnel experience, observed a celestial landscape or met with deceased persons, approximately one-quarter had an out-of-body experience, communication with ‘the light’ or perception of colors, 13% had a life review and 8% experienced the presence of a border. All the familiar elements of a NDE were reported in our study, with the exception of a frightening or negative NDE.
Were there any reasons why some people, 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 a NDE to the data of the 282 patients without NDE. To our surprise we did not identify any significant differences in the duration of the cardiac arrest (2 minutes or 8 minutes), nor differences in the duration of unconsciousness (5 minutes to three weeks in coma). So we failed to identify any differences between the patients with a very long or a very brief cardiac arrest. It was established that medication played no role. A psychological cause such as the infrequently noted fear of death immediate before the arrest did not affect the occurrence of a NDE. Whether or not patients had heard or read anything about NDE in the past also made no difference. Any kind of religious belief, or indeed its absence in non-religious people or atheists, was irrelevant and the same was true for the level of education. Only the large-scale Dutch study allowed for statistical analysis of the factors that may determine whether or not an NDE occurs.
As a result of our study, we could exclude physiological, psychological, pharmacological and demographic explanations for the occurrence of a NDE. We were particularly surprised to find no medical explanation for the occurrence of a NDE, because all the patients in our study had been clinically dead. 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. And because of some cases of veridical perception during resuscitation we reached the inevitable conclusion that patients 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 remained unanswered. See Figure 1.
Figure 1.
Only a small percentage of those clinically dead 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.
Results of the Dutch Longitudinal Study
Our Dutch study was also the first to include a longitudinal component with inter views after two and eight years, using a standardised inventory featuring 34 life-change questions, which allowed us to compare the processes of transformation between people with and without NDE.6 The question was whether the customary changes in attitude to life after a NDE were the result of surviving a cardiac arrest or whether these changes were caused by the experience of a NDE. This question had never been subject to scientific and systematic research with prospective design before. 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 a NDE. The second interviews showed that in people with NDE in particular fear of death had significantly decreased while belief in an afterlife had significantly increased. We were surprised to find that the processes of transformation that had begun in people with NDE after two years had clearly intensified after eight years. 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. The conversations also revealed that people had acquired enhanced intuitive feelings after a 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, or nonlocal perception, can be quite problematic, as people suddenly have a very acute sense of others, which can be extremely intimidating.
The integration and acceptance of a 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. For obvious reasons most people feel nostalgic about their NDE because of the unforgettable feelings of peace, acceptance, and love they encountered during the experience, and the feeling of being forced to return back into the body. We identified a distinct pattern of change in people with a NDE and revealed that integrating these changes into daily life is a long and arduous process because there is at first hardly any acceptance by oneself as well as by others, like doctors, nurses, family members, partner and friends. This makes the process of coming to terms with the experience difficult and painful. So the NDE is often a traumatic event with many years of strong feelings of depression, homesickness and loneliness.6
Other Prospective Studies on NDE in Survivors of Cardiac Arrest
Bruce Greyson, who published a prospective study in 116 survivors of cardiac arrest in the USA7, found that 15.5% of the patients reported a NDE: 9.5% reported a core NDE and 6% a superficial NDE. He 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.”
Sam Parnia and Peter Fenwick from the UK included in their prospective study 63 patients who survived their cardiac arrest.8 They found that 11% reported a NDE: 6.3% reported a core NDE, and 4.8% a superficial NDE. They report that the NDE cases with veridical perceptions during cardiopulmonary resuscitation (CPR) suggest 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 as 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 centers in the brain that are responsible for generating conscious experiences have stopped functioning as a result of the lack of oxygen.” Over a period of four years Penny Sartori carried out an even smaller prospective study into NDE in 39 survivors of cardiac arrest in the UK.9 She found that 23% reported a NDE: 18% reported a core NDE, and 5% a superficial NDE. She 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.”
