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Die another day: A brief look at ‘addiction to near death’

In previous blogs I have examined both people’s fascination with death and human near death experiences (NDEs). Another aspect to NDEs that I didn’t mention in those articles was the idea of people being “addicted” to NDEs. Arguably, most people’s perceptions of ‘near death addiction’ are probably based on the 1990 US film Flatliners. In that film, a group of five medical students (played by Keifer Sutherland, Kevin Bacon, Julia Roberts, Oliver Platt and William Baldwin) attempt to examine whether there is anything beyond death by carrying out experiments into NDEs. Keifer Sutherland’s character (Nelson) is continually made to experience clinical death (i.e., flatlining with no heartbeat) before being brought back to life by his classmates.

This Hollywood portrayal of possible ‘near death addiction’ bears little resemblance to the academic literature – most of which has been written from a psychodynamic perspective – and relates more to continual self-destructive experiences (usually by adolescents or young adults). The concept of ‘addiction to near death’ (ATND) originates from the writings of Dr. Betty Joseph, a distinguished psychoanalytic clinician often lauded as “the psychoanalysts’ psychoanalyst” and known for her work with highly resistant ‘difficult to treat’ patients. Dr. Joseph first wrote about the ‘addiction to near death’ concept in a 1982 issue of the International Journal of Psychoanalysis. This form of masochistic pathology was a concept that she found useful when working with psychologically dysfunctional adolescents. As Dr. Janet Shaw noted in a more recent 2012 paper on ATND in the Journal of Child Psychotherapy:

“At [the adolescent] stage of development, there is a tendency for adolescents who are troubled to turn to destructive or self-destructive behaviour, suicidal ideation, self-harm, self-starvation and inappropriate sexual behaviour. This is often profoundly shocking and alarming to others, especially if the young person finds the impact on others pleasurable. [Betty] Joseph described a patient addicted to near death as being caught up in a wish to gain pleasure by destroying both himself and the analytic relationship…[She] described masochistic destruction of the self taking place with libidinal satisfaction, despite much concomitant pain. The masochistic position is deeply addictive and this way of using pain for the purposes of pleasure becomes habitual. She summed this up as, ‘the sheer unequalled sexual delight of the grim masochism’ and described the awful pleasure that is achieved in this way”.

However, as Dr. Shaw rightly points out, not all types of destructive and self-destructive behaviour fall into such a category. In her 1982 paper, Dr. Joseph outlined case studies she had treated psychoanalytically from her private practice. Here, she described the masochistic dynamics of her patients, and how hard it was for them to alter these dynamics and get better. She noted that one of the key aspects of the dynamics she described was that her patients derived immense libidinal satisfaction from engaging in destructive near-death behaviours. More specifically, she wrote:

“There is a very malignant type of self-destructiveness, which we see in a small group of our patients, and which is, I think, in the nature of an addiction – an addiction to near-death. It dominates these patients’ lives; for long periods it dominates the way they bring material to the analysis and the type of relationship they establish with the analyst; it dominates their internal relationships, their so-called thinking, and the way they communicate with themselves. It is not a drive towards a Nirvana type of peace or relief from problems, and it has to be sharply differentiated from this. The picture that these patients present is, I am sure, a familiar one – in their external lives these patients get more and more absorbed into hopelessness and involved in activities that seem destined to destroy them physically as well as mentally, for example, considerable over-working, almost no sleep, avoiding eating properly or secretly over-eating if the need is to lose weight”.

In a 2006 issue of Psychanalytic Psychology, Dr. William Gottdeiner also noted that the ATND is such a strong motive that successful treatment of such individuals is unusually difficult. However, Dr. Gottdeiner asserted that one of the severe weaknesses of Joseph’s writings is that she failed to provide in-depth clinical examples of anyone who had engaged in potentially deadly activities. This, Gottdeiner contended, threatened the validity of the ATND construct. Despite such inherent weaknesses, Gottdeiner still believed the ATND construct had strong face validity (i.e., “there are people who seem to repeatedly engage in potentially lethal behavior, making the ATND construct plausible”). Consequently, Gottdeiner tested the construct validity of ATND on females with substance use disorders (SUDs). His argument was that:

“If individuals who are diagnosed with an SUD are successfully treated and they continue to engage in potentially deleterious behavior, then that finding would support the notion that the individual has an addiction to near-death experiences, and that the individual’s substance abuse was a comorbid disorder”.

Gottdeiner’s paper attempted to validate the ATND construct via secondary analysis “of data from a treatment outcome study of individuals who were in residential therapeutic community treatment for SUDs and who received simultaneous safe-sex education during treatment”. His study findings showed that despite safe-sex education and sexual activity in the therapeutic communities being prohibited, that some of the participants still engaged in risky sexual behaviour (irrespective of whether their sexual partners were HIV-positive or not). Gottdeiner argued that these findings tentatively supported the ATND construct. However, Gottdeiner was the first to admit that his study had inherent weaknesses. As he noted:

The limitations were: data were from retrospective self-reports [and] contained no baseline measures of sexual activity, safe-sex knowledge, condom use, HIV status; it had no male participants, no specific questions about near-death behavior, nor whether alternative safe-sex activities were practice…The limitations of [the] study are considerable, and some might even argue that the connection between the ATND construct and the data presented herein is too much of a stretch to be scientifically useful…Obviously, stronger data would lead to stronger conclusions. Despite the limitations of this study, the findings should motivate clinicians to more seriously consider the existence of an addiction to near-death in their clients”.

More recently, Dr. Janet Shaw examined the ATND construct through the description and evaluation of an in-depth case study account of an adolescent female (‘Susan’). Her paper explored “the way in which pleasure, which is sadistic and masochistic in nature, is associated with cruelty towards the self or others in adolescence”. Dr. Shaw wrote that it felt as if Susan’s main aim was to torment her. As Shaw reported:

“In addition to suicide threats, similar to those she made in the assessment, she made constant reference to systematically starving herself. She was painfully thin, although not actually anorexic and she was poisoning herself by repeatedly taking paracetamol. Susan’s threats to self-harm had a deeply disturbing quality and she clearly enjoyed making them. There was a wish to punish me, as well as herself, through her phantasised attacks…The case material is an example of an adolescent girl with ‘an addiction to near death’ constituting a dominant way of relating to others. Her relentless and manipulative references to self-harm, suicide and dangerous behaviour at various stages of the work were designed to shock and alarm…Susan’s self-destructive behaviour was also continuing in relation to her self- starvation. She said she took laxatives in an attempt to lose more weight. She was becoming dangerously thin and three years into her psychotherapy an appointment with the referring psychiatrist resulted in a diagnosis of anorexia nervosa”.

