|Robert L. Blum, MD, PhD|
Near Death Experiences:
In the Tucson Desert
With Dr. Pim Van Lommel
May 4, 2010
Are Near Death Experiences (NDEs) real or not?
My answer is that the reports are real. (Some people earnestly believe
they had a profound experience traveling outside their bodies,
meeting deceased relatives, reviewing their lives, and are deeply transformed thereby.)
The real question is how to interpret their NDEs. Did they ACTUALLY travel
outside their bodies and meet the souls of dead relatives while their
EEGs showed they were brain-dead? My answer to that is "No. No way!"
Gustave Dore's depiction of the highest heaven as described by Dante Alighieri
in the Paradiso (from Wikimedia Commons).
Forever the hard-bitten skeptic, your roving reporter was recently
shoved by fate (which famously works “synchronistically” and in strange ways)
into a delightful three hour hike and dinner with one of the world's
most famous researchers of NDEs, Dutch cardiologist Dr. Pim Van Lommel,
whose book Consciousness Beyond Life will be released in the USA in June, 2010.
I was attending the wonderfully eclectic TSC Conference
(Toward a Science of Consciousness) in Tucson, sponsored by the University of Arizona.
Since my main interest is in the neurobiology of consciousness, that was the main draw.
Among the banner invitees were Professors Antonio Damasio (emotional brain) ,
Marcus Raichle (default networks - wandering thoughts), Christof Koch
(NCC and Jennifer Aniston cells), Karl Deisseroth (optogenetic, laser-controlled mice)
- all A-list neuroscientists. Next, were the philosophers of mind including
famous names like David Chalmers (the easy vs the hard problem of consciousness) ,
Harvard’s Eugene Taylor, consciousness theorist Bernard Baars (global workspace), and
the computer scientists: Dharmendra Moda (IBM's connectome project)
and Ben Goetzel( AI guru and CEO of Novamente), who, like me, are trying
to determine if you can do it in silicon.
That's perhaps half the ideation of the TSC Conference, but then it gets,
shall we say, increasingly speculative ("further out"). Enter the researchers of
transformative experiences (Cassie Vieten) and enlightenment (Jeffrey Martin);
add in those seeking to establish a basis for consciousness
in quantum mechanics (Stuart Hameroff (famously joined by Roger Penrose);
further mix in those studying meditation and psychopharmacology,
fold in ZA Choeje Rinpoche (the “reincarnation of the 6th Dali Lama”),
and top it all off with sci-fi writer Rob Sawyer and some sixties-style
art and song and you’ve got an informative and entertaining week
in the Arizona sun (Burning Man for eggheads or Society for Neuroscience on LSD).
Sabino Creek in Tucson, Arizona
Now, back to Dr. Pim Van Lommel and NDEs.
After touring the verdant, riparian Sabino Canyon in the Tucson desert,
I have an hour to kill before dinner. I want to hike more, but there is no one around.
Suddenly, there is Julia Mossbridge, a psych post-doc from Northwestern -
a willing hiking partner. As we hunt for directions for our desert stroll,
she spies Dr. Van Lommel and asks him to join us.
As we head out amidst the sand and cactus, Pim (Van Lommel) tells me
that he was the organizer and lead author on a 2001 Lancet article on NDEs,
the largest, most detailed study to date. This study made headlines throughout the world,
and Pim has lectured about it worldwide. Furthermore, the Dutch edition of his book
alone and thousands more in Germany.
"Proves the existence of the soul ! ?" That is Ode selling magazines.
Pim’s study helped inspire another large multi-institution study of NDE’s
now going on in the USA and the UK. That is the Human Consciousness Project
whose lead researcher, Dr. Sam Parnia, was recently interviewed by MSNBC News on NDEs.
(This entertaining video was on my short-list to show at my recent two hour lecture on
mechanisms of consciousness.)
Over the next three hours we discussed many of the details of Pim's study
and of the NDE phenomenon itself. Here I paraphrase and summarize our conversation.
RLB: Tell me about the study!
PVL: I organized this study, and then conducted it over the course of ten years.
I am a cardiologist, now retired. My father was a neurologist. (Pim is age 67
and is in great shape. He, like me, loves hiking and the outdoors.)
The study included 344 patients who had experienced cardiac arrest.
Of those, 62 patients (18%) had an NDE (near death experience).
RLB: Of the 62 patients who experienced an NDE, were the experiences all the same?
PVL: There were many elements that they had in common, for example,
(I’ve reproduced Table 2 from his 2001 Lancet paper to show the elements that characterize
an NDE and how often they were experienced by patients in the NDE group.
