Consciousness Beyond Life: The Science of the Near-Death Experience (21 page)

Delusion Brought On by Medication

Another possibility is that certain types of medication, such as morphinelike substances or other strong painkillers that are administered to seriously or critically ill patients, could cause an NDE. Some believe that the near-death experience could be a delusion brought on by medication. But NDEs are frequently reported by people who do not use medication, so this assumption is incorrect.

Conversely, some medicines could have such a negative effect on memory that people are unable to remember their NDE. It remains unclear why only a small percentage of critically ill people report an NDE. People are kept in a coma while on a ventilator after an operation, a traffic accident, or a complicated resuscitation or they received general anesthesia during surgery. Is it possible that, as a recent article suggests, most of these patients have forgotten their NDE due to large doses of medication?
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This is not altogether likely because NDEs have been reported during surgery or coma, in which a heavily sedated patient was kept on a ventilator. The Dutch study included systematic research into the role of medication in NDE and statistically ruled out any effect.

In summary, a near-death experience is a special state of consciousness that arises during an impending or actual period of physical, psychological, or emotional death. Demographic, psychological, and physiological circumstances fail to explain why people do or do not experience an NDE.

Because an NDE can feature so many different elements, such as an out-of-body experience with verifiable perception, a tunnel experience, the experience of an unearthly environment, the sense of unconditional love in the presence of the light, the encounter with deceased persons, or a life review or preview, a range of different explanations have been put forward for each one of these elements. The various physiological and psychological factors set out in this chapter could all, to varying degrees, play a role but cannot explain the phenomenon in full.
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The theories on NDE set out above fail to explain the experience of an enhanced consciousness, with lucid thoughts, emotions, memories from earliest childhood, visions of the future, and the possibility of perception from a position outside and above the body. They also lack an adequate explanation for the fact that everything that is experienced during an NDE appears much more vivid and real than what happens during everyday waking consciousness. The fact that an NDE is accompanied by accelerated thought and access to greater than ever wisdom remains inexplicable. Current scientific knowledge also fails to explain how all these NDE elements can be experienced at a moment when, in many people, brain function has been seriously impaired. There appears to be an inverse relationship between the clarity of consciousness and the loss of brain function. There is no explanation for the fact that people across all ages and cultures have reported essentially similar experiences. Nor is there an answer to the question why some people have an NDE but most people cannot recall their period of unconsciousness after a life-threatening crisis. Interestingly, induced experiences are usually not completely identical to an NDE primarily because certain NDE elements are rarely if ever mentioned after drug use or brain stimulation but also because they are never followed by a process of change.

A satisfactory theory, one that explains the NDE in all its complexity, must consider both the range of different circumstances under which an NDE can be experienced and its various constituent elements. Perhaps such an all-embracing theory is indeed impossible and we should settle for a multifaceted approach that offers separate explanations for the separate aspects of an NDE. Oxygen deficiency appears to play a role at times, as do fear of death and perhaps also cerebral processes such as the blockage of certain receptors or the cessation of electrical activity in the temporal lobes. The role of DMT in triggering an NDE also merits further research.

Many fundamental questions remain unanswered. Most theories are based on anecdotal evidence and retrospective studies with self-selected patients and without accurate medical data. With the aim of meeting these objections and finding more definitive answers to the many unanswered questions, a group of researchers in the Netherlands launched a comprehensive and scientifically sound prospective study of the cause and content of near-death experience in 1988. The Dutch study, published in
The Lancet
in 2001, attracted worldwide interest. The next chapter considers it in detail.

My scientific curiosity into the phenomenon of NDE was aroused when I initiated a kind of pilot study in 1986. During a two-year period I asked all the cardiac arrest survivors who attended my outpatient clinic whether they had any recollection of their period of unconsciousness. To my surprise, twelve out of the fifty patients (24 percent) reported an NDE, often with extremely poignant details. But unfortunately I was unable to explain how it is possible for people to have any memories of this period of unconsciousness brought on by a cardiac arrest when, according to prevailing scientific opinion, this should be impossible. In the previous chapter I reviewed all the existing explanatory models based on retrospective studies.

