Flatliners

The first detailed write-up of the AWARE study is out, and it makes for interesting reading. It appears in the journal Resuscitation, and is signed by Sam Parnia and many co-authors, including longtime NDE researchers Peter Fenwick and Bruce Greyson.

The basic facts are these. Fifteen hospitals in the US, the UK, and Australia participated in the first large-scale prospective study of near-death experiences. The study took place between July 2008 and December 2012, during which time 2,060 cardiac arrests were recorded. Only 16% of the patients (330) survived. 140 of these consented to be interviewed. Of those interviewed, 61% (95) had no memory of any awareness during their cardiac episode. The other 39% (55) did report memories of some form of awareness. Of these, 46 patients described memories said to be "incompatible with a NDE," while the remaining nine had NDEs. Only two of the nine reported "visual awareness" of events in the hospital room during their cardiac arrest. One of them was interviewed on a preliminary basis, but could not give a more detailed interview because of poor health. The other went into some detail, and his observations seem to have been verified by hospital personnel.

The most publicized aspect of the study, at least prior to the release of the results, was that special visual targets had been concealed in many hospital rooms near the ceiling. The hope was that NDErs, who often report that they hovered near the ceiling and observed events transpiring below, would see these targets. But the two patients who reported visual observations were in rooms without targets.

The article quotes one NDEr who had a fairly typical otherworldly experience, involving travel through a tunnel toward a bright light, a "beautiful crystal city" and beautiful people "without faces" bathing in a "crystal clear" river, "beautiful singing," and strong emotion ("I was moved to tears").

The detailed veridical observation includes the patient's memory of an automated voice saying, "Shock the patient," and a "chunky fella" with a bald head who was part of the resuscitation team (and whom the patient recognized the next day). These details were later verified.

The less detailed veridical observation, which could not be followed up, involved seeing a nurse the patient did not know, but whom he recognized later, and seeing his blood pressure being taken, the intubation procedure, "a nurse pumping on my chest ... blood gases and blood sugar levels being taken."

I find some of the "non-NDE cognitive themes" interesting. From the brief quotes provided, it's hard to be sure, but many of them sound as if they could be compatible with NDEs, albeit perhaps of a negative or "hellish" variety. Examples:

"Being dragged through deep water with a big ring and I hate swimming - it was horrid."

"I felt scared."

"The whole event seemed full of violence ..."

"I had to go through a ceremony and ... the ceremony was to get burned. There were four men with me, whichever lied would die ... I saw men in coffins being buried upright."

And there are these:

"The sun was shining."

"Recalled seeing a golden flash of light."

"All plants, no flowers."

"Saw lions and tigers."

The first set of "non-NDE" reports are not necessarily dissimilar from hellish or nightmarish NDEs. The second set, though vague, suggest elements often found in NDEs - bright golden light, plants, animals.

But in general these excerpts are too brief to allow any real assessment.

The article stresses the likelihood that the detailed veridical NDE took place while the patient was in full cardiac arrest (not before or after), and that it appeared to occur beyond the point at which even residual brain activity should have ceased. Though the article doesn't go into detail, Sam Parnia's comments in an interview with the Telegraph provide more information:

“We know the brain can’t function when the heart has stopped beating,” said Dr Sam Parnia, a former research fellow at Southampton University, now at the State University of New York, who led the study.

“But in this case, conscious awareness appears to have continued for up to three minutes into the period when the heart wasn’t beating, even though the brain typically shuts down within 20-30 seconds after the heart has stopped.

“The man described everything that had happened in the room, but importantly, he heard two bleeps from a machine that makes a noise at three minute intervals. So we could time how long the experienced lasted for.

“He seemed very credible and everything that he said had happened to him had actually happened.”

The timing of the beeps seems to be the basis for the study's conclusion that awareness was present after three minutes or more.

