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Near-death experience
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"NDE" redirects here. For other uses, see NDE (disambiguation).

Ascent in the Empyrean (Hieronymus Bosch)A near-death experience (NDE) refers to a broad range of personal experiences associated with impending death, encompassing multiple possible sensations ranging from detachment from the body, feelings of levitation, extreme fear, security, or warmth, the experience of absolute dissolution, and the presence of a light, which some people [specify] interpret as a deity or spiritual presence.[citation needed] Many cultures and individuals revere NDEs as a paranormal and spiritual glimpse into the afterlife.

Such cases are usually reported after an individual has been pronounced clinically dead, or otherwise very close to death, hence the entitlement near-death experience. With recent developments in cardiac resuscitation techniques, the number of NDEs reported is continually increasing.[citation needed] Most of the scientific community regards such experiences as hallucinatory[1][2][3][4][5], while paranormal specialists and some mainstream scientists claim them to be evidence of an after life.[6][7]

Popular interest in near-death experiences was initially sparked by Raymond Moody, Jr's 1975 book "Life After Life" and the founding of the International Association for Near-Death Studies (IANDS) in 1978. According to a Gallup poll, approximately eight million Americans claim to have had a near-death experience.[8] NDEs are among the phenomena studied in the fields of parapsychology, psychology, psychiatry,[9] and hospital medicine.[10] [11]

Contents [hide]
1 Characteristics
2 Research
2.1 Variance in NDE Studies
2.2 Biological Analysis and Theories
2.3 Effects
3 Spiritual Viewpoints
3.1 Religious and Physiological Views
4 See also
5 Interviews
6 References
6.1 Footnotes
7 Further reading
7.1 Personal experiences
7.2 Fiction
8 External links
8.1 As an afterlife experience
8.2 Neutral
8.3 As a physiological and psychological experience

THE INDEPENDENT VICTIMS HELPLINE (UK)
No medical explanation for near death experiences
10:23 14 December 2001
NewScientist.com news service
Emma Young

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Medical explanations cannot account for near death experiences (NDEs), according to the results of the biggest prospective study to date of patients who were resuscitated after clinical death. However, patients who reported an NDE were more likely to die soon afterwards.

Pim Van Lommel and his team at Hospital Rijnstate in the Netherlands interviewed 344 patients who were resuscitated after heart failure at 10 hospitals across the country. The patients were questioned as soon as they were well enough.

Eighteen per cent reported an NDE - classed as a memory of "a special state of consciousness, including specific elements such as out-of-body experience, pleasant feelings and seeing a tunnel."

But the team found no link between NDEs and drugs used to treat the patients, the duration of cardiac arrest or unconsciousness, or the patients' reports of the degree to which they feared death before the incident.

"This was the surprising thing," van Lommel says. "It's always said that NDEs are just a phenomenon relating to the dying brain and the lack of oxygen to the brain cells. But that's not true. If there was a physiological cause, all the patients should have had an NDE."

Letting go
The patients were mostly elderly, with an average age of 62. Van Lommel found that those that reported an NDE were significantly more likely to die within 30 days.

"There is the idea that people can decide to some extent when they die," says van Lommel. "Perhaps when they had an NDE, their fear of death was over and they could let go."

The team did find that patients who were under 60 and female were more likely to report an NDE. But the causes of the experience remain a mystery, van Lommel says.

His team questioned surviving NDE patients again two years after their resuscitation, and then after eight years. Most of the patients recalled the event in striking detail. And most showed significant psychological changes, the team reports. The 23 NDE patients who were still alive eight years later "had become more emotionally vulnerable and empathic", they write.

Pushing the limit
Van Lommel's team report anecdotal stories of patients recalling events that happened around them during out of body experiences while they were clinically dead. These experiences "push at the limit of medical ideas about the range of human consciousness and the mind/brain relationship," Van Lommel says.

Christopher French, at the Anomalistic Psychology Research Unit at Goldsmiths College, London, says the team's paper is "intriguing", though he notes that van Lommel's team failed to contact the patients for corroboration. He points out that NDEs are impossible to objectively verify - and that out of body experiences have not been proved to exist.

But, in a commentary on the research, he writes: "the out of body component of the NDE offers probably the best hope of launching any kind of attack on current concepts of the relationship between consciousness and brain function."

If researchers could prove that clinically dead patients, with no electrical activity in their cortex, can be aware of events around them and form memories, this would suggest that the brain does not generate consciousness, French and Van Lommel think.

Journal reference: The Lancet (vol 358, p 2039)

[edit] Characteristics
The phenomenology of an NDE usually includes physiological, psychological and alleged transcendental aspects.[12] Typically, the experience follows a distinct progression: [13] [14] [15]

a very unpleasant sound/noise is the first sensory impression to be noticed (R. Moody: Life after Life);
a sense of being dead;
pleasant emotions; calmness and serenity;
an out-of-body experience; a sensation of floating above one's own body and seeing the surrounding area;
a sensation of moving upwards through a bright tunnel or narrow passageway;
meeting deceased relatives or spiritual figures;
encountering a being of light, or a light (often interpreted as being the Christian God or another divine figure);
being given a life review;
reaching a border or boundary;
a feeling of being returned to the body, often accompanied by a reluctance.
However, some people have also experienced extremely distressing NDEs, which can manifest in forewarning of a "Hell" or a sense of dread towards the cessation of their life in its current state.

According to the Rasch Scale, a "core" near-death experience encompasses peace, joy, and harmony, followed by insight and mystical or religious experiences.[16] The most intense NDEs are reported to have an envolvment and awareness of things occurring in a different place or time, and some of these observations are said to have been evidential.

Clinical circumstances that are thought to lead to a NDE include conditions such as: cardiac arrest, shock in postpartum loss of blood or in perioperative complications, septic or anaphylactic shock, electrocution, coma, intracerebral haemorrhage or cerebral infarction, attempted suicide, near-drowning or asphyxia, apnoea, and serious depression.[15] Many NDEs occur after a crucial experience (e.g. when a patient can hear that he or she is declared to be dead by a doctor or nurse), or when a person has the subjective impression to be in a fatal situation (e.g. during a near-miss automobile accident). In contrast to common belief, attempted suicides do not lead more often to unpleasant NDEs than unintended near-death situations.[17]

[edit] Research
Interest in the NDE was originally spurred by the research of such pioneers as Elisabeth Kübler-Ross, George Ritchie, and Raymond Moody Jr. Moody's book Life After Life, which was released in 1975, and brought a great deal of attention to the topic of NDEs.[18] This was soon followed by the establishment of the International Association for Near-death Studies (IANDS), founded in 1978, in order to meet the needs of early researchers and those with NDE experiences within this field of research. Today the association includes researchers, health care professionals, NDE-experiencers and people close to experiencers, as well as other interested people. One of its main goals is to promote responsible and multi-disciplinary investigation of near-death and similar experiences.

Later researchers, such as Bruce Greyson, Kenneth Ring and Michael Sabom, introduced the study of near-death experiences to the academic setting. The medical community has been somewhat reluctant to address the phenomenon of NDEs, and money granted for research has been relatively scarce.[18] However, although the research was not always welcomed by the general academic community, both Greyson and Ring made significant contributions in order to increase the respectability of near-death research.[19] Major contributions to the field include the construction of a Weighted Core Experience Index[20] in order to measure the depth of the near-death experience, and the construction of the near-death experience scale,[21] in order to differentiate between subjects that are more or less likely to have experienced a classical NDE. The NDE-scale also aims to differentiate between what the field claims are "true" NDEs and syndromes or stress responses that are not related to an NDE, such as the similar incidents experienced by sufferers of epilepsy. Greyson's NDE-scale was later found to fit the Rasch rating scale model.[22]

Other contributors to the research on near-death experiences come from the disciplines of medicine, psychology and psychiatry. Greyson (1997) has also brought attention to the near-death experience as a focus of clinical attention, while Morse et al. (1985; 1986) have investigated near-death experiences in a pediatric population.

Neuro-biological factors in the experience have been investigated by researchers within the field of medical science and psychiatry (Mayank and Mukesh, 2004; Jansen, 1995; Thomas, 2004). Among the researchers and commentators who tend to emphasize a naturalistic and neurological base, for the experience, are the British psychologist Susan Blackmore (1993) and the founding publisher of Skeptic magazine, Michael Shermer (1998).

Among the scientific and academic journals that have published, or are regularly publishing new research on the subject of NDEs, are: Journal of Near-Death Studies, Journal of Nervous and Mental Disease, British Journal of Psychology, American Journal of Disease of Children, Resuscitation, The Lancet, Death Studies, and the Journal of Advanced Nursing.

[edit] Variance in NDE Studies
The prevalence of NDEs has been variable in the studies that have been performed. According to the Gallup and Proctor survey in 1980-1981, of a representative sample of the American population, data showed that 15% had an NDE.[23] Though, Knoblauch in 2001 performed a more selective study in Germany and found that 4% of the sample population had experienced an NDE.[24] However, the information gathered from these studies may be subjected to the broad timeframe and location of the investigation.

Perera et al in 2005 conducted a telephone survey of a representative sample of the Australian population, as part of the Roy Morgan Catibus Survey, and concluded that 8.9% of the population had experienced an NDE.[25] In a more clinical setting, van Lommel et al (2001), a cardiologist from Netherlands, studied a group of patients who had suffered cardiac arrests and who were successfully revived. They found that 18% of these patients had an NDE, with 12% of those being core experiences.

According to Martens (1994), the only satisfying method to address the NDE-issue would be an international multicentric data collection within the framework for standardized reporting of cardiac arrest events. The use of cardiac-arrest criteria as a basis for NDE research has been a common approach among the European branch of the research field.[26]

[edit] Biological Analysis and Theories
In the 1990s, Dr. Rick Strassman conducted research on the psychedelic drug Dimethyltryptamine (DMT) at the University of New Mexico. Strassman advanced the theory that a massive release of DMT from the pineal gland prior to death or near-death was the cause of the near-death experience phenomenon. Only two of his test subjects reported NDE-like aural or visual hallucinations, although many reported feeling as though they had entered a state similar to the classical NDE. His explanation for this was the possible lack of panic involved in the clinical setting and possible dosage differences between those administered and those encountered in actual NDE cases. All subjects in the study were also very experienced users of DMT and/or other psychedelic/entheogenic agents. Some speculators consider that if subjects without prior knowledge on the effects of DMT been used during the experiment, that it is possible more volunteers would have reported feeling as though they had experienced an NDE.