This quote doesn’t do justice to the very detailed account that Dr. Shaw provided in her lengthy paper. However, her written account is heartfelt and brutally honest. Shaw concludes that the compelling power of addiction overviewed in Susan’s case mustn’t be underestimated. As she notes:

“The narcissistic idealisation of sadistic and masochistic behaviour offers some protection from fear and terror for the patient, but the consequence is to severely limit capacity for thought and imagination, and to restrict awareness. ‘Addition to near death’ forms a small but significant component of the clinical casework of a child and adolescent psychotherapist: it is hoped that Susan’s case material serves to illuminate the phenomenon further and its technical challenges”.

Whether the clinical case of Susan provides any more evidence for validation for Joseph’s ATND construct than the more empirical work of Gottdeiner is debatable. However, this is certainly a fascinating – if somewhat harrowing – area of clinical and academic work that certainly warrants further empirical examination.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Gottdiener, W.H. (2006). A preliminary test of the Addiction-to-Near-Death construct. Psychoanalytic Psychology, 23, 661-666.

Joseph, B. (1982). Addiction to near death. International Journal of Psychoanalysis, 449-456.

Joseph, B. (1988). Addiction to near death. In Bott Spillius, E. (Ed.) Melanie Klein Today (pp.311-323). London and New York: Routledge.

Ryle, A. (1993). Addiction to the death instinct? A critical review of Joseph’s paper ‘Addiction to near death’. British Journal of Psychotherapy, 10, 88–92.

Shaw, J. (2012). Addiction to near death in adolescence. Journal of Child Psychotherapy, 38, 111-129.

Tunnel vision: A brief look at near death experiences

In 1964, the comic actor Peter Sellers had a series of eight rapid heart attacks after which his heart stopped beating and he was pronounced clinically dead. Thankfully, the doctor successfully brought Sellers back from the brink of death by vigorous heart massage. However, what is not so well known was that Sellers said that while all this was happening, he rose out of his body, and reached for a hand in a bright, loving light. As a result of his experience, Sellers claimed that he had lost his fear of death, had become more introspective, and had found tranquility in yoga. However, he still felt “lost” and would spend many discussions with the Reverend John Hester trying to “reconcile the world of plenty he inhabited with the emptiness of soul that oppressed him”.

Twenty years earlier, in 1944, the world-renowned psychiatrist and analytical therapist Carl Jung also had a near death experience. During a heart attack, Jung claimed to have envisioned the earth from over a 1000 miles in space. He claimed that he could see the Arabian deserts and the Himalayas. Hurtling towards him was a meteorite in the shape of a Hindu temple that was surrounded by a wreath of flashing bright lights. Jung felt the temple held the answers to all life’s most important questions. Before he could enter the temple, a spirit who was to die in his place called him back to earth.

The cases of Peter Sellers and Carl Jung may seem very strange but they are not untypical examples of a near death experience (NDE). NDEs are fairly widespread and the scientific study of them has been a growing research area over the last three decades. It has been claimed that with the increased amount of medical technology such as resuscitation techniques, that the number of people experiencing NDEs is on the increase (also check out my previous blog on Lazarus Syndrome – people that have seemingly come back to life after being pronounced dead).

The medic and philosopher, Raymond Moody, coined the term “near death experience” and says that one of the most asked questions that we as humans ask is “What happens when people die?” Do we simply cease to live or do we go onto something else leaving our mortal remains behind? Without getting into heavy philosophical and theological debates, it is clear that research into NDEs can perhaps help us to understand more about our own mortality and what happens when we die.

There are very few reports on how widespread NDEs are. In 1982, a survey by the pollster George Gallup Jr. reported that 15% of all Americans (23 million people) had experienced a “close brush with death” and that about 8 million had an NDE (about one in twenty people). A 1990 survey by Gallup reinforced his original findings with 12% of people reporting that they had been on the verge of death or had a close call involving an unusual experience.

There has been a lot of research into whether particular types of people are more susceptible to NDEs. Unfortunately, very few consistent findings have been found. It seems that almost anyone can experience NDEs. In fact, it has been reported that factors such as age, social class, race, and marital status have little (if any) influence on NDEs. Other factors that have been found to have little influence on NDEs include religious belief, prior knowledge of NDEs, and whether or not the person has a terminal illness.

However, research appears to suggest that the type of death may influence the type of NDE. For instance, those involved in car accidents and other ‘sudden’ events tend to report more cognitive experiences such as a ‘life review’ where the person’s life flashes before their eyes. One factor that may make a person more likely to experience NDEs is a history of abuse or trauma. The psychologist Kenneth Ring (University of Connecticut) says that these individuals are more likely to dissociate from a painful reality and tune into other realities to feel safe. The Seattle-based pediatrician Melvin Morse has even reported an in-depth study of children showing that they too can experience NDEs in his 1990 book Closer to the Light: Learning from the Near Death Experiences of Children.

The original pioneering academic study of NDEs has been attributed to the American psychiatrist Elizabeth Kubler-Ross who wrote the influential book On Death and Dying in 1969. In her book, she recorded many accounts of NDEs and “out of body travel” from her terminally ill patients and formulated the five classic stages of grieving (denial, anger, bargaining, depression and acceptance). She also reported that her patients often spoke to people who had preceded them in death, and that after death most of their faces became very peaceful.

