Near Death Experiences and Death-Related Visions in Children: Implications for the Clinician Melvin L. Morse, MD Introduction poral lobe or by hallucinogenic drugs. It is possible Near death experiences (NDEs) have been reported that hallucinogenic neurotransmitters play a role in throughout human history in a wide variety of cul- the NDE. Wish fulfillment, death denial, dissociative tures. In the past 20 years an explosion of accounts psychologic trauma, and other psychologic defense of such experiences occurring to those surviving mechanisms have been advanced to explain the ex- coma, cardiac arrest, and noninjurious near fatal periences. Regardless of cause, the experiences are brushes with death has been reported. Such events apparently transformative, resulting in decreased occur to a broad cross section of society, including death anxiety, heightened spiritual perceptions and children, and are variously estimated to occur in be- awareness, increased subjectively perceived psychic tween 10% and 90% of near death situations. A num- abilities, and decreased symptoms of depression and ber of similar elements are common to NDEs, includ- anxiety. Adults who had NDEs as children describe ing out-of-body experiences (OBEs), hearing buzzing themselves as living mentally and physically healthy or rushing sounds, entering into a void or a tunnel, lives, even donating more money to charity than con- seeing or entering into a bright spiritual light, en- trol populations. countering a border or limit, and the subjective per- Many commentators agree that NDEs provide in- ception of making a conscious choice or being forced valuable insight into the processes of dying. Their im- to return to the body. Anecdotal cases exist in which portance lies in documenting that dying patients are the reality of the out-of-body perceptions can be in- often aware of their surroundings and undergoing dependently verified by external conditions, situa- spiritual and emotionally dynamic experiences, even tions, people, and objects. Childhood experiences are if patients appear to be unconscious. These experi- often compelling because children have a different ences theoretically can be invaluable in empowering perception of death than adults. Their experiences dying patients and their families to understand death are simple and reveal a core NDE that is universal to and heal grief. If society can institutionalize the con- the human dying experience. cept that the processes of dying are often joyous and The various elements of the experience can be spiritual, irrational use of medical technology in dy- replicated by electrical stimulation studies of the tern- ing patients may be reduced, leading to substantial savings in health care costs. The current debate over Melvin L. Morse, MD, is Associate Professor of Pediatrics, whether they document an objectively real heaven or University of Washington School of Medicine, Seattle Children's soul obscures the fact that NDEs are as real as any Hospital, Seattle, Washington. other human emotion and ability. Although enough CURRPROBL PEDIATR 1994;24:55-83. Copyright 1994 by Mosby-Year Book, Inc. evidence currently exists to make the survival hy- 0045-9380/94/$4.00 + .10 53/1/53896 pothesis scientifically respectable, near death studies Current Problems in Pediatrics / February 1994 55 are in their infancy and are not currently of sufficient shared denial in children who were dying of cancer caliber to support such a conclusion. These experi- between the children, parents, staff, and physicians. ences are the only objective evidence of what it is like Once a fatal diagnosis was made, conversations with to die. Near death experiences are best understood the child became briefer and often terminated as one element of a spectrum of related clinical expe- abruptly if the child asked too many questions about riences known as death-related visions. death. A child's death is seen as a defeat by every- For the past 100 years, there has been intense in- one involved. terest in the scientific community and by the general Pediatricians have been described as not being public in scientific verification and validation of spiri- trained to handle children's deaths. Residency train- tual experiences.1 At the end of the nineteenth cen- ing often provides a model that death occurs because tury, scientists in England and America investigated either we have failed or our medical systems ha;ce encounters with ghosts, mediums, spirit communica- failed. Colleagues often do not support each other tion with the dead, and death-bed and near death vi- when a patient dies, and it is difficult to create a cli- sions. Although interest in the scientific community mate in which death can be openly discussed and waned from 1910 to 1960, once again interest in grief expressed. 