by Jeffrey Long, MD & Paul Bernstein, PhD.
Originally published in 'Vital Signs', the quarterly newsletter of the International Association for Near-Death Studies, Issue #1 of 2002 - www.iands.org (http://www.iands.org/)
On December 15, 2001, the highly respected international medical journal, The Lancet, published a 13-year study of NDEs observed in 10 different Dutch hospitals. This is one of the very few NDE studies to be conducted prospectively, meaning that a large group of people experiencing cessation of their heart and/or breathing function were resuscitated during a fixed period of time, and were interviewed. Through those interviews the doctors discovered who had experienced NDEs. The advantage of this type of study is that it gives scientists a matched comparison group of non-NDE patients against which to compare the near-death experiencers, and that in turn gives scientists much more reliable data about the possible causes and consequences of the near-death experience.
For example, in the past some scientists have asserted that the NDE must be simply a hallucination brought on by the loss of oxygen to the brain [called "anoxia"] after the heart has stopped beating. This study casts doubt on that theory, in the words of its chief investigator, cardiologist Pim van Lommel, MD, "Our results show that medical factors cannot account for the occurrence of NDE. All patients had a cardiac arrest, and were clinically dead with unconsciousness resulting from insufficient blood supply to the brain. In those circumstances, the EEG (a measure of brain electrical activity) becomes flat, and if CPR is not started within 5-10 minutes, irreparable damage is done to the brain and the patient will die. According to the theory that NDE is caused by anoxia, all patients in our study should have had an NDE, but only 18% reported having an NDE... There is also a theory that NDE is caused psychologically, by the fear of death. But only a very small percentage of our patients said they had been afraid seconds before their cardiac arrest -- it happened too suddenly for them to realize what was occurring. More patients than the frightened ones reported NDEs." Finally, differences in drug treatments during resuscitation did not correlate with the likelihood of patients experiencing NDEs, nor with the depth of their NDEs.
Of the 344 patients tracked by the Dutch team, 18% had some memory from their period of unconsciousness, and 12% (1 out of every 8) had what the physicians called a "core" or "deep" NDE. The researchers defined that as a memory by the patient from their period of unconsciousness which scored six or more points on the scale published by Dr. Ken Ring in his 1980 study, Life at Death: A Scientific Investigation of the Near-Death Experience (http://www.iands.org/bib.html) (linked page size: 40Kb (http://www.iands.org/kb.html)),. This scale includes, among other things, out-of-body perception, moving through a tunnel, communication with light, blissful feelings, observation of a celestial landscape, meeting with deceased persons, life review, and presence of a border. The scientists were surprised that the NDErs recalled their experience with the same degree of detail when interviewed again several years later.
During those follow-up interviews (2 years and 8 years later), the scientists assessed the patients' attitudes about several key issues in life -- fear of death, acceptance of others, interest in spirituality, and the like. On 13 such issues they found substantial, statistically significant differences between the NDErs and the non-NDErs. For example, NDErs had become much more empathic and accepting of others since their NDE than had the non-NDErs. And NDErs had become both more appreciative of the ordinary things of life and much less afraid of death than had the non-NDErs.
Dr. van Lommel and his colleagues conducted the entire study without special funding; they volunteered their own time and engaged the volunteer efforts of many IANDS members in Holland (whose group is called Merkawah (http://www.merkawah.nl). Two years ago Dr. van Lommel and his colleagues were visited by Vital Signs columnist PMH Atwater (who described Merkawah's activities in VS Issue #1, 2000, pages 5-8). Following the recent publication of their study in The Lancet, Dr. van Lommel gave the following interview to IANDS' Vice-President Dr. Jeffrey Long.
Long: The Lancet article received enormous publicity world-wide. For
example, here in the US, ABC-TV featured it on their evening news. What reaction
did you notice from physicians/scientists? And from the general
Dr. van Lommel: There has been an incredible amount of reaction from all over the world, especially in newspapers, but also in journals, radio, and TV. I myself received more than 265 e-mails in just four weeks, including a lot from physicians who wrote to me about their own NDEs! Most of the reactions were positive, but I assume that people who want to ignore the subject would not e-mail me. In our 800-bed teaching hospital there has been a lot of positive reaction by colleagues, but of course they already have known for years that I was interested in NDE.
Long: Are you planning any further NDE studies?
Dr. van Lommel: I am not planning any research at this moment. I have ideas about a study-design, but at this moment I have no time.
Long: I understand you helped found Netherlands' only Friends-of-IANDS
group. Has the Lancet article affected attendance or interest in
Dr. van Lommel: Our IANDS-Netherlands group, Merkawah, has more than 400 members, national meetings, local meetings, a quarterly magazine with the name Terugkeer (which means Coming Back), local discussion groups, regional coordinators, and of course a governing board. In 1988 I was one of the founders, but at this moment I am not on the board any more. Also in Belgium and France there are actively operating IANDS organizations. Of course there has been a lot of attention in the newspapers, radio and TV, and that always stimulates reaction, including quite a lot of people who've had an NDE and did not know previously about Merkawah. There were reports about our study in the newspapers of England, Germany, Belgium, Switzerland, Italy, Greece, France, Canada, Australia, New Zealand, India, Nepal, and Brazil as far as I am aware of, and of course in the USA. This started a lot of discussion about NDE, in particular about the relationship of consciousness and memories to brain functioning. For me, not only is growing attendance for IANDS important, but more openness and awareness about NDEs by physicians and nurses, and having the scientific approach be taken towards the NDE instead of just a sensationalist approach.