The paper speculates that relatively few NDEs are recalled because post-resuscitation inflammation of the brain and/or post-resuscitation sedatives erase these memories. The "surge" theory is briefly addressed, with the article asserting that "in contrast to anesthesia typically there is no measurable brain function within seconds after cardiac arrest." Moreover, the flatlined EEG continues throughout conventional CPR since there is greatly reduced blood flow to the brain. It is also noted that reductions in cerebral blood flow would be expected to lead to delirium and coma, not "an accurate and lucid mental state."

So what can we make of all this? As I said, the study is interesting, and it has added one or two cases to the list of "veridical" NDEs. But since only two veridical accounts were obtained, and since neither patient was in a room with a visual target, the results are, to me, somewhat less than jaw-dropping. Even the more detailed veridical NDE is open to skeptical dismissal. The patient's reported sighting of the bald hospital worker could possibly be explained as his having seen the man previously, or as a false memory created when he saw the man the next day. Inasmuch as the sense of hearing is the last to go when entering unconsciousness, it is arguable that the patient heard the automated voice by normal means. Hearing a second beep seems, in itself, to be a slender reed on which to hang any conclusion.

Of course the whole study is already being trashed by skeptics - as in this online organ of "critical thinking," which declares that the study found "no evidence of NDE." It would be more correct to say that the study found some evidence, but not conclusive evidence. But drawing that distinction would require, well, critical thinking.

What the study mainly shows is just how difficult it is to study NDEs prospectively. Over a four-year period at 15 hospitals, only 2 veridical cases were obtained. I'm sure the study's organizers hoped for a larger number. As it is, we'll have to hope for future studies, perhaps on an even larger scale - and for a dash of luck.

===

A couple of commenters feel I'm downplaying the study too much. They make good points, so I'm reproducing edited versions of their comments below.

GregL wrote,

The study, to me anyway, does indeed have significance. They have good evidence of a functioning consciousness three minutes after heart stoppage. I don’t think that I have seen this documented before, and I see no reason to begin to doubt the veracity of the patient’s remarks. The main skeptical argument against the NDE has been that the events are occurring either during the early recovery period or during the very early stage of heart stoppage. This study, as Parnia’s own comments suggest, refutes this. The material brain should just not be producing lucid consciousness this long after heart stoppage.

Duck soup wrote,

The [veridical] case is remarkable, though the sceptics of course are creatively posing mundane explanations as is their business. I'm not a doctor but I've read up on the physiological state of the brain in cardiac arrest and what the sceptics are saying about the brain still having some activity enabling the ears to work is nonsense. And I do mean nonsense.

When the heart stops as in VF the brain stem goes down very quickly and with that all the global reflexes of the brain follow rapidly so that the whole caboodle is off line. You can't hear, see, feel or experience anything after 10-20 seconds, that is why you can stick a tube down the patients throat and they don't gag etc etc.

This man was definitely in cardiac arrest VF, the machine (which cannot make a mistake) tells us that ... so when the patient heard the first shock he would already have been "out" for two minutes before it had completed its analysis and advised a shock. There followed a prescriptive round of CPR for two minutes until the machine was used to analyse his heart rhythm again ... no pump action, brain still down (because CPR cannot force sufficient blood into the brain to enable consciousness) and the patient was shocked again.

Now he heard these two automated instructions to shock the patient, not only that, he remembered them which he should not have been able to do. That is impossible according to medical science and don't let the sceptics tell you otherwise because if they do they are being dishonest. So he had cognition and memory working actively when his brain could not have been. Also worth bearing in mind is that if the the patient had been conscious in a normal way during the shock treatment, he would have felt the pain of the shocks which is variously described as like being kicked by a mule or having your insides torn out, furthermore, CPR is very painful and bruises the patients chest sometimes breaking ribs. He reported no pain or discomfort and that is very significant.

As I say, good points. Though we might have hoped for more, the study is still an important contribution to the growing evidence for the NDE as a non-hallucinatory state.

Besides, I don't want to be too much of a Debbie Downer ...

