January 2015 Article of the Month
This month's article selection is by Chaplain John Ehman,
University of Pennsylvania Medical Center-Penn Presbyterian, Philadelphia PA.
Holden, J. M., Kinsey, L. and Moore, T. R. "Disclosing near-death experiences to professional healthcare providers and nonprofessionals." Spirituality in Clinical Practice 1, No. 4 (December 2014): 278-287.
SUMMARY and COMMENT: Near-death experiences (NDEs) have been the focus of research in over 65 studies over the past 40 years. The experience has been reported in 20% of research subjects who have survived a close brush with death, and most near-death experiencers consider the event to be of a spiritual nature [pp. 278-279]. "Although most NDErs describe their NDEs as predominantly pleasurable -- dominated by feelings such as peace, joy, and love -- perhaps as many as 10–15% describe them as predominantly distressing -- dominated by feelings such as terror, horror, or guilt" [pp. 278-279]. These events can have profound effects, and people may take years to integrate the experience. Previous research has indicated that "the speed and ease of integration is influenced by several factors, a primary one being an NDEr’s first experience of disclosure of the experience" [p. 279].
In particular, although disclosure to a health care provider with knowledge and facilitative attitudes could markedly advance the integration process..., both researchers and NDErs themselves have reported NDErs’ reluctance to disclose their NDEs to health care providers. NDErs cited fear that their NDEs would be dismissed as neither real nor even potentially real and/or discounted as meaningless experiences resulting from purely physiological processes and that they and/or their experiences would be diagnosed as manifestations of mental illness and/or demonized as somehow evil.... [p. 279]
Against this background, the authors of our featured study state:
To date, no study has addressed the pervasiveness of therapeutically facilitative or detrimental responses to NDE disclosure among health care providers and others. We undertook research to answer these questions: (a) How good or bad have NDErs’ experiences of disclosure been to health care providers overall? (b) Do NDErs’ reports of their disclosure experiences vary by category of health care provider, how long ago the NDE occurred, how soon after their NDEs NDErs disclosed them, or intensity of NDE?
Recruiting from online sources for a period of 18 months, the researchers collected data from a final sample of 105 participants who completed a web battery utilizing the Near-Death Experience Scale (Greyson) and the Near-Death Experiencers’ Experiences of Disclosure Scale (NEEDS; Holden, et al.). "Because respondents were able to report on up to three NDEs and on up to three experiences of disclosure per NDE, we received data on 106 NDEs and a total of 188 incidents of disclosing those NDEs" [p. 282].
Among the results:
The authors consider well the limitations of the study [--see pp. 284-285], but importantly state that "as most discussion in the professional literature has been of harmful disclosure experiences, the results of this study actually were more positive than we anticipated" [p. 284]. Nevertheless:
- "...of 188 disclosure experiences, respondents rated 153 (81%)...a neutral to strongly positive experience, and 35 (19%)...a mildly to strongly negative experience" [p. 283]
- "...participants indicated no more positive or negative disclosure experiences with one professional group than another"
- "...participants’ experiences of disclosure -- both positive and negative -- remained consistent with regard to NDEs that occurred over the past 80 years"
- "...9% disclosed immediately, 10% disclosed within a day, 7% disclosed within a week, 12.2% disclosed within a month, 13% disclosed within a year, and 49% disclosed after more than a year"
- "...the sooner NDErs disclosed, the more negative their experiences of disclosure"
- "...the deeper the NDE, the more negative, unpleasant, and harmful the NDEr's experience of disclosure" [pp. 283-284].
