Psychology of Religion and Spirituality © 2010 American Psychological Association 2010, Vol. 2, No. 1, 37–45 1941-1022/10/$12.00 DOI: 10.1037/a0018548 Implications of Near- Experiences for a Postmaterialist Psychology

Bruce Greyson

Classical physics, anchored in materialist reductionism, offered adequate descriptions of everyday mechanics but ultimately proved insufficient for describing the mechanics of extremely high speeds or small sizes, and was supplemented nearly a century ago by quantum physics, which includes consciousness in its formulation. Materialist psychol- ogy, modeled on the reductionism of classical physics, likewise offered adequate descriptions of everyday mental functioning but ultimately proved insufficient for describing mentation under extreme conditions, such as the continuation of mental function when the brain is inactive or impaired, such as occurs near death. “Near-death experiences” include phenomena that challenge materialist reductionism, such as enhanced mentation and memory during cerebral impairment, accurate perceptions from a perspective outside the body, and reported visions of deceased persons, includ- ing those not previously known to be deceased. Complex consciousness, including cognition, perception, and memory, under conditions such as cardiac arrest and general anesthesia, when it cannot be associated with normal brain function, require a revised psychology anchored not in 19th-century classical physics but rather in 21st-century quantum physics that includes consciousness in its conceptual formulation.

Keywords: materialism, reductionism, near-death experience, mind–body problem, consciousness

Until the early 20th century, classical me- cus exclusively on phenomena that could be chanics was the foundation for all sciences on described objectively by independent observers the assumption that observations of all sciences and to ignore consciousness. Materialist psy- might someday be reduced to the laws of me- chology was epitomized by Watson (1914), chanics. At the heart of the classical worldview who asserted, “Psychology, as the behaviorist was materialist reductionism, the idea that any views it, is a purely objective, experimental complex phenomenon could be understood by branch of natural science which needs con- reducing it to its individual components and sciousness as little as do the sciences of chem- eventually down to elementary material parti- istry and physics” (p. 27). It is ironic that while cles. This worldview implied that all complex Watson was aligning behaviorist psychology psychological phenomena could ultimately be with classical mechanics, physicists were al- understood in material terms. ready moving beyond that model with a quan- This materialist worldview permeated psy- tum physics that could not be formulated with- chology as it did other sciences, even though out reference to consciousness. this reductionism required psychologists to fo- Classical dynamics adequately described the motion of macroscopic objects moving at everyday speeds; it was only the investigation of extraordinary circumstances, involving ob- Bruce Greyson, Division of Perceptual Studies, Univer- jects moving with velocities approaching the sity of Virginia. speed of light or the behavior of microscopic Portions of this research were presented at the Columbia University/Coudert Institute Joint Symposium, “Conscious- wave-particles, that revealed the limits of the ness, Spirituality, and Healing: A Post-Newtonian Psychol- classical model and the need for additional ogy” (Palm Beach, FL, March 27–29, 2009). explanatory paradigms. So too with the ques- Correspondence concerning this article should be ad- tion of the mind–brain relationship: It is the dressed to Bruce Greyson, Division of Perceptual Studies, University of Virginia Health System, 210 10th Street NE, exploration of extraordinary circumstances of Suite 100, Charlottesville, VA 22902-5328. E-mail: mental function that reveals the limitations of [email protected] the current model of mind–brain identity and

37 38 GREYSON the need for a more comprehensive explana- watching events from an out-of-body perspec- tory model. tive; a cessation of pain; seeing an unusually bright light, sometimes experienced as a “Being Near-Death Experiences of Light” that radiates love and may speak or otherwise communicate with the person; en- One such extraordinary circumstance calling countering other beings, often deceased people; into question the adequacy of the mind–brain experiencing a revival of memories or even a identity model is the continued functioning of full life review; seeing some “other realm,” the mind when the brain appears to be inactive often of great beauty; sensing a barrier or border or impaired, such as may occur near death. beyond which the person cannot go; and return- Dozens of case reports in the medical literature ing to the physical body, often reluctantly. spanning centuries have documented the phe- A number of reductionistic hypotheses nomenon of terminal lucidity, the unexplained have been proposed to explain NDEs, attrib- return of mental clarity and memory shortly uting them to psychopathology, personality before death in patients who had suffered years traits, altered blood gases, neurotoxic meta- of chronic