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Friday, March 04, 2005

Near Death Experiences, Part III

Tonight's segment comes from searches on Medline and Proquest, and consists of some abstracts and a document. I'm still refraining from commentary. Besides, my copy of Tibetan Book of the Dead hasn't yet arrived.

1. Schizophrenia, dissociative anaesthesia and near-death experience; three events meeting at the NMDA receptor.
Med Hypotheses 2004;62(1):23-8    (ISSN: 0306-9877)
Department of Pharmacology, Erasmus University Rotterdam, The, Netherlands.

The three events, viz. schizophrenia, dissociative anaesthesia and Near-Death Experience, despite their seemingly unrelated manifestation to each other, have nevertheless similar functional basis. All three events are linked to the glutamate sensitive N-methyl-D-aspartate (NMDA) receptor complex, which serves as their common functional denominator. Arguments and speculations are presented in favor of the view that, the three events might be considered as functional models of each other. Antagonism to the recognition NMDA-site of the receptor induces dissociative anaesthesia and precipitates Near-Death Experience. Agonist reinforcement at the modulatory glycine-site of the receptor counteracts negative symptoms of schizophrenia. Both types of challenges towards the receptor are compatible with a glutamate deficiency concept which underlies the meeting of the three events at the NMDA receptor.

2. Near-death experiences and the temporal lobe.
Psychol Sci 2004 Apr;15(4):254-8    (ISSN: 0956-7976)
Britton WB; Bootzin RR
Department of Psychology, University of Arizona, Tucson, AZ 85721, USA.

Many studies in humans suggest that altered temporal lobe functioning, especially functioning in the right temporal lobe, is involved in mystical and religious experiences. We investigated temporal lobe functioning in individuals who reported having transcendental "near-death experiences" during life-threatening events. These individuals were found to have more temporal lobe epileptiform electroencephalographic activity than control subjects and also reported significantly more temporal lobe epileptic symptoms. Contrary to predictions, epileptiform activity was nearly completely lateralized to the left hemisphere. The near-death experience was not associated with dysfunctional stress reactions such as dissociation, posttraumatic stress disorder, and substance abuse, but rather was associated with positive coping styles. Additional analyses revealed that near-death experiencers had altered sleep patterns, specifically, a shorter duration of sleep and delayed REM sleep relative to the control group. These results suggest that altered temporal lobe functioning may be involved in the near-death experience and that individuals who have had such experiences are physiologically distinct from the general population.

3. Near-death experiences with reports of meeting deceased people.
Death Stud 2001 Apr-May;25(3):229-49    (ISSN: 0748-1187)
Kelly EW
University of Virginia Health System, Charlottesville, Virginia, USA.

Few scientists have taken seriously the interpretation of near-death experiences (NDEs) as evidence for survival after death, even though most people having such an experience have become convinced that they will survive death and several features of NDEs are at least suggestive of survival. This article compares survival and some nonsurvival interpretations of NDEs in light of one feature suggestive of survival, that of reports of having seen deceased persons during the NDE. Several features of 74 NDEs involving such reports were compared with those of 200 NDEs not involving such reports. Although some of the findings could support either a survival or a nonsurvival interpretation, several other findings may weaken the primary nonsurvival hypothesis, that of expectation. Additionally, the convergence of several features suggesting survival and the convergence of features that require multiple kinds of alternative explanations, in individual cases as well as in large groups of cases, warrant our considering the survival hypothesis of NDEs more seriously than most scientists currently do.

4. What Emergency Department Staff Need to Know About Near-Death Experiences
Debbie James. Topics in Emergency Medicine. 
Jan-Mar 2004.Vol.26, Iss. 1;  pg. 29, 6 pgs

A CASE TO REMEMBER

J.B., a 42-year-old white man, was taken to the Emergency Department (ED) by emergency medical services (EMS) after he was resuscitated at his son's high school football game. He had suddenly collapsed and 2 bystanders started Cardiopulmonary resuscitation (CPR), which was continued until paramedics arrived 5 minutes later. he was placed on a cardiac monitor, defibrillated, intubated, and transported once an IV was in place and a rhythm established. Upon arrival, J.B. had 2 more episodes of ventricular fibrillation, which was treated according to the Advanced Cardiac Life Support (ACLS) protocol. he was transferred to the coronary care unit within the next 2 hours. Over the subsequent 24 hours, J.B. was stabilized, extubated, and closely monitored.

