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Old 11-07-2010, 09:44 AM
 
Location: Golden, CO
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A few years ago I just read two recent articles that prefer a naturalistic explanation for NDE's. For those who are interested, have a look. Here is article 1:

Near Death Experiences
& the Medical Literature


by Mark Crislip
Miracle Max: See, there’s a big difference between mostly dead and all dead. Now, mostly dead: he’s slightly alive. All dead, well, with all dead, there’s usually only one thing that you can do.
Inigo: What’s that?
Miracle Max: Go through his clothes and look for loose change.
—The Princess Bride
In a recent issue of Skeptic (Vol. 13, No. 4), in the debate between Michael Shermer and Deepak Chopra about life after death, both authors refer to an article in the prestigious British medical journal Lancet about Near Death Experiences (NDEs), in which of 344 cardiac patients resuscitated from clinical death, 12 percent reported near-death experiences, where they had an out-of-body experience and saw a light at the end of a tunnel.: Lommel, P. V., R. V. Wees, V. Meyers, I. Elfferich. 2001. “Near-Death Experience in Survivors of Cardiac Arrest: A Prospective Study in the Netherlands.” Lancet. Vol 358 No. 9298: 2039.

I read the article from the perspective of a practicing physician who spends all his time in an acute care hospital and has been involved with many cardiac arrests over the years. The NDE question in this study hinges on whether the were dead or nearly dead. In the article the authors “defined clinical death as a period of unconsciousness caused by insufficient blood supply to the brain because of inadequate blood circulation, breathing, or both. If, in this situation, CPR is not started within 5–10 min, irreparable damage is done to the brain and the patient will die.”

Every patient in this study had CPR, most within 10 minutes of their cardiac arrest, so they all had blood delivered to their brain. That is the point of CPR. The authors write: “If purely physiological factors resulting from cerebral anoxia caused NDE, most of our patients should have had this experience.” Yet, good CPR does not lead to cerebral anoxia. Most patients in this study did not have an NDE because they had CPR, so they had blood and oxygen delivered to the brain; thus, they could not have an anoxia mediated NDE.

So the real question is whether patients who had brain anoxia had an NDE, and there is no way to determine that in this paper. CPR by its self is not a good surrogate for cerebral anoxia. Having a cardiac arrest and being promptly coded does not mean there is insufficient blood and oxygen being supplied to the brain. CPR has variable efficacy, depending on the both the patient and the experience of the provider. Most of us who have had to be involved with a code know, for example, the horrible sensation of all the ribs cracking when you start CPR on a frail old lady and knowing that the CPR is probably not going to be effective.

As a result of variable CPR, the time it takes the brain to become anoxic is variable. And it is surprising at how little oxygen people can tolerate with no discernible dysfunction in their cognition, although you might not want them flying your 747. People come into the hospital all the time with the amount of oxygen in their blood decreased by 30,40, and even 50 percent, and yet can still walk and talk.

The point is that during a resuscitated cardiac arrest the ability of the brain to get oxygen can be quite variable, and if the CPR is done effectively the brain gets enough oxygen that it is not damaged. By the definitions presented in the Lancet paper, nobody experienced clinical death. No doctor would ever declare a patient in the middle of a code 99 dead, much less brain dead. Having your heart stop for 2 to 10 minutes and being promptly resuscitated doesn’t make you “clinically dead”. It only means your heart isn’t beating and you may not be consciousness. Declaring someone dead if their heart isn’t beating is not a good definition.

What about brain death? Here there are many criteria: the patient has to have no clinical evidence of brain function by physical examination, including no response to pain and a variety of nerve reflexes that do not work: cranial nerve, pupillary response (fixed pupils), oculocephalic reflex (steady gaze), corneal reflex (lack of reflexive blinking to stimulation), and no spontaneous respirations. They have to be off all drugs that mimic brain death for several days and they cannot have metabolic conditions that mimic death. It is important to distinguish between brain death and states that mimic brain death and most of the patients received either a benzo (valium like drugs) and/or a narcotic. A flat line EEG, two at least 24 hours apart, is another criteria. In other words, being declared brain dead is a time consuming and detailed procedure, as it should be. This will become important in a moment.