Critics have argued that neurobiological models often fail to explain NDEs that result from close brushes with death, where the brain does not actually suffer physical trauma, such as a near-miss automobile accident. Such events may however have neurobiological effects caused by stress.

In a new theory devised by Kinseher in 2006, the knowledge of the Sensory Autonomic System is applied in the NDE phenomenon. His theory states that the experience of looming death is an extremely strange paradox to a living organism - and therefore it will start the NDE: during the NDE, the individual becomes capable of "seeing" the brain performing a scan of the whole episodic memory (even prenatal experiences), in order to find a stored experience which is comparable to the input information of death. All these scanned and retrieved bits of information are permanently evaluated by the actual mind, as it is searching for a coping mechanism out of the potentially fatal situation. Kinseher feels this is the reason why a near-death experience is so unusual.

The theory also states that out-of-body experiences, accompanied with NDEs, are an attempt by the brain to create a mental overview of the situation and the surrounding world. The brain then transforms the input from sense organs and stored experience (knowledge) into a dream-like idea about oneself and the surrounding area.

Whether or not these experiences are hallucinatory, they do have a profound impact on the observer. Many psychologists not necessarily pursuing the paranormal, such as Susan Blackmore, have recognized this. These scientists are not trying to debunk the experience, so much so as searching for biological reasons that cause an NDE.[27]

[edit] Effects
Main article: Effects of near-death experiences
Near-death experiences can have tremendous effects on the people who have them, their families, and medical workers.

[edit] Spiritual Viewpoints
Some view the NDE the precursor to an afterlife experience, claiming that the NDE cannot be completely explained by physiological or psychological causes, and that consciousness can function independently of brain activity.[28] Many NDE-accounts seem to include elements which, according to several theorists, can only be explained by an out-of-body consciousness. For example, in one account, a woman accurately described a surgical instrument she had not seen previously, as well as a conversation that occurred while she was under general anesthesia.[29] In another account, from a proactive Dutch NDE study [2], a nurse removed the dentures of an unconscious heart attack victim, and was asked by him after his recovery to return them. It might be difficult to explain in conventional terms how an unconscious patient could later have recognized the nurse.[30]

Dr. Michael Sabom reports a case about a woman who underwent surgery for an aneurysm. The woman reported an out-of-body experience that she claimed continued through a brief period of the absence of any EEG activity. If true, this would seem to challenge the belief by many that consciousness is situated entirely within the brain.[31]

A majority of individuals who experience an NDE see it as a verification of the existence of an afterlife.[32] This includes those with agnostic/atheist inclinations before the experience. Many former atheists, such as the Reverend Howard Storm[33][34] have adopted a more spiritual viewpoint after their NDEs. Howard Storm's NDE might also be characterized as a distressing near-death experience. The distressing aspects of some NDE's are discussed more closely by Greyson & Bush (1992).

Greyson claims that "No one physiological or psychological model by itself explains all the common features of NDE. The paradoxical occurrence of 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."[35]

A few people feel that research on NDEs occurring in the blind can be interpreted to support an argument that consciousness survives bodily death. Dr. Kenneth Ring claims in the book "Mindsight: Near-Death and Out-of-Body Experiences in the Blind" that up to 80% of his sample studied reported some visual awareness during their NDE or out of body experience.[36]Skeptics however question the accuracy of their visual awareness [37]

[edit] Religious and Physiological Views
Main article: Religious and physiological views of near-death experiences
There are many religious and physiological views about NDEs, such as the Tibetan belief of bardo; a transpersonal dimension that houses souls awaiting reincarnation.

[edit] See also
Out-of-body experience
Near-Death Studies
Alister Hardy
Beyond and Back
Form constant
Sheol
Lobsang Rampa
Lazarus phenomenon
Suspended animation
Premature burial
Near-birth experience

[edit] Interviews
Play and the Paranormal A Conversation with Dr. Raymond Moody

[edit] References

[edit] Footnotes
^ Buzzi, Giorgio. "Correspondence: Near-Death Experiences." Lancet. Vol. 359, Issue 9323 (June 15, 2002): 2116-2117.
^ Bressloff, Paul C., Jack D. Cowan, Martin Golubitsky, Peter J. Thomas, and Matthew C. Wiener. "What Geometric Visual Hallucinations Tell Us About the Visual Cortex." Neural Computation. Vol. 14, No. 3 (March 2002): 473-491.
^ Britton, Willoughby B. and Richard R. Bootzin. "Near-Death Experiences and the Temporal Lobe." Psychological Science. Vol. 15, No. 4 (April 2004): 254-258.
^ Bünning, Silvia and Olaf Blanke. "The Out-of Body Experience: Precipitating Factors and Neural Correlates." In The Boundaries of Consciousness: Neurobiology and Neuropathology, ed. Steven Laureys. New York: Elsevier Science, 2005: 331-350.
^ Blackmore, Susan:Dying to Live: Near-Death Experiences (1993). London, Grafton.
^ Grossman, Neil (Indiana University and University of Illinois), Who's Afraid of Life After Death? Why NDE Evidence is Ignored, Institute of Noetic Sciences (IONS), 2002
^ Fontana, David (Cardiff University and Liverpool John Moores University), Does Mind Survive Physical Death?, 2003
^ Mauro, James (1992) Bright lights, big mystery. Psychology Today, July 1992.
^ Greyson, Bruce (2003), "Near-Death Experiences in a Psychiatric Outpatient Clinic Population", Psychiatric Services, Dec., Vol. 54 No. 12. The American Psychiatric Association.
^ van Lommel, Pim (Hospital Rijnstate), "Near-death experience in survivors of cardiac arrest: a prospective study in the Netherlands" in The Lancet, 2001.
^ van Lommel, Pim (Hospital Rijnstate),"A Reply to Shermer: Medical Evidence for NDEs" in Skeptical Investigations, 2003.
^ Parnia, Waller, Yeates & Fenwick, 2001.
^ Mauro, James (1992). "Bright lights, big mystery", Psychology Today, July 1992.
^ Morse, Conner & Tyler, 1985; Morse & Perry, 1992.
^ a b van Lommel P, van Wees R, Meyers V, Elfferich I. (2001) "Near-Death Experience in Survivors of Cardiac Arrest: A prospective Study in the Netherlands", Lancet, December 15; 358(9298):2039-45.
^ Lange, Greyson & Houran, 2004.
^ Ring, Kenneth: "Heading toward Omega. In search of the Meaning of Near-Death Experience", 1984.
^ a b Mauro, James. "Bright lights, big mystery", Psychology Today, July 1992.
^ IANDS, printable brochure.
^ Ring, K. "Life at death. A scientific investigation of the near-death experience." 1980, New York: Coward McCann and Geoghenan.
^ Greyson, 1983.
^ Lange, Greyson & Houran, 2004.
^ Gallup, G., and Proctor, W. (1982). Adventures in immortality: a look beyond the threshold of death. New York, McGraw Hill.
^ Knoblauch, H., Schmied, I. and Schnettler, B. (2001). "Different kinds of Near-Death Experience: a report on a survey of near-death experiences in Germany", Journal of Near-Death Studies, 20, 15-29.
^ Perera, M., Padmasekara, G. and Belanti, J. (2005), "Prevalence of Near Death Experiences in Australia", Journal of Near-Death Studies, 24(2), 109-116.
^ Parnia, Waller, Yeates & Fenwick, 2001; van Lommel, van Wees, Meyers & Elfferich, 2001.
^ Bruce Greyson, Kevin Nelson, Susan Blackmore, webpage: News-wdeath11-2006-04.
^ Rivas, 2003
^ Sabom, Michael. Light & Death: One Doctor's Fascinating Account of Near-Death Experiences. 1998. Grand Rapids, Michigan: Zondervan Publishing House
^ van Lommel P, van Wees R, Meyers V, Elfferich I. (2001) Near-Death Experience in Survivors of Cardiac Arrest: A prospective Study in the Netherlands. Lancet, December 15;358(9298):2039-45.
^ Sabom, Michael. Light & Death: One Doctor's Fascinating Account of Near-Death Experiences. 1998. Grand Rapids, Michigan: Zondervan Publishing House
^ Kelly, 2001
^ Rodrigues, 2004
^ [1]
^ Greyson, 2001
^ Ring, Cooper, 1999
^ Hallucinatory Near-Death Experiences (2003) (Revised 2006)
^ Commentary