The results of this study indicate that NDErs have felt harmed -- fortunately a minority, but unfortunately a substantial minority of virtually one of every five disclosures -- by disclosure to members of every professional group. Of even greater concern is that the presumably most vulnerable of NDErs -- those with the deepest experiences involving greater number and/or intensity of features and, therefore, with relatively more intense aftereffects and integration challenges -- reported the most negative disclosure experiences; the richer their NDE narrative, the more they perceived their confidante to respond detrimentally -- dismissing, pathologizing, and/or demonizing the NDE and/or NDEr. [p. 284]
Regarding the particular finding that "the sooner NDErs disclosed, the more negative their experiences of disclosure" [p. 283], the authors cite other research that suggests that this may be because NDErs become over time "more discerning in the confidantes in whom they confide, learning over time to assess who is more likely to be open, accepting, affirming, and supportive of NDErs and their ongoing inquiry into the meaning of their NDEs" [p. 285]. The authors then go on offer advice that "[n]ovice NDErs would likely be wise to curb an urge to disclose without carefully considering the characteristics of the individual to whom they are about to disclose -- and wise not to assume that a confidante will necessarily be helpful just because that person is a professional medical, mental, or spiritual/religious health care provider" [p. 285]. They also advocate for more education about NDEs among professionals [--see p. 285].
This study grouped chaplains together with all other clergy as "religious professionals," [p. 282], so it is not known whether there was a difference when NDEs were disclosed. The data show that NDErs disclosed to religious (and mental health) professionals somewhat later than to medical professionals and non-professionals [--see Table 1, p. 282], yet what is behind that pattern is unclear. This is all surely a topic for further investigation. Also not known is the relationship between the 19% of negative experiences of disclosure and any general caution around disclosure. While the proportion of people's negative experiences here may have been smaller than expected, that doesn't mean that NDErs' feelings of fear and vulnerability around disclosure aren’t without cause. One takeaway from this study for chaplains may be that there is good opportunity to engage patients in discussion of NDEs, and this may be crucial for providing people an early positive experience of disclosure. Chaplains could help -- early on -- in NDErs' process to discern safe confidantes for subsequent disclosures. And, regarding patients for whom a hospitalization may bring up past NDEs, chaplains may be able not only to address previous negative disclosure experiences but also to build upon more positive disclosure experiences than might be assumed to have occurred. Chaplains could also figure into the call for NDE education for other disciplines [--see p. 285]
Suggestions for the Use of the Article for Student Discussion:
CPE students should appreciate the nice introductory overview of the topic, including the enumeration of psychological, biological, social and spiritual aftereffects of NDEs [--see p. 279], and they should find engaging the cautionary tale offered in a case illustration [p. 280]. They may, however, have difficulty with the statistical language in the Results section, but the Discussion section makes the findings quite plain and also puts points in context. The article is obviously an entrée to the topic of NDEs in general and to the place of chaplains regarding patients' desires or hesitancies to disclose. The CPE group may benefit from looking at the items on the Near-Death Experience Scale [Greyson, 1983 --see Related Items of Interest §I, below]. Have students ever had people disclose NDEs to them? What are their attitudes toward NDEs, and what theological or psychological constructs are behind these attitudes? What might be the value of exploring with NDErs their history of disclosure experiences? Discussion could be augmented by inclusion of a nurse or physician known to be open to NDEs and from a clinical area where brushes with death are common (e.g., cardiac care or surgical intensive care units).
Related Items of Interest:
I. This month's study employed the Near-Death Experiences Scale. The 16-item measure is online through the International Association for Near-Death Studies at http://iands.org/research/important-research-articles/698-greyson-nde-scale.html. Note: the scoring information about the scale states only that a score of 7 or greater identifies a Near-Death Experience. The scale is also explained in the original article:
Greyson, B. "The Near-Death Experience Scale: construction, reliability, and validity." Journal of Nervous and Mental Diseases 171, no. 6 (June 1983): 369-375. [Near-death experiences (NDEs) have been described consistently since antiquity and more rigorously in recent years. Investigation into their mechanisms and effects has been impeded by the lack of quantitative measures of the NDE and its components. From an initial pool of 80 manifestations characteristic of NDEs, a 33-item scaled-response preliminary questionnaire was developed, which was completed by knowledgeable subjects describing their 74 NDEs. Items with significant item-total score correlations that could be grouped into clinically meaningful clusters constituted the final 16-item NDE Scale. The scale was found to have high internal consistency, split-half reliability, and test-retest reliability; was highly correlated with Ring's Weighted Core Experience Index; and differentiated those who unequivocally claimed to have had NDEs from those with qualified or questionable claims. This reliable, valid, and easily administered scale is clinically useful in differentiating NDEs from organic brain syndromes and nonspecific stress responses, and can standardize further research into mechanisms and effects of NDEs.]
