The Witch in the Waiting Room: A Physician Investigates Paranormal Phenomena in Medicine

by Robert S. Bobrow M. D. M. D.

  Merely fainting can occasionally cause NDE features. A 1994 letter to Lancet described a study where syncope (a doctors' term for fainting) was induced in forty-two healthy young adults by having them hyperventilate and then pushing to exhale with the mouth tightly closed (we call this a Valsalva maneuver). This briefly cuts off blood flow and, consequently, oxygen to the brain and causes one to faint. When I was a teenager in the late 1950s, we didn't have drugs, so we occasionally amused ourselves by fainting, using the same method. The Lancet volunteers frequently reported visual and auditory hallucinations and an occasional out-of-body experience. Most described the overall feeling as pleasurable. When we did it, there was something vaguely pleasant about the experience, although no one ever said anything about odd perceptions; as an amusement, it got old fast.

  The Real McCoy

  Australian sociologist Allan Kellehear studied NDEs in nonWestern societies, particularly India and China, to look for common elements across cultures. The tunnel experience was not found. Unifying features included a sense of other beings or of another world. Combining Kellehear's data with Owens's and the syncope report, one gets a sense of core aspects of what human beings undergo, sometimes, when truly near death: a bright light, clarity of thinking, and another world.

  Polls and Probabilities

  So, how many people have had NDEs, and what is your likelihood, if resuscitated, of reporting one? A Gallup poll, published in 1982, found 5 percent of the adult American population to have had such an experience, which they said represented about half those resuscitated. I find these figures a little difficult to accept, not so much because no one I know has ever told me they've had one, but because it would mean that 10 percent of the adult population in 1982 had at some point teetered on the very edge of life. A US. New, & World Report poll in the March 31, 1997, issue claims that eighteen percent of' Americans believed that they had once been on the verge of dying. I again find this high, to say the least. Greyson's sixteen-point scale wasn't used for these surveys, allowing for the possibility that many of the reported experiences would not have qualified as research-grade NDEs. As we saw in the Lancet paper above, people often describe near-death phenomena when in fact, they only thought they had cheated the grim reaper.

  There is more recent, scientifically rigorous work on the subject. Dr. Sam Parma, a physician and university researcher at Southampton General Hospital in England, along with his colleagues, surveyed all survivors of cardiac arrest at their hospital during an entire year. This 2001 study was prospective, meaning planned in advance, which is generally considered more valid than retrospective, where you go back and look afterward. The surviving patients were interviewed within a week of the arrest. Of sixty-three such patients, seven (11 percent) reported memories, four with NDE features.

  Another prospective study, published the same year in Lancet, came from the Netherlands, where 344 consecutive patients at ten Dutch hospitals who had been successfully revived were interviewed within a few days of suffering cardiac arrest. A previously published scoring system was used, although not Greyson's. These patients had been clinically dead, defined as "a period of unconsciousness caused by insufficient oxygen supply to the brain." After a few minutes of oxygen deprivation, irreparable brain damage occurs. Of the 344 subjects studied, sixty-two (18 percent) had some remembrance at the time of clinical death. Since none of the 344 patients was getting oxygen to his/her brain during the arrests, the authors (cardiologist Pim van Lommel and colleagues) felt that dire medical straits alone could not account for these remembrances, since the majority of the people studied had neither NDEs nor any recollections around the cardiac arrest.

  When the patients' memories were scored, two-thirds of the recollections qualified as NDEs, which means that twelve percent overall had them. These twelve percent were no sicker than, nor medically distinguishable from, the others. Dr. van Lommel wonders if society's negative attitude toward NDEs could deter people from reporting them, making their incidence appear lower. He concludes, at any rate, that "we do not know why so few patients report NDE" after resuscitation, and that a "purely physiological explanation" (such as lack of brain oxygen or activity) fails to correlate with who will have them.

  Bruce Greyson published a 2003 paper about a survey done in a cardiac inpatient unit at a Virginia hospital. Over thirty months, all those admitted to the cardiac care unit-almost sixteen hundred in all-were evaluated for NDEs. Seven percent of these admissions suffered cardiac arrest, and one out of ten of these described an NDE. By contrast, one out of a hundred cardiac patients who did not have an arrest reported one.

  Greyson has more recently estimated the percentage of Americans who will report an NDE after being truly near death to be between 9 and 18 percent. Obviously, it matters whether or not the person really was near, or if the memories meet NDE criteria. Most of the studies seem to come up with similar numbers. I can't say that any of my own patients ever volunteered any sort of NDE to me. Then again, my practice is largely outpatient, so I'm not usually dealing with the critically ill; and, as mentioned above, this is not something that's ordinarily talked about by patients or physicians.

  When Dr. Jeffrey P. Long emailed over five hundred physicians at Brown University Medical Center to inquire about their views on patients' NDEs, only 3 percent bothered to respond. In 1977, when Michael Sabom was at the University of Florida College of Medicine in Gainesville, he reported on eleven patients with NDE descriptions consistent with what had been published elsewhere. At the same time, he also took an informal survey of the medical center physicians, who seemed to have no awareness of such events in gravely ill patients. In a 1980 letter of reply to Dr. Sabom in JAiWA, physician Richard Blacher of the Tufts University School of Medicine stated that he had interviewed several thousand patients who had undergone cardiac and heart surgery without ever having had such an episode described. I don't know if each beholder's eye saw things differently, or if the way the questions were asked influenced the response. A lot goes on under our noses, medically speaking, that our patients don't tell us about.