Michael Shermer at least quotes the paper that the patients were “clinically dead” using the authors’ own flawed definitions. But as we have seen, their definition of being clinically dead is an artifice used for the paper but of no clinical or physiological relevance. Deepak Chopra declares “when there was no measurable activity in the brain, when they were in fact brain dead,” and yet nowhere in the Lancet article do the authors mention whether, besides being unconscious, neurologic function was assessed and the clinical diagnosis of brain dead was determined.

In the discussion of the paper the authors state “Also, in cardiac arrest the EEG usually becomes flat in most cases within about 10 seconds from onset of syncope [loss of consciousness].” They reference an Annals of Internal Medicine article (“Electrocerebral accompaniments of Syncope Associated with Malignant Ventricular Arrhythmia’s.” 1988 Jun;108(6):791–6), as well as one in the journal Anesthesiology ( “Electroencephalographic Changes During Brief Cardiac Arrest in Humans.” 1990;73:821–25), where they put EEG monitors on patients who were having defibrillators implanted. One of the side effects of having a defibrillator implanted is that your heart is often stopped for a period of time, or you have a heart rhythm induced called ventricular tachycardia, that is usually fatal but can, to a small degree, perfuse the brain.

That is not true. I pulled the articles and read them. What they showed was slowing, attenuation, and other changes, but only a minority of patients had a flat line, and it took longer than 10 seconds. The curious thing was that even a little blood flow in some patients was enough to keep EEG’s normal To quote the annals paper, “Electroencephalographic changes were variable. Background slowing was usually followed by relative loss of electrocerebral activity.” It is a big difference between this and saying everyone flat lines in 10 seconds.

How long does it take to flat line? If there is zero perfusion, the experts at my hospital tell me it is more like 20 seconds. That’s with no perfusion. And the EEG experts tell me that the sensitivity of an EEG for function is more like a one megapixel camera than a 5 megapixel. The brain probably doesn’t start to die until several minutes elapses. In my state an EEG is considered so insensitive it does not have to be included as part of the criteria for determining if someone is brain dead; although we get it anyway, a flat line EEG is only part of the mix.

So there is a flat line EEG that occurs acutely when the brain is not getting oxygen, and there is the flat line that occurs when the brain is dead, and an EEG cannot distinguish between them. Only the person at the bedside can do that. So when the authors of the Lancet article write, “in cardiac arrest the EEG usually becomes flat in most cases within about 10 seconds from onset of syncope,” this is not supported by the literature they reference.

Mr. Chopra’s analysis that NDE patients are flat line and brain dead suffers from the same problems as the authors of the Lancet article. It simply isn’t supported by the particulars of the literature he quotes. Both Chopra and Shermer quote the article correctly as to number of NDE, although it depends on how an NDE is defined, hence saying 12 percent (Shermer) or 18 percent (Chopra) of patients had an NDE is correct, depending on how many criteria you include in a definition of an NDE. As well, the Lancet paper authors suspect a selection bias in their study and offer a “real” rate of 10 percent for NDE, or only 5 percent of patients if based on the number of resuscitations, as more CPRs lead to more NDEs. They also admit in the discussion that their broad definition of NDEs makes their percentage higher because it is more inclusive. It is all in how you define NDE.

One final curious caveat appears in the Lancet paper: “The investigators report that, at the 2-year follow-up, four of 37 patients contacted to act as controls (i.e., people who had not initially reported an NDE) reported that they had had one. Although these patients represent fewer than 1% of the total sample, they represent over 10% of the 37 patients interviewed with a view to acting as controls. If this subsample is at all representative, it implies that around 30 patients from the sample of 282 who initially denied an NDE would, if they had survived for another 2 years, be claiming that they had had one. ” Some of the NDEs were, it seems, implanted memories.

The discussion also greatly exaggerates the conclusions that can be drawn from their data. “We did not show that psychological, neurophysiological, or physiological factors caused these experiences after cardiac arrest.” Of course not, since the study could not have any reliable data as to causation of NDE’s.

This is followed by “NDE pushes at the limits of medical ideas about the range of human consciousness and the mind-brain relation.” I do not see this conclusion from the data in this article. Upon close reading I think the only thing this paper is qualified to determine is a description of who get NDEs and what patients report. As to etiology of NDEs, much less mind-brain relations, it can say nothing. The authors’ reach exceeds their grasp.