II. For more on near-death experiences, see our earlier Articles-of-the-Month pages for September 2013 and May 2006, plus the following recent articles:
Goza, T. H., Holden, J. M. and Kinsey, L.
"Combat near-death experiences: an exploratory study." Military Medicine 179, no. 10 (October 2014): 1113-1118. [(Abstract:) The purpose of this study was to add to the professional literature regarding combat near-death experiences (cNDEs) and to help clinicians and experiencers (cNDErs) recognize this phenomenon as an experience that is not indicative of mental illness. cNDErs were military personnel whose NDEs occurred during active combat or sequelae. Sixty-eight self-reported survivors of combat-related close brushes with death completed an online survey that included the Near-Death Experience Scale (NDE Scale), the Life-Changes Inventory-Revised, and a few open-ended questions. Respondents were 20 cNDErs-participants who scored at least 7 on the NDE Scale-and 48 non-NDErs. Compared to NDErs from two methodologically similar studies, cNDErs scored lower on Bonferroni corrected t-tests than NDErs on the NDE Scale overall (p < 0.0003) and on Affective and Transcendental subscales; they scored higher on the Cognitive subscale (p < 0.0007). In Life-Changes Inventory-Revised total change and six of seven value clusters, cNDErs, compared to non-NDErs, scored in the same direction as numerous other studies of NDE aftereffects, but none of the differences were statistically significant and all reflected small effect sizes except total change and changes in spirituality that reflected medium effect sizes--a finding that corresponded to analysis of narrative responses.]
Greyson, B. and Khanna, S. "Daily spiritual experiences before and sfter near-death experiences." Psychology of Religion and Spirituality 6, no. 4 (November 2014): 302-309. [(Abstract:) People who have near-death experiences (NDEs) often report a subsequently increased sense of spirituality and a connection with their inner self and the world around them. In this study, we examined daily spiritual experiences, using Underwood and Teresi's (2002) Daily Spiritual Experience Scale, among 229 persons who had come close to death. Frequency of daily spiritual experiences before the close brush with death did not differentiate participants who had NDEs (n = 204) from those who did not (n = 25). However, participants who described having had NDEs reported more daily spiritual experiences after their brush with death than those who did not, and frequency of daily spiritual experiences after the brush with death was positively correlated with depth of NDE. We discussed the implications of these findings in light of other reported aftereffects of NDEs and of daily spiritual experiences among other populations.]
Greyson, B. and Khanna, S. "Spiritual transformation after near-death experiences." Spirituality in Clinical Practice 1, no. 1 (March 2014): 43-55. [(Abstract:) Traumatic events may lead to dramatic changes in spirituality. The objective of this study was to explore whether posttraumatic spiritual transformation results not just from the traumatic event, but from spiritual experience during the crisis. The hypothesis tested was that survivors of a brush with death who had spiritual "near-death experiences" have greater spiritual growth and lesser spiritual decline than survivors without near-death experiences. Two hundred thirty self-selected participants who had come close to death completed questionnaires that included the NDE Scale, the Spiritual Transformation Scale, and relevant demographic questions. Near-death experiencers reported greater spiritual growth than comparison survivors, and spiritual growth was correlated with depth of near-death experience. Spiritual decline was comparable in the two groups, and was not associated with depth of near-death experience. Near-death experiences thus are associated with greater posttraumatic spiritual growth but do not influence posttraumatic spiritual decline. The relevance of spiritual transformation to individuals' lives and well-being suggest that further research is warranted, and that strategies to promote spiritual growth be incorporated into therapeutic practice.]