[edit] Further reading
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).
Blackmore, Susan (1993) Dying to live: Science and Near-Death Experiences. London: Harper Collins.
Blanke, Olaf; Ortigue, Stéphanie; Landis, Theodor; Seeck, Margitta (2002) Stimulating illusory own-body perceptions. The part of the brain that can induce out-of-body experiences has been located. Nature, Vol. 419, 19 September 2002
Britton WB & Bootzin RR. (2004) Near-death experiences and the temporal lobe. Psychol Sci. Apr;15(4):254-8. PubMed abstract PMID 15043643
Carey, Stephen S. (2004) A Beginner's Guide to Scientific Method. Third Edition. Toronto: Thomson Wadsworth
Cowan, J. D. (1982) Spontaneous symmetry breaking in large-scale nervous activity. International Journal of Quantum Chemistry, 22, 1059-1082.
Delog Dawa Drolma: Delog - Journey to realms beyond death, Publisher: Padma Publishing (March 1, 1995), ISBN 1881847055 (10), ISBN 978-1881847052 (13)
Father Rose, Seraphim (1980) The Soul after Death. Saint Herman Press, ISBN 0-938635-14-X
Greyson, B. (1983) The Near-Death Experience Scale: Construction, reliability, and validity. Journal of Nervous and Mental Disease, 171, 369-375.
Greyson, Bruce (1983) The near-death experience scale. Construction, reliability, and validity. Journal of Nervous and Mental Disease, Jun;171(6):369-75.
Greyson B. (1997) The near-death experience as a focus of clinical attention. Journal of Nervous and Mental Disease. May;185(5):327-34. PubMed abstract PMID 9171810
Greyson, B. (2000) Some neuropsychological correlates of the physio-kundalini syndrome. Journal of Transpersonal Psychology, 32, 123-134.
Greyson, Bruce (2003) Near-Death Experiences in a Psychiatric Outpatient Clinic Population. Psychiatric Services, December, Vol. 54 No. 12. The American Psychiatric Association
Greyson, Bruce & Bush, Nancy E. (1992) Distressing near-death experiences. Psychiatry, Feb;55(1):95-110.
IANDS. IANDS: The International Association for Near-Death Studies. Printable Brochure. Available at www.iands.org
Jansen, Karl L. R. (1995) Using ketamine to induce the near-death experience: mechanism of action and therapeutic potential. Yearbook for Ethnomedicine and the Study of Consciousness (Jahrbuch furr Ethnomedizin und Bewubtseinsforschung) Issue 4 pp55-81.
Jansen, Karl L. R. (1997) The Ketamine Model of the Near Death Experience: A central role for the NMDA Receptor. Journal of Near-Death Studies Vol. 16, No.1
Kelly EW. (2001) Near-death experiences with reports of meeting deceased people. Death Stud. Apr-May;25(3):229-49
Lange R, Greyson B, Houran J. (2004) A Rasch scaling validation of a 'core' near-death experience. British Journal of Psychology, Volume: 95 Part: 2 Page: 161-177
Lukoff, David, Lu, Francis G. & Turner, Robert P. (1998) From Spiritual Emergency to Spiritual Problem - The Transpersonal Roots of the New DSM-IV Category. Journal of Humanistic Psychology, 38(2), 21-50
Martens PR. (1994) Near-death-experiences in out-of-hospital cardiac arrest survivors. Meaningful phenomena or just fantasy of death? Resuscitation. Mar;27(2):171-5. PubMed abstract PMID 8029538
Morse M, Castillo P, Venecia D, Milstein J, Tyler DC. (1986) Childhood near-death experiences. American Journal of Diseases of Children, Nov;140(11):1110-4.
Morse M., Conner D. and Tyler D. (1985) Near-Death Experiences in a pediatric population. A preliminary report, American Journal of Disease of Children, n. 139 PubMed abstract PMID 4003364
Morse, Melvin (1990) Closer to the Light: Learning From the Near-Death Experiences of Children. New York: Villard books
Morse, Melvin & Perry, Paul (1992) Transformed by the Light. New York: Villard books
Moody, R. (1975) Life After Life: The Investigation of a Phenomenon - Survival of Bodily Death. New York: Bantam
Moody, R. (1977) Reflections on Life After Life: More Important Discoveries In The Ongoing Investigation Of Survival Of Life After Bodily Death. New York: Bantam
Moody, R. (1999) The Last Laugh: A New Philosophy of Near-Death Experiences, Apparitions, and the Paranormal. Hampton Roads Publishing Company
Mullens, K. (1992) Returned From The Other Side. Publ. Kenneth G. Mullens
Mullens, K. (1995) Visions From The Other Side. Publ. Kenneth G. Mullens
Orne RM. (1995) The meaning of survival: the early aftermath of a near-death experience. Research in Nursing & Health. 1995 Jun;18(3):239-47. PubMed abstract PMID 7754094
Parnia S, Waller DG, Yeates R, Fenwick P (2001) A qualitative and quantitative study of the incidence, features and aetiology of near death experiences in cardiac arrest survivors. Resuscitation. Feb;48(2):149-56. PubMed abstract PMID 11426476
Peake, Anthony (2006) "Is There Life After Death?" (Chartwell Books in USA & Arcturus in UK)
Pinchbeck, Daniel (2002) Breaking Open the Head: A Psychedelic Journey into the Heart of Contemporary Shamanism. Broadway Books, trade paperback, 322 pages
Pravda (2004) Reanimators try to grasp the afterlife mystery. Pravda article 21.12.2004. (Article translated by: Maria Gousseva)
Raaby et al. (2005) Beyond the Deathbed.
Rapini, Mary Jo with Harper, Mary (2006) "Is God Pink? Dying to Heal". Baltimore:Publish America. www.maryjorapini.com
Rivas T. (2003). The Survivalist Interpretation of Recent Studies into the Near-Death Experience. Journal of Religion and Psychical Research, 26, 1, 27-31.
Rodrigues, Linda Andrade (2004) Ex-atheist describes near-death experience. Standard Times, Page C4, January 31, 2004
Sabom, Michael (1998) Light & Death: One Doctor's Fascinating Account of Near-Death Experiences. Grand Rapids, Michigan: Zondervan Publishing House
Simpson SM. (2001) Near death experience: a concept analysis as applied to nursing. Journal of Advanced Nursing. Nov;36(4):520-6. PubMed abstract PMID 11703546
Rick Strassman, DMT: The Spirit Molecule: A Doctor's Revolutionary Research into the Biology of Near-Death and Mystical Experiences, 320 pages, Park Street Press, 2001, ISBN 0-89281-927-8
Thomas, Shawn (2004) Agmatine and Near-Death Experiences. Article published at www.neurotransmitter.net
Kinseher Richard (2006) Geborgen in Liebe und Licht - Gemeinsame Ursache von Intuition, Déjà-vu-, Schutzengel- und Nahtod-Erlebnissen, ISBN 3-8334-51963, German Language, (A new theory: During a Near-Death-Experience, a person can observe the scan of the own episodic memory. These stored experiences are then judged by the topical intellect.)
Tulku Thondup: Peaceful Death, Joyful Rebirth: A Tibetan Buddhist Guidebook with a CD of Guided Meditations",Publisher: Shambhala; Pap/Com edition (December 12, 2006), ISBN 1590303857 (10), ISBN 978-1590303856 (13)

[edit] Personal experiences
Return from Tomorrow by George G. Ritchie, M.D. with Elizabeth Sherrill (1978). George G. Ritchie, M.D. held positions as president of the Richmond Academy of General Practice; chairman of the Department of Psychiatry of Towers Hospital; and founder and president of the Universal Youth Corps, Inc. He lived in Virginia. At the age of twenty, George Ritchie died in an army hospital. Nine minutes later he returned to life. What happened to him during those minutes was so compelling, it changed his life forever. In Return from Tomorrow, he tells of his out-of-the-body encounter with other beings, his travel through different dimensions of time and space, and ultimately, his transforming meeting with the Light of the world, the Son of God, Jesus Christ. Ritchie's extraordinary experience not only altered his view of eternity, it directed and governed his entire life, and provided a startling and hopeful description of the realm beyond. Ritchie's story was the first contact Dr. Raymond Moody, PhD (who was studying at the University of Virginia, as an undergraduate in Philosophy, at the time) had with NDEs. It inspired Moody to investigate over 150 cases of near-death experiences, in his book Life After Life, and two other books that followed.
"Is God Pink? Dying to Heal: by Mary Jo Rapini, with Mary Harper (2006). While awaiting surgery for a near-fatal brain aneurysm, Rapini experienced an encounter with a loving God. A psychotherapist, Rapini had counseled dying cancer patients and was skeptical of their visions. After her near-death experience, Rapini realized the power of spiritual healing for herself and her patients. www.maryjorapini.com
Embraced by the Light by Betty Eadie (1992). One of the most detailed near-death experiences on record.
Saved by the Light by Dannion Brinkley. Brinkley's experience documents one of the most complete near death experiences, in terms of core experience and additional phenomena from the NDE scale. Brinkley was clinically dead for 28 minutes and taken to a hospital morgue.
Placebo by Howard Pittman (1980). A detailed record of Mr. Pittman's near-death experience.
The Darkness of God by John Wren-Lewis (1985), Bulletin of the Australian Institute for Psychical Research No 5. An account of the far-reaching effects of his NDE after going through the death process several times in one night.
Bahá'í Reinee Pasarow has presented her experiences and an extended talk which was filmed Part 1,Part2, with a partial transcript, and analyzed from a religious point of view in a Commentary and analyzed as part of the paper The Exploration of Life After Death. Pasarow was interviewed by Dr. Kenneth Ring.[38]
Anita Moorjani, an ethnic Indian woman from Hong Kong experienced a truly remarkable NDE which has been documented on the Near Death Experience Research Foundation (NDERF) website as one of the most exceptional accounts on their archives. She had end-stage cancer and on February 2, 2006, doctors told her family that she only had a few hours to live. Following her NDE, Anita experienced a remarkable total recovery of her health. Her full story can be read at www.nderf.org titled "Anita M's NDE".
Goldie Hawn, while giving a speech at the Buell Theater in Denver, Colorado, reflected upon her near-death experience. When she was younger, and starting out as an actress, she and a group of friends were in a severe car crash together. While she was unconscious, she remembers looking over herself while the paramedics were trying to revive her. She also mentioned seeing a bright light and being told it was not her time soon before she awoke.

[edit] Fiction
In Passage, a 2001 novel by Connie Willis, the principal storyline centers around a researcher who has developed a technique for inducing an experience very much like a natural NDE. By studying the effects and comparing them with real NDEs, she hopes to find a biological basis for NDEs.
In the end of Scorpia, 5th installment in the Alex Rider series, Alex Rider, the protagonist, is shot near the heart by a sniper, collapses and sees his deceased parents appear before him in bright light, before losing consciousness.
The novel Fearless (1993) by Rafael Yglesias is about an architect that survives a planecrash. His near-death experience starts a period of fearlessness and existential concerns which puts him in conflict with both his family and the surrounding culture. The book was later adapted to the screen by director Peter Weir, starring Jeff Bridges as the main character, Max Klein. See Fearless (film).
The French novel Les Thanatonautes by Bernard Werber is about a group of scientists trying to study life after death by using drugs to throw them into cardiac arrest. It is the beginning of a successful trilogy including L'Empire des Anges and Nous, Les Dieux.
Another French novel, "Le Serment des Limbes" by Jean Christophe Grangé, deals with negative NDE and its impact on devil worshipping.
The movie Flatliners (1990) is about a group of medical students who want to study the near-death experience. They volunteer to clinically die and be revived by their fellow students. However, their experiment begins to go awry.
In Final Destination 2, Kimberly Corman has a life review before dying. Later she is saved by Ellen Kallarjian.
In the movie Stay (2005) the character of Henry (Ryan Gosling) has a NDE that lasts throughout the entire film. As he lies dying after a car crash that killed the rest of his family his mind wanders between life and death. Henry's final minutes of his life extended into a dream that lasts several days in his mind. He sees the illusion through the eyes of the man who is trying to keep him alive (Ewan McGregor).
In the game Metal Gear Solid 3: Snake Eater, Naked Snake undergoes a NDE after falling into the river, almost drowning in the process.
In the movie White Noise: The Light (2007), the sequel of White Noise (2005), the main character Abe Dale (Nathan Fillion) has a NDE after his suicide attempt. His spirit separates from his body. His consciousness then floats through a grey tunnel at the end of which there is a bright light to be found. It shines upon his murdered wife and child who are already expecting him. His astral body is pulled back into his physical body after a successful resuscitation.
In the Christian film Escape from Hell, a man attempts to prove Heaven's existence by purposefully placing himself in cardiac arrest. However, he finds himself in a completely different place: Hell.
At the end of the computer animated film Ice Age 2: The Meltdown, the saber-toothed squirrel character Scrat, in perpetual sisyphean pursuit of an acorn, dies and goes on to a shimmering ethereal place abundant with acorns surrounding one very large one, as if in final reward for his patience, but just as he is about to sink his teeth into it, he is pulled out of the place back to earth where he has been revived by the character Sid, who is baffled at his anger instead of gratitude at finding himself back alive.
On the medical show Grey's Anatomy, the main protagonist, Meredith, drowned during a mass casualty incident and had a near-death experience with former deceased patients.