I am not saying NDEs don’t happen, and I am certainly not going to disagree with the idea that nearly dying is transformative. It is probably why real NDEs have greater effects on people than lab induced NDEs. The knowledge that you are truly mortal is life altering. Cancer survivors can have the same epiphany without the cardiac arrest.

The devil is in the details. As is so often the case, when you go back and read the original paper and its references, what the paper says and what the paper is purported to say often turn out to be two very different things.
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Old 11-07-2010, 09:46 AM
 
Location: Golden, CO
2,108 posts, read 2,629,994 times
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Here is Article 2:

NDEs Redux
Skeptics need to reclaim, redefine
& embrace Near Death Experiences


by Sebastian Dieguez
I agree one hundred percent with everything Dr. Crislip wrote in his recent article published in eSkeptic. In fact, I have co-authored a forthcoming book chapter that makes similar points (Blanke & Dieguez, 2009). It is perfectly true that loss of consciousness and brain status were not satisfactorily assessed in the NDE Dutch study (van Lommel et al., 2001) and that all claims of cerebral inactivity, or even dysfunction, were largely unwarranted by the methods used. It is also an understatement to say, as Crislip rightly does, that NDE research crucially depends on how NDEs are defined.

This simple fact is still an unresolved issue 30 years after Raymond Moody published Life after Life, and the occult literature is still begging the question about what exactly should or should not count as “a glimpse on the afterlife”.

Notwithstanding Crislip’s observation that, upon follow-up, some subjects suddenly remembered an NDE that was at first not reported (see also French, 2001), there are other interesting findings in this study that should be pointed out. First, subjects who scored worse on a task of short-term memory were significantly less likely to have reported an NDE. Second, subjects who had a previous NDE were more likely than not to report one in the present study. Third, younger subjects were more likely to report an NDE and females tended to report “deeper” NDEs. And fourth, subjects with an NDE — especially a “deep” one — were more likely to die in the following 30 days.

All these facts, in my opinion, do point to biological and psychological factors involved in the probability to endure and recall an NDE. At the very least, the findings of the study should have been properly discussed by its authors before jumping to the outrageous conclusion that because no consistent biological explanation could be found (never mind that, as Crislip notes, none was really looked for), then NDEs are not biological by nature. Actually, any person who sees the point of the principle of parsimony should agree that the prospect of NDEs challenging any tenet of biological naturalism, for the time being, simply vanish in the light of a large number of observations.

First, it is indubitable that most, if not all aspects of the NDE fit entirely into neuroscientific knowledge: observations from reduced cerebral oxygenation, drug intake, sleep-wake cycle disturbances, awareness during anaesthesia, brain damage, epilepsy and direct brain stimulation all clearly point to neural correlates of NDE-related phenomena. Then, there is the embarrassing failure to find even one irrefutable case of “veridical perceptions” during brain inactivity (or simply unconsciousness), whereas such cases should be all over the place according to any transcendental or non-reductionist account. Finally, we have the mounting evidence of crosscultural differences in NDEs, various suggestive psychological correlates associated with those who report these experiences, and the largely silenced cases that indicate plainly hallucinated (i.e. non “veridical”) features (Augustine, 2007a, 2007b).

But I think it is time to move one step further from this type of discussion. NDE researchers have frequently observed that on this topic, skeptics have merely indulged in debunking other’s claims and speculating about plausible biological frameworks to “explain away” the NDE, mostly out of the armchair. This is perfectly true. The reason is, in my view, that the pioneers of NDE research, and most of their successors, have largely contributed to discredit the whole field. They did more than they were asked for to turn it into a shameful religious war involving syrupy new age “support groups”, amateur quantum enthusiasts, Mormon propagandists, and Christian fundamentalists (for an embarrassing “discussion”, see Ring, 2000 and Sabom, 2000). Really, it is no wonder that so few scientists were ever attracted to this area of research.