Comments

[Fred Bloggs]

The study is interesting, but of course has been hyped by the media into 'evidence for life after death', when it is no such thing.

As skeptics would be quick to point out, the patients' brains may have flatlined, but the people themselves were not 'dead' in the full meaning of that word. (Otherwise they wouldn't be alive now.)

Surely the nub of the matter is nothing (necessarily) to do with life after death, and everything to do with the nature of consciousness.

Let us assume for a moment that these patients were definitely not 'dead', but that they had no detectable brain function. The interesting question is then 'how does the brain produce conscious experience when it is out of action?'

Of course, the usual skeptical argument is that there is a glimmer of brain activity going on, which we have so far failed to detect. In other words, a few neurons are firing somewhere.

That may be so, but then the question must be asked: 'why do we need a whole brain to produce conscious experience when, clearly, only a few neurons are actually necessary?' And moreover, the near-death experience is usually far more 'real' to the percipient than is everyday reality - so much so that it can often be life-changing (unlike dreams or hallucinations.) So a HIGHER level of conscious awareness is produced by FEWER neurons. This does not compute with our current model of brain function.

I would like to see the whole 'life after death' aspect of NDE research put to one side, and emphasis placed on this paradox of virtually-nonexistent brain function producing high-level awareness.

[Matt Rouge]

140 interviews just isn't enough of a sample to expect much. In that sense, the study is a disappointment.

||of these consented to be interviewed. Of those interviewed, 61% (95) had no memory of any awareness during their cardiac episode.||

I think a large percentage of people in cardiac arrest of this type simply stay in their body and don't "travel" very far. I don't think it's even necessarily the case that they have memories that are later erased by the drugs, etc.

||The other 39% (55) did report memories of some form of awareness. Of these, 46 patients described memories said to be "incompatible with a NDE,"||

I should read the study, but I am curious about these. It's one thing to claim "awareness," but did they identify their experiences as seeming real? Otherwise they could simply be describing dreams (which are actually Astral experiences).

[no one]

The AWARE results are kind of pathetic given all the hype surrounding not only the study, but NDEs themselves.

A patient seeing and remembering numbers on a hidden flash cards was always a distant long shot.

But, just one NDE of the type that has been promoted in popular books?

Bizarre and unpleasant experiences more common than wonderful beings of light?

Unfortunately, the results are pretty much as I thought they would be. I've been saying for years that all of the "saved by the light"/"into the light" type books are cherry picking experiences and creating the impression that these things are common; for the purpose of increasing sales.

What we need now is several replications of AWARE. I'd also like to see the addition of a psychological profile correlating personality traits and life styles to where an NDE falls of the positive to negative scale. Additionally correlate medical condition with the same (basically seeing if there is anything that could possibly account for the bizarre, unpleasant or dream like "NDEs").

[no one]

Reading the full text of the results as opposed to the summary makes the outcomes look marginally more interesting. out of 101 interviewed (first number is raw count of participants affirming and second is the %):

1) Did you have the impression that everything happened faster or slower than usual? 27 27
(2) Were your thoughts speeded up? 7 7
(3) Did scenes from your past come back to you? 5 5
(4) Did you suddenly seem to understand everything? 6 6
(5) Did you have a feeling of peace or pleasantness? 22 22
(6) Did you have a feeling of joy? 9 9
(7) Did you feel a sense of harmony or unity with the universe? 5 5
(8) Did you see, or feel surrounded by, a brilliant light? 7 7
(9) Were your senses more vivid than usual? 13 13
(10) Did you seem to be aware of things going on that normally should have been out of sight from your actual point of view as if by extrasensory perception? 7 7
(11) Did scenes from the future come to you? 0 0
(12) Did you feel separated from your body? 13 13
(13) Did you seem to enter some other, unearthly world? 7 7
(14) Did you seem to encounter a mystical being or presence, or hear an unidentifiable voice? 8 8
(15) Did you see deceased or religious spirits? 3 3
(16) Did you come to a border or point of no return? 8 8

[Duck soup]

The major problem with the study was that they did not have the resources to interview the majority of the patients who actually survived their arrests. So they were lost, probably with a "hit"...somewhere...sometime... that just disappeared down the drain.

