Near-Death Experience among Iranian Muslim Cardiopulmonary Resuscitation Survivors

Abstract

Background:

Near-Death Experience (NDE) refers to a broad range of subjective experiences associated with forthcoming death. The majority of Cardiopulmonary Resuscitation (CPR) survivors experience NDEs. It seems that near-death events are experienced differently by people with different cultural and religious viewpoints. Thus, this study aimed to explain NDEs in Iranian Muslim CPR survivors.

Materials and Methods:

A qualitative hermeneutic phenomenological approach influenced by Ricoeur was used to understand the meaning of CPR survivors' NDEs. Eight survivors were interviewed in private. The study was conducted in southeast Iran. In-depth, semi-structured interviews were used for data collection, and probing questions were added when necessary. The duration of the interviews was between 40 and 65 min. According to Lindseth and Norberg, in the naive understanding phase, we read the interviews several times for achieving naive understanding. In the structural analysis phase, the whole text is divided into meaningful units. Finally, the researchers formulated a comprehensive understanding of the contextualization of the text.

Results:

Four main themes emerged including 1) pleasing experiences along with flying and seeing light, 2) the experience of transport to the beyond, 3) out-of-body experience, and 4) reviewing life and memories in a religious context.

Conclusions:

Iranian Muslim CPR survivors, reported NDEs, much similar to those reported by survivors in Western countries with different theistic religions. This means that medical professionals dealing with these patients need to be aware of such experiences in Iranian Muslims.

Introduction

In the 1970s it was reported that many people who were near-death described unusual, but similar experiences.[1] A Near-Death Experience (NDE) is a personal experience associated with death or impending death.[2] NDE refers to a broad range of subjective experiences associated with forthcoming death. People having NDE are unconscious, lack heartbeat or respiration, and have a flat electroencephalogram.[3] Out-of-Body Experiences (OBEs) and NDEs are complex phenomena that have fascinated mankind from the beginning of human history. OBEs are defined as experiences in which a person seems to be awake and sees their body and the world from a disembodied location outside their physical body.[2] Scientific interest in NDEs is rather recent, and there is still a lack of rigorous experimental data and controlled and reproducible experiments.[4] NDEs have been described differently in several studies,[1,2,5] where individuals describe their OBEs as including the presence of light,[1,5] feeling pleasant and relaxing sensations, going through a tunnel,[1,6] seeing a quick overview of their whole life from birth to death, experiencing another world with indescribable beauty,[1] and having feelings of levitation, total serenity, security, warmth, and the experience of absolute dissolution.[5]

Accounts of NDE's have been found in many different cultures and throughout historical time.[7] The occurrence of NDE is on the rise because of improved survival rates via modern medical techniques. The NDEs of the majority of CPR survivors have brought about life-changing effects.[7] Patients who have had NDEs report more daily spiritual experiences than those who did not. Daily spiritual experiences have been positively correlated with the intensity of NDE.[8] Leading a more altruistic life has also been mentioned as one of the outcomes of NDE.[9] Situations such as death, where the very core a person's life is shaken, are known as boundary situations.[10] According to Jaspers, surviving CPR can be considered a boundary situation. Some of the survivors may “gain strength,” clearly understand the boundary situation, and emerge from it successfully.[11] NDEs have been described by different cultural and religious views in many areas of the world, including India, China, South America, and the Middle East.[6] NDEs differ according to the survivor's own cultural and religious background and are almost always described in terms of the person's religious beliefs.[6] A review of the literature revealed only one study examining NDEs in the Iranian context, where Fracasso et al. (2010) reported that NDEs are not rare among Iranian Muslims.

Since limited qualitative research on NDEs in CPR survivors has been conducted both in the world and in Iran, as the impact of cultural and religious beliefs on these experiences is inevitable, the research team decided to conduct a reliable qualitative study to examine NDEs in CPR survivors in the Iranian context by taking a qualitative phenomenological approach.

Materials and Methods

The study was conducted from February 2016 to May 2017. This article is part of a larger qualitative nursing thesis. A qualitative approach was used to understand the accounts of CPR survivors' NDEs.[12] The data were analyzed using a hermeneutic phenomenological approach influenced by Ricoeur (1976). In-depth, semi-structured interviews, followed by probing questions when necessary, were used for the collection of data on CPR survivors' NDE. The duration of the interviews was between 40 and 65 min. Following Lindseth and Norberg, the interviews were transcribed verbatim.[13]

Eight CPR survivors chosen through purposive sampling were interviewed for 6 months in southeast Iran. Inclusion criteria were: 1) 18 years of age or older, 2) non-end-stage CPR survivor of any cause 3) being conscious, and 4) having experienced NDE. The participants' mean age was 50 years, and they consisted of five males and three females. The mean time passed since CPR was 14 months. Data saturation were obtained after interviewing eight CPR survivors. The demographic characteristics of the participants are shown in Table 1.

Table 1.