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[edit] As an afterlife experience
Negative Near Death Testimonies Hell
International Association for Near-Death Studies (IANDS)
Near-Death Experience Research Foundation (NDERF)
University of Wales, Lampeter Press release: A Near Death Experience
SpiritualTravel Explaining Neath-death Experiences Objections on current scientific arguments
Near-Death Experiences and the Afterlife Near-Death.com
High Gravity Causes of NDE Near-Death.com
Near-death experience in survivors of cardiac arrest: a prospective study in the Netherlands Lommel, Hospital Rijnstate
A Reply to Shermer: Medical Evidence for NDEs Lommel, Division of Cardiology - Hospital Rijnstate
Does Mind Survive Physical Death? Fontana, Cardiff University and Liverpool John Moores University
Who's Afraid of Life After Death? Why NDE Evidence is Ignored Grossman, Institute of Noetic Sciences (IONS)
How Stuff Works - Near Death Experience
BBC Documentary about Near Death Experience
News for the Soul, Archived Webradio Interview with P.M.H. Atwater and Dannion Brinkley on NDE research (mp3 realplayer set at 20, 32, 42 min.)
With Good Reason by VFH Radio with Bruce Greyson, November 2006
The Near Death Chronicles Part 1 The Near Death Experiences of Howard Storm, Ned Dougherty, and Dr. George Rodonaia (video documentary)
The Near Death Chronicles Part 2
The Near Death Chronicles Part 3
The Near Death Chronicles Part 4
The Near Death Chronicles Part 5
The Near Death Chronicles Part 6
Thoughtful Living, a study of near death experiences

[edit] Neutral
Scientists find proof of near-death experiences - UK newspaper article
Near Death Experience Man - humorous webcomic about a super hero
Using Ketamine to Induce the Near-Death Experience:Mechanism of Action and Therapeutic Potential - Dr. Karl L. R. Jansen MD, PhD, MRCPsych
University of Virginia Health System - Division of Personality Studies

[edit] As a physiological and psychological experience
A Special Report: What Is Betty Eadie Hiding? Christian Research Institute Journal
Skepdic Article
Near-Death Experiences: In or out of the body? - Susan Blackmore, Published in Skeptical Inquirer 1991, 16, 34-45
The Ketamine Model of the Near Death Experience:A Central Role for the NMDA Receptor - Dr. Karl L. R. Jansen MD, PhD, MRCPsych
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Against Evil · Hell · Nonbelief · Inconsistent revelations · Poor design · Transcendental · Noncognitivism · Omnipotence · Free will · Atheist's Wager · 747 Gambit · Occam's Razor
[show]v • d • eDeath and related topics
In medicine Autopsy · Brain death · Clinical death · Euthanasia · Persistent vegetative state · Terminal illness
Lists Causes of death by rate · People by cause of death · Notable deaths in 2007
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Near-Death Experience - NDE

A near-death experience (NDE) is the perception reported by a person who nearly died or who was clinically dead and revived. They are somewhat common, especially since the development of cardiac resuscitation techniques, and are reported in approximately one-fifth of persons who revive from clinical death. The experience often includes an out-of-body experience. Some people refer to this phenomenon as an 'After Death Experience'.
The phenomenology of an NDE usually includes physiological, psychological and transcendental factors (Parnia, Waller, Yeates & Fenwick, 2001) such as subjective impressions of being outside the physical body (an out-of-body experience), visions of deceased relatives and religious figures, transcendence of ego and spatiotemporal boundaries and other transcendental experiences.
Typically the experience follows a distinct progression, starting with the sensation of floating above one's body and seeing the surrounding area, followed by the sensation of passing through a tunnel, meeting deceased relatives, and concluding with encountering a being of light (Morse, Conner & Tyler, 1985).
A 'core' near-death experience reflects - as intensity increases according to the Rasch scale - peace, joy and harmony, followed by insight and mystical or religious experiences. The most intense NDEs involve an awareness of things occurring in a different place or time (Lange, Greyson & Houran, 2004).
Dr. Raymond Moody is recognized as the father of NDE research. He has chronicled and studied many of these experiences in several books (Moody, 1975;1977;1999). Another early pioneer is Dr. Kenneth Ring, co-founder and past President of the International Association for Near-Death Studies (IANDS).
Major contributions to the field include the construction of a Weighted Core Experience Index (Ring, 1980) in order to measure the depth of the Near-Death experience, and the construction of the Near-Death Experience Scale (Greyson, 1983) in order to differentiate between subjects that are more or less likely to have experienced a genuine NDE. These approaches include criteria for deciding what is to be considered a classical or authentic NDE.
Well-known researchers in the field who support a moderate view, or sympathize with aspects of the after-life view are Kevin Williams, Bruce Greyson, Michael Sabom, Melvin Morse, PMH Atwater, Yvonne Kason, Sam Parnia, Peter Fenwick, Jody A. Long and Jeffrey P. Long.
Much of this research is co-ordinated through the field of Near-Death Studies.Among the researchers who support a naturalistic and neurological base for the experience we find the British psychologist Susan Blackmore (1993), and founding publisher of Skeptic magazine, Michael Shermer (1998).
The possibility of altered temporal lobe functioning in the near-death experience is suggested by Britton & Bootzin (2004). In this study Near-Death experiencers were also found to have altered sleep patterns compared to subjects in the control group. Dr. Rick Strassman has attempted to induce NDE in a clinical setting by injecting subjects with DMT. This research is described in his book DMT - The Spirit Molecule (2001).
According to Martens (1994), the only satisfying method to address the NDE-issue would be an international multicentric data collection within the framework for standardized reporting of cardiac arrest events. The use of cardiac arrest-criteria as a basis for NDE-research has been a common approach among the European branch of the research field (Parnia, Waller, Yeates & Fenwick, 2001; van Lommel, van Wees, Meyers & Elfferich, 2001).
Many commentators see near death experiences as an afterlife experience, and some accounts include elements that, according to some theorists, are most simply explained by an out-of-body consciousness. For example, in one account, a woman accurately described a surgical instrument she had not seen previously, as well as a conversation that occurred while she was understood to be clinically dead (Sabom, 1998).
In another account, from a proactive Dutch NDE study, a nurse removed the dentures of an unconscious heart attack victim, and was asked by him after his recovery to return them (van Lommel et.al, 2001).
However, researchers have been unsuccessful in running proactive experiments to establish out-of-body consciousness. There have been numerous experiments in which a random message was placed in a hospital in a manner that it would be invisible to patients or staff yet visible to a floating being, but so far, according to Blackmore (1991), these experiments have only provided equivocal results and no clear signs of ESP.
Other commentators see near death experiences as a purely naturalistic phenomenon. For example; a Swiss study (Blanke. et.al, 2002), published in Nature Magazine, found that electrical stimulation on the brain region known as the right angular gyrus repeatedly caused out-of-body experiences to the patient.
According to this perspective the etiology of the NDE is understood as a result of neurobiological mechanisms, related to such factors as epilepsy and brain stimulation. The similarities amongst the experiences of the many documented cases of NDE may be understood to signify that the pathology of the brain during the dying and reviving process is more or less the same in all humans, as suggested by Russian specialist Dr. Vladimir Negovsky (Unkn. publ. year) in Clinical Death As Seen by Reanimator.
However, this model fails to explain NDEs that result from close brushes to death where the brain does not actually suffer trauma, such as a near-miss automobile accident.A well-known scientific hypothesis that attempts to explain NDEs was originally suggested by Dr. Karl Jansen (1995;1997) and deals with accounts of the side-effects of the drug Ketamine. Ketamine was used as an anesthetic on U.S. soldiers during the Vietnam War; but its use was abandoned and never spread to civilian use because the soldiers complained about sensations of floating above their body and seeing bright lights.
Further experiments by numerous researchers verified that intravenous injections of ketamine could reproduce all of the commonly cited features of an NDE; including a sense that the experience is "real" and that one is actually dead, separation from the body, visions of loved ones, and transcendent mystical experiences.
Ketamine acts in part by blocking the NMDA receptor for the neurotransmitter glutamate. Glutamate is released in abundance when brain cells die, and if it weren't blocked, the glutamate overload would cause other brain cells to die as well. In the presence of excess glutamate, the brain releases its own NMDA receptor blocker to defend itself; and it is these blockers Dr. Jansen (amongst others) hypothesize as the cause of many NDEs. Shawn Thomas, director of Neurotransmitter.net, has suggested that agmatine is the key substance involved in near-death experiences.
Dr. Jansen's own shifting perspective on the conclusions to be drawn from the ketamine-NDE analogy has been notable. He started out as an unequivocal debunker of the notion that NDE's are evidence of a spiritual (or at least transnormal) realm. But with time he has developed a more agnostic hypothesis: that ketamine may in fact be one particularly powerful trigger of authentic spiritual experiences - of which near-death may be another.
In each case, according to Jansen's more recent pronouncements, all we can say is that the subject gets catapulted out of ordinary 'egoic' consciousness into an altered state - we cannot comfortably rule out the possibility that the 'worlds' disclosed in these 'trips' have ontological status. Latterly, therefore, Jansens position appears closer to thinkers like Daniel Pinchbeck (2002), who has written a book on hallucinogenic shamanism, and other names like Carl Jung, Ken Wilber and Stanislav Grof, than to thinkers like Susan Blackmore or Nicholas Humphrey (two particularly high-profile materialist skeptics).
Ultimately, the hallucination theory is one which is very convincing to materialists, and very unconvincing to the vast majority of NDE experiencers
Spiritual and psychological after-effects
NDE subjects often report long-term after-effects, and changes in worldview, such as an increased interest in spirituality, an increased interest in the meaning of life, increased empathic understanding and a decrease in fear of death (van Lommel et.al, 2001).
Some subjects also report internal feelings of bodily energy and/or altered states of consciousness similar to those associated with the yogic concept of kundalini (Greyson, 2000). Greyson (1983) developed The Near-Death Experience Scale in order to measure the after-effects of a near-death experience.
This research note that the aftermath of the experience is associated with both positive and healthy outcomes related to personality and appreciation for life, but also a spectrum of clinical problems in situations where the person has had difficulties with the experience (Orne, 1995). These difficulties are usually connected to the interpretation of the experience and the integration of it into everyday life. The near-death experience as a focus of clinical attention, and the inclusion of a new diagnostic category in the DSM-IV called "Religious or spiritual problem" (American Psychiatric Association, 1994 - Code V62.89), is discussed more closely by Greyson (1997) and Lukoff, Lu & Turner (1998).
Simpson (2001) notes that the number of people that have experienced an NDE might be higher than the number of cases that are actually reported. It is not unusual for near-death experiencers to feel profound insecurity related to how they are going to explain something that the surrounding culture perceives as a strange, paranormal incident.
Metaphysics
In a near-death experience the spirit - soul spark - leaves the physical body usually after a major trauma - accidents, illnesses, problems in surgery - cardiac arrest - anaphylactic shock, coma, fever, anesthetic, unconsciousness, physical injury, arrhythmia, seizures, suicide, or severe allergic reactions. It is a moment of release by the soul from the physical.
Most people report that they are outside of their physical bodies - traveling through a tunnel toward a source of white light - the creational source of our reality.
They usually report meeting a deceased relative or heavenly being, coming to a precipice or place where a decision about life or death must take place, seeing one's life pass before their eyes, sometimes in order called a 'life review', acute awareness, a feeling of timelessness, and intense emotions.
Most near-death experiences are positive but occasionally negative experiences do occur. Upon awakening the near-death experiencer may return with unusual abilities previously unknown to them. Some of these include: seeing auras and other related paranormal abilities, awareness of science and other technologies regarding time and space, change in personality and spiritual transformations.
In what seems like a long period of time to the soul, though perhaps only several seconds or minutes in our linear time, the soul may get to review what will happen to it should it return. There are always the physical ailments that may or may not heal. Then there are those that would be left behind to consider. As linear time does not exist in other than our physical dimensional reality, the soul will often ponder it's choices.
Sometimes a soul will come back even if it does not want to as it has issues to work out. Usually that soul will consider this a second chance and become more spiritual in the remaining time it has here on earth. Many of these souls have gone on to write about near-death experiences to help others understand what is going on, on the other side.
Many believe that have returned because they have been chosen to do something spiritual for the planet. Most people who return do have a more spiritual slant on life. After all they have faced the other side and should return on a higher frequency and with more knowledge. Some go on to become healers or helpers.
Some people remember their near-death experiences while others have some vague memories.
This is similar to dreamtime wherein some people wake up and remember events on the other side - while others have no memory of anything.
I had a near-death experience at age 5 when I had pneumonia and nearly died. I was in the hospital and saw myself out of my body watching. Next thing I knew I was sitting on the branch of a tree with a little boy my age - talking about meeting again in this lifetime - much later on - to do something related to the tree. (This could symbolize the Tree of life - based on they way my life path has unfolded.) I don't think I've met him yet - but I feel him connected on another level where we still meet on the other side. I also know this links with Alexander in my book Sarah and Alexander.
In January 2000, I had a dream that was like a near-death experience in that I remember being in a source of light. Then hearing water whooshing and remember moving backwards through the tunnel as I looked at 2 entities that I recognized as other aspects of my soul. Quickly, I returned to my physical body and woke up.
The media has given much publicity to near-death experiences as the are reported more openly and freely. They are another way for souls to remember their connection to a Source of Consciousness or Light of Consciousness Creation.
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ARTICLES