I was disappointed that Parnia published the case of Mr A and wouldn't let on that THAT was the case he's been talking about. I actually thought based on what Parnia said recently about embargos being applied to author's who leek results, that it couldn't have been that case.. but of course, it was.
It doesn't alter the fact that the case is remarkable, though the sceptics of course are creatively posing mundane explanations as is their business.
I'm not a doctor but I've read up on the physiological state of the brain in cardiac arrest and what the sceptics are saying about the brain still having some activity enabling the ears to work is nonsense.

And I do mean nonsense. When the heart stops as in VF the brain stem goes down very quickly and with that all the global reflexes of the brain follow rapidly so that the whole caboodle is off line. You can't hear, see, feel or experience anything after 10-20 seconds, that is why you can stick a tube down the patients throat and they don't gag etc etc.

This man was definitely in cardiac arrest VF, the machine (which cannot make a mistake) tells us that... so when the patient heard the first shock he would already have been "out" for two minutes before it had completed it's analysis and advised a shock.
There followed a prescriptive round of CPR for two minutes until the machine was used to analyse his heart rhythm again...no pump action, brain still down (because CPR cannot force sufficient blood into the brain to enable consciousness)and the patient was shocked again.

Now he heard these two automated instructions to shock the patient, not only that, he *remembered* them which he should not have been able to do. That is impossible according to medical science and don't let the sceptics tell you other wise because if they do they are being dishonest. So he had cognition and memory working actively when his brain could not have been.

Also worth bearing in mind is that if the the patient HAD been conscious in a normal way during the shock treatment, he would have FELT the pain of the shocks which is variously described as like being kicked by a mule or having your insides torn out, furthermore, CPR is very painful and bruises the patients chest sometimes breaking ribs. He reported no pain or discomfort and that is very significant.

Note I have left out the patients observations of the bald chunky fella (who he could not have seen from his bed) for no good reason other than to pander to the sceptics favourite fall back, retrospective reconstruction and contamination based on the hopeless nature of memory in humans who cannot be trusted to ever remember anything accurately when the subject is NDE :-)

That.. I am prepared to let them have if they are so desperate but they're not telling me (And I've been arguing with them on comments boards) that people in cardiac arrest can hear and remember things after three minutes, no sir, that's a load of bull.

http://greenlanefilms.co.uk/peter-fenwicks-near-death-experience-video-gets-most-views-from-consciousness-conferene/

Start at 8.30

[FDRLincoln]

I'm not surprised by this. It is enough information for believers to accept as confirmation, but with a small enough sample and enough doubt for skeptics to focus on and avoid changing their views.

I doubt that we will EVER get 100% proof. It would likely "break the game" so to speak.

[GregL]

" the results are, to me, somewhat less than jaw-dropping. Even the more detailed veridical NDE is open to skeptical dismissal…”

Michael, I think I disagree somewhat with you here. The study, to me anyway, does indeed have significance. They have good evidence of a functioning consciousness three minutes after heart stoppage. I don’t think that I have seen this documented before, and I see no reason to begin to doubt the veracity of the patient’s remarks. The main skeptical argument against the NDE has been that the events are occurring either during the early recovery period or during the very early stage of heart stoppage. This study, as Parnia’s own comments suggest, refutes this. The material brain should just not be producing lucid consciousness this long after heart stoppage.

As to evidence for life after death, I guess it depends on where we draw the line for “death.” Parnia seems to be saying that these patients are “dead.” As Raymond Moody has said, however, we can never prove life after death, as the goal posts are constantly being moved back. It’s too bad they did not get a bigger pool of experiencers though. It is indeed difficult to study this phenomena. Results less than jaw dropping, yes, but significant nonetheless.

[Michael Prescott]

Duck soup and GregL, I think what you're saying is important, so I've appended abridged versions of your comments to the main post.