In 1975, the first book to bring NDEs to mass public attention was Life After Life, a study of 150 cases written by Raymond Moody, and in 1988 wrote the follow-up best seller, The Light Beyond. In 1980, further research by the psychologist Kenneth Ring published in his book Life At Death concluded that NDEs consist of up to five stages. Based on an in-depth study of 102 cases, Ring reported that most people who have NDEs will experience the first stage but that very few reach the final one. His stages included peace (60%), body separation (37%), entering the darkness (23%), seeing the Light 16%), and entering the Light (10%). As with most areas, there are other typologies of NDEs that have been developed. For instance, the psychiatrist Bruce Greyson (University of Virginia) claimed that NDEs consisted of four different types – cognitive, affective, paranormal, and transcendental.

  • Cognitive: These experiences involve thought process alterations, such as time shifts, life review and sudden understanding. These tend to occur with unexpected brushes with death rather than anticipated ones such as those with a terminal illness.
  • Affective: These experiences involve peace, joy, painlessness, cosmic unity and encounters with a loving being of Light.
  • Paranormal: These experiences involve out-of-body travel, precognitive visions, extra-sensory perception, and hyper-acute physical senses.
  • Transcendental: These involve travel to an unearthly realm, encounters with a mystical being, visible spirits of deceased or religious figures, and a final point of no return.

It is also clear that not all NDEs are positive. Although most of the case studies reported by Raymond Moody were uplifting, a small proportion of the Gallup poll (about 1%) described their NDEs as “hell” or “tormenting”. As a result of more recent research, Bruce Greyson, and Nancy Bush refined the typology to include those who experienced more negative effects. As a result, it has been reported that there are three fundamentally different types of distressing NDEs: (i) prototypical NDEs with a tunnel and a bright Light, but experienced as terrifying, (ii) NDEs that had a sense of non-existence, eternal void or absurdity, and (iii) NDEs which features classical hellish imagery of tormenting demons and agonizing pain.

Thankfully, most people who have NDEs appear to have positive after-effects as a result of their experience. In his research, Kenneth Ring reports that survivors typically feel a heightened appreciation of life, a sense of personal renewal and a search for purpose, increased confidence, compassion, empathy, tolerance and understanding. At the core of most of these experiences is some kind of spiritual reawakening – although this is not necessarily religious. Life comes to be viewed as a precious gift. Scientific research also indicates that those who have NDEs show significant increases in psychic experiences. In fact, the more a person has, the more psychic experiences they have. Such experiences include precognitive awareness of incoming phone calls, and middle-of-the-night visits by recently deceased loved ones. Recent research suggests that transcendental near-death experiences show some cross-cultural variation that suggests they may be influenced by societal beliefs.

Some scientists are adamant that NDEs can wholly be explained by biological phenomena. For instance, the neurologist Ernst Rodin claims that a lack of oxygen supply to the brain (known as cerebral anoxia) causes delusions and hallucinations, and is a possible cause of NDEs. The London-based psychiatrist Karl Jansen and his colleague the endocrinologist Daniel Carr maintain that the body’s own morphine like substances (endorphins) increase before death and produce the feelings of calm and peacefulness reported by many who undergo NDEs. The neurologist Michael Persinger argues that temporal lobe brain activity and instability above the right ear is responsible for the deep meaningfulness, early memories and out-of-body experiences. The psychologist Susan Blackmore adds to this theory and argues that instability of the temporal lobe is also responsible for paranormal and mystical experiences. She also claims that the “Light at the end of the dark tunnel” experiences are optical illusions created by the effects of anoxia and drugs in which random light spots radiate from the centre of a dark internal visual field (also known as cortical disinhibition). Blackmore also believes that out-of-body experiences are drug-induced illusions as these are common experiences for people who use the drug ketamine recreationally. However, nearly all of these theories are at best only part explanations as none of them can fully explain all NDE accounts.

There are many psychological theories that have been forwarded as an explanation for NDEs. These range from historically based Freudian and Jungian theories through to more contemporary cognitive explanations. An early psychiatric explanation claimed that NDEs were linked with theories of depersonalization that “defend” the nervous system from the mental disorganization during the death crisis. Other psychologists claimed that depersonalization produces an altered passage of time, vivid and accelerated thoughts, a sense of detachment, unreality, automatic movements, and revival of memories. Some psychiatrists such as Ronald Siegal claim that NDEs are simply hallucinations (albeit very ordered ones) whereas some psychoanalysts claim that NDEs are a denial of death – a hallucinatory wish fulfillment defending the ego from its impending annihilation.

Other psychoanalysts claim that ‘birth trauma’ is the root of all neuroses and therefore explain NDEs as a regression to infantile object relations with the dark tunnel as the mother’s birth canal and the bright light as the mother’s radiant face. The famous cosmologist Carl Sagan saw some merit in this idea and proposed that people who have NDEs are reliving their descent down the birth canal. However, this has not been without its critics. On the technical side, it has been argued that infants descending down the birth canal not only have their eyes closed but their brains are too underdeveloped to allow memories of birth. The psychologist Susan Blackmore has also pointed out that that those born by Caesarian section are equally as likely as those born naturally to have NDEs that feature tunnels and out-of-body experiences! A theory by the psychologist Susan Blackwell claims that the human mind creates various mental models of reality based on its experiences, and the most stable one wins out as the favoured version. She claims that NDEs occur when the mind is in crisis and makes up models of reality such as out-of-body experiences, imagining the mind to be floating up above the body.

Whatever the explanation for NDEs, study of them from them is clearly an interesting area for both academics and the public alike. Whether the explanations are biologically, psychologically, or spiritually defined, it will not stop the growth of scientific research in this fascinating area.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Athappilly, G.K., Greyson, B. & Stevenson, I. (2006). Do Prevailing Societal Models Influence Reports of Near-Death Experiences? A Comparison of Accounts Reported Before and After 1975.Journal of Nervous and Mental Disease, 194, 218-224.

Belanti, J., Perera, M. & Jagadheesan, K. (2008). Phenomenology of near-death experiences: A cross-cultural perspective. Transcultural Psychiatry, 45, 121–133.

Blackmore, S. (1996). Near death experiences. Journal of Royal Society of Medicine, 89, 73-76

Kubler-Ross, E. (1969). On Death And Dying. New York: MacMillan

Moody, R. (1975). Life After Life. New York: Bantam/Mocking bird.