In order to corroborate or refute the existing theories on the cause and content of an NDE on the strength of more reliable data, we needed a well-designed scientific study. This is why in 1988 Ruud van Wees and Vincent Meijers, both psychologists specializing in NDE, joined me, a cardiologist, for a prospective study in the Netherlands. At that point, no large-scale prospective NDE studies had been undertaken anywhere in the world. Our study aimed to include all consecutive cardiac arrest survivors in the participating hospitals. In a prospective study such patients are asked, within a few days of their resuscitation, whether they have any memory of the period of their cardiac arrest, that is, of their unconsciousness. The patients’ medical and other data are carefully recorded before, during, and after their resuscitation. In other words, this prospective study would include only patients with an objective life-threatening crisis. All of these patients would have died of their cardiac arrest had they not been resuscitated within five to ten minutes. This design also created a control group of cardiac arrest survivors without any memory of their period of unconsciousness.

The Organization

I started giving lectures to nurses and doctors at various hospitals in the hope of securing support to conduct the study of NDE in resuscitated patients at the coronary care units of these hospitals. We managed to include ten hospitals in our study, often thanks to the commitment of the nursing staff. The coronary care units of the four hospitals where I worked as a cardiologist at the time, which later merged to form the Rijnstate Hospital in Arnhem/Velp, took part in the study throughout the period from 1988 to 1992, as did the Antonius Hospital in Nieuwegein. Five smaller hospitals participated for a shorter period of time. We terminated a hospital’s involvement when it emerged that because of the pressures of work not all consecutive revived cardiac patients were included in the study. The latter was particularly common when patients had not reported any recollection after their resuscitation. If people without an NDE were excluded from the study, some of its results, for instance about the incidence of NDE after a cardiac arrest, would be distorted. We had a contact for each hospital as well as a person on standby so that we were covered at all times. We also had someone who regularly visited the hospitals and monitored proceedings. We applied for and received permission from the ethics committees of the various hospitals. Patients were always asked if they wanted to participate; fortunately they all consented during their initial interview, probably because they were asked by a nurse or doctor at their own hospital.

The Mortality Rate of Cardiac Arrest Patients

For every one hundred successfully resuscitated patients we were able to include in our study, at least two hundred people died of their cardiac arrest in the same period. Few people realize just how many resuscitation attempts are made at a coronary care unit (CCU) every year and that more than half of these patients do not survive their cardiac arrest.
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The Longitudinal Study

The longitudinal study of life changes was based on interviews after two and eight years with all NDE patients who were still alive, as well as with a control group of postresuscitation patients who were matched for age and sex but who had not had an NDE. The question was whether the common life changes that are reported after an NDE were the result of surviving a cardiac arrest or whether these changes were caused by the NDE itself. This question had never been subject to systematic scientific research before. The two-year follow-up interviews were coordinated by Ruud van Wees and Vincent Meijers while the eight-year follow-up interviews were coordinated and conducted by life-span psychologist Ingrid Elfferich. All the work for our prospective study, including the taped two- and eight-year follow-up interviews, was carried out by nursing staff and university-educated volunteers who had been briefed and trained by us. The study was designed, planned, and coordinated by the Merkawah Foundation, the Dutch branch of IANDS (International Association of near-death Studies), and most of the volunteers were active members of this foundation. Throughout our ten-year study we did not receive any subsidies because research into near-death experience was not eligible for financial support from bodies such as the Dutch Heart Foundation.

The Design of the Study

We had a registration of the electrocardiogram (ECG) for all patients included in our study. An ECG displays the heart’s electrical activity. In cardiac arrest patients this ECG always displays a lethal arrhythmia (ventricular fibrillation, or the chaotic flailing of the heart, resulting in a cardiac arrest that can be treated only by electric shock, or defibrillation) or an asystole (a flat line on the ECG). In the event of resuscitation outside the hospital, we were given the ECG done by ambulance staff.

For patients who were successfully resuscitated, we recorded their demographic data, including age, sex, standard of education, religion, prior knowledge of NDE, and whether or not they had experienced an NDE before. Patients were also asked whether they had been afraid prior to the cardiac arrest. We also carefully recorded all medical information: What was the duration of the actual cardiac arrest? What was the length of time of unconsciousness? How often did the patient require resuscitation? What was the exact nature of their cardiac arrhythmia? Was intubation (a tube inserted into the trachea for artificial respiration) needed because of a prolonged coma following a complicated resuscitation? Was the patient resuscitated inside or outside the hospital? Did the cardiac arrest occur during electrophysiological stimulation (EPS) during a heart catheterization, when patients are usually defibrillated through an electric shock to the chest within fifteen to thirty seconds? Was this the patient’s first heart attack, or had the patient had a previous one? What medication, and in what dosage, did the patient receive before, during, and after resuscitation? (In the case of prolonged artificial respiration these are often extremely powerful drugs, which can keep the patient in a kind of coma.) We also recorded how many days after resuscitation the interview took place, whether the patient was lucid during the interview, and whether his or her short-term memory was functioning well.