Klemenc-Ketis, Z. "Life changes in patients after out-of-hospital cardiac arrest : the effect of near-death experiences." International Journal of Behavioral Medicine 20, no. 1 (March 2013): 7-12. [(Abstract:) BACKGROUND: Cardiac arrest is a traumatic event that often affects patients' lives in many ways. Patients after near-death experiences (NDEs) often express strong and permanent change of their values, beliefs and principles. PURPOSE: The aim of this study was to determine the association between NDEs and life changes in patients 6 months after out-of-hospital cardiac arrest. METHOD: This was a prospective observational study, which included 37 patients (average age 54.0 years, range 22-81 years, 29 males) 6 months after out-of-hospital cardiac arrest. The presence of NDEs was assessed with a self-administered Greyson's NDE scale. The intensity of life changes was assessed with a self-administered Ring's life change inventory. Univariate analysis was performed. RESULTS: NDEs were reported by seven (18.9%) patients. In comparison to the non-NDEs group, patients in the NDEs group expressed significantly stronger changes in the following items: tolerance for others, understanding of myself, appreciation of nature, sense that there is some inner meaning to my life and concern with questions of social justice. CONCLUSIONS: Cardiac arrest survivors do not express extensive life changes. But, the presence of NDEs is significantly associated with the change of interest in some aspects of patients' lives. Such patients should be prepared for significant life changes that might occur after NDEs by health workers and receive professional help to accommodate to them.]
Palmieri, A., Calvo, V., Kleinbub, J. R., Meconi, F., Marangoni, M., Barilaro, P., Broggio, A., Sambin, M. and Sessa, P. "'Reality' of near-death-experience memories: evidence from a psychodynamic and electrophysiological integrated study." Frontiers in Human Neuroscience 8 (June 2014): 429 [electronic journal article designation]. [(Abstract:) The nature of near-death-experiences (NDEs) is largely unknown but recent evidence suggests the intriguing possibility that NDEs may refer to actually "perceived," and stored, experiences (although not necessarily in relation to the external physical world). We adopted an integrated approach involving a hypnosis-based clinical protocol to improve recall and decrease memory inaccuracy together with electroencephalography (EEG) recording in order to investigate the characteristics of NDE memories and their neural markers compared to memories of both real and imagined events. We included 10 participants with NDEs, defined by the Greyson NDE scale, and 10 control subjects without NDE. Memories were assessed using the Memory Characteristics Questionnaire. Our hypnosis-based protocol increased the amount of details in the recall of all kind of memories considered (NDE, real, and imagined events). Findings showed that NDE memories were similar to real memories in terms of detail richness, self-referential, and emotional information. Moreover, NDE memories were significantly different from memories of imagined events. The pattern of EEG results indicated that real memory recall was positively associated with two memory-related frequency bands, i.e., high alpha and gamma. NDE memories were linked with theta band, a well-known marker of episodic memory. The recall of NDE memories was also related to delta band, which indexes processes such as the recollection of the past, as well as trance states, hallucinations, and other related portals to transpersonal experience. It is notable that the EEG pattern of correlations for NDE memory recall differed from the pattern for memories of imagined events. In conclusion, our findings suggest that, at a phenomenological level, NDE memories cannot be considered equivalent to imagined memories, and at a neural level, NDE memories are stored as episodic memories of events experienced in a peculiar state of consciousness.]