schizophrenia or dementia (Nahm & bolic reactions, or neuroanatomical malfunc- Greyson, 2009). Beyond this paradoxical en- tions, although such speculations generally hanced mental clarity while brain function pre- lack any empirical support and address only sumably deteriorates, considerable research in selected aspects of the phenomena (Greyson, the past several decades has been published Kelly, & Kelly, 2009). The most important delineating parameters of what have come to be objection to the adequacy of all reductionistic called near-death experiences (NDEs). These psychophysiological theories, however, is profound subjective experiences that many peo- that mental clarity, vivid sensory imagery, a ple report when they are near death pose chal- clear memory of the experience, and a convic- lenges to the materialist mind–brain identity tion that the experience seemed more real than model (Greyson, 2003; Parnia, Waller, Yeates, ordinary consciousness are the norm for NDEs, & Fenwick, 2001; Schwartz, Stapp, & Beaure- even when they occur in conditions of drasti- gard, 2005; van Lommel, van Wees, Meyers, & cally altered cerebral physiology under which Elfferich, 2001). the reductionistic model would deem con- Such experiences of altered consciousness on sciousness impossible. the threshold of death have been described spo- radically in the Western medical literature since Extreme Physiology of Cardiac Arrest the 19th century (Brierre de Boismont, 1859; and Anesthesia Cullen, 1894), were identified as a discrete syn- drome toward the end of that century (Heim, Although experiences resembling NDEs may 1892), and have been studied more systemati- occur in a wide variety of medical circum- cally in the past 30 years (Holden, Greyson, & stances, NDEs are most reliably triggered when James, 2009). Recent research suggests that patients are clinically near death, such as during NDEs are reported by 12% to 18% of cardiac cardiac arrest or some other, usually sudden, arrest survivors (Greyson, 2003; Parnia et al., loss of vital functions. In one study of 1,595 2001; van Lommel et al., 2001), and that they consecutive admissions to a cardiac care unit, are more consistent with a normal response to NDEs were reported 10 times more often by stress than with a pathological disorder (Grey- patients who had survived definite cardiac arrest son, 2000, 2001). compared with patients with other serious car- These NDEs are vivid experiences involving diac incidents (Greyson, 2003). The particular mystical or transcendental features occurring to challenge of NDEs to materialist reductionism people who have been physiologically close to lies in one central feature that makes this phe- death, as in cardiac arrest or other life- nomenon uniquely important in any consider- threatening conditions, although mystical and ation of the mind–brain problem: specifically, transcendental experiences may of course occur the occurrence of vivid and complex mentation, under other circumstances as well. Frequent sensation, and memory formation under condi- NDE features include feelings of peace and joy; tions in which materialist models of the mind a sense of being out of one’s physical body and deem them impossible. The stark incompatibil- NEAR-DEATH EXPERIENCES 39 ity of NDEs with the current reductionistic with major surgical procedures involving gen- model of mind–brain relations is particularly eral anesthesia. There are numerous reports of evident in connection with experiences that NDEs in connection with cardiac arrest, and, occur under two conditions, namely, general like those that occur with general anesthesia, anesthesia and cardiac arrest. they include the typical features associated with NDEs, most notably vivid or even enhanced General Anesthesia sensation and mentation. However, in cardiac arrest, cerebral function- In our collection at the University of Vir- ing shuts down within a few seconds. Whether ginia, 22% of our NDE cases occurred under the heart actually stops beating entirely or goes anesthesia, and they include the same features into ventricular fibrillation, the result is essen- as other NDEs, such as out-of-body experiences tially instantaneous circulatory arrest, with that involved watching medical personnel blood flow and oxygen uptake in the brain working on their body, an unusually bright or plunging swiftly to near-zero levels. EEG signs vivid light, meeting deceased persons, and, sig- of cerebral ischemia, typically with global slow- nificantly, thoughts, memories, and sensations ing and loss of fast activity, are detectable that were as clear or clearer than usual. within 6–10 s and progress to isoelectricity John et al. (2001) recently carried out a mas- (flat-line EEGs) within 10–20 s of the onset of sive study intended specifically to identify reli- arrest. In sum, full arrest leads rapidly to the able electroencephalographic (EEG) correlates three major clinical signs of death (absence of of loss and recovery of consciousness during cardiac output, absence of respiration, and ab- general anesthesia. Their results confirmed the sence of brainstem reflexes) and provides the standard thinking about anesthesia and EEG, best model we have of the dying process namely, that unconsciousness is associated with (DeVries, Bakker, Visser, Diephuis, & van