Show me heaven BBC - January 2004
As more and more people come forward with accounts of near-death experiences, new research is about to examine the out of body experience to see whether mind and body really do separate at the point of death.
Scientists Validate Near-Death Experiences ABC News - January 2002
A new study validates near-death experiences reported by heart attack patients.
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Evidence of 'life after death'
October 23, 2000 - BBC
Scientists investigating 'near-death' experiences say they have found evidence to suggest that consciousness can continue to exist after the brain has ceased to function.
However, the claim has been challenged by neurological experts.
The researchers interviewed 63 patients who had survived heart attacks within a week of the experience.
Of these 56 had no recollection of the period of unconsciousness they experienced whilst, effectively, clinically dead.
However, seven had memories, four of which counted as near-death experiences.
They told of feelings of peace and joy, time speeded up, heightened senses, lost awareness of body, seeing a bright light, entering another world, encountering a mystical being and coming to "a point of no return".
None of the patients were found to be receiving low oxygen levels - which some scientists believe may be responsible for so-called "near-death" experiences.
Lead researcher Dr Sam Parnia, of Southampton General Hospital, said nobody fully understands how brain cells generate thoughts.
He said it might be that the mind or consciousness is independent of the brain.
He said: "When we examine brain cells we see that brain cells are like any other cells, they can produce proteins and chemicals, but they are not really capable of producing the subjective phenomenon of thought that we have.
"The brain is definitely needed to manifest the mind, a bit like how a television set can take what essentially are waves in the air and translate them into picture and sound."
Dr Chris Freeman, consultant psychiatrist and psychotherapist at Royal Edinburgh Hospital, said there was no proof that the experiences reported by the patients actually occurred when the brain was shut down.
"We know that memories are extremely fallible. We are quite good at knowing that something happened, but we are very poor at knowing when it happened.
"It is quite possible that these experiences happened during the recovery, or just before the cardiac arrest. To say that they happened when the brain was shut down, I think there is little evidence for that at all."
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Life after near death

More people are now brought back from the brink
February 4, 2000 - BBC News
From the corner of the room, Christine Ellingham says she could see emergency medical staff crowding around an unconscious body.
They were desperately trying to revive the woman, and to save her unborn baby.
"I knew that it was me lying on the table. But I was outside of my body, floating in the corner of the room. I was very calm and it made perfect sense to me that I should be watching what I understood to be the final moments of my life.

"I felt absolute peace and serenity. There was light around me and it grew and grew until I couldn't see my body any more.
"Then I felt an amazing sensation of rushing forwards through the light, or rather that the light was rushing back over me. I couldn't see him, but I knew that my father, who had died four years previously, was there with me, and I felt totally, totally safe."
"I felt that my father was almost carrying me, like I was a child again, and then the light slowed and stopped and my father told me that my baby needed me. I felt very sad that I had to leave, but I wanted to be with my baby.
"There was another instant where I was still surrounded by light, and then, bang! I slammed backwards."
She said that the next thing she experienced was "excruciating pain" - and her eyes opened and she saw the nurses she said she had seen from behind just moments ago.
"I cried and cried. I was in so much pain, but I felt an elation and a certainty that both me and my baby were going to live."
Christine underwent an emergency Caesarian operation, and her son Liam, her first child, was born six weeks early. She said that she had been planning to go back to work as soon as possible, but instead decided to look after Liam full-time.
he said: "I was spared, and I was spared to look after Liam. I have never been a religious person, but the experience has made me feel secure that there is an afterlife, and the people that I love and have passed away are still there, watching over me and my family."
Professor Paul Badham of Lampeter University - who studies the philosophical implications of near death experiences - said that despite media hype, the phenomenon is quite rare.
However, he says the reports of people who have had near death experiences tend to contain similar elements.
"It is very common for people to report going out of their body and looking down on their body," he said
"Going through a tunnel is also a common experience, as is being surrounded by light. The meeting of deceased relatives or friends is also commonly reported.
"People will also say that they feel they are in the presence of a spiritual reality. A Christian may interpret this as Jesus. One atheist who had an out of body experience said that he later realized that this presence was responsible for the governance of the universe."
Prof Badham said that the numbers of people experiencing the phenomena are rising, as medicine improves and pulls more people back from the brink.
He says that people who report near death experience sometimes "see" things that it would have been impossible for them to see if they had been unconscious on an operating table.
He said: "Not everyone who is near death has this experience - it just does not follow that it is a last physical response to death.
"This is an experience which transcends cultures, religions and classes - I believe this experience is probably the base for our belief in an afterlife."

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Near-death experience in survivors of cardiac arrest: a prospective study in the Netherlands

Near-death experience in survivors of cardiac arrest: a prospective study in the Netherlands
Pim van Lommel, Ruud van Wees, Vincent Meyers, Ingrid Elfferich
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Division of Cardiology, Hospital Rijnstate, Arnhem, Netherlands (P van Lommel MD); Tilburg, Netherlands (R van Wees PhD); Nijmegen, Netherlands (V Meyers PhD); and Capelle a/d Ijssel, Netherlands (I Elfferich PhD)
________________________________________
Correspondence to: Dr Pim van Lommel, Division of Cardiology, Hospital Rijnstate, PO Box 9555, 6800 TA Arnhem, Netherlands (e-mail:pimvanlommel@wanadoo.nl)

Summary
Introduction
Methods
Results
Discussion
References

Summary
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.
Lancet 2001; 358: 2039-45

See Commentary

Introduction
Some people who have survived a life-threatening crisis report an extraordinary experience. Near-death experience (NDE) occurs with increasing frequency because of improved survival rates resulting from modern techniques of resuscitation. The content of NDE and the effects on patients seem similar worldwide, across all cultures and times. The subjective nature and absence of a frame of reference for this experience lead to individual, cultural, and religious factors determining the vocabulary used to describe and interpret the experience.1
NDE are reported in many circumstances: cardiac arrest in myocardial infarction (clinical death), shock in postpartum loss of blood or in perioperative complications, septic or anaphylactic shock, electrocution, coma resulting from traumatic brain damage, intracerebral haemorrhage or cerebral infarction, attempted suicide, near-drowning or asphyxia, and apnoea. Such experiences are also reported by patients with serious but not immediately life-threatening diseases, in those with serious depression, or without clear cause in fully conscious people. Similar experiences to near-death ones can occur during the terminal phase of illness, and are called deathbed visions. Identical experiences to NDE, so-called fear-death experiences, are mainly reported after situations in which death seemed unavoidable: serious traffic accidents, mountaineering accidents, or isolation such as with shipwreck.
Several theories on the origin of NDE have been proposed. Some think the experience is caused by physiological changes in the brain, such as brain cells dying as a result of cerebral anoxia.2-4 Other theories encompass a psychological reaction to approaching death,5 or a combination of such reaction and anoxia.6 Such experiences could also be linked to a changing state of consciousness (transcendence), in which perception, cognitive functioning, emotion, and sense of identity function independently from normal body-linked waking consciousness.7 People who have had an NDE are psychologically healthy, although some show non-pathological signs of dissociation.7 Such people do not differ from controls with respect to age, sex, ethnic origin, religion, or degree of religious belief.1
Studies on NDE1,3,8,9 have been retrospective and very selective with respect to patients. In retrospective studies, 5-10 years can elapse between occurrence of the experience and its investigation, which often prevents accurate assessment of physiological and pharmacological factors. In retrospective studies, between 43%8 and 48%1 of adults and up to 85% of children10 who had a life-threatening illness were estimated to have had an NDE. A random investigation of more than 2000 Germans showed 4•3% to have had an NDE at a mean age of 22 years.11 Differences in estimates of frequency and uncertainty as to causes of this experience result from varying definitions of the phenomenon, and from inadequate methods of research.12 Patients' transformational processes after an NDE are very similar1,3,13-16 and encompass life-changing insight, heightened intuition, and disappearance of fear of death. Assimilation and acceptance of these changes is thought to take at least several years.15
We did a prospective study to calculate the frequency of NDE in patients after cardiac arrest (an objective critical medical situation), and establish factors that affected the frequency, content, and depth of the experience. We also did a longitudinal study to assess the effect of time, memory, and suppression mechanisms on the process of transformation after NDE, and to reaffirm the content and allow further study of the experience. We also proposed to reassess theories on the cause and content of NDE.