Two days later he asked his nurse to explain what had happened to him because he recalled "dreams" about how the paramedics had intervened with him at the game and how the ED staff had participated in his resuscitation. The nurse nervously stated that she was not at liberty to discuss his resuscitative care and encouraged him to consult his cardiologist about any concerns. J.B. did not inquire further about his "dreams."

Two years later, J.B. attended a cardiac rehabilitation support group meeting and heard the guest speaker present the topic of near-death experiences (NDEs). he was shocked to learn that several people in the group had vivid memories of "dreams" they had following their resuscitation. J.B. became emotional and fought the urge to ask the speaker questions regarding his close brush with death. he had not allowed himself to discuss the subject though the memories were as clear that night as they were 2 years prior. Before he realized it he was asking the speaker about his memory of hearing one paramedic saying to the other, "Hurry up, crank it up to 200.. .we're losing him, we're losing him!" he continued to divulge that he felt something funny and then heard the paramedic yell, "Hurry up dammit, crank it up to 300; we're losing this guy."

After J.B. had recounted the 200-300-360 sequence, the speaker explained that he had just given the exact energy settings that health care providers are taught to use to defibrillate patients. J.B. innocently asked, "then you think it happened like that?" The speaker compassionately responded, "I think it happened exactly like that" as she saw others in the group wiping tears from their eyes.

J.B. is one of the estimated 10 million Americans who has reported a near-death experience (NDE) associated with resuscitation. he had an immediate desire to disclose the NDE but based on the reaction of the person he first chose to tell, he suppressed any further desire to share.

DEFINITION OF NEAR-DEATH EXPERIENCE

Absolute consensus on the definition of the NDE among researchers has not been reached though most will agree that it is one of the most powerful emotional and psychological events known. For the last 3 decades, the term NDE typically describes a close brush with physical, psychological, emotional, and/or spiritual death. Pirn van Lommel, Dutch cardiologist, recently defined the NDE as "the reported memory of all impressions during a special state of consciousness."

CHARACTERISTICS

Survivors often recall certain characteristics about their close brush with death. The most common characteristics include, but are not limited to, a bright light, encountering others, the presence of Deity, and peace and/or an understanding of love and knowledge. Van Lommel1 notes that specific elements of the NDE include an out-of-body (OOB) experience, pleasant feelings, and seeing a tunnel, a light, deceased relatives, or a life review.

STAGES OF THE NDE

Consensus about the stages of the NDE has also not been reached, probably due to the fact that no two NDEs are identical; however, patterns have emerged as patients report their experience. A composite of the stages described across cultures and centuries might include euphoria, an OOB experience, a tunnel experience, an unearthly world of light, and a decision-making period.

* Euphoria-a floating, peaceful feeling. Most report that they had no human wants or needs. They were not hungry, thirsty, in pain, hot, or cold.

* Out-of-body experience-a separation of body and spirit. Reports most commonly include watching the body from an outward perspective, feeling little to no attachment to the physical self.

* Tunnel experience-being pulled into a dark hole or the center of the earth. Some feel they were in a black vastness and/or moving quickly toward the center.

* An unearthly world of light-being in surroundings that are not of this earth. Some report seeing objects and beings that are unfamiliar or have features of light. Sounds such, as music, have also been noted in this stage.

* The decision-making period-being involved in the decision to stay or return. Some report knowing or being told that "it is not time" or that "you must go back" or being given the choice to return or not.

These stages are certainly not experienced by every person who has had an NDE. Some people report being in a bright light or a dark tunnel and having a "knowing" that they must return and that is the entire experience. Others describe all the stages of the event in elaborate detail.