These elements comprise the Weighted Core Experience Index WCEI developed in 1980
by Ken Ring, a well known NDE researcher. The table also shows
the approximate sequence of events in a deep (full) NDE.)
Elements of an NDE (total number of NDE patients =62)
1 Awareness of being dead 31 (50%)
2 Positive Emotions 35 (56%)
3 Out of body experience 15 (24%)
4 Moving through a tunnel 19 (31%)
5 Communication with light 14 (23%)
6 Observation of colours 14 (23%)
7 Observation of a celestial landscape 18 (29%)
8 Meeting with deceased persons 20 (32%)
9 Life review 8 (13%)
10 Presence of border 5 (8%).
Ascent of the Blessed by Hieronymous Bosch (from Wikimedia Commons)
RLB: Before we go further, I must admit that I'm a huge skeptic of supernatural
and paranormal claims. I believe your patients reported these experiences,
but attributing objective reality to these claims is hard to swallow.
PVL: When you say you're a skeptic, do you mean you're completely
closed off to this possibility?
RLB: No, as a scientist, I'm always open to new hypotheses, but,
if you're attributing objective reality to the experiences of these patients,
then you’re making several extraordinary claims. One of my favorite sayings,
popularized by Carl Sagan, is this:
"Extraordinary Claims Require Extraordinary Proof."
RLB: I've got a number of hard questions and issues that need to be addressed.
(Here, as always, the trick is getting to the heart of the matter while remaining polite.)
PLV: Go right ahead. I've been asked all these questions by many physicians
throughout the world.
RLB (continuing): What were the diagnoses in these patients?
PVL: Almost all the patients had myocardial infarctions.
(An MI is doctorspeak for a heart attack, death of heart muscle caused by
sudden blockage of a coronary artery.
RLB: And what was the state of their cerebral perfusion (blood flow to the brain)?
PVL: Stopped completely. These patients were in ventricular fibrillation (VF).
There was no cardiac output. Without any blood flow, the brain
stops functioning within seconds.
RLB: (Here we discussed details of their cardiac arrests and resuscitations.
Pim assures me that cardiac rhythms were continuously monitored and recorded.
Without going into details, one piece of the puzzle is how long the NDE patients'
brains were without blood flow.
(No physicians - not even most cardiologists - have more experience
in dealing with acute cardiac arrests than emergency physicians. All of us
career ER doctors have treated hundreds of these cases. As front-line physicians,
it is the ER docs who are there 24 by 7 by 365 where the action is. I also taught
Advanced Cardiac Life Support (ACLS) for over a decade – this is my home turf.)
In my experience, even though VF may predominate in a given arrest,
it usually doesn't persist for more than a minute or so, although it can.
These patients are being intensively treated. They are being shocked
every 10 -15 seconds, and various drugs are being administered
(epinephrine, lidocaine, procainamide, amiodarone, et al). In a typical patient,
VF is intermittently present interspersed with ventricular tachycardia (VT) and other
partially perfusing tachycardias. MI patients also nearly always get large doses
of morphine and other opiates and doses of sedatives.
Reviewing Table 3 in the Lancet paper, I see that the average duration
of the cardiac arrest was 4 minutes. My view is that it is highly likely that
there was intermittent cerebral (brain) perfusion during that time.
I hammer him on this point, but he insists that the patients were
without blood flow during their arrests. This crucial point cannot be resolved
from the data presented in the Lancet paper.
Further examining Table 3: I see that only 10% of the patients
required intubation (putting a plastic tube into their tracheas (windpipes))
to assist their breathing. Intubation is a very high priority in a
"code blue" patient. It can be quite difficult but is extremely helpful.
The whole team breathes a sigh of relief after the ER doc has passed
the tube into the right place. That only 10% of the patients required intubation
reinforces my impression that these were brief arrests in which cerebral perfusion
was adequate to support some mentation/ cognition (albeit altered).)
RLB: How do you know there was no cerebral perfusion?
PVL: Besides the fact that the patients were in VF, their EEGs were flat.
RLB: (I ask him many questions about the EEGs (electroencephalograms).
Typically, an EEG is an elective study that a neurologist performs when
a patient is suspected of having seizures. A dozen or more electrodes are placed
on the scalp to monitor the brain's electrical activity. Getting the electrodes
to stick to the scalp is difficult without shaving areas of the scalp.
I have never seen an EEG done in a cardiac arrest. More typically
they will be done in the ensuing weeks in a comatose patient to ascertain
that the patient is "brain dead" and can be disconnected from life support.
PVL's answers to my questions about EEG monitoring were vague,
and there is no relevant data in the Lancet paper. I suspect that EEG monitoring
was only done on occasional patients, as above.
Even if an EEG is flat-line that does not mean there is no cerebral activity.