Methods
Patients
We included consecutive patients who were successfully resuscitated in coronary care units in ten Dutch hospitals during a research period varying between hospitals from 4 months to nearly 4 years (1988-92). The research period varied because of the requirement that all consecutive patients who had undergone successful cardiopulmonary resuscitation (CPR) were included. If this standard was not met we ended research in that hospital. All patients had been clinically dead, which we established mainly by electrocardiogram records. All patients gave written informed consent. We obtained ethics committee approval.
Procedures
We defined NDE as the reported memory of all impressions during a special state of consciousness, including specific elements such as out-of-body experience, pleasant feelings, and seeing a tunnel, a light, deceased relatives, or a life review. We defined clinical death as a period of unconsciousness caused by insufficient blood supply to the brain because of inadequate blood circulation, breathing, or both. If, in this situation, CPR is not started within 5-10 min, irreparable damage is done to the brain and the patient will die.
We did a short standardised interview with sufficiently well patients within a few days of resuscitation. We asked whether patients recollected the period of unconsciousness, and what they recalled. Three researchers coded the experiences according to the weighted core experience index.1 In this scoring system, depth of NDE is measured with weighted scores assigned to elements of the content of the experience. Scores between 1 and 5 denote superficial NDE, but we included these events because all patients underwent transformational changes as well. Scores of 6 or more denote core experiences, and scores of 10 or greater are deep experiences. We also recorded date of cardiac arrest, date of interview, sex, age, religion, standard of education reached, whether the patient had previously experienced NDE, previously heard of NDE, whether CPR took place inside or outside hospital, previous myocardial infarction, and how many times the patient had been resuscitated during their stay in hospital. We estimated duration of circulatory arrest and unconsciousness, and noted whether artificial respiration by intubation took place. We also recorded type and dose of drugs before, during, and after the crisis, and assessed possible memory problems at interview after lengthy or difficult resuscitation. We classed patients resuscitated during electrophysiological stimulation separately.
We did standardised and taped interviews with participants a mean of 2 years after CPR. Patients also completed a life-change inventory.16 The questionnaire addressed self-image, concern with others, materialism and social issues, religious beliefs and spirituality, and attitude towards death. Participants answered 34 questions with a five-point scale indicating whether and to what degree they had changed. After 8 years, surviving patients and their partners were interviewed again with the life-change inventory, and also completed a medical and psychological questionnaire for cardiac patients (from the Dutch Heart Foundation), the Utrecht coping list, the sense of coherence inquiry, and a scale for depression. These extra questionnaires were deemed necessary for qualitative analysis because of the reduced number of respondents who survived to 8 years follow-up. Our control group consisted of resuscitated patients who had not reported an NDE. We matched controls with patients who had had an NDE by age, sex, and time interval between CPR and the second and third interviews.
Statistical analysis
We assessed causal factors for NDE with the Pearson2 test for categorical and t test for ratio-scaled factors. Factors affecting depth of NDE were analysed with the Mann-Whitney test for categorical factors, and with Spearman's coefficient of rank correlation for ratio-scaled factors. Links between NDE and altered scores for questions from the life-change inventory were assessed with the Mann-Whitney test. The sums of the individual scores were used to compare the responses to the life-change inventory in the second and third interview. Because few causes or relations exist for NDE, the null hypotheses are the absence of factors. Hence, all tests were two-tailed with significance shown by p values less than 0•05.