Summary Scientific Research on Near-Death Experiences
In four recently published prospective studies on NDE in survivors of cardiac arrest, with identical study design, between ten and twenty percent of a total of 562 included patients reported an experience of enhanced consciousness during the period of apparent unconsciousness, during clinical death. With our current medical and scientific concepts it seems impossible to explain all aspects of the subjective experiences as reported by patients with an NDE during a transient functional loss of the cortex and the brainstem. Scientific studies into the phenomenon of NDE highlight 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 a NDE the commonly accepted, but never proven, assumption 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 a transient loss of all functions during a period of clinical death, even with a flat EEG?10 Furthermore, even blind people have described veridical perceptions during out-of-body experiences at the time of their NDE. 11
Nonlocal Consciousness
It is a scientific challenge to discuss new hypotheses that could explain: the reported interconnectedness with the consciousness of other persons and of deceased relatives; to explain the possibility of experiencing instantaneously and simultaneously (nonlocality) a review and a preview of someone’s life in a dimension without our conventional body-linked concept of time and space, where all past, present and future events exist and are available, and the possibility to have clear and enhanced consciousness with persistent and unaltered ‘Self ‘-identity, with memories, with cognition, with emotion, with the possibility of perception out and above the lifeless body, and even with the experience of the conscious return into the body. In my recent book12 I describe a concept in which our endless consciousness with declarative memories finds its origin in, and is stored in a nonlocal realm as wave-fields of information, and the brain only serves as a relay station for parts of these wave-fields of consciousness to be received into or as our waking consciousness. The latter relates to our physical body. These informational fields of our nonlocal consciousness become available as our waking consciousness only through our functioning brain in the shape of measurable and changing electromagnetic fields. The function of the brain should thus be compared with a transceiver, a transmitter/receiver, or interface, exactly like the function of a computer. Different neuronal networks function as interface for different aspects of our consciousness, and the function of neuronal networks should be regarded as receivers and conveyors, not as retainers of consciousness and memories.
In this concept, consciousness is not rooted in the measurable domain of physics, our manifest world. This also means that the wave aspect of our indestructible consciousness in the nonlocal realm is inherently not measurable by physical means. However, the physical aspect of consciousness can be measured by means of neuroimaging techniques like EEG, fMRI, and PET-scan. There is a kind of biological basis of our waking consciousness, because during life our physical body functions as an interface or place of resonance. But there is no biological basis of our whole, endless, or enhanced consciousness because it is rooted in a nonlocal realm. Our nonlocal consciousness resides not in our brain and is not limited to our brain, and our brain seems to have a facilitating, and not a producing function to experience consciousness. One cannot avoid the conclusion that endless or nonlocal consciousness has always existed and will always exist independently from the body, because there is no beginning nor will there ever be an end to our consciousness. For this reason we should seriously consider the possibility that death, like birth, can only be a transition to another state of consciousness. According to this idea death is only the end of our physical aspects, and during life our body functions as an interface or place of resonance for our nonlocal consciousness.
This view of a nonlocal consciousness also allows us to understand a wide variety of special states of consciousness,13 not only near-death experiences, but also mystical and religious experiences, deathbed visions (end-of-life experiences), shared death experiences, peri-mortem and post-mortem experiences (after death communication, or nonlocal interconnectedness with the consciousness of deceased relatives), heightened intuitive feelings and prognostic dreams (nonlocal information exchange), remote viewing (nonlocal perception) and perhaps even the effect of consciousness on matter like in placebo-effect or neuroplasticity,14,15 where in EEG, fMRI and PET-scan studies functional and structural changes in the brain are demonstrated following changes in consciousness (nonlocal perturbation).
Conclusion
It often takes an NDE to get people to think about the possibility of experiencing consciousness independently of the body and to realize that presumably consciousness always has been and always will be, that everything and everybody is connected in higher levels of our consciousness, that all of our thoughts will exist forever, and that death as such does not exist. Only if we are willing and able to ask open questions and abandon preconceptions research into NDE may help the scientific community to reconsider some unproven assumptions, not only about life and death, but above all about consciousness and its relation with brain function.
Biography
Pim van Lommel, MD, worked from 1977–2003 as a cardiologist in Hospital Rijnstate, a teaching hospital in Arnhem, the Netherlands, and is now doing full-time research on the mind-brain relation. Through his research on near-death experiences in survivors of cardiac arrest, he is the author of over 30 articles, one book, and several chapters about NDE.
Contact: pimvanlommel@gmail.com
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