Nevertheless, I believe that the NDE might become a legitimate area of research, and even benefit from the messy situation inherited from its pioneers. Let me explain. First, notwithstanding the problem of defining what exactly NDEs are, I actually do think that the term loosely denotes a specific state-class of phenomenal awareness. In other words, such experiences do exist. And second, we can now positively exploit the fact that the term NDE is in current usage to turn it into profitable use. From this wider perspective, it becomes possible to define the NDE as
a set of spontaneously evoked phenomenal experiences during stressful or threatening situations for the organism, that is or could plausibly be taken by either the subject who experienced it or by those that hear about it, as indicative of the existence of a disembodied mind and/or an afterworld when the body has ceased to live.
Let’s say that these are NDEs, regardless of the specific attributes or neurocognitive mechanisms involved. To reiterate, whatever conscious mental experience — by anyone during any kind of subjective or objective period of physical danger — is taken as having occurred to a disembodied self and/or in an environment that is not of this world, is an NDE. Note that it does not matter what the subject of the experience herself believes, it suffices that the narration is perceived as an “NDE” by someone. I think that this general approach can be a useful one for many sciences interested in human behavior.

Instead of obsessively focusing on specific features like out-of-body experiences, tunnels, lights, life-reviews, spiritual encounters, personality changes, and so forth, this definition aptly shifts the focus away and opens on the wider and more interesting questions of the nature of subjective experience, personal belief and collective mythology, all in the same framework of analysis. And of course, the question of whether these experiences are “true” or not becomes completely irrelevant by this definition. Rather, it entirely frees the hands of interested scientists from the boring job of debunking the same claims over and over again, and allows them to turn to the really interesting things (exactly like memory researchers have studied “alien abductees”, focusing on the really relevant issues instead of looking for answers into the skies; e.g. Clancy, 2005). Studying NDEs thus defined could yield fascinating insights to better understand belief formation, folk psychology, feelings of “realness”, bodily awareness, mental imagery, memory processes, myth formation, thanatology, neuropsychiatric conditions such as hallucinations, depersonalization, dissociation and other peculiar syndromes, and maybe even to approach rationally that old conundrum of whether it is cognitively possible or not to imagine oneself dead (Nichols, 2007).

I would then personally be interested in a specific subfield of NDE research, which I would call neuro-eschatology, and which would study the possibility that the very concept of the “afterworld” is a residue of our ancestors trying to make sense of the NDEs they had or they’ve heard of. In any case, it is high time for the tide to turn, and I hope that I have convinced some skeptics that there is something to NDEs, and that it will be our task to reveal where their real interest lies.
References

  1. Augustine, K. 2007a. “Near-Death Experiences with Hallucinatory Features.” Journal of Near-Death Studies, 26 (1), pp. 3–31.
  2. Augustine, K. 2007b. “Psychophysiological and Cultural Correlates Undermining a Survivalist Interpretation of Near-Death Experiences.” Journal of Near-Death Studies, 26 (2), pp. 89–125.
  3. Blanke, O. & Dieguez, S. 2009. “Leaving body and life behind: out-of-body and near-death experience.” In Laureys, S. The Neurology of Consciousness: Cognitive Neuroscience and Neuropathology. Amsterdam: Elsevier. pp. 303–325.
  4. Clancy, S. A. 2005. Abducted: how People Come to Believe They Were Kidnapped by Aliens. Cambridge/London: Harvard University Press.
  5. Crislip, M. 2008. “Near Death Experiences & the Medical Literature.” eSkeptic, www.skeptic.com/eskeptic/08-06-18.html
  6. French, C. C. 2001. “Dying to know the truth: visions of a dying brain, or false memories?” Lancet, 358, pp. 2010–2011.
  7. Nichols, S. 2007. “Imagination and Immortality: Thinking of Me.” Synthese, 159 (2), pp. 215–234.
  8. Ring, K. 2000. “Religious Wars in the NDE Movement: Some Personal Reflections on Michael Sabom’s Light & Death.” Journal of Near-Death Studies, 18 (4), pp.
  9. Sabom, M. 2000. “Response to Kenneth Ring’s “Religious Wars in the NDE Movement: Some Personal Reflections on Michael Sabom’s Light & Death. Journal of Near-Death Studies, 18 (4), pp.
  10. van Lommel, P., van Wees, R., Meyers, V., Elfferich, I. 2001. “Near-Death Experience in Survivors of Cardiac Arrest: A Prospective Study in the Netherlands.” Lancet, 358, pp. 2039–2045.