  The Non-Association of Mind and Body

  What sort of a person is likely to report an NDE, given the appropriate circumstances? In Greyson's chapter on NDEs in a 2000 publication by the American Psychological Association,4 he comments that few personal traits have been identified that can predict who will have an NDE or which type they will have. Experiencers tend to be psychologically healthy and no different from non-experiencers in age, sex, race, or religion. Dr. Greyson wrote a Lancet paper the same year asking the question: "Dissociation in people who have near-death experiences: out of their bodies or out of their minds?" As I mentioned in chapter 7 on possession, there is a psychiatric classification known as dissociative disorders, meaning the patient displays a dissociation (i.e., separation) between what's going on in the mind and what's actually happening. Daydreaming is a non-pathological form of dissociation. Pathological dissociation includes trances, stress-induced amnesia, and multiple personality disorder, things where the patient's "reality" is so separated from normal consciousness and memory as to appear quite unreal to anyone else. Obviously, an NDE, which involves floating above and away from bleak reality, would qualify.

  Greyson employed a commonly used psychiatric screening instrument for dissociation, the dissociative experiences scale (DES), and sent it to ninety-six people who had reported an NDE, and to an additional thirty-eight who had come close to death but had no NDE (these thirty-eight would be a comparison, or control, group). The DES is a twenty-eight-item scale that grades intensity of dissociative-type experiences, and scores of thirty or higher usually indicate a dissociative disorder. In this study, the NDE patients had a median score of 10.7; the non-NDE sample's median was 7.3. Although these are significantly different, both are well below the pathological cutoff. Greyson concludes that NDEs are not pathological and not part of a dissociative disorder, and that they are a normal stress response that some people undergo-i
n other words, "out of their bodies," not minds.

  The Aftermath

  Okay, you've returned from the brink and you remember a divine, albeit bizarre, scenario. What is life like from here on in? This is the part that surprised me from researching NDEs: A lot of people seemed to be better off. This was not invariably true, but several observers have noted a positive change. In the Netherlands study of'344 resuscitated patients (which had compared NDE-ers with the merely unconscious), experiencers were more likely to come out with an increased belief in an afterlife and a lessened fear of deathwhich may not be surprising, considering what they went through. They were also found at follow-up to have "gone through a positive change, and were more self-assured, socially aware, and religious than before." Greyson, in a 1993 publication in the journal R~ivchtatry, comments about the "long-lasting changes in values, beliefs, and behavior" that have been seen.

  Some studies suggest that it may take a while until what seems to have happened fully sinks in. How a patient's family, friends, and physicians react can make the difference between having had a transforming experience versus a brief immersion in psychosis. Sabom, in his original eleven-case review, writes that such a patient "is often relieved at being able to discuss his experience in an atmosphere of openness and understanding and is comforted with the knowledge that others have had similar encounters." Unfortunately, you can't always count on finding an attitude of openness and understanding; so reveal that neardeath epiphany at your own risk. I was hesitant to even ask a patient (the one time I tried) about a possible NDE; if I had had one myself, I'd hesitate even more. Fortunately, I'm not aware that I've ever been near death (I'm not counting that creepy feeling you get before general anesthesia), but I suppose if I had opened death's door, looked inside, and gone back home, I'd be a changed and more spiritual fellow.

  Biologic Explanations

  Biologic explanations as to why NDEs might occur are reviewed by Greyson in his book chapter, mentioned above. Many of the references are in the Journal of Near-Death Studie<+, which is not MEDLINE-indexed but contains scientific work. Are NDE's figments of one's imagination? Greyson believes that people who have never heard or read about NDEs, including children, have nevertheless described them, with typical features. Does the NDE simply reflect the brain's reaction to lack of oxygen? Sabom's aneurysm patient had, temporarily, a dead brain, devoid of any ability to react. And most patients with oxygen-deprived brains do not have NDEs. Brain chemistry gone awry is another hypothesis. Endorphins-naturally occurring brain opiates-have been postulated to cause NDEs; but giving patients opiates, such as morphine, does not induce true NDE features. Michael Persinger, a Canadian neurobiologist mentioned in other places in this book, can induce many aspects of an NDE by applying external electric or magnetic fields to the head of an awake person, although the totality of an NDE does not occur. (A Swedish team, however, was unable to replicate Persinger's findings.) In fact, Greyson concludes that No theory had yet been proposed that can account satisfactorily for all the common elements of NDEs."

  British lecturer and psychologist Susan Blackmore is a fellow of the United Kingdom skeptics' organization and has also been an officer of the Society for Psychical Research. In her 1996 paper in the Journal of the Royal Society of Jfedic•ute, she examines six extant medical or psychological theories of NDEs, finds them all inadequate, and remarks that while there's no evidence that NDEs indicate a reality of survival after death, the experiences can't be dismissed as fantasy or as a by-product of medical intervention.