Moody, R. (1988). The Light Beyond. New York: Bantam/Mocking bird.

Morse, M. & Perry, P.J (1991). Closer To The Light: Learning From The Near-Death Experiences Of Children. London: G.K. Hall.

Ring, K. (1980). Life At Death. New York: William Morrow Co.

State of the heart: A brief look at Lazarus Syndrome‬

Back in the late 1990s and early 2000s I used to write regularly for the British magazine Bizarre. One of the articles of mine that they published was on ‘near death experiences’ and it was during my research on that topic that I first came across what has been termed the Lazarus syndrome (sometimes referred to as the Lazarus Phenomenon). The syndrome takes its name after Lazarus (who according to the New Testament was raised from the dead by Jesus), and refers to the spontaneous return of blood circulation after the person has been declared dead. The condition is very rare and there have been less than 30 documented cases in the medical literature over the last 30 years. The term ‘Lazarus Phenomenon’ is relatively recent and was first used by Dr. J. Bray in a paper published in a 1993 issue of the journal Anesthesiology.

Earlier this year, a story appeared in the British press about a Scottish woman who came back from the dead after collapsing while gardening (February 10, 2012). The newspaper reported:

“A woman declared dead after she suffered a massive heart attack astonished doctors and her grieving family when she suddenly came back to life. Relatives of Lorna Baillie were devastated when a team of medics withdrew treatment after spending three hours trying to revive her. The family gathered around her hospital bed to say their goodbyes after doctors told them the 49-year-old grandmother was ‘technically dead’… It was then, 45 minutes later, that Mrs Baillie’s disabled husband John, 58, whispered ‘I love you’ to his wife. And when Mrs Baillie’s eyelids flickered and she appeared to squeeze her eldest daughter Leanne’s hand, the nurse again assured the family that ‘involuntary movements’ were to be expected. Unconvinced, the family demanded the nurse call in a doctor, who found a pulse and rushed Mrs Baillie to intensive care. Mrs Baillie’s miraculous signs of recovery followed, but medics warned that her chances of survival remained slim because her kidneys had failed and she was in a coma. But Mrs Baillie’s condition continued to improve and [was] moved from intensive care to a medical ward. An MRI scan yesterday revealed no obvious brain damage”.

The causes of how seemingly dead people to come back to life are not clearly understood among the medical community. One explanation that has been suggested is that as a consequence of cardiopulmonary resuscitation, there is the buildup of pressure in the chest as a result of cardiopulmonary resuscitation (CPR), and that the relaxing of the pressure (post-CPR) initiates electrical impulses that restart the heartbeat. Other physiological factors that have been suggested include the affected individuals having elevated levels of (i) potassium electrolytes (i.e., hyperkalemia) or (ii) adrenaline (epinephrine). Here are a few ‘typical’ examples reported in the medical literature:

  • Case 1: After suffering an abdominal aneurysm, a 66-year-old American man was declared dead after 17 minutes of failed treatment. However, 10 minutes later, one of the doctors felt a pulse, and he made a full recovery with no long-lasting medical problems (Reported in Anesthesia and Analgesia, 2001).
  • Case 2: After renal failure secondary to embolism of the superior mesenteric artery, a 93-year old American woman was pronounced dead after 6 minutes of failed resuscitation treatment. Five minutes after being declared dead cardiac activity was observed on the heart monitor, and she made a full recovery (Reported in Anesthesia and Analgesia, 2001).
  • Case 3: Following a drug overdose-related heart attack, 27 year-old British man was declared dead after 25 minutes of failed treatment. Shortly after death had been declared, a nurse noticed the heart monitor was again showing heart rhythms so the resuscitation attempt continued and the man made a full recovery with no long-term medical complications (Reported in Emergency Medical Journal, 2001).
  • Case 4: A 65-year-old male with congenital deafness and dumbness was found unconscious in his room at a public home. After 35 minutes of resuscitation treatment he was declared death. Approximately 20 minutes later, a police officer found the man moving in the mortuary. He lived for a further four days (Reported in Forensic Science International, 2002)

In 2010, Dr. K. Hornby and colleagues (all at McGill University, Montreal, Canada) published a systematic literature review of auto-resuscitation after cardiac arrests in the journal Critical Care Medicine. They started from the position that there was a lack of consensus as to how long after circulation has topped for death to be determined after cardiac arrest. At present, and because of the Lazarus Syndrome, the medical literature recommends that death should not be certified until 5-10 minutes after failed CPR has taken place. The condition also raises questions and interesting ethical issues as to when post-mortem procedures should occur (e.g., organ harvesting, autopsies, etc.)

The authors located 32 cases (aged 27-94 years of age across 16 different countries) published in the medical literature (from 27 different articles, so most were single case studies). They then systematically collated all data relating to a number of different factors including (i) patient characteristics, (ii) duration of cardio-pulmonary resuscitation, (iii) terminal heart rhythms, (iv) time to unassisted return of spontaneous circulation, (v) monitoring, and (vi) outcomes.

The authors considered the papers to be of “very low quality” (all were case reports or letters to the editor). All of the 32 cases reported auto-resuscitation following failed CPR. The times ranged from just a few seconds up to 33 minutes. They also noted that there was a lot of inconsistency in reporting methods and that only eight of the cases reported continuous electrocardiogram monitoring and exact times. In these eight cases, auto-resuscitation did not occur beyond the 7-minute barrier. They also noted that there were no cases of auto-resuscitation in the absence of CPR. The findings of their review therefore suggest that the provision of CPR may influence the occurrence of auto-resuscitation. Their study concluded that there was insufficient evidence to support or refute the current recommended waiting period of 5-10 minutes to determine death following a heart attack. Similar conclusions were reached by Dr. Vedamurthy Adhiyaman and colleagues, in a 2007 literature review published in the Journal of the Royal Society of Medicine. They looked more widely at auto-resuscitation and located 38 cases published in the medical literature. They also examined the longer-term outcome and reported:

“Seventeen patients (45%) achieved good neurological recovery following ROSC [return of spontaneous circulation]. Three of these patients subsequently died during their hospital stay due to sepsis and pulmonary embolism and 14 (35%) were eventually discharged home with no significant neurological sequelae. Seventeen patients (45%) did not achieve neurological recovery following ROSC and died soon after. The outcome is not known in four patients (10%). There was no significant correlation between the outcome and duration of CPR, time interval for ROSC or the diagnosis”.