The Resuscitation article does not make the details of the veridical case sufficiently clear. I suppose the authors wanted to avoid "pitching woo" in a mainstream journal, so they did not do a detailed rundown of the case and the minute-by-minute significance of the patient's report.

[Paqdream]

What we have here is excellent evidence of rarity, and that is worth the price of the study all by itself. This is because if skeptic complaints were accurate, that various types of physical factors cause NDEs (or NDE-like memories), then we would expect to see them more regularly, particularly among a cohort that is selected on the basis of their membership in a group that supposedly meets at least some of the skeptic criteria for having NDEs.

This is like the old skeptic claim that dreams at about the time of a given person's death are not precognitive or after death communications on the basis of the large number of dreams we all have, and the large number of those dreams likely to be similar enough that chance alone can explain seeming correspondences. I checked my records on that to see how well it played. Out of over 11,000 dream entries, I found 8 examples that appeared to contain paranormally obtained information about a specific person's death. Moreover, most involved people who appeared only once in the journal and then never recurred. In that case, like this one, rarity is just as interesting, if not moreso, than abundance.

AP

[william]

Fred: excellent overview and questions about NDE'S

[Leo MacDonald]

Hi Duck I have been arguing back and for on Steven Novella's blog. I am thinking it's a waste of time to argue with skeptics who's minds are already made up.

[Matt Rouge]

Paqdream,

That is a great point about rarity.

Leo,

It certainly is! What is more, they tend not to make such conversations enjoyable intellectual exercises.

[Simon Oakes]

"Fred: excellent overview and questions about NDE'S"

I agree. That said I also think research into NDEs is of great importance; but surely the important outcome from AWARE is the evidence it provides that consciousness per se is not just a by product of physical processes in the brain.

I think the way forward is to build on the AWARE study by way of a research programme that aims to establish a substantive and compelling body of evidence on this issue.

For me, materialistic/physicalist explanations of perception, mind & consciousness are already on very shaky ground philosophically. Reinforcing these shortcomings with evidence from AWARE type studies can only help in further breaking down the (what I'm sure will be seen in the future as mind bogglingly silly) prejudices against taking psi seriously.

[Ian K]

I have not read any skeptical reviews for I would expect the usual distortions and omissions.

[Duck soup]

Thanks for headlining the post, Michael, fame at last :)

@Leo
It is a waste of time but many of us do it anyway. They (the sceptics) don't seem to realise that this experience of seeing themselves from a detached out of body position and going up a tunnel is likely to happen to them.

When it does, how will they be able to deny what they are seeing and witnessing, it doesn't make any sense.

Therefore what is the logic in them denying the sensed reality of the experiences of those that have already been there ?
Tony Cicoria and all the other doctors that have had NDE's are convinced their experience was real in every sense of the word and they are just as savvy as Novella.

[Kathleen]

For me at least, I see this as pretty positive for NDEs and after death survival, especially in light of GregL's and duck soup's comments. Imagine if there had been nothing. But as FDR commented, I don't think we'll ever have 100% proof. Part of that is. because the way I understand it at least, the medical definition of death isn't set in concrete and keeps changing. If someone was "dead" for a week and "came back" with an NDE, the skeptics would still argue that they weren't "really" dead.

As for negative NDEs, I've read several accounts of them in older books. They do occur. You won't find them in books like Eben Alexander's or the boy-who-met-Jesus, but those books IMO are just cash grabs. I'm not surprised to see them here.

[Luciano]

I've read in several books that the Afterlife environment is set according to what the newly deceased thinks and expects of death... If you're scared of death you're likely to find yourself in a hellish or scary place, until you create something different.

If you think death is the ceasing of existence, then probably you won't experience anything at all for some time (maybe some of the people who do not report NDE's fall into this category, and the others maybe do forget them), death will be like falling asleep...

And there are others who suddenly lose all fear to death and experience something beautiful.

[Christine]

Fred Bloggs: Great arguments and questions, which perfectly show how skeptical explanations for NDE directly contradict the very materialist theory that consciousness is an "emergent" property of the brain, that is: a few neurons do not produce consciousness but 100 billions of neurons do. Either a whole brain is needed for consciousness to "emerge",or only a few neurons are needed; it can't be both.

[Boo boo]

Hey, everybody. I'm not sure if you already seen this, but somebody at skepticforum.com said something about me. I'm not a member of that forum btw. Here it is. http://www.skepticforum.com/viewtopic.php?f=7&t=24398

They think I'm a sock puppet of MU. A poster who went to many forums and blogs including this one and posted inappropriate comments. He was in his 60s and a perv. Here's more info. http://rationalwiki.org/wiki/Talk:Andrew_B._Chung/archive1#MU_pretending_to_be_Jon_Donnis.2C_Forests.2C_and_eveshi

I've been a member of skeptiko since Tuesday and another member sent me these links. I'm not MU.

[Boo boo]

Also, I agree with whoever said something about Open Mind in the forum mind energy on that rational wiki page. 'Open mind' is not open minded at all. No matter what evidence against mediums, ghosts, or something like that, he won't accept it and dismisses it all. And calls EVERY skeptic out there pseudoskeptics. You can't just dismiss evidence or contrary evidence just because you don't like it.

[Leo MacDonald]

One of the skeptics on the blog mentioned to me was the problem with the Mr. A case that you mentioned Ducksoup is that he wasn't interviewed 1 year after this apparent verifiable case.

[Fred Bloggs]

@William, Simon Oakes & Christine,

Thanks for your kind comments. I forgot to mention the other Skeptical explanation for NDEs, which is that the experience takes place as the person is recovering consciousness but it's mistakenly thought to have occurred while the brain was flatlined.

This runs into the same problems as the 'few hidden neurons' explanation. (In this case, we have to postulate a 'rebooting' brain generating a fully-detailed, technicolour version of a reality, which is a more persuasive experience than the one produced by a brain that is fully back online).

Obviously both these explanations must be taken seriously and properly investigated, but it is difficult to see how either of them are compatible with current models of 'mind=neurons'.

@Duck Soup:

I think the Organised Skeptic movement is headed for collapse in the long term, for the simple reason that increasing numbers of Skeptics will have their own 'anomalous' experiences and be unable to reconcile them with their 'accepted' models of reality. They may be forced to abandon their models - although they may just decide that a self- diagnosis of insanity is a preferable option.

(Michael Shermer's recent synchronicity experience seems to have shaken his certainty somewhat. Lesser Skeptical intellects than Michael's might have their worldview completely shattered.)

[Julie Baxter]

Yes, Fred Bloggs, in short the result will be a psychological breakdown of one kind or another. But that's what happens when we hold onto rigid ideas about the world and the nature of 'reality'. The more fundamentalist in outlook the more the world threatens one's sense of certainty - the sense that is so important at the fundamentalist stage of psychological development. The only solution is to develop a comfortable relationship with ambiguity. :)

[Rossoli]

The other 39% (55) did report memories of some form of awareness. Of these, 46 patients described memories said to be "incompatible with a NDE,"

This is an important study and I'm surprised your post didn't receive more comments, Michael.

39 %, WOW, That's great! But why not typical NDE's? Why all these dismissed NDE's? Perhaps a combination of:

a) NDE's are socially/culturally dependent. It seems they are constructs of mind (expanded) more than of an objective afterlife.

b) Memory is a very limiting factor. Fragments or distorted fragments are what's left.

c) NDE's might be influenced by the leaders of and the doctors and nurses involved in the study (if there was a religious hospital the result could be different)and (not least) of the situation around the patient before the crisis.

d) It is more difficult today than before to get significant results in many types of psi studies (stress and electromagnetic fields might play a role. As demonstrated by Radin & Co, meditators succeed better). Perhaps that's true also for NDE's?