  NDEs in Children

  And then there are the children. Much of this work has been done by Seattle pediatrician Melvin Morse. In 1983, he reported a near-death experience, with the usual trimmings, in a sevenyear-old child who had almost drowned. Three years later, in the same Ameri<•an Journal of Diee«+e.+ of Children, he wrote up a series of eleven children, aged three through sixteen, who had survived life-threatening illness; seven had memories of the NDE type. An additional twenty-nine children, matched for age, were sick enough to be in an intensive-care unit and unconscious, but were not deemed close to dying. None of this group had any recollection of the time they were unconscious. Morse also makes note of the differences between adult and pediatric NDEs. Children were less likely to have time distortions or to undergo a lifereview. While adults tended to meet dead relatives and friends, children reported meeting living teachers and friends. Children's parents, for some reason, seemed never to appear in their NDEs. Like adults, Morse believes children survive an NDE with a new, more serene life outlook.

  So what does this all mean? How does someone emerge from general anesthesia and a brain-dead coma and accurately describe concurrent operating-room events? Why do some doctors encounter patients with NDEs with relative frequency, while others never see or hear of such a patient? Is it just a question of being receptive? Why can some people experience NDE features without actually being near death, or by merely fainting, or by just having their brain stimulated by a magnetic field? When these answers are known, the "near-death experience" will no longer be paranormal.

  men

  I Remember It Well: The Collective Unconscious and the Nature of Memory

  Logic tells us that what each human being "knows" comes from individual learning and life experience. But are there experiences and memories that all human beings-no matter what race, creed, or country of origin-share? In 1906, thirty-oneyear-old Swiss psychiatrist Carl Gustav Jung (who would ultimately become world-famous for his theories of psychotherapy and personality, founding the field of analytic psychology and coining the terms "introvert" and "extrovert") encountered what he considered a "curious delusion",' while examining a schizophrenic patient residing in a mental hospital.

  The Vision

  The patient was a man in his thirties who suffered from a paranoid form of psychosis that had begun in his early twenties. Before being institutionalized, he had been an ordinary man who worked as an office clerk. During active periods of illness, he suffered from hallucinations or became megalomaniacal and thought himself to be the Savior. In quieter times, he was allowed to roam the corridors of the institution, which is where Dr. Jung encountered him at a window one day, staring at the sun and moving his head oddly to and fro.

  The patient called the doctor over to the window and asked him to look at the sun, through half-closed eyes, in order to appreciate the "sun's penis"-the horizontal, almost tubular yellow glow as it would appear through the squint. Then he had the doctor turn his head from side to side, to make the "penis" move, and claimed this movement to be the origin of the wind.

  Jung found no particular meaning in this madman's vision; but, like any good scientist, he made note of it. Four years later, Jung was studying mythology when he read about a recently translated ancient Greek papyrus in which an essentially identical vision was described. In the Greek text, a tube from which the wind is created hangs down from the sun, a windstream emanating from it. The author even intends for the reader to experience this illusion as it appears "through the disc of the sun."

  The Collective Unconscious: The Thoughts We All Share Although the first printing of the Greek translation was in 1903, this patient had been committed well before then and could not possibly have seen it. He had never traveled and was not highly educated. How did an institutionalized man come up with this? Jung postulated a "collective unconscious": a universal human consciousness that holds the collective memories, experiences, and wisdom of the human race, and into which certain people are able to tap. This would be distinct from the personal unconscious, assembled from memories of this lifetime. To Jung, this primordial memory bank explained how vastly different cultures living in different eras could construct myths and fablesof heroes and villains, of struggles between good and evil -that were otherwise inexplicably similar to each other.

  In addition to the "sun's penis" example, Jung related the story of a girl who stated that she had a black snake in her belly. To Jung, this was a symbo
l from the collective unconscious, as the concept of a serpent within the body existed in India (unknown to this girl) as Kundalini-a latent, coiled energy at the base of the spine. Even ideas of power, God, spirit, and the soul were seen as universal and innate within all of homo sapiens and throughout history, not as things learned during any one individual's lifetime.

  Jung also believed that the emergence of the concept of conservation of energy had somehow percolated up from the collective unconscious. Nowadays, energy conservation (also called the first law of thermodynamics) is elementary physics. But this principle-that energy is neither created nor destroyed, but only changes form-had eluded Galileo and Newton and was not fully accepted until the end of the nineteenth century. What's more, it was simultaneously and independently discovered during the first half of that century by at least six individuals, none of whom were physicists, and all of whom met with much resistance. One of the six, physician Robert Mayer, is generally credited with the idea. Jung cites an 1844 letter of Mayer's regarding the genesis of this theorem. Mayer was a ship's doctor in the tropics who preferred to stay on board rather than go exploring. Here he could reflect peacefully, and describes "flashes of thought" that "came to the surface." These inspirations culminated in Mayer's epiphany. To Jung, "the idea of energy and its conservation must be a primordial image that was dormant in the collective unconscious." 6