The paper most importantly points out that “death is not an event, but a process…a process during which various organs supporting the continuation of life fail”. As their review points out, the ceasing of circulation and respiration is a good example. Obviously, the absence of heartbeat and respiration are the “traditional and the most widely used criteria” to certify that someone has died, but the Lazarus phenomenon demonstrate that on their own they are not a sign of definitive death.

(Footnote: The paper by Adhiyaman and colleagues also notes the many other medical contexts and conditions in which the word ‘Lazarus’ has been used to describe many other unexpected and scientifically unexplained phenomena. For instance: “Lazarus complex describes the psychological sequence in the survivors of cardiac arrest, near-death experiences and unexpected remission in AIDS. Lazarus syndrome is described in paediatric palliative care, when a child is expected to die but unexpectedly goes into remission. Spontaneous movement in brain dead and spinal cord injury patients has been described as Lazarus sign. Survival of species after mass extinction has been called Lazarus effect. The term Lazarus phenomenon was also used for unexpected survival of renal graft patients”).

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Abdullah, R.S. (2001). Restoration of circulation after cessation of positive pressure ventilation in a case of “Lazarus Syndrome”. Anesthesia and Analgesia, 93, 241.

Adhiyaman, V., Adhiyaman, S. & Sundaram, R. (2007). The Lazarus Phenomenon. Journal of the Royal Society of Medicine, 100, 552-557.

Ben-David, B., Stonebraker, V.C., Hershman, R., Frost, C.L. & Williams, H.K. (2001). Survival after failed intraoperative resuscitation: A case of “Lazarus Syndrome”. Anesthesia and Analgesia, 92, 690-692.

Bray, J.G. (1993). The Lazarus phenomenon revisited. Anesthesiology, 78, 991.

Hornby, K., Hornby, L. & Shemie, S.D. (2010). A systematic review of autoresuscitation after cardiac arrest. Critical Care Medicine, 38, 1246–1253.

Maeda, H., Fujita, M.Q., Zhu, B.L., et al (2002). Death following spontaneous recovery from cardio-pulmonary arrest in a hospital mortuary: “Lazarus phenomenon” in a case of alleged medical negligence. Forensic Science International, 127, 82-87.

Walker, A., McClelland, H. & Brenchley, J. (2001). The Lazarus phenomenon following recreational drug use. Emergency Medical Journal, 18, 74–75. 

Ashes to ashes: Does “cremainlining” really exist?

I’m starting today’s blog with a news story from May 13th 1993 that occurred in Boynton Beach (Florida, US) and can be found on the website:

“When Nathan Radlich’s house was burgled, thieves left his TV, his VCR, and even left his watch. What they did take was ‘generic white cardboard box filled with greyish-white powder’. (That at least is the way the police described it.) A spokesman for the Fort Lauderdale police said ‘that it looked similar to cocaine and they’d probably thought they’d hit the big time.’ Then Nathan stood in front of the TV cameras and pleaded with the burglars: ‘Please return the cremated remains of my sister, Gertrude. She died three years ago. Well, the next morning, the bullet-riddled corpse of a drug dealer known as Hoochie Pevens was found on Nathan’s doorstep. The cardboard box was there too; about half of Gertrude’s ashes remained. And there was this note. It said: ‘Hoochie sold us the bogus blow, so we wasted Hoochie. Sorry we snorted your sister. No hard feelings. Have a nice day’”

This story is arguably the first instance of “cremainlining” (the snorting of someone’s cremated ashes). However, the myth-busting website Snopes says that the part about ‘cremainlining’ is simply not true. In fact, Barbara Mikkelson, author of the online article for Snopes said that no dead body turned up on Radlich’s doorstep, and no note was left by the people who bought the “drugs”. Mikkelson also says that even the reference to Radlich appealing on television for the return of his sister’s ashes was made up just to tell a better story. Fast forward to London (UK) seven years later when this gem of a story did the rounds in British newspapers such as The Sun.

“Cocaine-crazy thieves tried to snort powder they found in an English housewife’s living room, not realizing it was the ashes of her dead dog, according to a British press report…The burglars thought they had hit the jackpot when they saw the powder marked “Charlie” – slang for cocaine – in a dainty ceramic pot on pet-lover Dee Blyth’s mantelpiece, said the report in The Sun. But they were unaware the pot was an urn and the “drugs” really the remains of her beloved Newfoundland Charlie, who died in 1997. A policeman called to investigate the break-in at Chadwell Heath fell about laughing when he saw the burglars had arranged the ashes in cocaine-style lines. “I’d love to see their faces when these thieves realize,” said Blyth. “It was horrible knowing they were in my house, but the idea of them trying to get high on a dead dog certainly made me feel a bit better. ‘I didn’t realize the significance until the policeman started laughing’”

While the burglary did indeed take place, there is actually no evidence that the thieves engaged in any unintentional cremainlining. More recently, in April 2007, Keith Richards, the guitarist in The Rolling Stones, was interviewed by the New Musical Express (NME) about his lifelong drug exploits. In that interview he was asked what the strangest thing he had ever tried to snort. He replied by saying he had snorted his father Bert’s cremated ashes mixed with cocaine. He told the NME: “My dad wouldn’t have cared” and then added that the snorted mixture “went down pretty well, and I’m still alive”. However, in his 2010 autobiography (“Life”), Richards reveals the truth behind the whole story (pp.611-612) which was a lot less ‘rock ‘n’ roll’:

“After having Dad’s ashes in a big black box for six years, because I really couldn’t bring myself to scatter him around, I finally planted a sturdy English oak to spread him around. And as I took the lid of the box, a fine spray of his ashes blew out onto the table. I couldn’t just brush him off, so I wiped my finger over it and snorted the residue”.