LITERATURE REVIEW

For hundreds of years, people have reported stories related to their close encounters with death. Notations may be found in The Bible, The Tibetan Book of the Dead, and many widely read sources, but not until 1975 was the term Near-Death Experience used to describe such encounters. Moody published Life After Life, a book containing stories and accounts revealed to him by over 100 people. he was criticized for his "nonscientiflc" study by other researchers. Moody's work has been accepted as the foundation upon which others have based their research. he identified perceptions frequently described by patients who had been successfully resuscitated. These include but are not limited to

* feelings of separation of mind from body

* sensations of drifting, floating, passing through solid objects

* awareness of actual events but an inability to communicate to living beings

* hearing loud, hissing, thunderous noises

* moving through a tunnel

* meeting a brilliant, warm Light

* experiencing peace, indescribable beauty, splendor, and a longing to be part of it

* recognizing others

* communication with deceased others by thoughts

* returning through darkness, propelled by force

* feeling a purpose about life

Kubler-Ross3 subsequently included this phenomenon in her publications related to aspects of death and dying. She reported anecdotes of deathbed visions, visits, and stories. The patients sharing these anecdotes described many perceptions which had been identified by Moody.

The first scientific study of NDEs was documented by Ring4 in 1980. he found that in a sample of 102 people who came close to death, 49 described an NDE that fit the core experience concept. Of the 102 subjects, 61 appeared to be unable to verbalize language to describe the feelings, perceptions, and time frame of the NDE.

Articles in the medical literature in the late seventies and early eighties primarily reported qualitative studies which focused on "stories"from patients who had close brushes with death. Sabom5 reported "recollections" of patients in his practice who had suffered a myocardial infarction. They too, recounted many of the same characteristics cited by Moody.

George Gallup reported a landmark study conducted by the prestigious Gallup Poll. He reported that "approximately 35 percent of those persons who have come close to death undergo an NDE."6

Greyson noted a lack of quantitative measures of the NDE and its components and introduced an NDE Scale. The 16-item final questionnaire resulted from an original 33-item tool Greyson developed after identifying 80 manifestations characteristic of an NDE. he used cluster analysis to reveal 3 factor clusters, which are transcendental, affective, and cognitive NDEs. Greyson reported that "this reliable, valid, and easily administered scale is clinically useful in differentiating NDEs from organic brain syndrome, and nonspecific stress responses. "7(p569)

Oakes, in 1978, published a 3-part segment entitled The Lazarus Syndrome in RN magazine. Here she reported the first nursing research study that focused on "what patients perceive in near-death events."8(p55) She noted that "strong cultural influences and religious beliefs affect a patient's expectation of what death will bring; and that this is reflected in the dying process."8(p56) Oakes concluded her 2-year study, in which she interviewed 21 postresuscitation patients, with a Care Plan for the Unique Needs of Those Who've Died.8(p60) The care plan included 5 major guidelines to consider when CPR becomes necessary. The first suggestion helped guide care when a patient is in cardiac arrest and apparently unconscious. Specific interventions included avoidance of threatening language, reassurance about care, and incorporation of comforting touch. The second guideline related to caring for patients who become unconscious. Reassurance and support, reality orientation, and care during transfer to intensive care unit (ICU) are recommended for the plan of care. Establishment of a low stress environment, which included considerations about personal care items, privacy, verbal support, was the third care plan item. The fourth guideline dealt 'with interventions regarding the post-CPR reports of NDE. Attention and active listening, nonjudgmental behavior, assistance in exploring the event, and documentation were discussed and encouraged in this section. Lastly, methods for follow-up care were reviewed. Care plan items included assessment of the impact on the patient, intervention with the family, and long-term support.

Orne reported her findings related to nurses' attitudes about NDEs and what they considered appropriate interventions. Results indicated "listening to NDE accounts and encouraging discussion" ranked highest among responses.9(p420) She concluded her study with a list of research questions which need to be answered. Two of these provided foundation for this study. They included "Is coping influenced by what is (or is not) said or done by nurses?" and "What strategies are most needed: reassurance, information, invitations to talk and explore feelings, or referral?"

Corcoran10 presented insights on how to best provide care for patients who have had an NDE. She reviewed the phenomenon, characteristics, incidence, and aftereffects. In addition, she provided a new concept. Research has shown that "NDEs have fairly common characteristics around the world, so, if an NDE is a hallucination, it must be a universal hallucination."10(p36) She urged nurses to carefully listen to patients' information regarding their experience without judgment.