Parnia, S., Spearpoint, K., de Vos, G., Fenwick, P., Goldberg, D., Yang, J., Zhu, J., Baker, K., Killingback, H., McLean, P., Wood, M., Zafari, A. M., Dickert, N., Beisteiner, R., Sterz, F., Berger, M., Warlow, C., Bullock, S., Lovett, S., McPara, R. M., Marti-Navarette, S., Cushing, P., Wills, P., Harris, K., Sutton, J., Walmsley, A., Deakin, C. D., Little, P., Farber, M., Greyson, B. and Schoenfeld, E. R. "AWARE -- AWAreness during Resuscitation -- a prospective study." Resuscitation 85, no. 12 (December 2014): 1799-1805. [(Abstract:) BACKGROUND: Cardiac arrest (CA) survivors experience cognitive deficits including post-traumatic stress disorder (PTSD). It is unclear whether these are related to cognitive/mental experiences and awareness during CPR. Despite anecdotal reports the broad range of cognitive/mental experiences and awareness associated with CPR has not been systematically studied. METHODS: The incidence and validity of awareness together with the range, characteristics and themes relating to memories/cognitive processes during CA was investigated through a 4 year multi-center observational study using a three stage quantitative and qualitative interview system. The feasibility of objectively testing the accuracy of claims of visual and auditory awareness was examined using specific tests. The outcome measures were (1) awareness/memories during CA and (2) objective verification of claims of awareness using specific tests. RESULTS: Among 2060 CA events, 140 survivors completed stage 1 interviews, while 101 of 140 patients completed stage 2 interviews. 46% had memories with 7 major cognitive themes: fear; animals/plants; bright light; violence/persecution; deja-vu; family; recalling events post-CA and 9% had NDEs, while 2% described awareness with explicit recall of 'seeing' and 'hearing' actual events related to their resuscitation. One had a verifiable period of conscious awareness during which time cerebral function was not expected. CONCLUSIONS: CA survivors commonly experience a broad range of cognitive themes, with 2% exhibiting full awareness. This supports other recent studies that have indicated consciousness may be present despite clinically undetectable consciousness. This together with fearful experiences may contribute to PTSD and other cognitive deficits post CA.]
Sleutjes, A., Moreira-Almeida, A. and Greyson, B.
"Almost 40 years investigating near-death experiences: an overview of mainstream scientific journals." Journal of Nervous & Mental Disease 202, no. 11 (November 2014): 833-836. [(Abstract:) This article reviews mainstream scientific publications on near-death experiences (NDEs). We searched near-death experience in titles, key words, and abstracts at the Web of Knowledge database published between 1945 and 2013. We identified 266 relevant documents, the oldest from 1977. There was a strong predominance of opinion articles (book reviews, commentaries, and editorials), review articles, phenomenological description articles, and articles that originated in the United States. Since 2000, the number of longitudinal and cross-sectional studies has increased; there has been a diversification in the countries that have published on the subject and more articles that discuss the implications of NDEs for the mind-brain relationship. The results indicate that most scholarly publications on NDEs are recent, usually have no original empirical data, and are concentrated in North America and Western Europe. Future studies should focus on increasing the cultural diversity in the field and on testing explanatory hypotheses based on high-quality empirical data.]
Tassell-Matamua, N. A. "Near-death experiences and the psychology of death." Omega - Journal of Death & Dying 68, no. 3 (2013-2014): 259-277. [(Abstract:) Little is known about the psychological phenomenology of death. Reported across known history and in all cultures by those who have died or been close to death, NDEs challenge objective-mechanistic models by suggesting the phenomenology of death may involve a variety of complex psychological processes. This article discusses three notable characteristics of the NDE--loss of the fear of death, psychological sequelae, and complex conscious abilities--supporting this claim. The implications these have for advancing societal understandings of death are discussed, and their pragmatic application for professions where death is frequently encountered, such as palliative care, is addressed.]
Thonnard, M., Charland-Verville, V., Bredart, S., Dehon, H., Ledoux, D., Laureys, S. and Vanhaudenhuyse, A. "Characteristics of near-death experiences memories as compared to real and imagined events memories." PLoS ONE 8, no. 3 (2013): e57620 [electronic journal article designation]. [(Abstract:) Since the dawn of time, Near-Death Experiences (NDEs) have intrigued and, nowadays, are still not fully explained. Since reports of NDEs are proposed to be imagined events, and since memories of imagined events have, on average, fewer phenomenological characteristics than real events memories, we here compared phenomenological characteristics of NDEs reports with memories of imagined and real events. We included three groups of coma survivors (8 patients with NDE as defined by the Greyson NDE scale, 6 patients without NDE but with memories of their coma, 7 patients without memories of their coma) and a group of 18 age-matched healthy volunteers. Five types of memories were assessed using Memory Characteristics Questionnaire (MCQ--Johnson et al., 1988): target memories (NDE for NDE memory group, coma memory for coma memory group, and first childhood memory for no memory and control groups), old and recent real event memories and old and recent imagined event memories. Since NDEs are known to have high emotional content, participants were requested to choose the most emotionally salient memories for both real and imagined recent and old event memories. Results showed that, in NDE memories group, NDE memories have more characteristics than memories of imagined and real events (p<0.02). NDE memories contain more self-referential and emotional information and have better clarity than memories of coma (all ps<0.02). The present study showed that NDE memories contained more characteristics than real event memories and coma memories. Thus, this suggests that they cannot be considered as imagined event memories. On the contrary, their physiological origins could lead them to be really perceived although not lived in the reality. Further work is needed to better understand this phenomenon.]