The EEG is only monitoring "local field potentials" in the cortex - the outer
few millimeters of brain tissue. There can still be normal activity in subcortical areas.
RLB: So, basically you're saying that these patients had no cardiac output,
no cerebral perfusion, and a flat-line EEG but were still capable of experiencing
NDEs with all their elaborate visual images (viewing their own resuscitation
from above, seeing deceased relatives, reviewing their lives) ?
PVL: Yes! They are having those experiences independent of and
despite the fact that their brains have ceased to function.
RLB: (I repeat my intense skepticism.) That is quite an extraordinary claim
and (if true) requires a revision of our thinking about neuroscience and consciousness.
Pim with philosopher David Chalmers and I - after dinner and a few glasses of wine.
RLB: Are you religious and were many of the patients religious?
PVL: I am not religious but many of the patients were. However, the number
of religious patients in the NDE and control groups were not significantly different.
RLB: My view is that your patients are genuinely reporting their experiences but
those experiences are illusory (hallucinations or delusions). Consider the work
of Henrik Ehrsson (a Swedish neuroscientist, who presented his work at our conference,
and who joined Pim and I for dinner.) Prof. Ehrsson and others have shown that
experience (OOBE) by artificially stimulating some parts of the cortex.
PVL: Yes, Henrik has shown that but you must distinguish those illusory
or delusional experiences from the veridical experiences in my NDE patients.
Consider these two examples. First, is a man who had a cardiac arrest and was in a
deep coma during the resuscitation. Prior to his being intubated, a nurse removed
his dentures and put them in a cup in the bottom drawer of the crash cart.
A week later when that nurse reintroduced herself to him in the ICU, the man said,
"I remember you. You're the nurse who took out my dentures and put them
in the drawer of that cart." (This story is also told in the Lancet paper.)
Second, Pim tells me the story of a woman who had an NDE during which she
encountered a stranger who told her facts that she had never heard.
When she later recovered, her family verified the facts and identified the stranger,
whom she had, indeed, never met.
(The NDE literature is replete with stories similar to these in which
patients hover over their bodies in the resuscitation room and observe details of
procedures done on them and instruments used, all while being comatose.
These stories are part of the essential evidence which persuades adherents
like Dr. Van Lommel that souls and consciousness have an existence
independent of normal brain functioning.)
RLB: These are extraordinary claims you're making that require fundamental revisions
to neuroscience, to physics, and to our view of the Universe.
PVL: Yes. Fundamental revisions are required.
RLB: All I can do is repeat my assertion that all conventional explanations
must be ruled out before invoking these extraordinary claims.
(I mention a well-known article that British psychologist Sue Blackmore
wrote called Why I Have Given Up (on parapsychology). Needless to say,
Pim and Sue do not see "eye to eye" on these issues.)
Even though I still believe that the patients' brains were producing these
illusory perceptions, the fact remains that the experiences themselves
and their aftermath are quite interesting and deserving of study.
PVL: Yes. We interviewed the NDE patients (and a control group) initially in the hospital,
two years later, and eight years later. Almost all the NDE patients had
profound transformations in their personalities. Relative to controls, the NDE patients
underwent several positive changes: a heightened appreciation of ordinary things,
an increase in empathy, a decreased fear of death, increased involvement with their families,
and an increased interest in others, and in the meaning of life.
Triumphal Ascent to Heaven by Johann Michael Rottmayr (from Wikimedia Commons)
(This is shown in Table 4 from the Lancet study, reproduced below.)
Life-change inventory questionnaire
(p values show large differences between NDE patients and controls)
Showing own feelings 0·034
Acceptance of others 0·012
More loving, empathic 0·002
Understanding others 0·003
Involvement in family 0·008
Understand purpose of life 0·020
Sense inner meaning of life 0·028
Interest in spirituality 0·035
Attitude to death
Fear of death 0·009
Belief in life after death 0·007
Interest in meaning of life 0·020
Understanding oneself 0·019
Appreciation of ordinary things 0.0001
RLB: I am aware of Sam Parnia's on-going multi-institution study of NDE
(The Human Consciousness Project). Your study must have inspired him to undertake his study.
PVL: Perhaps. I've chatted with Sam.
RLB: It will be informative to see if his results agree with yours from the Lancet study.
(One of the interesting features of that study is that high shelves near the ceilings
were constructed in the resuscitation rooms. Images are placed on those shelves that might
be viewable, if the patient, while having an OOBE, is able to see them and accurately report what he sees.)
(Understanding how the brain produces consciousness is one of the great mysteries of science.
Until it is solved, alternative theories of consciousness including souls floating in an after-life
will continue to be promulgated even by prominent researchers. Meanwhile, my faith in