Results
Patients
We included 344 patients who had undergone 509 successful resuscitations. Mean age at resuscitation was 62•2 years (SD 12•2), and ranged from 26 to 92 years. 251 patients were men (73%) and 93 were women (27%). Women were significantly older than men (66 vs 61 years, p=0•005).The ratio of men to women was 57/43 for those older than 70 years, whereas at younger ages it was 80/20. 14 (4%) patients had had a previous NDE. We interviewed 248 (74%) patients within 5 days after CPR. Some demographic questions from the first interview had too many values missing for reliable statistical analysis, so data from the second interview were used. Of the 74 patients whom we interviewed at 2-year follow-up, 42 (57%) had previously heard of NDE, 53 (72%) were religious, 25 (34%) had left education aged 12 years, and 49 (66%) had been educated until aged at least 16 years.
296 (86%) of all 344 patients had had a first myocardial infarction and 48 (14%) had undergone more than one infarction. Nearly all patients with acute myocardial infarction were treated with fentanyl, a synthetic opiod antagonist; thalamonal, a combined preparation of fentanyl with dehydrobenzperidol that has an antipsychotic and sedative effect; or both. 45 (13%) patients also received sedative drugs such as diazepam or oxazepam, and 38 (11%) were given strong sedatives such as midazolam (for intubation), or haloperidol for cerebral unrest during or after long-lasting unconsciousness.
234 (68%) patients were successfully resuscitated within hospital. 190 (81%) of these patients were resuscitated within 2 min of circulatory arrest, and unconsciousness lasted less than 5 min in 187 (80%). 30 patients were resuscitated during electrophysiological stimulation; these patients all underwent less than 1 min of circulatory arrest and less than 2 min of unconsciousness. This group were only given 5 mg of diazepam about 1 h before electrophysiological stimulation.
101 (29%) patients survived CPR outside hospital, and nine (3%) were resuscitated both within and outside hospital. Of these 110 patients, 88 (80%) had more than 2 min of circulatory arrest, and 62 (56%) were unconscious for more than 10 min. All people with brief cardiac arrest and who were resuscitated outside hospital were resuscitated in an ambulance. Only 12 (9%) patients survived a circulatory arrest that lasted longer than 10 min. 36% (123) of all patients were unconsciousness for longer than 60 min, 37 of these patients needed artificial respiration through intubation. Intubated patients received high doses of strong sedatives and were interviewed later than other patients; most were still in a weakened physical condition at the time of first interview and 24 showed memory defects. Significantly more younger than older patients survived long-lasting unconsciousness following difficult CPR (p=0•005).
Prospective findings
62 (18%) patients reported some recollection of the time of clinical death (table 1). Of these patients, 21 (6% of total) had a superficial NDE and 41 (12%) had a core experience. 23 of the core group (7% of total) reported a deep or very deep NDE. Therefore, of 509 resuscitations, 12% resulted in NDE and 8% in core experiences. Table 2 shows the frequencies of ten elements of NDE.1 No patients reported distressing or frightening NDE.
________________________________________
WCEI score* n
A No memory 0 282 (82%)
B Some recollection 1-5 21 (6%)
C Moderately deep NDE 6-9 18 (5%)
D Deep NDE 10-14 17 (5%)
E Very deep NDE 15-19 6 (2%)
WCEI=weighted core experience index. NDE=near-death experience. *A=no NDE, B=superficial NDE, C/D/E=core NDE.
Table 1: Distribution of the 344 patients in five WCEI classes*
________________________________________
________________________________________
Elements of NDE1 Frequency (n=62)
1 Awareness of being dead 31 (50%)
2 Positive emotions 35 (56%)
3 Out of body experience 15 (24%)
4 Moving through a tunnel 19 (31%)
5 Communication with light 14 (23%)
6 Observation of colours 14 (23%)
7 Observation of a celestial landscape 18 (29%)
8 Meeting with deceased persons 20 (32%)
9 Life review 8 (13%)
10 Presence of border 5 (8%)
NDE=near-death experience.
Table 2: Frequency of ten elements of NDE
________________________________________
During the pilot phase in one of the hospitals, a coronary-care-unit nurse reported a veridical out-of-body experience of a resuscitated patient:
"During a night shift an ambulance brings in a 44-year-old cyanotic, comatose man into the coronary care unit. He had been found about an hour before in a meadow by passers-by. After admission, he receives artificial respiration without intubation, while heart massage and defibrillation are also applied. When we want to intubate the patient, he turns out to have dentures in his mouth. I remove these upper dentures and put them onto the 'crash car'. Meanwhile, we continue extensive CPR. After about an hour and a half the patient has sufficient heart rhythm and blood pressure, but he is still ventilated and intubated, and he is still comatose. He is transferred to the intensive care unit to continue the necessary artificial respiration. Only after more than a week do I meet again with the patient, who is by now back on the cardiac ward. I distribute his medication. The moment he sees me he says: 'Oh, that nurse knows where my dentures are'. I am very surprised. Then he elucidates: 'Yes, you were there when I was brought into hospital and you took my dentures out of my mouth and put them onto that car, it had all these bottles on it and there was this sliding drawer underneath and there you put my teeth.' I was especially amazed because I remembered this happening while the man was in deep coma and in the process of CPR. When I asked further, it appeared the man had seen himself lying in bed, that he had perceived from above how nurses and doctors had been busy with CPR. He was also able to describe correctly and in detail the small room in which he had been resuscitated as well as the appearance of those present like myself. At the time that he observed the situation he had been very much afraid that we would stop CPR and that he would die. And it is true that we had been very negative about the patient's prognosis due to his very poor medical condition when admitted. The patient tells me that he desperately and unsuccessfully tried to make it clear to us that he was still alive and that we should continue CPR. He is deeply impressed by his experience and says he is no longer afraid of death. 4 weeks later he left hospital as a healthy man."
Table 3 shows relations between demographic, medical, pharmacological, and psychological factors and the frequency and depth of NDE. No medical, pharmacological, or psychological factor affected the frequency of the experience. People younger than 60 years had NDE more often than older people (p=0•012), and women, who were significantly older than men, had more frequent deep experiences than men (p=0•011) (table 3). Increased frequency of experiences in patients who survived cardiac arrest in first myocardial infarction, and deeper experiences in patients who survived CPR outside hospital could have resulted from differences in age. Both these groups of patients were younger than other patients, though the age differences were not significant (p=0•05 and 0•07, respectively).
________________________________________
Frequency of NDE Depth
NDE No NDE p of NDE
(n=62) (n=282) (n=62)
Categorical factors
Demographic
Women 13 (21%) 80 (28%) NS 0•011
Age* <60 years 32 (52%) 96 (34%) 0•012 NS
Religion† (yes) 26 (70%) 27 (73% ) NS NS
Education†‡ Elementary 10 (27%) 15 (43%) NS NS
Medical
Intubation 6 (10%) 31 (11%) NS NS
Electrophysiological 8 (13%) 22 (8%) NS NS
stimulation
First myocardial 60 (97%) 236 (84%) 0•013 NS
infarction
CPR outside hospital§ 13 (21%) 88 (32%) NS 0•027
Memory defect after 1 (2%) 40 (14%) 0•011 NS
lengthy CPR
Death within 30 days 13 (21%) 24 (9%) 0•008 0•017
Pharmacological
Extra medication 17 (27%) 70 (25%) NS NS
Psychological
Fear before CPR†§ 4 (13%) 2 (6%) NS 0•045
Previous NDE 6 (10%) 8 (3%) 0•035 NS
Foreknowledge of NDE† 22 (60%) 20 (54%) NS NS
Ratio-scaled factors
Demographic
Age (mean [SD], years)* 58•8 (13•4) 63•5 (11•8) 0•006 NS
Medical
Duration of cardiac 4•0 (5•2) 3•7 (3•9) NS NS
arrest (mean [SD], min)
Duration of 66•1 (269•5) 118•3 (355•5) NS
NS
unconsciousness
(mean [SD], min)
Number of CPRs (SD) 2•1 (2•5) 1•4 (1•2) 0•029 NS
Data are number (%) unless otherwise indicated. CPR=cardiopulmonary resuscitation. NS=not significant (p>0•05). *3 missing values. †n=74 (data from 2nd interview, 35 NDE, 39 no NDE). ‡2 missing values. §10 missing values.
Table 3: Factors affecting frequency and depth of near-death experience (NDE)
________________________________________
Lengthy CPR can sometimes induce loss of memory and patients thus affected reported significantly fewer NDEs than others (table 3). No relation was found between frequency of NDE and the time between CPR and the first interview (range 1-70 days). Mortality during or shortly after stay in hospital in patients who had an NDE was significantly higher than in patients who did not report an NDE (13/62 patients [21%] vs 24/282 [9%], p=0•008), and this difference was even more marked in patients who reported a deep experience (10/23 [43%] vs 24/282 [9%], p<0•0001).
Longitudinal findings
At 2-year follow-up, 19 of the 62 patients with NDE had died and six refused to be interviewed. Thus, we were able to interview 37 patients for the second time. All patients were able to retell their experience almost exactly. Of the 17 patients who had low scores in the first interview (superficial NDE), seven had unchanged low scores, and four probably had, in retrospect, an NDE that consisted only of positive emotions (score 1). Six patients had not in fact had an NDE after all, which was probably because of our wide definition of NDE at the first interview.
We selected a control group, matched for age, sex, and time since cardiac arrest, from the 282 patients who had not had NDE. We contacted 75 of these patients to obtain 37 survivors who agreed to be interviewed. Two controls reported an NDE consisting only of positive emotions, and two a core experience. The first interview after CPR might have been too soon for these four patients (1% of total) to remember their NDE, or to be willing or able to describe the experience. We were therefore able to interview 35 patients who had had an affirmed NDE, and 39 patients who had not.
Only six of the 74 patients that we interviewed at 2 years said they were afraid before CPR (table 3). Four of these six had deep NDE (p=0•045, table 3). Most patients were not afraid before CPR, as the arrest happened too suddenly and unexpectedly to allow time for fear.
Significant differences in answers to 13 of the 34 items in the life-change inventory between people with and without an NDE are shown in table 4. For instance, people who had NDE had a significant increase in belief in an afterlife and decrease in fear of death compared with people who had not had this experience. Depth of NDE was linked to high scores in spiritual items such as interest in the meaning of one's own life, and social items such as showing love and accepting others. The 13 patients who had superficial NDE underwent the same specific transformational changes as those who had a core experience.
________________________________________
LIfe-change inventory questionnaire p
Social attitude
Showing own feelings 0•034
Acceptance of others* 0•012
More loving, empathic* 0•002
Understanding others* 0•003
Involvement in family* 0•008
Religious attitude
Understand purpose of life* 0•020
Sense inner meaning of life* 0•028
Interest in spirituality* 0•035
Attitude to death
Fear of death* 0•009
Belief in life after death* 0•007
Others
Interest in meaning of life 0•020
Understanding oneself 0•019
Appreciation of ordinary things 0•0001
NDE=near-death experience. 35 patients had NDE, 39 had not had NDE. 1 value missing for patients wih NDE in all categories; *2 values missing for patients with NDE (ie, n=33).
Table 4: Significant differences in life-change inventory-scores16 of patients with and without NDE at 2-year follow-up
________________________________________
8-year follow-up included 23 patients with an NDE that had been affirmed at 2-year follow-up. 11 patients had died and one could not be interviewed. Patients could still recall their NDE almost exactly. Of the patients without an NDE at 2-year follow-up, 20 had died and four patients could not be interviewed (for reasons such as dementia and long stay in hospital), which left 15 patients without an NDE to take part in the third interview.
All patients, including those who did not have NDE, had gone through a positive change and were more self-assured, socially aware, and religious than before. Also, people who did not have NDE had become more emotionally affected, and in some, fear of death had decreased more than at 2-year follow-up. Their interest in spirituality had strongly decreased. Most patients who did not have NDE did not believe in a life after death at 2-year or 8-year follow-up (table 5). People with NDE had a much more complex coping process: they had become more emotionally vulnerable and empathic, and often there was evidence of increased intuitive feelings. Most of this group did not show any fear of death and strongly believed in an afterlife. Positive changes were more apparent at 8 years than at 2 years of follow-up.
________________________________________
Life-change inventory 2-year follow-up 8-year follow-up
questionnaire NDE no NDE NDE no NDE
(n=23) (n=15) (n=23) (n=15)
Social attitude
Showing own feelings 42 16 78 58
Acceptance of others 42 16 78 41
More loving, empathic 52 25 68 50
Understanding others 36 8 73 75
Involvement in family 47 33 78 58
Religious attitude
Understand purpose of life 52 33 57 66
Sense inner meaning of life 52 25 57 25
Interest in spirituality 15 -8 42 -41
Attitude to death
Fear of death -47 -16 -63 -41
Belief in life after death 36 16 42 16
Others
Interest in meaning of life 52 33 89 66
Understanding oneself 58 8 63 58
Appreciation of ordinary things 78 41 84 50
NDE=near-death experience. The sums of all individual scores per item are reported in the same 38 patients who had both follow-up interviews. Participants responded in a five-point scale indicating whether and to what degree they had changed: strongly increased (+2), somewhat increased (+1), no change (0), somewhat decreased (-1), and strongly decreased (-2). Only in the reported 13 (of 34) items in this table were significant differences found in life-change scores in the interview after 2 years (table 4).
Table 5: Total sum of individual life-change inventory scores16 of patients at 2-year and 8-year follow-up
________________________________________