a pronounced shift toward lower frequencies in Huffelin, 1998; Parnia & Fenwick, 2002; van the delta and low theta range, with a more Lommel et al., 2001; Vriens, Bakker, DeVries, frontal distribution and higher power. More sig- Wieneke, & van Huffelin, 1996). Nevertheless, nificantly, John et al. showed that gamma- in four published studies alone, more than 100 type EEG rhythms lost power and became cases of NDEs occurring under conditions of decoupled across the brain when patients lost cardiac arrest have been reported (Greyson, consciousness, and that these changes were 2003; Parnia et al., 2001; Sabom, 1982; van reversed with return of consciousness. The Lommel et al., 2001). pattern reflects the complete disabling of the Those intent on defending materialist reduc- brain under anesthesia. tionism might object that even in the presence Additional results supportive of this conclu- of a flat-line EEG there still could be undetected sion derive from other recent functional imag- brain activity going on; current scalp-EEG tech- ing studies that have looked at blood flow, glu- nology detects only activity common to large cose metabolism, or other indicators of cerebral populations of neurons, mainly in the cerebral activity under general anesthesia (Alkire, 1998; cortex. However, the issue is not whether there Alkire, Haier, & Fallon, 2000; Shulman, Hyder, is brain activity of any kind whatsoever, but & Rothman, 2003; White & Alkire, 2003). In whether there is brain activity of the specific these studies, brain areas essential to the global form agreed on by contemporary neuroscien- workspace are consistently deactivated individ- tists as the necessary condition of conscious ually and decoupled functionally. Auditory and experience. Activity of this form is eminently other stimuli are no longer able to ignite the detectable by current EEG technology, and it is large-scale cooperative network interactions abolished either by adequate general anesthesia that normally accompany conscious experience. or by cardiac arrest. In cardiac arrest, even neuronal action-potentials, the ultimate physical Cardiac Arrest basis for coordination of neural activity be- tween widely separated brain regions, are rap- The situation is even more dramatic with idly abolished. Moreover, cells in the hip- regard to NDEs occurring during cardiac arrest, pocampus, the region thought to be essential for many of which in fact occur also in conjunction memory formation, are especially vulnerable to 40 GREYSON the effects of anoxia (Vriens et al., 1996). In brain produces mind, or indeed is the mind, short, it is not credible to suppose that NDEs several features of NDEs call into question occurring under conditions of adequate general whether materialist reductionism will ever pro- anesthesia, let alone cardiac arrest, can be ac- vide a full explanation of them. counted for in terms of some hypothetical re- sidual capacity of the brain to process and store Enhanced Mentation During Cerebral complex information under those conditions. Impairment A second defense of a materialist explanation for NDEs is to suggest that these experiences do Perhaps the most important of these features, not occur when they appear to occur, during the because it is so commonly reported in NDEs, is actual episodes of brain insult, but at a different the occurrence of normal or even enhanced time, perhaps just before or just after the insult, mental activity at times when, according to the when the brain is more or less functional. How- mind–brain identity model, such activity should ever, unconsciousness produced by cardiac ar- be diminishing, if not impossible. Individuals rest characteristically leaves patients amnesic reporting NDEs often describe their mental pro- and confused for events immediately preceding cesses during the NDE as remarkably clear and and following these episodes (Aminoff, Schei- lucid and their sensory experiences as unusually nman, Griffin, & Herre, 1988; Parnia & Fen- vivid, equaling or even surpassing those of their wick, 2002; van Lommel et al., 2001). In addi- normal waking state. Reports of NDEs from tion, the confusional experiences occurring as a widely divergent cultures confirm that people person is losing or regaining consciousness do have consistently reported, from different parts not have the life-transforming impact so char- of the world and across different periods of acteristic of NDEs. Second, a substantial num- history, having had complicated cognitive and ber of NDEs contain apparent time “anchors” in perceptual experiences at times when brain the form of verifiable reports of events occur- functioning was severely impaired. ring during the period of insult itself. For ex- A recent analysis of several hundred NDE ample, a cardiac-arrest victim described by van cases showed that 80% of experiencers de- Lommel et al. (2001) had been discovered lying scribed their thinking during the NDE as in a meadow 30 min or more prior to his arrival “clearer than usual” (45%) or “as clear as usual” at the emergency room, comatose and cyanotic, (35%). In addition, 74% described their think- and yet days later, having recovered, he was ing as “faster than usual” (37%) or “at the usual able to describe accurately various circum- speed” (37%); 