Demographic characteristics of participants with NDEs*

Participant	Age (Year)	Time passed from CPR** (months)
1	55	10
2	62	28
3	19	8
4	64	19
5	32	11
6	78	14
7	56	18
8	38	7

*NDEs: Near Death Experiences. *CPR: Cardiopulmonary Resuscitation

Data analysis was done by the Lindseth and Norberg method, inspired by Ricoeur.[13] According to this method, the analysis of the text has three methodological phases. In the first (naive understanding) phase, we read the interviews several times for achieving naive understanding. In the second phase (structural analysis) the whole text is divided into meaning units. The units are condensed and interpreted against the background of the naive understanding. All meaning units are sorted and condensed and then abstracted into subthemes and themes. Finally, the researchers formulate a comprehensive understanding of the contextualization of the text.[13] The third phase is called “comprehensive understanding.” Regarding the aim, structural analysis is done by a comprehensive study of all interview texts so that a comprehensive understanding is achieved.[13]

In this study, credibility was verified by presenting the preliminary findings at a seminar to a group of faculty members with expertise in qualitative research methodology. Besides, the descriptions of themes were returned to some participants for member checking. For transferability, a purposive sampling technique with maximum variation was used. More than one researcher was engaged in data analysis to strengthen dependability.

Ethical considerations

This research was approved by the Institutional Ethics Committee of Kerman University of Medical Sciences (IR.KMU.REC.1395.253). Participants were informed that they could withdraw at any time. All procedures performed in parts of the study involving human participants were following the ethical standards of the institutional national research committee and with the 1964 Declaration of Helsinki.

Results

Naive understanding

It seems that NDE for CPR survivors involves a sense of lightness and flying, which is combined with seeing and entering a light-filled tunnel. These survivors stated that their experiences were ambiguous and pleasing. OBE with the consciousness of surrounding events during CPR is another type of NDE. It seems freedom from the bonds of time during CPR is an opportunity for reviewing one's whole life in a religious context.

Structural analysis

In the structural analysis, the text was divided into meaningful units, which were further condensed, compared across the interviews, grouped, and labeled. Finally, from approximately 610 primary codes, and after completing the structural analysis, the labeled groups of the units were abstracted into four themes as described below.

Pleasing experiences, along with flying and seeing the light

In the experiences of the participants, NDE is associated with pleasing and indescribable sensations and pleasure beyond the imagination of the limited human mind. They touched lightness and engaged in flight. This feeling is accompanied by a movement towards the light. When participants came out of the darkness of the body, they saw the light. Their eyes were opened to the truth, and their religious journey was connected to a source full of light. Their descriptions of such experiences were different, including “being carried by others,” “movement through a bright tunnel,” and “a pathway blocked by a light.”

Oh my god! You cannot believe it, it was so supernatural. Everything was very interesting and beautiful. Perhaps this seems superstitious, but when I was unconscious, I only remember that I was going through a tunnel. No one took me, I was going myself, but a light blocked my way. (Participant No. 2).

One man fascinatingly describes these experiences:

I was being pulled toward a source of extreme light. I can remember the light. I was watching it, and after some time, it was over. The light was white and maybe sometimes dark. I had a feeling of flying and weightlessness. (Participant No. 4).

It seems that one of the manifestations of a deeper understanding of God is losing the fear of death. The participants also acknowledged their readiness for death. An old woman describes her experience interestingly:

After this event, I prepared for death. I used to be afraid of death, and I was always worried about the fate of my children. Now, I am certain that God will take care of my children after my death. (Participant No. 6).

They also considered meeting God as another motive for their acceptance of death.

It is so much fun when you die. The world hereafter is a good world because you can meet God. (Participant No. 1).

During CPR the physical barrier was removed and the soul moved easily outside the body. This supernatural insight cannot be achieved in normal daily life. It seems that the participants' descriptions of this experience were different based on their professional experiences. For example, one of the participants, who was an electrician, said:

It was like a very strong fan that pulled me to itself. I did not understand what it was, but it was wonderful. Believe me… I was flying. (Participant No. 3).

The separation of the soul from the body in the participants in this study was very interesting. As mentioned, these survivors had experienced such as “the feeling of flight,” “the sense of lightness,” and “seeing light.” They described all these sensations as pleasurable.

When I arrived at the light, it prevented me from moving on and it sent me back. It was very interesting and so enjoyable. (Participant No.2).

The experience of being transported to the beyond

Participants stated that the sense of lightness is the reason for the freedom of spirit. It is a feeling of a powerful force pulling at them, and then being pulled back by another one. Below are three examples of this feeling. A retired teacher said:

It was like the lights were dimmed. I understood my soul was separated from my body. After a few moments, I realized that this light was becoming stronger. (Participant No. 7).

A 65-year-old man states:

When I was in the CPR room, I just remember I was going through a tunnel. Of course, I did not go myself, I was carried by others, and at this moment, a light blocked my path. (Participant No. 2).

One of the participants who survived from very complicated conditions stated:

I thought I was still hearing what was going on. I heard a whisper. The sound of voices increased and then declined, like a car radio. (Participant No. 5).