The possibility of consciousness existing outside of the brain, when the brain itself appears to be dead, is for Dr. van Lommel an especially important outcome of this research. As he wrote at the end of The Lancet article, and then added in a letter to Dr. Long:
Such emphasis on transcendent experience is not welcomed by all medical professionals. The Lancet editors included a "Commentary" on Dr. van Lommel's article, which argued that even when patients accurately report events that occur while their brain and heart are not functioning, the cause might not be a true separation of their consciousness from their bodies but rather "prior knowledge, fantasy or dreams, lucky guesses, ...details learned between the NDE and giving an account of it, and...false memories" the mind trying to retrospectively "fill in the gap" after a period of cortical inactivity. 1
The Commentary's author, British psychology professor Christopher French, explained further why he finds it hard to believe these patients' reports of their NDEs. He pointed to the fact that two persons who'd originally told van Lommel's team of no memory that would be categorized as an NDE, later told them in the two-year follow-up interview of experiences in the hospital that the researchers would categorize as core NDEs. Professor French's conclusion was that, "It seems likely that at least some patients, on hearing about other survivors' NDEs, would start to imagine what it would have been like if they had had the same experience.... Recent psychological studies have shown conclusively that simply imagining that one has had experiences that had in fact never been encountered will lead to the development of false memories for those experiences. 1
But psychiatrist Dr. Bruce Greyson, a member of The Lancet's peer review team and a long-time NDE researcher, offered Vital Signs a different explanation. "In my own research with patients hospitalized for attempted suicide, ...there were a few ...who, on follow-up visits, later described NDEs in the course of their initial suicide attempt. They all told me that they simply hadn't trusted me sufficiently in our initial interview to share the NDE. This should not be surprising, because many of them were concerned about being regarded as crazy... There is quite a lot of evidence that NDErs often are unwilling to share their accounts with researchers until they have earned their trust. Unless we have some reason to suspect that NDErs are highly suggestible and have some strong motivation to imagine having had their NDEs, it seems irrational to assume that all NDEs are 'false memories'."
IANDS congratulates Dr. van Lommel for his excellent research.
Van Lommel's article in Lancet is a landmark that should be read by every doctor. It reports on the largest prospective study to ask people about NDEs after a cardiac arrest. Its results show that NDEs are a significant phenomenon in the setting of cardiac arrest. Equally important, the study followed people for eight years after their NDE. The observations gleaned from that follow-up demonstrate that NDEs really are life transforming, and that the transformation in values is consistent over time. The study showed that NDEs create much greater changes in a person's life than does simply having a cardiac arrest or being near death.
Family doctors may not be the physicians present at the time of cardiac arrest, but they are the doctors people usually talk to the most, because they are the doctors people go to most often for a variety of problems. I would encourage Vital Signs readers to obtain the complete Lancet article to share with your doctor. You will be doing your family doctor a great favor. Basically, we doctors change our minds about diagnoses and treatments because of articles in medical journals.
When people read van Lommel's article, they are often drawn to one or two items in his vast array of findings. I have mentioned the major ones in my first paragraph. Near the end of the summary on this page, Dr. Greyson addresses the question of false memories, which the Lancet commentary brought up regarding patients who later recalled an NDE they hadn t initially reported on. For me, the most fascinating statistic in van Lommel's article has to do with predictors of death in the 30 days following cardiac arrest. Each person in the study was very ill or they would not have had a cardiac arrest. Statistically, it is quite common to die soon after a cardiac arrest, particularly if it occurred as the result of a chronic medical condition. In his study, Dr. van Lommel measured the depth of the NDE by using Kenneth Ring's scale. People who had more of certain aspects of the NDE (e.g., tunnels, light, life reviews) were labeled core experiencers. Having a core experience was a predictor of death over the next 30 days at a probability of .0001. That means that there is a 1-in-10,000 chance that those results would have occurred by chance alone. Why would that be?
Two very different hypotheses come to mind. One is that people with very deep experiences might be so taken with the experience that they simply allowed themselves to slip over to the other side. (The will to live is crucial in people who are extremely ill. Though it doesn t predict whether or not the person will die, it can have a bearing on when their death occurs. For example, people who are terminally ill frequently put off their own deaths until after they have finished waiting for an important day such as their daughter's wedding.) The sense of what lies ahead of NDErs may be so peaceful, that they simply complete unfinished business here and then let go into death. Another possible interpretation of the data, however, is that the depth of the NDE may be related to the severity of the illness of the person. In a statistically precise study of NDErs, Dr. Bruce Greyson found that psychic abilities are more common after a core NDE (Theta, 11:26-29, 1983). Since we have not had studies until now that interviewed large numbers of people within 30 days of their NDEs, the reasons for the relationship between the depth of the NDE and impending death have not yet been identified.
I believe that the findings in van Lommel's study challenge hospitals to ask people about their NDEs after a cardiac arrest. As it becomes common practice to invite resuscitated people to discuss their NDEs with health care personnel in the hospital, the relationship between having a core NDE and dying a short time later will become clearer. In addition, NDEs in resuscitated persons will be seen as a normal concomitant of the experience. Finally, I believe that people with NDEs will be able to adjust more easily to the changes that occur in their values, if they have some assistance with that from immediate caregivers while still in the hospital setting.
Colorado physician Pam Kircher is board certified in both hospice care and family practice. She has taught at Baylor College of Medicine, and was Chief of Family Medicine at Memorial Southwest Hospital in Houston, Texas.
To read the full Lancet article and its accompanying Commentary, you may visit the website (http://www.thelancet.com), register there for free, and search for the keywords "near death". The article's title is, Near-death experience in survivors of cardiac arrest: a prospective study in the Netherlands, to be cited as Lancet 2001; 358: 2039-45. Its authors, in addition to Dr. van Lommel, are Ruud van Wees, Vincent Meyers, and Ingrid Elfferich.