III. The journal Missouri Medicine has recently published a number of articles on NDEs. These are reviews and some personal essays, but the journal editor, John C. Hagan, III, states in an introduction to the series that it "will be the most encyclopedic and up-to-date" on the subject [p. 363 of the Hagan reference, below]. Almost all of these articles are freely available from the journal in a compilation PDF at www.msma.org/docs/communications/momed/Death_Near_Death_Experiences.pdf.
Cicoria, T. and Cicoria, J. "Getting comfortable with near-death experiences. My near-death experience: a telephone call from God." Missouri Medicine 111, no. 4 (July-August 2014): 304-307.
Greyson, B. "Getting comfortable with near death experiences. An overview of near-death experiences." Missouri Medicine 110, no. 6 (November-December 2013): 475-481.
Hagan, J. C. 3rd. "Getting comfortable with death & near-death experiences. Medical metaphysics: what is a "good death"? What happens when we almost die?" Missouri Medicine 110, no. 5 (September-October 2013): 363-366.
Hausheer, J. R. "Getting comfortable with near-death experiences. My unimaginable journey: a physician's near-death experience." Missouri Medicine 111, no. 3 (May-June 2014): 180-183.
Long, J. "Near-death experience: evidence for their reality." 110, no. 5 (September-October 2013): 372-380.
Moody, R. A. "Getting comfortable with death & near-death experiences. Near-death experiences: an essay in medicine & philosophy." Missouri Medicine 110, no. 5 (September-October 2013): 368-371.
Murray, K. "Getting comfortable with death & near death experiences. How doctors die: a model for everyone?" Missouri Medicine 110, no. 5 (September-October 2013): 372-374.
Radin, D. "Getting comfortable with near death experiences. Out of one's mind or beyond the brain? The challenge of interpreting near-death experiences." Missouri Medicine 111, no. 1 (January-February 2014): 24-28.
IV. Two older, related articles of pertinence especially to the disclosure of near-death experiences:
Hoffman, R. M. "Disclosure habits after near-death experiences: Influences, obstacles, and listener selection." Journal of Near-Death Studies 14, no. 1 (1995): 29-48. [Used research gathered through interviews with 50 near-death experiencers (NDErs) to describe habits of disclosure regarding NDEs. Decisions to talk about one's near-death experience mark a symbolic shift in an individual's relationship to that valued happening. Far from being a binary decision (to disclose or not disclose), talk about NDEs represents entry into a multifaceted, controversial, and deeply contextual experiential world. NDErs apparently go through a specific process of assessing listener responsiveness and readiness before deciding to disclose. Finally, some comments about secrecy emphasize the importance of discerning between appropriate, nourishing choices of secrecy and choices of beneficial disclosure.]
Hoffman, R. M. "Disclosure needs and motives after a near-death experience." Journal of Near-Death Studies 13, no. 4 (1995): 237-266. [Analyzed the communication processes used by 50 near-death experiencers during lengthy interviews and discussed their disclosure needs and motives, as well as influences and obstacles that affected disclosure habits. Findings suggested that disclosure needs evolve through 5 stages after an experience: shock/surprise, validation, interpersonal implications, active exploration, and integration. In addition, findings also revealed 5 disclosure motives: interaction with the chronicle of human experience, integrity, helping others, mutual inquiry, and anamnesis.]