65% described their thinking as stances occurring in conjunction with the ensu- “more logical than usual” (29%) or “as logical ing resuscitation procedures in the hospital. as usual” (36%); and 55% described their con- trol over their thoughts as “more control than NDE Features Problematic for Materialist usual” (19%) or “as much control as usual” Reductionism (36%; Kelly, Greyson, & Kelly, 2007, p. 386). An analysis of NDEs with contemporaneous Most near-death experiencers are convinced medical records showed that, in fact, people that during the NDE they temporarily separated reported enhanced mental functioning signifi- from their physical bodies. In our collection, for cantly more often when they were actually example, 81% of experiencers reported feeling physiologically close to death than when they separated from the body during the NDE. The were not (Owens, Cook, & Stevenson, 1990). idea that mind and brain are not identical is not Another example of enhanced mental func- inherently unscientific. Although it contradicts tioning during an NDE is a rapid revival of the assumption of materialistic reductionism memories that sometimes extends over the per- that the mind can be reduced to physical enti- son’s entire life. An analysis of several hundred ties, the direction that physics has taken in the NDE cases showed that in 24% of them there last century justifies ample caution when it was a report of some degree of revival of mem- comes to making assumptions about the scope ories during the NDE. Moreover, in contrast to and the fundamental character of the natural the isolated and often just single brief memories world. Although most psychologists and neuro- evoked during cortical stimulation, memories scientists accept the reductionistic model that revived during an NDE are frequently described NEAR-DEATH EXPERIENCES 41 as being “many” or even as an almost instanta- even painful (Osterman, Hopper, Heran, Keane, neous “panoramic” review of the person’s entire & van der Kolk, 2001; Spitellie, Holmes, & life: 57% of those reporting memories said that Domino, 2002). The experiences are typically they had experienced many memories of a re- brief and fragmentary, and primarily auditory or view of their entire life, whereas only 43% tactile, and not visual; for example, the patient reported one or a few memories (Kelly et al., may report hearing noises or snippets of speech, 2007, p. 386). In addition, an analysis of 68 or briefly feeling sensations associated with in- published life review cases found that in 71% tubation or with specific surgical procedures. the experience had involved memories of many There have been occasional reports of pa- events of the person’s whole life (Stevenson & tients who appeared to display some degree of Cook, 1995, p. 455). memory for events that occurred during surgery (Cheek, 1964, 1966), but there were numerous Accurate Perception From an Out-of-Body methodological problems with studies purport- Perspective ing to show this (Trustman, Dubovsky, & Tit- ley, 1977), and more recent and better con- Another important feature of NDEs that ma- trolled studies have not substantiated such terialist reductionism cannot adequately ac- claims (Ghoneim & Block, 1992, 1997). There count for is the experience of being out of the is no convincing evidence for adequately anes- body and perceiving events that one could not thetized patients having any explicit, or con- ordinarily have perceived. A recent analysis of scious, memory of events during the surgery several hundred cases showed that 48% of near- (apart from patients who have reported such death experiencers reported seeing their physi- memories in connection with an NDE). It is not cal bodies from a different visual perspective. plausible that memories of complex sensory Many of them also reported witnessing events experiences occurring during general anesthesia going on in the vicinity of their body, such as could have been acquired by the impaired brain the attempts of medical personnel to resuscitate itself during the period of unconsciousness. Fur- them at the scene of an accident or in an emer- thermore, any such explanatory claims are even gency room (Kelly et al., 2007). A materialist less credible when, as commonly happens, the reductionism could attribute the belief that one specific sensory channels involved in the re- has witnessed events going on around one’s ported experience have been blocked as part of body to a retrospective imaginative reconstruc- the surgical routine—for example, when visual tion attributable to a persisting ability to hear, experiences are reported by patients whose eyes even when unconscious, or to the memory of were taped shut during the relevant period of objects or events that one might have glimpsed time. just before losing consciousness or while re- Sabom (1982) carried out a study specifically gaining consciousness, or to expectations about to examine whether claims of out-of-body per- what was likely to have occurred (Blackmore, ceptions could be attributed to retrospective 1993; Saavedra-Aguilar & Go´mez-Jeria, 1989; reconstruction. He interviewed patients who re- Woerlee, 2004). ported NDEs in which they seemed to be watch- Such explanations are inadequate, however, ing what was going on around