On the 15th December 2010, five teenage burglars in the US broke into a woman’s house in Silver Springs (Florida, US) and all snorted what they thought was cocaine or heroin but were in fact the ashes of a dead man and two Great Dane dogs. They stole jewelry, electronic equipment, and two urns (one containg the dead man’s ashes, and the other the cremated remains of the two dogs). Waldo Soroa (aged 19 years), Matrix Andaluz (18), Jose David Diaz Marrero (19), and two juveniles who could not be named were eventually arrested on charges of burglary and grand theft.

Earlier this year, it was alleged that a 51-year old man in Florida (why does Florida seem to be the epicentre of many of these cremainlining stories?) – Joseph Pointer – stole a dead woman’s ashes and told the dead woman’s mother that he was going to snort the remains. Pointer was living with a woman called Angela Speakman who shared the cremated remains of her sister (who in 2008 had been killed in a car accident) with her parents. On moving out of the house he shared with Speakman, Pointer stole the ashes. He then drove past Angela’s mother’s house allegedly shouting  “I’ve got your dead daughter’s ashes and I’m going to snort them”. Pointer was arrested before he could snort the ashes but was charged with grand theft and jailed.

Just to finish with, I did mention in a previous blog I wrote on people’s fascination with death, the story of the woman who was “addicted to eating the ashes of her late husband” from the US television documentary series My Strange Addiction. The woman in question lost her husband following a fatal asthma attack and allegedly developed “a strong compulsion” to keep his ashes by her side at all times that then developed into eating the ashes. She says the ashes eating began when she was first transferring her husband’s cremated remains from a box into an ornamental urn. She accidentally got some of the ashes on her finger and “not wanting to just brush them off, licked them off, starting a habit that has become compulsive”. At the time of the television programme being recorded (and despite the ashes tasting horrible) she had been eating the ashes for two months and had consumed approximately six pounds of the ashes. In this particular case, the behaviour appears to be an unusual type of pica (i.e., the behaviour in which individuals eat non-nutritive items or substances) and which in some cases has been shown to be compulsive. Other online commentators have speculated that the eating of her husband’s ashes is a way of symbolically holding onto her husband in the easiest way possible.

So what are we to conclude? Certainly ashes have been ingested by a few loved ones, and there appears to be some evidence that a few thieves may have snorted cremated human remains mistakenly thinking it was cocaine during a burglary (a case of ‘crim0-cremainlining’ perhaps?). However, there doesn’t seem to be a single case of anyone doing it because they got any pleasure or enjoyment out of it.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Daily Mail (2011). Dumb, dumber and dumbest: Burglars snort ashes of a man and two dogs after they mistook them for cocaine, January 20. Located at:

Geekosystem (2011). Woman is addicted to eating the ashes of her late husband. August 9. Located at:

Herzberg, R. (2012). Man steals dead woman’s ashes and threatens to snort them. The Dream Demon, April 17. Located at:

Mikkelson, B. (2012). Cremainlining. Snopes, July 2011, Located at:

MSNBC News (2007). Keith Richards says he snorted father’s ashes, April 4. Located at:

Richards, K. (2010). Life. London: Orion Books.

Zipadeeday (2000). Thieves snort the line of a dog, November 6. Located at:

You’re killing me: A brief psychological and ethical consideration of autassassinophilia

Autassassinophilia is a paraphilia in which an individual derives sexual pleasure and arousal by the thought and/or risk of being killed. The paraphilia may on occasion overlap with other paraphilias such as autoerotic asphyxiation (i.e., sexual suffocation) where there is a risk to their life. In some instances, the autassassinophile may also derive sexual pleasure and arousal from planning their own death. Given these facts, it is clear that autassassinophilia is exceedingly rare and very dangerous. The condition was first written about in a clinical (and academic) context by Professor John Money in his 1986 book Lovemaps. He wrote that:

“Autassassinophilia [is] a paraphilia of the sacrificial/exploratory type in which sexuerotic arousal and facilitation or attainment of orgasm are responsive to, and dependent upon stage-managing the possibility if one’s own masochistic death by murder. The reciprocal paraphilic condition is lust murder or erotophonophilia…Erotophonophilia [is] a paraphilia of the sacrificial/exploratory type in which sexuerotic arousal and facilitation or attainment of orgasm are responsive to, and dependent upon stage-managing and carrying out the murder of an unsuspecting sexual partner. The erotophonophiliac’s orgasm coincides with the expiration of the partner. The reciprocal paraphilic condition is autassassinophilia”

Brenda Love cites one of Money’s own cases in her Encyclopedia of Unusual Sex Practices:

“The masochistic drama of erotic death and atonement may be enacted not as an autoerotic monologue, but as a dialogue with a co-opted partner in collusion. The partner is not necessarily a paraphilic sadist, but rather a daredevil hustler or mercenary given to trying almost anything for kicks, or for profit. This was not the type of hustler whom a young man with a paraphilia of homosexual masochism would pick up, one or more at a time, on the waterfront. With his beguiling brand of macho, he would cue the hustlers into their roles in his masochistic drama. First he would supply them with squeeze bottles of mustard or ketchup and a spray can of shaving cream to squirt on him as he lay naked, masturbating. Then he would direct them to bind him up with rope, urinate on him, degrade and abuse him verbally, hit hum, and kick him harder with heavy boots, harder and harder, until he would ejaculate, not knowing whether a blow on the head would wound him or kill him”.

A paper on the phenomenology of autassassinophilia by Dr. Lisa Downing in a 2004 issue of Sexuality and Culture questioned the definitions provided by Money and argued that the reciprocal conditions outlined by Money were fundamentally flawed. Downing made the interesting observation that:

“The autassassinophiliac, for Money, is more interested in his orgasm than in his death, resulting in a compulsion to ‘stage manage the possibility’ rather than the actuality of his end at the hands of another person. The erotophonophiliac, on the other hand, is driven by the actualization of the other’s death and – crucially – this other must be unaware of the killer’s intentions. These difinitions, then, effectively preclude reciprocity”.

