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
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.
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
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.