their body, most for several reasons. First, memory of events of them cardiac patients who were undergoing occurring just before or after loss of conscious- cardiopulmonary resuscitation at the time of ness is usually confused or completely absent their NDE. He also interviewed “seasoned car- (Aminoff et al., 1988; Parnia & Fenwick, 2002; diac patients” who had not had an NDE during van Lommel et al., 2001). Second, claims that their cardiac-related crises, and asked them to adequately anesthetized patients retain any sig- describe a cardiac resuscitation procedure as if nificant capacity to be aware of or respond to they were watching from a third-person per- their environment in more than rudimentary spective. He found that 80% of the comparison ways—let alone to hear and understand—have patients made at least one major error in their in general not been substantiated. The phenom- descriptions, whereas none of the NDE patients enology of such awakenings in anesthesia is made any. Moreover, 19% of the NDE patients altogether different from that of NDEs, and related accurate details of specific idiosyncratic often extremely unpleasant, frightening, and or unexpected events during their resuscitation 42 GREYSON

(pp. 87–115). Sartori (2008) recently replicated hands from possibly becoming contaminated Sabom’s findings in a 5-year study of hospital- before beginning surgery, he had developed the ized intensive care patients, in which patients idiosyncratic habit of flattening his hands who reported leaving their bodies during car- against his chest, while rapidly giving instruc- diac arrests described their resuscitations accu- tions by pointing with his elbows. rately, whereas every cardiac arrest survivor In a recent review of 93 reports of potentially who had not reported leaving the body de- verifiable out-of-body perceptions during scribed incorrect equipment and procedures NDEs, Holden (2009) found that 43% had been when asked to describe their resuscitation. corroborated to the investigator by an indepen- An even more difficult challenge to material- dent informant, an additional 43% had been istic models of NDEs comes from cases in reported by the experiencer to have been cor- which experiencers report that, while out of the roborated by an independent informant who body, they became aware of events occurring at was no longer available to be interviewed by the a distance or that in some other way would have investigator, and only 14% relied solely on the been beyond the reach of their ordinary senses experiencer’s report. Of these out-of-body per- even if they had been fully and normally con- ceptions, 92% were completely accurate, 6% scious. Clark (1984) and Owens (1995) each contained some error, and only 1% was com- published a case of this type, and we have pletely erroneous. Even among those cases cor- reported on 15 cases, including seven cases roborated to the investigator by an independent previously published by others and eight from informant, 88% were completely accurate, 10% our own collection (Cook, Greyson, & Steven- contained some error, and 3% were completely son, 1998; Kelly, Greyson, & Stevenson, 2000), erroneous. The cumulative weight of these again including accurate perceptions of unex- cases is inconsistent with the conception that pected or unlikely details. In addition, Ring and purported out-of-body perceptions are nothing Cooper (1997, 1999) reported 31 cases of blind more than hallucinations. individuals, nearly half of them blind from birth, who experienced during their NDEs qua- Visions of Deceased Acquaintances si-visual and sometimes veridical perceptions of objects and events. Many people who approach death and re- One criticism of these reports of perceptions cover report that, during the time they seemed of events at a distance from the body is that they to be dying, they met deceased relatives and often depend on the experiencer’s testimony friends. In a recent analysis of several hundred alone. However, some cases have been corrob- NDEs, 42% of experiencers reported meeting orated by independent witnesses (Clark, 1984; one or more recognizable deceased acquaintan- Hart, 1954; Ring & Lawrence, 1993). van Lom- ces during the NDE. Such experiences have mel et al. (2001, p. 2041), for example, reported been widely viewed as being hallucinations, a case in which a cardiac arrest victim was caused by drugs or other physiological condi- brought into the hospital comatose and cyanotic tions or by the person’s expectations or wishes and remained in a coma and on artificial respi- to be reunited with deceased loved ones at the ration in the intensive care unit for more than a time of death. However, a closer examination week. When he regained consciousness, he im- of these experiences indicates that such expla- mediately recognized one of the nurses as the nations are not adequate (Kelly, 2001). person who had removed his dentures during People close to death are more likely to per- the resuscitation procedures, and he described ceive deceased persons than do people who are “correctly and in detail” the emergency room not close to death: The latter, when they have and the procedure, including the cart in which waking hallucinations, are more likely to report the nurse had put his dentures. The nurse cor- seeing living persons (Osis & Haraldsson, roborated his account. Cook et al. (1998, pp. 1977). Near-death experiencers whose medical 399–400) reported a case in which the patient records show that they really were close to described leaving his body and watching the death also were more likely to perceive de- cardiac surgeon “flapping his arms as if trying ceased persons than experiencers who were ill to fly.” The surgeon verified this detail by ex- but not close to death, even though many of the plaining that, in order to keep his scrubbed latter thought they were dying (Kelly, 2001). NEAR-DEATH EXPERIENCES 43