Some of you reading this might think that autoassassinophile is more of a theoretical (rather than an actual) paraphilia, but there are a number of documented cases of two lovers in a consensual ‘murder pact’. The most high profile heterosexual case is that of Sharon Lopatka and Robert Glass. Lopatka (from Maryland, US) was strangled and killed consensually by Glass who she met online at an “extreme fantasy” website. Over a number of months in 1996, they exchanged 1000s of emails (found by the police after she was found dead) fantasizing about – and planning – her own murder. Glass eventually pleaded guilty to manslaughter claiming he had never actually intended to kill her.

The most high profile homosexual case was that of the German men Armin Meiwes and Jürgen Brandes – a case that I examined in relation to a previous blogs on vorarephilia (i.e., a sexual paraphilia in which people are sexually aroused by the idea of being eaten, eating another person, or observing this process for sexual gratification) and autosarcophagy (i.e., self-cannibalism). Meiwes, a computer technician, gained worldwide media attention as the ‘Rotenburg Cannibal’ for killing and eating a fellow German male victim (also a computer technician). The one aspect that shocked most people was not the fact that Meiwes ate a lot of Brande’s body but that Brande appeared to consent to being eaten. Email exchanges between Meiwes and Brandes were later shared in the court case:

Brandes: “Thanks for your mail. You really turn me on…Winter with the temperature at around 5 to 15 degrees below freezing is good weather for slaughter. Great to be naked and tied in weather like that and to be driven to the slaughter. Where you then stun me and I collapse. You then hang me up, jerking, and cut my carotid artery. Warm blood flows. Everything goes routinely. I don’t have any chance to escape my slaughter at the last moment. It’s a real turn-on, the feeling of being at your mercy being in your possession. Having to give up my flesh”

Meiwes: “It’ll be awesome, anyway. Your tasty body on show like that. Spicing it…Tying you up will be no problem, I’ve got rope and some cuffs for your hands and feet. I’ll really enjoy the bit with the needles. I’ll see if I can get hold of some really long ones. I can’t wait for you to be here”

In court, Brande’s consent to being killed was accepted by the jury and Meiwes was given an eight and a half year prison sentence for manslaughter. These (and other) cases raise some interesting and controversial ethical questions. These were discussed at length in Dr. Downing’s excellent and thought provoking phenomenological paper on autassassinophilia. She clearly makes the point that being killed for sexual pleasure “problematizes commonplace assumptions about the legitimacy to consent”. When it comes to sexual behaviour, I would describe my views as liberal and are in line with the liberal sex tenets outlined by Robert Solomon that (i) the essential aim of sex is enjoyment, (ii) sex is an essentially private activity, and (ii) any sexual activity is as valid as any other. However, like Downing, I think the idea of consensual lust murder appears to exceed “acceptable” limits of sexual behaviour. However, that doesn’t mean I believe totally in the commandment “thou shalt not kill”. I am pro-euthanasia and have much sympathy with those who have carried out so-called ‘mercy killings’ when a person is in intolerable pain and is unable to end their own life (and a loved one is asked by the suffering person to kill them as humanely as possible).

Downing makes reference to the work of Alan Soble who has written widely of the philosophy of sex. Soble’s 1996 book Sexual Investigations makes the following observation:

“If persons of sound mind and adequate foreknowledge consent to engage in sex together, and do only the acts that both agree to, and do not wrongfully affect third parties, how could their acts be morally wrong? [However], one person’s harming another – and perhaps a person’s allowing himself to be harmed – is wrong even when both parties enter into the act voluntarily”.

Downing considers the last sentence here as “moral absolutism” overriding the liberal standpoint. In fact she says that: “this interventionist and infantilizing approach assumes a class of person (professionals, and theorists) who just know better than the people who consent to certain types of activity”. Given that some sections (like myself) are socially tolerant of euthanasia, it’s more a case of having “a problem with the idea of validating the right to consent to a sexually pleasurable death. I have to be honest and say that although I am a sexual liberal, I find it hard to accept consensual sex killing and think it is morally wrong.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Beier, K. (2008). Comment on Pfafflin’s (2008) “Good enough to eat”. Archives of Sexual Behavior, 38, 164-165

Downing, L. (2004). On the limits of sexual ethics: The phenomenology of autassassinophilia. Sexuality and Culture, 8, 3–17.

Love, B. (1992). Encyclopedia of Unusual Sex Practices. Fort Lee, NJ: Barricade Books

Money, J. (1986). Lovemaps: Clinical concepts of sexual/erotic health and pathology, paraphilia, and gender transposition in childhood, adolescence, and maturity. New York: Irvington.

Pfafflin, F. (2008). Good enough to eat. Archives of Sexual Behavior, 37, 286-293.

Pfafflin, F. (2009). Reply to Beier (2009). Archives of Sexual Behavior, 38, 166-167.

Soble, A. (1996). Sexual Investigations. New York: New York University Press.

Solomon, R. (1997). Sexual paradigms. In A. Soble (Ed.), The Philosophy of Sex: Contemporary Readings (Third Edition, pp.21-29). Oxford: Rowman and Little.

Into the black: Why are we so fascinated by death and dying?

If you type the words “weird addictions” or “strange addictions” into Google, there is one story from 2006 that comes up time and time again. It is usually headlined “Addiction to Funerals” and concerns a Brazilian man called Luis Squarisi. The story claimed that Squarisi (who was 42-years old at the time) had attended every funeral in his hometown of Batatais for more than 20 years. The story also claimed that in order to attend every funeral, Squarisi had given up his job to “feed his addiction to funerals”. He was quoted as saying:

“What set me off was my father’s death in 1983. The first thing I do every morning is to turn on the radio to find out if anyone has died, if I don’t hear it on the radio I call the hospitals and the local funeral home”.

A spokesman from the local São Vicente funeral home where Squarisi lives said: “We don’t want him to go to therapy, everyone expects to see him at the funerals.” If you are regular reader of my blog, it won’t surprise you to learn that I don’t consider Mr. Squarisi’s activity an addiction at all (although the habitual daily ringing of the hospitals and funeral parlour combined with the giving up of his job might potentially be indicators for some types of addiction or compulsion).