Discussion
Our results show that medical factors cannot account for occurrence of NDE; although all patients had been clinically dead, most did not have NDE. Furthermore, seriousness of the crisis was not related to occurrence or depth of the experience. If purely physiological factors resulting from cerebral anoxia caused NDE, most of our patients should have had this experience. Patients' medication was also unrelated to frequency of NDE. Psychological factors are unlikely to be important as fear was not associated with NDE.
The 18% frequency of NDE that we noted is lower than reported in retrospective studies,1,8 which could be because our prospective study design prevented self-selection of patients. Our frequency of NDE is low despite our wide definition of the experience. Only 12% of patients had a core NDE, and this figure might be an overestimate. When we analysed our results, we noted that one hospital that participated in the study for nearly 4 years, and from which 137 patients were included, reported a significantly (p=0•01) lower percentage of NDE (8%), and significantly (p=0•05) fewer deep experiences. Therefore, possibly some selection of patients occurred in the other hospitals, which sometimes only took part for a few months. In a prospective study17 with the same design as ours, 6% of 63 survivors of cardiac arrest reported a core experience, and another 5% had memories with features of an NDE (low score in our study); thus, with our wide definition of the experience, 11% of these patients reported an NDE. Therefore, true frequency of the experience is likely to be about 10%, or 5% if based on number of resuscitations rather than number of resuscitated patients. Patients who survive several CPRs in hospital have a significantly higher chance of NDE (table 3).
We noted that the frequency of NDE was higher in people younger than 60 years than in older people. In other studies, mean age at NDE is lower than our estimate (62•2 years) and the frequency of the experience is higher. Morse10 saw 85% NDE in children, Ring1 noted 48% NDE in people with a mean age of 37 years, and Sabom8 saw 43% NDE in people with a mean age of 49 years; thus, age and the frequency of the experience seem to be associated. Other retrospective studies have noted a younger mean age for NDE: 32 years,9 29 years,6 and 22 years.11 Cardiac arrest was the cause of the experience in most patients in Sabom's8 study, whereas this was the case in only a low percentage of patients in other work. We saw that people surviving CPR outside hospital (who underwent deeper NDE than other patients) tended to be younger, as were those who survived cardiac arrest in a first myocardial infarction (more frequent NDE), which indicates that age was probably decisive in the significant relation noted with those factors.
In a study of mortality in patients after resuscitation outside hospital,18 chances of survival increased in people younger than 60 years and in those undergoing first myocardial infarction, which corresponds with our findings. Older people have a smaller chance of cerebral recovery after difficult and complicated resuscitation after cardiac arrest. Younger patients have a better chance of surviving a cardiac arrest, and thus, to describe their experience. In a study of 11 patients after CPR, the person that had an NDE was significantly younger than other patients who did not have such an experience.19 Greyson7 also noted a higher frequency of NDE and significantly deeper experiences at younger ages, as did Ring.1
Good short-term memory seems to be essential for remembering NDE. Patients with memory defects after prolonged resuscitation reported fewer experiences than other patients in our study. Forgetting or repressing such experiences in the first days after CPR was unlikely to have occurred in the remaining patients, because no relation was found between frequency of NDE and date of first interview. However, at 2-year follow-up, two patients remembered a core NDE and two an NDE that consisted of only positive emotions that they had not reported shortly after CPR, presumably because of memory defects at that time. It is remarkable that people could recall their NDE almost exactly after 2 and 8 years.
Unlike our results, an inverse correlation between foreknowledge and frequency of NDE has been shown.1,8 Our finding that women have deeper experiences than men has been confirmed in two other studies,1,7 although in one,7 only in those cases in which women had an NDE resulting from disease.
The elements of NDE that we noted (table 2) correspond with those in other studies based on Ring's1 classification. Greyson20 constructed the NDE scale differently to Ring,1 but both scoring systems are strongly correlated (r=0•90). Yet, reliable comparisons are nearly impossible between retrospective studies that included selection of patients, unreliable medical records, and used different criteria for NDE,12 and our prospective study.
Our longitudinal follow-up research into transformational processes after NDE confirms the transformation described by many others.1-3,8,10,13-16,21 Several of these investigations included a control group to enable study of differences in transformation,14 but in our research, patients were interviewed three times during 8 years, with a matched control group. Our findings show that this process of change after NDE tends to take several years to consolidate. Presumably, besides possible internal psychological processes, one reason for this has to do with society's negative response to NDE, which leads individuals to deny or suppress their experience for fear of rejection or ridicule. Thus, social conditioning causes NDE to be traumatic, although in itself it is not a psychotraumatic experience. As a result, the effects of the experience can be delayed for years, and only gradually and with difficulty is an NDE accepted and integrated. Furthermore, the longlasting transformational effects of an experience that lasts for only a few minutes of cardiac arrest is a surprising and unexpected finding.
One limitation of our study is that our study group were all Dutch cardiac patients, who were generally older than groups in other studies. Therefore, our frequency of NDE might not be representative of all cases--eg, a higher frequency could be expected with younger samples, or rates might vary in other populations. Also, the rates for NDE could differ in people who survive near-death episodes that come about by different causes, such as near drowning, near fatal car crashes with cerebral trauma, and electrocution. However, rigorous prospective studies would be almost impossible in many such cases.
Several theories have been proposed to explain NDE. We did not show that psychological, neurophysiological, or physiological factors caused these experiences after cardiac arrest. Sabom22 mentions a young American woman who had complications during brain surgery for a cerebral aneurysm. The EEG of her cortex and brainstem had become totally flat. After the operation, which was eventually successful, this patient proved to have had a very deep NDE, including an out-of-body experience, with subsequently verified observations during the period of the flat EEG.
And yet, neurophysiological processes must play some part in NDE. Similar experiences can be induced through electrical stimulation of the temporal lobe (and hence of the hippocampus) during neurosurgery for epilepsy,23 with high carbon dioxide levels (hypercarbia),24 and in decreased cerebral perfusion resulting in local cerebral hypoxia as in rapid acceleration during training of fighter pilots,25 or as in hyperventilation followed by valsalva manoeuvre.4 Ketamine-induced experiences resulting from blockage of the NMDA receptor,26 and the role of endorphin, serotonin, and enkephalin have also been mentioned,27 as have near-death-like experiences after the use of LSD,28 psilocarpine, and mescaline.21 These induced experiences can consist of unconsciousness, out-of-body experiences, and perception of light or flashes of recollection from the past. These recollections, however, consist of fragmented and random memories unlike the panoramic life-review that can occur in NDE. Further, transformational processes with changing life-insight and disappearance of fear of death are rarely reported after induced experiences.
Thus, induced experiences are not identical to NDE, and so, besides age, an unknown mechanism causes NDE by stimulation of neurophysiological and neurohumoral processes at a subcellular level in the brain in only a few cases during a critical situation such as clinical death. These processes might also determine whether the experience reaches consciousness and can be recollected.
With lack of evidence for any other theories for NDE, the thus far assumed, but never proven, concept that consciousness and memories are localised in the brain should be discussed. How could a clear consciousness outside one's body be experienced at the moment that the brain no longer functions during a period of clinical death with flat EEG?22 Also, in cardiac arrest the EEG usually becomes flat in most cases within about 10 s from onset of syncope.29,30 Furthermore, blind people have described veridical perception during out-of-body experiences at the time of this experience.31 NDE pushes at the limits of medical ideas about the range of human consciousness and the mind-brain relation.
Another theory holds that NDE might be a changing state of consciousness (transcendence), in which identity, cognition, and emotion function independently from the unconscious body, but retain the possibility of non-sensory perception.7,8,22,28,31
Research should be concentrated on the effort to explain scientifically the occurrence and content of NDE. Research should be focused on certain specific elements of NDE, such as out-of-body experiences and other verifiable aspects. Finally, the theory and background of transcendence should be included as a part of an explanatory framework for these experiences.
Contributors
Pim van Lommel coordinated the first interviews and was responsible for collecting all demographic, medical, and pharmacological data. Pim van Lommel, Ruud van Wees, and Vincent Meyers rated the first interview. Ruud van Wees and Vincent Meyers coordinated the second interviews. Ruud van Wees did statistical analysis of the first and second interviews. Ingrid Elfferich did the third interviews and analysed these results.
Acknowledgments
We thank nursing and medical staff of the hospitals involved in the research; volunteers of the International Association of Near Death Studies; IANDS-Netherlands; Merkawah Foundation for arranging interviews, and typing the second and third interviews; Martin Meyers for help with translation; and Kenneth Ring and Bruce Greyson for review of the article.

References
1 Ring K. Life at death. A scientific investigation of the near- death experience. New York: Coward McCann and Geoghenan, 1980.
2 Blackmore S. Dying to live: science and the near-death experience. London: Grafton--an imprint of Harper Collins Publishers, 1993.
3 Morse M. Transformed by the light. New York: Villard Books, 1990.
4 Lempert T, Bauer M, Schmidt D. Syncope and near-death experience. Lancet 1994; 344: 829-30. [PubMed]
5 Appelby L. Near-death experience: analogous to other stress induced physiological phenomena . BMJ 1989; 298: 976-77. [PubMed]
6 Owens JE, Cook EW, Stevenson I. Features of "near-death experience" in relation to whether or not patients were near death . Lancet 1990; 336: 1175-77. [PubMed]
7 Greyson B. Dissociation in people who have near-death experiences: out of their bodies or out of their minds? Lancet 2000; 355: 460-63. [Text]
8 Sabom MB. Recollections of death: a medical investigation. New York: Harper and Row, 1982.
9 Greyson B. Varieties of near-death experience. Psychiatry 1993; 56: 390-99. [PubMed]
10 Morse M. Parting visions: a new scientific paradigm. In: Bailey LW, Yates J, eds. The near-death experience: a reader. New York and London: Routledge, 1996: 299-318.
11 Schmied I, Knoblaub H, Schnettler B. Todesnäheerfahrungen in Ost- und Westdeutschland--eine empirische Untersuchung. In: Knoblaub H, Soeffner HG, eds. Todesnähe: interdisziplinäre Zugänge zu einem außergewöhnlichen Phänomen. Konstanz: Universitätsverlag Konstanz, 1999: 217-50.
12 Greyson B. The incidence of near-death experiences. Med Psychiatry 1998; 1: 92-99. [PubMed]
13 Roberts G, Owen J. The near-death experience. Br J Psychiatry 1988; 153: 607-17. [PubMed]
14 Groth-Marnat G, Summers R. Altered beliefs, attitudes and behaviors following near-death experiences. J Hum Psychol 1998; 38: 110-25. [PubMed]
15 Atwater PMH. Coming back to life: the after-effects of the near-death experience. New York: Dodd, Mead and Company, 1988.
16 Ring K. Heading towards omega: in search of the meaning of the near-death experience. New York: Quill William Morrow, 1984.
17 Parnia S, Waller DG, Yeates R, Fenwick P. A qualitative and quantitative study of the incidence, features and aetiology of near death experiences in cardiac arrest survivors. Resuscitation 2001; 48: 149-56. [PubMed]
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19 Schoenbeck SB, Hocutt GD. Near-death experiences in patients undergoing cardio-pulmonary resuscitation. J Near-Death Studies 1991; 9: 211-18. [PubMed]
20 Greyson B. The near-death experience scale: construction, reliability and validity. J Nervous Mental Dis 1982; 171: 369-75. [PubMed]
21 Schröter-Kunhardt M. Nah--Todeserfahrungen aus psychiatrisch-neurologischer Sicht. In: Knoblaub H, Soeffner HG, eds. Todesnähe: interdisziplinäre Zugänge zu einem außergewöhnlichen Phänomen. Konstanz: Universitätsverlag Konstanz, 1999: 65-99.
22 Sabom MB. Light and death: one doctors fascinating account of near-death experiences. Michigan: Zondervan Publishing House, 1998: 37-52.
23 Penfield W. The excitable cortex in conscious man. Liverpool: Liverpool University Press, 1958.
24 Meduna LT. Carbon dioxide therapy: a neuropsychological treatment of nervous disorders. Springfield: Charles C Thomas, 1950.
25 Whinnery JE, Whinnery AM. Acceleration-induced loss of consciousness. Arch Neurol 1990; 47: 764-76. [PubMed]
26 Jansen K. Neuroscience, ketamine and the near-death experience: the role of glutamate and the NMDA-receptor. In: Bailey LW, Yates J, eds. The near-death experience: a reader. New York and London: Routledge, 1996: 265-82.
27 Greyson B. Biological aspects of near-death experiences. Perspect Biol Med 1998; 42: 14-32. [PubMed]
28 Grof S, Halifax J. The human encounter with death. New York: Dutton, 1977.
29 Clute HL, Levy WJ. Electroencephalographic changes during brief cardiac arrest in humans. Anesthesiology 1990; 73: 821-25. [PubMed]
30 Aminoff MJ, Scheinman MM, Griffing JC, Herre JM. Electrocerebral accompaniments of syncope associated with malignant ventricular arrhythmias. Ann Intern Med 1988; 108: 791-96. [PubMed]
31 Ring K, Cooper S. Mindsight: near-death and out-of-body experiences in the blind. Palo Alto: William James Center for Consciousness Studies, 1999.

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