Moreover, numerous people near death also to brain. The predominant contemporary mod- perceive figures other than known deceased per- els of consciousness are based on principles of sons during the NDE, most of these being un- classical physics that were shown to be incom- recognized. If expectation alone were driving plete in the early decades of the 20th century. the process, people would presumably recog- However, the development of postclassical nize the hallucinatory figures, either as actual physics over the past century offers empirical deceased or living people or as known religious support for a new scientific conceptualization of figures, more often than was in fact the case. the interface between mind and brain (Schwartz People more often perceive deceased people et al., 2005). with whom they were emotionally close, but in one third of the cases, the deceased person was References either someone with whom the experiencer had a distant or even poor relationship or someone Alkire, M. T. (1998). Quantitative EEG correlations whom the experiencer had never met, such as a with brain glucose metabolic rate during anesthe- relative who died long before the experiencer’s sia in volunteers. Anesthesiology, 89, 323–333. birth (Kelly, 2001). van Lommel (2004, p. 122) Alkire, M. T., Haier, R. J., & Fallon, J. H. (2000). reported the case of a man who had an NDE Toward a unified theory of narcosis. Conscious- during cardiac arrest in which he saw his de- ness and Cognition, 9, 370–386. Aminoff, M. J., Scheinman, M. M., Griffin, J. C., & ceased grandmother and an unknown man. Herre, J. M. (1988). Electrocerebral accompani- Later shown a picture of his biological father, ments of syncope associated with malignant ven- whom he had never known and who had died tricular arrhythmias. Annals of Internal Medicine, years ago, he immediately recognized him as 108, 791–796. the man he had seen in his NDE. Blackmore, S. (1993). Dying to live. Buffalo, NY: There is one particular kind of vision of the Prometheus. deceased that calls into question even more Brierre de Boismont, A. (1859). On hallucinations directly their dismissal as subjective hallucina- (R. T. Hulme, trans.). London: Henry Renshaw. tions: cases in which the dying person appar- Cheek, D. B. (1964). Surgical memory and reaction ently sees, and often expresses surprise at see- to careless conversation. American Journal of Clinical Hypnosis, 6, 237–239. ing, a person whom he or she thought was Cheek, D. B. (1966). The meaning of continued living, but who had in fact recently died. Re- hearing sense under general chemo-anesthesia. ports of such cases were published in the 19th American Journal of Clinical Hypnosis, 8, 275– century and have continued to be reported in 280. recent years (Greyson, in press). Because in Clark, K. (1984). Clinical interventions with near- these cases the experiencers had no knowledge death experiencers. In B. Greyson & C. P. Flynn of the death of the recently deceased person, the (Eds.), The near-death experience (pp. 242–255). vision cannot plausibly be attributed to the ex- Springfield, IL: Charles C. Thomas. periencer’s expectations. Cook, E. W., Greyson, B., & Stevenson, I. (1998). Do any near-death experiences provide evidence for the survival of human personality after death? Conclusion Journal of Scientific Exploration, 12, 377–406. Cullen, W. L. (1894). What drowning feels like. In sum, the challenge of NDEs to materialist British Medical Journal, 2, 941–944. reductionism lies in asking how complex con- DeVries, J. W., Bakker, P. F. A., Visser, G. H., sciousness, including mentation, sensory per- Diephuis, J. C., & van Huffelin, A. C. (1998). ception, and memory, can occur under condi- Changes in cerebral oxygen uptake and cerebral tions in which current physiological models of electrical activity during defibrillation threshold mind deem it impossible. This conflict between testing. Anesthesia & Analgesia, 87, 16–20. a materialist model of brain–mind identity and Ghoneim, M. M., & Block, R. I. (1992). Learning the occurrence of NDEs under conditions of and consciousness during general anesthesia. An- esthesiology, 76, 279–305. general anesthesia or cardiac arrest is profound Ghoneim, M. M., & Block, R. I. (1997). Learning and inescapable. Only when we expand models and memory during general anesthesia. Anesthesi- of mind to accommodate extraordinary experi- ology, 87, 378–410. ences such as NDEs will we progress in our Greyson, B. (2000). Dissociation in people who have understanding of consciousness and its relation near-death experiences. Lancet, 355, 460–463. 44 GREYSON

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