However, it did get me thinking about the morbid (and for some almost compulsive) fascination that some people have with death and dying, and whether there were other possible links to addictive, obsessive, and/or compulsive behaviour. Fascination with death and dying is not a recent phenomenon and extends back into ancient history. Historically, many cults have been formed around death gods and figures including Anubis (the jackal-headed Egyptian religious god associated with mummification and the afterlife), Osiris (an Egyptian god usually identified as the god of the afterlife, the underworld and the dead), Hades (the ancient Greek god of the underworld), and Santa Muerte (i.e., “Saint Death”, a sacred and skeletal Mexican figure symbolizing death to remind people of their own mortality).

More recently, people’s fascination with death have included wanting to contact the dead via séances and/or psychics. The greatest evidence of the general public’s fascination with death is the coverage that death gets in the popular media (“if it bleeds, it leads”). There also seems to be an appetite for death as art such as Gunter von Hagen’s Body World’s exhibitions. As US journalist Winda Benedetti put it in her article Is digging the dead normal or just plain weird?”:

“I have gawked at the skeletons decorating the walls of the Kutna Hora Bone Church in the Czech Republic. I’ve stood transfixed before the towering piles of skulls that mark the Khmer Rouge’s Killing Fields in Cambodia. In Cairo, it was the display of mummified kings and queens that lured me to the Egyptian Museum. And in London, not even the cruel bite of the bitterest winter on record could keep me from standing in a line half a city block long for a peek at “Body Worlds,” a display of dozens of cadavers skinned, dissected and posed for all to see… A new thought occurred: Does my preoccupation with the dead make me a freak? Am I really so different from everyone else? Take a look around. These days it seems the dead are everywhere. Every week on television, actors pretending to be crime-scene investigators pick over the fetid cadavers of the deceased on not just one but three different ‘CSI’ shows. And while these programs are TV-fake, the images of the dead are unflinchingly real”.

While researching this blog, I came across a number of online references about US novelist Charles Dickens being “addicted” to and/or ‘obsessed” with mortuaries and checking out murder scenes. Dickens admitted: “I am dragged by invisible force to the morgue [and] the attraction of repulsion”. He allegedly visited the city mortuary for days at a time observing the dead bodies coming in and watching the morticians who worked on them.

Anyway, the next death-related “addiction” I came across (excluding some recent reports of some people becoming addicted to ingesting embalming fluid!) was “Woman is addicted to eating the ashes of her late husband” from the US television documentary series My Strange Addiction. The woman in question lost her husband following a fatal asthma attack and allegedly developed “a strong compulsion” to keep his ashes by her side at all times that then developed into eating the ashes. She says the ashes eating began when she was first transferring her husband’s cremated remains from a box into an ornamental urn. She accidentally got some of the ashes on her finger and “not wanting to just brush them off, licked them off, starting a habit that has become compulsive”. At the time of the television programme being recorded (and despite the ashes tasting horrible) she had been eating the ashes for two months and had consumed approximately six pounds of the ashes.

Again, I don’t think the woman in question is addicted but the behaviour appears to be an unusual type of pica (i.e., the behaviour in which individuals eat non-nutritive items or substances) and which in some cases has been shown to be compulsive. Other online commentators have speculated that the eating of her husband’s ashes is a way of symbolically holding onto her husband in the easiest way possible.

To me, this ash eating behaviour is reminiscent of one of the ten sub-types of necrophilic activity described by Dr Anil Aggrawal (Maulana Azad Medical College, New Delhi, India). He published a necrophilia typology in a 2009 issue of the Journal of Forensic and Legal Medicine. This new classification of necrophilia included one sub-type that he termed “romantic necrophiles”. According to Aggrawal romantic necrophiles display only “very mild necrophilic tendencies”. This type of necrophile typically comprises people whose loved ones have just died and who do not seem to fully believe or psychologically appreciate that the person they love is dead. Therefore, the sexual contact may not (in the person’s view) be seen as necrophilic as they still believe the person is alive to them. Aggrawal claims that in some cases, romantic necrophiles may mummify the body (or body parts) of their partner. The necrophilic activity is typically short-lived and is something that stops once the person fully accepts that their loved one is dead.

Back in the 18th century, Martin Schurig in his book Spermatologia, described the case of a Belgian woman, who secretly cut off her husband’s penis he died and treasured it as a sacred relic in a silver casket. This was then turned into a powder and described it is an efficacious medicine. The sexologist, Havelock Ellis, cited the case of a French woman who embalmed and perfumed her dead husband’s genitals and preserved them in a gold casket. Obviously the women who ate her husband’s ashes did not do it for anything sexual but all these cases kept some embodiment of their loved ones in order, as Dr Aggrawal might argue: “to fill up a psychosexual vacuum that their death has caused”.

Maybe the internet will start to fuel the sexual side of death? I’ll leave you with two confessions I came across on the internet. They may – of course – not be in any way representative, but they do seem to suggest that some people out there are fascinated by the sexual macabre:

“I have an addiction to dead bodies. The site of gore porn really turns me on. How should I satisfy my sexual fantasies?”

“I’m 15 years old – female, and I love looking and reading about murder cases and I’m addicted to looking at pictures of murder victims on the internet. I’ve seen ‘3 guys one hammer’ and it didn’t disturb me at all. When I see people I look at them and I can picture in my mind how I could kill them (even if I don’t know them or they’re my friends). Am I disturbed?”

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Aggrawal, A. (2009). A new classification of necrophilia. Journal of Forensic and Legal Medicine, 16, 316-320.

Aggrawal A. (2011). Necrophilia: Forensic and Medico-legal Aspects. Boca Raton: CRC Press.

Benedetti, W. (2006). Is digging the dead normal or just plain weird? Seattle PI, September 29. Located at:

Digital Journal (2006). Man addicted to funerals. November 10. Located at:

Ellis, H.H. (1923). Studies in the Psychology of Sex (Volume V: Erotic Symbolism, The Mechanism of Detumescence, The Psychic State in Pregnancy). Davis FA.

Geekosystem (2011). Woman is addicted to eating the ashes of her late husband. August 9. Located at:

Neatorama (2009). Four writers and their strange obsessions. February 7. Located at:

Schurig, M. (1720). Spermatologia historico-medica. Frankfurt: Johannis Beckii.

Seaward, A. (2012). Embalming fluid as a drug., April 19. Located at: