REIMS, France — A little more than 20 years ago, American psychiatrist Bruce Greyson, MD, professor emeritus of psychiatry and neurobehavioral sciences at the University of Virginia in Charlottesville, came up with the following definition of near-death experiences: "profound psychological events with transcendental and mystical elements typically occurring to individuals close to death or in situations of intense physical or emotional danger."
Near-death experiences continue to be thought of as a mysterious phenomenon, although anyone who takes the time to seek out and speak with people who have been close to death will quickly discover that they are not, in fact, rare.
General practitioner François Lallier, MD, PhD, from the Reims University Hospital in France, conducted a retrospective study on near-death experiences for his general medicine dissertation, the results of which he discusses in his book Le mystère des expériences de mort imminente.
Medscape 's French edition interviewed him to find out why the resident physician, who is neither priest nor mystic, made this unconventional — some would say "daring" — choice. We also asked him about the results of his study, which involved 120 people from the Reims area who had been resuscitated after cardiac arrest.
Medscape: Where did you get the idea to do your general medicine dissertation on near-death experiences?
Lallier: One evening back in 2012, when I was in my seventh year of medical school, I was channel-surfing and stumbled on a documentary about near-death experiences. I'd already heard a bit about them, a tunnel, a light, etc. But as I watched the program, I was struck by the similar elements, the common features in the people's stories. And that there were so many scientists researching these experiences also intrigued me. I said to myself, 'Wouldn't it be cool to do my general medicine dissertation on near-death experiences in survivors of cardiac arrest?' (This was back when you could choose your topic.)
Medscape: What did your colleagues think about it?
Lallier: They fell into two groups. Some were thrilled at the idea, and others quite the opposite. So it was an accurate representation of the divide one finds among medical professionals when it comes to what is admittedly not the most scientific subject out there. Nevertheless, I decided to move forward with my idea. I went to Alain Léon, MD — at the time, he was the head of the anesthesia-intensive care-emergency unit at Reims University Hospital — and asked him to be the chair of my dissertation committee. And, to my surprise, he said yes!
Medscape: How did you go about your research? Why did you choose to focus on survivors of cardiac arrest as opposed to survivors of a different life-threatening condition?
Lallier: I ended up deciding to do a retrospective study — a Herculean task that I was only able to work on in my downtime, that is, in the evenings and on weekends, even during breaks in my shifts at the hospital. Over the course of a year and a half, I looked through about 300 files of cardiac arrest patients who were successfully treated at Reims University Hospital between 2005 and 2012. Out of these, I was able to come up with a group of patients I wanted to contact. As to why survivors of cardiac arrest, it's because near-death experiences most often occur in people whose hearts stop. But from a medical standpoint, what's so interesting about these particular occurrences is that cardiac arrest stops the blood supply to the brain. So, these patients shouldn't be able to form or have any memories of it at all.
Medscape: How many people did you end up contacting, and what did you ask them?
Lallier: It turned out that 91 had passed away shortly after their cardiac arrest. Then there were 86 who I didn't include for various reasons (there was no contact information for them, they had difficulty expressing themselves, etc.). So, out of the 300 or so patients whose files I reviewed, I was able to speak with 118. The group consisted mostly of men (69%), with an average age of 54 years. The average time since their cardiac arrest was 55 months.
At the beginning of the phone call, I asked them three questions, which I'd recommend that all doctors who have a cardiac arrest survivor as a patient ask. First: Do you have any memories from when you were unconscious/being resuscitated? If they answered 'No,' I would ask: Do you remember having a dream that seemed a bit strange? Now, near-death experiences are different from dreams. The only reason I asked this question was to change the tone of the conversation from the extraordinary to the everyday, so that hopefully the person would be put at ease and would speak more freely. If it seemed appropriate, I would bring up the subject of near-death experiences by mentioning some of the phenomenon's characteristic elements, that is, a tunnel, a light, etc. And I would ask whether they happened to see anything like that. We have to keep in mind that some patients are very reluctant to speak about their experience. This is because sometimes, when they shared it with the ICU doctor, the response they got was: 'Don't mention that to anyone. They'll think you're nuts.'
Medscape: And what happened when the patients told you that they did have a near-death experience?
Lallier: When the account they gave sounded like a near-death experience, I would have them answer the questions in the Greyson Near-Death Experience Scale. In addition, I would gather information about their education level and their possible near-death experience, or their knowledge of the subject.
Asking these patients about what could have been a near-death experience was one part of the research. As I reread the literature, I came up with another approach. I noticed that there was one thing that had never been taken into account: the patient's medical and surgical history. Perhaps an explanation could be found in their state of health pre-near-death experience. So I went through the files and noted each patient's medical and surgical history, the medications they were taking, the cause and the duration of their cardiac arrest, the methods used to resuscitate them, the drugs administered during the resuscitation efforts, etc.
Medscape: What is the Greyson Near-Death Experience Scale?
Lallier: No two near-death experiences are the same; each one is unique. That said, they do have a certain number of characteristic features. There's a light (brilliant, but not blinding), a tunnel with a light at the end of it, and a feeling of overwhelming peace — an impression that's so incredibly powerful, patients say it's impossible to put into words. Some people see a life review, like a movie but one where they see things from every angle, where they feel what they felt at the time. Others relive scenes from their past or encounter deceased loved ones. Greyson, the American psychiatrist and expert on near-death experiences, took these characteristic features and developed a 16-item scale. Each item has 0, 1, or 2 points. Adding up the points gives us the total Near-Death Experience Scale score, which ranges from zero to 32. If that total score is 7 or higher, the experience is considered a near-death experience for research purposes.
