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The Art of Dying

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That is all I want to say about retrospective studies, so let me turn now to the cutting edge of NDE research. This is a new and very exciting developing area: prospective studies. Just to remind you, these are studies in which the researcher begins studying the participants before they have their NDEs, and thus has information about the circumstances in which the near-death experience occurs and can start to ask focused scientific questions about it. Greyson, B. (2003a). Incidence and correlates of near-death experiences on a cardiac care unit. General Hospital Psychiatry, 25, 269–276. Ring, K. (1980). Life at death: A scientific investigation of the near-death experience. New York, NY: Coward, McCann and Geoghegan.

A major and relatively rapid shift is underway in the field of medicine. In the past 10 years, medical professionals have gone from looking upon spirituality with a skeptical if not cynical eye, to embracing it enthusiastically. Consider these developments: Now, Major Scull is very clear that his OBE happened during his cardiac arrest. What we need to do is to test this. Sartori, from Morriston hospital in the U.K., did this in a study for her Ph.D. thesis, not yet published. Using a method suggested by Janice Holden (Holden, 1988; Holden and Joesten, 1990), Sartori put randomized cards on top of the monitors displaying the patient’s medical data, which are always present in patient rooms, usually beside the bed. Because the monitors were above eye level of a person standing up, the cards on top of them could not normally be seen by the nurses. The experiences described in this book are all first-hand accounts from people who wrote to me or to David Lorimer, chairman of the International Association of Near Death Studies (UK), after a television programme, radio broadcast or magazine or newspaper article made them aware of our interest in near-death experiences. Moving on to the Schwaninger study, 30 cardiac arrest survivors were interviewed over three years (Schwaninger, Eisenberg, Schechtman, and Weiss, 2002). Twenty-three percent had NDEs, all of which were pleasurable; there were no ‘‘negative’’ NDEs. She found no difference in demographic variables, so, again, there is nothing special about people who get NDEs. How people interpreted their NDEs, however, was, as we know, based on personal, cultural, and religious views. An interesting point was that they needed psychosocial support before hospital discharge. And at 6-month follow-up – not as long as van Lommel’s, but the results show the same trend – spiritual and religious views changed, as did attitudes towards others, personal understanding, and social customs. I was also particularly interested in the heavenly music and wonderful birdsong reported by some of our participants, because of my interest in how the brain works with music. Our respondents reported mainly concordant music, strong emotional music. At that time, neuroscientists thought that music was mainly a phenomenon involving the right hemisphere of the brain; since then, the neuroscience of music has progressed and indicates that the whole brain is involved in music. Nevertheless, the strong emotional quality of this music indicated a strong involvement of the right hemisphere.Bhugra, Dinesh (1997). Psychiatry and Religion: Context, Consensus and Controversies. Routledge. ISBN 978-0-415-16512-9. Suddenly there was the most brilliant light shining from my husband’s chest, and as this light lifted upward, there was the most beautiful music and singing voices. My own chest seemed filled with infinite joy, and my heart felt as if it was lifting to join this light and music. Suddenly, there was a hand on my shoulder, and a nurse said, ‘‘Sorry, love. He’s just gone.’’ I lost sight of the light and the music and felt so bereft at being left behind. The first point is that signs of cardiac arrest are the same as clinical death. There is no detectable cardiac output, no respiratory effort, and brainstem reflexes are absent. If you are in this state and I put a tube down your throat, you will not cough. You will have dilated pupils. Your blood pressure has fallen to zero. You are, in fact, clinically dead. Even if I start cardiopulmonary resuscitation (CPR), I cannot get your blood pressure any higher than 30 millimeters of mercury, and this is not going to produce an adequate blood flow to your brain. In 1963, I nearly died from a suicide attempt. I went down into a deep pit, slowly, like Alice in Wonderland, as if I were in a lift.

I want now particularly to mention van Lommel’s Dutch study (van Lommel, van Wees, Meyers, and Elfferich, 2001). This was a huge study, with 344 cardiac arrest survivors in 10 hospitals. Forty-one survivors reported NDEs. The occurrence of NDEs was not influenced by the duration of either unconsciousness or cardiac arrest, or by medication. So that is really interesting: you do not have to be unconscious for long, but there may be a critical limit; we do not know. More NDEs were reported in the group of survivors who actually died shortly after their experience, so it looks as though the closer you are to death, the more likely you are to get an NDE.Krupitsky, E. M., and Grinenko, A. Y. (1997). Ketamine psychedelic therapy (KPT): A review of the results of ten years of research. Journal of Psychoactive Drugs, 29, 165–183. Greyson, B. (1983). The near-death experience scale: Construction, reliability, and validity. Journal of Nervous and Mental Disease, 171, 369–375. So although the ketamine model is the best scientific candidate so far to account for the NDE in cardiac arrest, it cannot explain every feature of NDEs. And I am not sure that even if we say that the NDE is a ketamine-like experience, we can, in fact, completely understand the whole of the NDE during cardiac arrest. Because we are left with the problem of exactly when does the NDE occur? And the only way you can get an answer to this is through out-of-body experiences (OBEs). In the final part of this presentation, I would like to try and put the near-death experience in the context that I feel it deserves. Is the NDE a model for the final stage of dying? My current view is that it may be. My reasoning begins with those experiences that I call approaching-death experiences, which sometimes occur in the 24 hours before death. These consist of ‘‘take-away’’ deathbed visions of relatives or friends; experiences of light and other worlds; and deathbed ‘‘coincidences,’’ that is, visits by the dying person to friends or relatives at the time of death. We, in fact, have three studies ongoing at the moment. One is a study with a palliative care team, asking caregivers about approaching-death experiences in the dying for whom they are caring; a paper describing this study has been accepted by the American Journal of Hospice and Palliative Medicine. Another is a study in hospices in Holland, looking at patients’ accounts of their experiences as they approach death. Thirdly, we are in the process of setting up a hospice study in the U.K.

Greyson, B. (2003b). Near-death experiences in a psychiatric outpatient clinic population. Psychiatric Services, 54, 1649–1651.

So then, as far as science is concerned, the NDE cannot occur at the point the heart stops, it cannot occur at any point during the period of unconsciousness, and it is unlikely to occur at the point of confusional arousal, because it is not typical of that level of consciousness; and if it occurred after recovery, the NDErs would say it occurred after recovery, because they know they have recovered. So there are real difficulties in accepting that the NDE happens when the NDErs say it happens: during unconsciousness. So are you beginning to feel the significance of the timing of the NDE both for neuroscience as well as for our understanding of the NDE? The night before they took Kelly to the vet [to be euthanized], the women were in the house with the three dogs, and for no apparent reason, the old chow [Kelly] started smiling. The blind schnauzer jumped up and started wagging his tail like he was seeing an old friend. And the young chow started barking at a blank wall. Arthur Myers, Communicating with Animals Atwater, P. M. H. (2007). The Big Book of Near-Death Experiences. Hampton Roads Publishing. ISBN 978-1-57174-547-7.

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