More reading for those interested:

Near-Death Experiences: In or Out of the Body (http://www.susanblackmore.co.uk/si91nde.html - broken link)
near-death experience (NDE)
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Old 11-07-2010, 09:47 AM
 
Location: Golden, CO
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Atypical experiences happen all the time.

You have to read this article: Hallucinatory Near-Death Experiences
Even if we disregard the overwhelming evidence for the dependence of consciousness on the brain, there remains strong evidence from reports of near-death experiences themselves that NDEs are not glimpses of an afterlife. This evidence includes:

(1) discrepancies between what is seen in the out-of-body component of an NDE and what's actually happening in the physical world;

(2) bodily sensations incorporated into the NDE, either as they are or experienced as NDE imagery;

(3) encountering living persons during NDEs;

(4) the greater variety of differences than similarities between different NDEs, where specific details of NDEs generally conform to cultural expectation;

(5) the typical randomness or insignificance of the memories retrieved during those few NDEs that include a life review;

(6) NDEs where the experiencer makes a decision not to return to life by crossing a barrier or threshold viewed as a 'point of no return,' but is restored to life anyway;

(7) hallucinatory imagery in NDEs, including encounters with mythological creatures and fictional characters; and

(8) the failure of predictions in those instances in which experiencers report seeing future events during NDEs or gaining psychic abilities after them.
From here: Damn Interesting • The Threshold to the Other Side
In fact, among western cultures, stories of NDE so closely follow these lines most every time that at first examination, one might think there is outside power directing them along the same road. Studies in other parts of the world are starting to confirm that NDE in their regions also consistently follow a pattern … but that pattern varies depending on the culture involved.

A study was conducted in the 1970s in India, seeking and interviewing Hindus about NDEs. Forty-five people who had such experiences were found. Only one reported having seen his body from outside. Most insisted that they felt as though still in a physical body, and two “messengers” were escorting them along a path—some accounts insist this is the mafia form of “escorting” where the thugs get them by the elbows and drag them along. One, a man named Durga Jatav, tried to make a break for it, and his escorts cut off his legs prevent his escape. The messengers hauled the deceased into a field of white light, and to a desk, lectern, or similar which is manned by Yamraj, the Hindu god of the dead. Sometimes a charter of their life works were read off, but none reported the visual reliving of life as their western counterparts, and most reported a common means of being sent back to life, namely that of Yamraj pointing out that a mistake had been made. He was expecting someone of the same name in a different caste or town, or someone of the same description with a different name. Durga Jatav was allowed to pick his legs out a pile of discarded limbs, reattach them, then he, like the others, was escorted back and forced or pushed back into the body.

NDEs among Muslims differ from both the Hindu and Christian accounts. Several tenets of the Buddhist faith seem built on the act of death, and accordingly, their reports of NDE follow the faith for the most part. No two cultures have the exact same accounting of the experiences after death— though all share an allusion to a bright, clear light. Save that one common element, it would seem that the events that one encounters are more based on culture than on the machinations of an actual post-mortem process.
Native American NDE's have typical features from their culture like war eagles and mocassins thatNDE's from other cultures don't have:
http://uploads.pacifica.edu/gems/grothmarnat/CrossCulturalNDE.pdf (broken link)
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Old 11-07-2010, 09:52 AM
 
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Please forgive a tangent: I have read many books on OBE, NDE and so on with most stories involving a being of light, a tunnel, etc. I read one book about a vision of hell instead. Can any of you help me remember the name of that book? It was published in the late '70s most likely. Thanks!
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Old 11-07-2010, 09:54 AM
 
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I just want to point out there is another possibility, which is that something happens after death to us that is in some ways universal, and in other ways shaped by our thoughts and beliefs.
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Old 11-07-2010, 10:08 AM
 
Location: Golden, CO
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Quote:
Originally Posted by nimchimpsky View Post
I just want to point out there is another possibility, which is that something happens after death to us that is in some ways universal, and in other ways shaped by our thoughts and beliefs.
It is possible; I just highly doubt it.
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