Currently several researchers are exploring various aspects of the NDE and reporting the data in the Journal of Near Death Studies as well as major medical journals such as lancet.

AFTEREFFECTS OF THE NDE

Recognizing that no two NDEs are the same, it would stand to reason that the aftereffects of the NDE are unique as well. However, there are certain aftereffects that are reported more frequently than others. The most common of these include having no fear of death, less regard for material wealth, chemical sensitivities, and difficult disclosure decisions.

No fear of death

Though many state that they are not eager to die or separate from loved ones, they see death from a different perspective and therefore accept it as a part of life. Additionally, individuals who have suffered chronic pain and have an NDE often become more comfortable with death knowing that it will bring peace and comfort. On the surface, realizing that a patient may have an acceptance of death especially when death is imminent and suffering has become more apparent might bring comfort to caregivers and loved ones. However, if the patient is a small child who-now accepts death when his parents and family have not reached the same point can be very difficult for all concerned. Healthcare providers also may feel conflicted when the patient seems unconcerned about the possibility of death. Patients who request that no resuscitative efforts be taken in their plan of care may meet resistance from their health care team.

Less regard for material wealth

Near-death survivors often report a decreased desire for material wealth as they note an increase in the importance of relationships. Affluent near-death experiencers (NDEers) explain that the need for money, resources, and even fame no longer drives their behavior. As they integrate the experience and such a significant change in philosophy, they find loved ones have difficulty in accepting them as well as their life goals. Unfortunately, studies have shown that the divorce rate for NDEers is higher than the national average. Individuals who have strivecl to meet personal, financial, and spiritual goals suddenly find themselves on divided paths. For the near-death survivor the path may be lonely but acceptable.

Increased chemical sensitivity

Near-death survivors report strange reactions to certain chemicals following the NDE. Individuals state that they no longer enjoy drinking alcohol, experience hypersensitivity to medications they have used for years, as well as encounter unusual reactions to dyes used for diagnostic procedures. Problems associated with such sensitivities may include physical compromise in addition to delays in treatment when health care providers do not understand and/or accept the phenomenon.

Difficult disclosure decisions

Multiple factors which influence decision making regarding disclosure of the NDE were documented by James.11 These factors included considerations related to timing of the disclosure, the individual(s) to be told, motives for sharing the experience, as well as motives which lead to nondisclosure.

Timing of the disclosure

With regard to when the NDE is disclosed to another, James found that the NDEer may attempt to discuss part of the phenomenon immediately after the experience, or as soon as he/she can communicate, simply to validate that he/she was as close to death as was perceived. An in-depth discussion of the actual experience may not be the desire of the NDEer at such time because he/she may not understand what occurred and time may be needed for acceptance of the circumstances which led to the NDE. On the other hand, NDEers may desire to talk about the actual experience soon after the event to share with a loved one the beauty, peace, and joy of the experience. NDEers report attempting to share their story immediately, but felt as though others "did not understand, were not interested, or thought they were crazy or confused." NDEers who do not attempt to share their story immediately report trying to tell someone as soon as they felt they "needed or wanted to. " On the basis of the reaction of the confidant, the NDEer may wait years before disclosure may be possible.

Individuals chosen for disclosure

James concluded from her data that the NDEer will most likely attempt to tell a nurse or physician about the NDE regardless of the timing. The primary reason is because these individuals are more apt to understand the severity of the situation or condition. The next choice is typically a family member; however, a greater risk may be perceived as disclosure may impact a long-term relationship.

Motives for disclosure and nondisclosure

Motives for disclosure include the need for support or information, and because someone cared. Motives for nondisclosure are personal issues and noncaring behaviors. Personal issues may include that the NDEer feels it is not practical to share for various reasons or that he/she has negative feelings about the listener.

SUMMARY

The NDE is not uncommon, but is so profound and personal that often the experiencer desires to disclose the event immediately after it occurs. This desire frequently results in an attempt to share the event with those responsible for the care of the experiencer. Health care professionals are often in a position to promote a path of physical and spiritual health and well-being. Therefore, their increased awareness and sensitivity of the needs of the NDEer are essential.