Out-of-body experience

According to the participants' statements, their NDEs led to a complete awareness of what happened to them in the CPR room. A flying soul separated from the body can see all the surrounding environment and watch and record all the details. After gaining consciousness, the patient can remember the experience clearly and in detail.

It was very clear … I can tell you everything. You probably do not believe me, but I knew those emergency medical personnel who saved me, even after 8 days. I was watching them when they were trying to save me. (Participant No. 3).

A young woman who had drowned in a river and was saved by an emergency nurse stated:

Do you know I saw everything during CPR? I was watching my body; my soul was separated from my body. I don't know how this is possible, but I saw the nurse who was trying to save my life. (Participant No. 5).

Reviewing life and memories in a religious context

In NDEs, the boundaries of time disappear. Time has no meaning and the spirit is released from time. All of the individual's lifetime is reviewed by them. This recall is quite precise and clear, and the patient remembers every single event in detail. One of the participants stated:

My whole life passed in front of me. All the moments of my life….. reviewed in full detail. All the memories of my childhood, youth, adolescence, and school. (Participant No. 1).

One of the different NDEs in this study was related to the divine experiences about Qur'an.

I heard my uncle reciting the Qur'an. It was a marvel because I was dead. Most of all, it was my uncle's whispers of Qur'an that healed me. (Participant No. 8).

Comprehensive understanding

The meaning of CPR survivors' NDEs seems to be a kind of peacefulness and happiness accompanied by spirituality. NDEs are completely intertwined and are inseparable from each other. Most of the experiences are similar but some of the participants had exceptional NDEs as well. Other NDEs include floating into a near-death dream, uncommunicable experiences, communicating with the holy, seeing light, the consciousness of the events during CPR, and full recall of past events and memories.

Discussion

This study aimed to investigate NDEs in CPR survivors in the Islamic context in Iran. According to the results, Iranian CPR survivors reported NDEs similar to those of other societies. These findings were consistent with those of Fracasso et al. (2010) who stated in a study on 19 Iranian Muslims that NDEs are not rare and Muslim people had experiences similar to those of Westerners.[14] Chandradasa and Wijesinghe (2017) stated Muslims who had stronger religious beliefs reported more NDEs than those who were less devout.[15] In another study in the Muslim context, Engmann (2013) reported NDEs like the experience of seeing light and OBE.[16]

In contrast with these findings, Kreps (2009) reported that Muslims have fewer NDEs than Westerners.[17] The results of the current study rejected this hypothesis and showed that Muslims can have NDEs similar to those of other religious societies, which has also been supported by other researchers such as Nahm and Nicolay.[18] These differences in findings can be attributed to the differences among the studied populations.

”Pleasing experiences along with flying and seeing light” was one of the NDEs reported in this study; the light the participants speak of is consistent with other studies.[1,9,19] Besides, flying experience has been reported in an Islamic context study from central Asia [16] by Khanna and Greyson (2014), who reported that NDEs are affected by daily spiritual experiences and spiritual pleasure.[8]

Results showed seeing the borderline between this world and the afterlife was by itself what alleviated the fear of death. This is inconsistent with the fearful association death has among the Iranian population and in the Iranian culture.[20] In contrast with the general population, CPR survivors with NDEs have a different view about death. CPR survivors have grown and have arrived at a higher form of perception.[21] Haydon et al. (2017) maintain that the reason is that CPR survivors had prepared themselves for death.[22] This is probably why feeling close to death and becoming aware of it [23] and also the low anxiety about death [16,3,24,25] are among the CPR survivors' experiences.

Another NDE experienced by Iranian CPR survivors was “the experience of being transported to the beyond.” This finding was unique to this study, and we were not able to find any similar experiences in the literature. Experiences like going through a tunnel have been reported in other studies,[1] but these studies do not mention going through a tunnel and then returning, as mentioned by the subjects of our study. Royse and Badger (2017) reported that one of the NDEs among burn survivors was “the sense of a border or point of no return.” It seems this experience is similar to the experience described in our study.[19]

Recalling past life memories in a religious context during CPR was another experience in Iranian CPR survivors. This finding is consistent with similar studies.[26,27] Many patients with NDEs have claimed to have achieved a more complete understanding of their religious or spiritual insights and its profound impact on their lives.[28] The use of religious and spiritual beliefs is one of the most important strategies for adapting to difficult situations.[29]

Among our participants, there were neither any end-stage patients nor quadriplegics. These populations may report different experiences. This research was conducted on a Muslim population, so generalization of the results should be done with caution.

Conclusion

Iranian Muslim CPR survivors reported NDEs similar to those of survivors in Western countries. Some of these experiences are “pleasing experiences along with flying and seeing light,” “transport to the beyond,” “out-of-body experience,” and “recalling the life and memories.” For the Iranian Muslim society in which death is considered taboo, people could benefit from these experiences. Nurses need to be aware of these experiences in Muslims, to provide more effective care.

Financial support and sponsorship

Karman University of Medical Sciences

Conflicts of interest

Nothing to declare.