Medscape: What did you learn from your interviews?
Lallier: Out of the 118 individuals that I spoke with, 18 may have experienced a near-death experience. That's 15.3%, which is consistent with the numbers we see in the literature. I started from the premise that if the experience was a hallucination, then one would likely find a psychiatric basis for it in the individual's medical history, and that if it was connected to an epileptic seizure, then one would see this type of experience more often in individuals who have that neurological disorder. However, the findings showed the exact opposite. In other words, there were actually fewer near-death experiences among those with a history of psychiatric or neurological issues than among those without. Meanwhile, there were more near-death experiences among individuals with a history of respiratory, endocrine, and rheumatic issues. And, in general, patients who were taking medication were less likely to have had a near-death experience.
Medscape: What research has been done on cardiac arrest patients?
Lallier: This field owes a lot to psychiatrist Raymond Moody, who brought research into near-death experiences to the forefront when he published his seminal work, Life After Life, in 1975. In 2001, Dutch cardiologist Pim van Lommel, MD, Hospital Rijnstate, Netherlands, published what is still, to this day, the largest study on the subject in the Lancet. The study involved 344 cardiac patients who were successfully resuscitated after cardiac arrest. van Lommel and his team reported that 62 patients (18%) described themselves as having some recollection of the time of clinical death, and 41 (12%) of these had memories characterized as unusual — out-of-body experiences, going down a tunnel, encountering deceased loved ones, intense positive emotions, etc. — suggesting that these patients had had a near-death experience.
And in 2014, English critical care specialist Sam Parnia, MD, PhD, NYU Langone Health, and colleagues published results of the AWARE study, which interviewed 101 patients out of an initial sample size of 2060. They found that nine patients (9%) had experienced a near-death experience as defined by the Greyson Scale.
More recently, there is the work done by the Coma Science Group at the University of Liège, Belgium, headed by Steven Laureys, MD, PhD. The group takes a qualitative approach in researching near-death experiences. In one study, they reviewed the detailed narratives of patients who had these experiences. Among other things, the researchers concluded that the [characteristic] features do not appear in a strict temporal order, but rather in a variable one (i.e., they differ from patient to patient).
Medscape: Do near-death experiences occur more often than we think?
Lallier: One of the theories I put forth in my dissertation is that everyone who experiences a cardiac arrest has a near-death experience, but not everyone remembers it, like with dreams. One could say that, when it comes to the brain, the greater the "damage" — due to neurological or psychiatric disorders and/or treatments, or due to conditions that impair the memory — the greater the impact on one's ability to remember things and the fewer the reports of near-death experiences. This is consistent with the findings that 60% of children have these experiences, compared with 15% to 20% of adults.
Medscape: Near-death experiences are often explained away by saying that it's all just a release of neurotransmitters. What are your thoughts on that argument?
Lallier: These arguments are based on experiences induced by N,N-Dimethyltryptamine (DMT) or, in the case of the Ketamine model, the blockade of N-methyl-D-aspartate (NMDA) receptors. DMT is an extremely potent, naturally occurring psychedelic found in certain plants. Its release seems to activate areas of the brain that produce near-death experiences. And yes, injecting DMT gives rise to sensations and visions similar to those described by patients who have had near-death experiences — feeling unconditional love, seeing beings of light, communicating through thoughts, not words, etc. But this is still only a theory. And even if it turns out that DMT occurs naturally in the human body, this wouldn't "explain away" everything. For example, how is it that near-death experiences can occur in circumstances where the person is not "near death," such as in a state of pure relaxation, or when a person feels totally at one with another?
Medscape: Why do doctors take such little interest in this phenomenon that occurs in medical settings?
Lallier: One reason is that near-death experiences are not part of the med school curriculum. But it's also the case that many doctors associate these experiences with religious belief, so, for them, these cases have no relevance in to scientific inquiry. And while accounts of near-death experiences may indeed feature religious themes, I don't think that religion underlies the phenomenon. There are many reasons why I think that. For example, the frequency of near-death experiences is greatest among children, and children are not influenced much, if at all, by religion. Another reason is that there are reports of these experiences that predate modern religions, if we're to believe what Plato wrote in his Republic four centuries before Christ. In fact, it would be more interesting to explore the possibility that accounts of near-death experiences were what inspired people to found religions.
Medscape: You're now a general practitioner. How has your research changed the way you practice medicine?
Lallier: Thanks to the coverage that my study has gotten in the media, my patients know that I'm open-minded about this topic, so they'll just bring it up themselves. They feel a great sense of comfort in knowing that a near-death experience is far from being a trivial thing. These experiences often have a profound impact on the lives of the people who have had them. In some cases, this impact is positive, but not always. In up to 46% of people who have had near-death experiences, we see cases of post-traumatic stress disorder, divorce, and depression. This is why patients need to be able to speak about their experiences. It's so important that they have an outlet where they know they'll be taken seriously, and where they know they can seek guidance.
If a patient's history includes an event that could have led to a near-death experience, the doctor should start that discussion, and have that conversation without any skepticism or criticism. And who knows? They might even be surprised by what they hear. They might even come up with their own theories about the phenomenon.
This article originally appeared in the French edition of Medscape.
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Cite this: A Young Doctor Explores Near-Death Experiences - Medscape - Jan 13, 2022.