The need to create a healing environment was first documented by Florence Nightingale12 in I860 in her Notes on Nursing. In many cases, the NDE occurs in a health care setting, such as a hospital, ambulance, or clinic, wherein the nurses and physicians, and sometimes clergy and family, are immediately available to the NDEer. Health care professionals play a key role in the promotion of an environment of healing.

The decision as to which individual(s) the experiencer will select for disclosure depends primarily on the demonstration of specific caring behaviors of the caregiver. The NDEer must recognize the promotion of a safe environment before sharing is possible. The response to the first attempt at disclosure will have a serious impact on future disclosure decisions.

RECOMMENDATIONS

Possible interventions for ED staff caring for patients who have had an NDE might include but are not limited to the following:

* Actively listen to verbal and nonverbal communication. The patient may desire to share very personal data and may be searching for permission to proceed. Remain alert to phrases like "I had a strange dream," or "a weird thing happened."

* Foster a caring environment. Use positive language and pleasant tones of voice. Promote a healing atmosphere in every aspect of patient care. Realize that even in resuscitation efforts patients may be aware of certain behaviors.

* Listen. Allow the patient to describe what is on his mind and do not interrupt with explanations about drugs and hypoxia. Remain nonjudgmental.

* Be there. NDEers state that they told "the nurse show was really there." Make eye contact, slow down, look at the patient, and ask about their feelings. Hold the patient's hand and listen. Care.

* Research. Conduct research regarding the impact of specific interventions used in the care of the survivors of near-death events.

* Allow the patient/NDEer to decide how to proceed. Respect the confidentiality of the experiencer. If he/she would like assistance in discussing the NDE with the family, assist. If he/she asks about resources, refer to the local FOI (Friends of International Association of Near-Death Studies) Chapter.

* Prepare the patient who will undergo life-threatening procedures or surgery. If the patient has had a serious compromise during a procedure, be alert for clues and ask open-ended question. Establish a safe environment.

* Answer questions. Recognize the fact that many NDEers question their own sanity and need support and information. Reorient as needed. Listen. Explain that "sometimes people who have had this type of injury or illness have told about interesting feelings or dreams." Open the door. Validate the severity of their illness or injury.

* Inform colleagues. Assist other health care providers in understanding the significance of the NDE and the support the experiencer needs.

* Utilize available resources. For further information, such as frightening NDEs, NDEs in children, and additional aftereffects, contact the International Association for Near-Death Studies at www.IANDS.org.

* Share the story. Share NDEer's stories with those who survive close brushes with death. Listen.

[Reference]

REFERENCES

1. van Lommel P, van Wees R1 Meyers V, Elffcrich I. Near death experience in survivors of cardiac arrest: a prospective study in the Netherlands. Lancet. 2001;358:2040.
2. Moody R. Life After Life. New York: Bantam; 1975.
3. Kublcr-Ross E. To Live Until We Say Good-Bye. New Jersey: Prentice-Hall; 1978.
4. Ring. 1980.
5. Sabom MB. Recollections of Death: A Medical Investigation. New York: Harper & Row; 1982.
6. Gallup G. Adventures in Immortality. New York: McGraw-Hill; 1982.
7. Greyson B. The near-death experience scale: construction, reliability, and validity. J Nerv Ment Dis. 1983:171:369-375.
8. Oakes AR. The Lazarus syndrome: eare for patients who've returned from the dead. RN. 1978;4l:54.
9. Orne R. Nurses' views of NDEs. Am J Nurs. 1986;4:419-420.
10. Corcoran D. Helping patients who've had near-death experiences. Nursing 88. 1988;ll:34-39.
11. James DL. Factors in the Nursing Environment Which Promote Disclosure of Near-Death Experiences [thesis]. San Antonio, Tex: Incarnate Word College; 1994:74-79.
12. Nightingale F. Notes on Nursing: What il is and What it is Not. London: Harrison; I860.

Debbie James, MSN, RN, CCRN, CNS
From The University of Texas MD Anderson Cancer Center, Houston, Tex.

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