The Initial Interview

During the initial interview, usually within five days of resuscitation, the patient was asked only a single, open question: “Do you have any recollection of the period of your cardiac arrest?” If the answer to this question was yes, an initial, unstructured interview was conducted and recorded, preferably by one of the study’s principal researchers, although this was not always possible. One drawback of this method was that if the patient was on record as having thought that “he was going to die,” this was coded as a possible NDE with the lowest score (score 1). However, two years later it emerged that some of the patients with this minimum score had not experienced an NDE. Likewise, a few patients who were listed as not having had an NDE did report an experience two years later. They had kept quiet about their NDE immediately after resuscitation, a common occurrence because people are scarcely able to grasp their extraordinary experience and remain silent for fear of being ridiculed or disbelieved.
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I will come back to these findings when discussing the results of the longitudinal study.

A Hidden Sign, Visible Only During an Out-of-Body Experience

At one of the hospitals in Arnhem, the top cover of the surgical lamp in the resuscitation room was decorated with a hidden sign, invisible from a normal position. None of the attendant doctors or nurses were informed of this hidden sign so they would not influence patients. Even I never knew which sign (a cross, circle, or square, in red, yellow, or blue) had been applied by a colleague of mine. Unfortunately, no patients who were resuscitated in this room ever reported an out-of-body experience with perception. Because people are resuscitated everywhere—on the street, in the ambulance, in a CCU room, on the ward—we had estimated the chances of a hit to be relatively low. Still, one verified out-of-body experience would have been sufficient. Luckily, during our study a nurse told us about the case with the dentures, as described in an earlier chapter, although the resuscitation room in question featured no hidden sign.

The Design of the Longitudinal Study

The two-year and eight-year follow-up interviews were recorded on tape and transcribed. This allowed us to compare the content of the NDE with the experience as it had been reported to us in the hospital immediately after the cardiac arrest. Remarkably, after two and eight years patients related their NDE in almost the exact same wording, down to the very last detail. This is nearly impossible in the case of a dream or an invented story. The later interviews were accompanied by Kenneth Ring’s life-change inventory, which all participants were asked to complete.
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This inventory features thirty-four questions about self-image, compassion for others, material and social issues, religious and spiritual matters, and attitude toward death. To specify the level of change, patients were asked to answer these questions on a five-point scale. For the eight-year follow-up, the inventory was expanded with surveys on medical and psychological aspects drawn up by the Dutch Heart Foundation; this included a list of questions on coping with problems and a questionnaire on feelings of depression. These questionnaires were added for the purpose of qualitative analysis because after eight years very few people were still alive and the group under investigation had become quite small.

All the findings of the prospective study and the longitudinal study underwent statistical analysis to identify significant differences, with P
0.05; P is the probability of getting a statistical significant difference, and P
0.05 means that there is a 5 percent or less probability that the result is only by chance. The lower the P value, the more significantly different is the result.

Findings of the Prospective Study

The Dutch study was published in
The Lancet
in December 2001.
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Within a four-year period, between 1988 and 1992, 344 consecutive patients who had undergone a total of 509 successful resuscitations were included in the study. In other words, all patients in our study had been clinically dead. Clinical death is defined as a period of unconsciousness caused by a lack of oxygen supply to the brain (anoxia) because of the arrest of circulation, breathing, or both following cardiac arrest in patients with an acute myocardial infarction. If no resuscitation is started, the brain cells suffer irreparable damage within five to ten minutes and the patient always dies. People who survived a resuscitation-with-complications outside the hospital were significantly younger, and only twelve patients survived a cardiac arrest that lasted more than ten minutes. Statistics show that only 10 percent of people who suffer cardiac arrest outside the hospital leave the hospital alive because they frequently undergo irreparable brain damage, which results in brain death and, ultimately, death.