1~ deathbed and NDEs has exploded. This is not an iso- If it is difficult for us to confront death, it is un- lated phenomenon but has appeared in the context derstandable that it is equally difficult to discuss spiri- of tremendous public interest in a wide variety of tual visions associated with near death. Spiritual vi- spiritual and paranormal issues, including spirit sions are often stigmatized as being irrational and ab- channeling, paranormal abilities, spiritual healing, surd within the scientific community. 11 Our world encounters with UFOs, and even kidnappings by view is so closed to anything nonmaterial that schol- UFOs. 2"5 It has been pointed out that the first wave arship and a belief in the spiritual are perhaps mutu- of UFO sightings occurred in the late nineteenth cen- ally exclusive. In describing a case of spontaneous tury at the same time of the first modern accounts of cure of a patient who was moribund with meningo- deathbed visions. 5 Carl Sagan 6 is the most articulate coccal meningitis and Waterhouse-Friderichsen syn- proponent of the idea that perhaps these visions and drome, Gardner 12 reports that the patient ascribed encounters originate in our own cultural psychology her recovery to spiritual intervention. The physicians and are not so much an understanding of another involved described her as "the one that got away," world but a reflection of our own inner psychic long- meaning that she simply defied the odds of dying for ings. unknown reasons. Although her case was well docu- Interest in these experiences has become most mented, soon the accuracy of the diagnosis was pronounced during a time in which our society is los- called in doubt. He concludes that so fixed is our ing its cultural myths and shared spiritual rituals and world view that even in such well-documented cases longings. Joseph Campbell stated that the image of where patients and physicians are available for ques- death is the beginning of mythology. Mythology tioning, spiritual cures are probably impossible to makes one "part of a society of living and dead that prove. This case dramatically illustrates the wide gap came long before you were here and will be here long between the world view of physicians adhering to after you are gone. It nourishes you and protects our current scientific medical model and the more you. "'Mankind's myths give meaning to individual spiritual world view often seen in our patients. lives and help to interpret events such as death. Technology has so dominated modern medicine It is precisely this current lack of meaning for our that a recent editorial in the New England Journal of own death and the death of others that, in my opin- Medicine advocated rehabilitating auscultation of the ion, has led to such intense interest in NDEs, espe- heart with a stethoscope because it might lead to the cially the experiences of children, who are often re- physician actually touching and talking to the pa- garded as too naive to invent stories based on re- tient. "This therapeutic aspect of the diagnostic pro- pressed fear of death. Historian Philip Aries s de- cedure is thwarted if, instead of meeting the doctor, scribes modern society as having abandoned the the patient is given a sheaf of requisitions for expen- traditional relationship between death and society, sive laboratory tests that may or may not be germane which had previously existed for tens of thousands to his or her condition. ''13 of years. Starting with modern funeral practices in Clearly, much of the success of modern medicine which the body was embalmed and preserved, death is because of those very technological advances that has become taboo, medicalized, and a defeat for pa- allow so many to have NDEs. Yet every experienced tient and physician alike. Bluebond-Langer, 9 an an- physician acknowledges that there is a faith or a spirit thropologist who studied children on a cancer ward or a vague undefined something that motivates the for 1 year, described a sense of mutual pretense and human body sometimes to heal and other times to 56 Current Problems in Pediatrics ]. February 1994 die. Extensive reviews of the interactions of the mind the general public, must be resolved before we can and body to heal have been published. Prayer, begin to use these experiences to best advantage. guided imagery, cancer support groups, and simply having patients talk with an anesthesiologist about what the pain of surgery will be like all have docu- Historical Perspective mented effects on biologic healing. One recurrent The process of dying or surviving near death has theme in the mechanisms of the mind's effect on the been associated throughout history with spiritual vi- body is that there is a belief system that has mean- sions that are strikingly similar to modern NDEs. The ing for the patient. 14"17 One of the main effects of Egyptian Book of the Dead26 (1500 Bc) is a manual to pro- NDEs is that they create new meanings of life and vide magical means by which the dead soul can join death for those who have them, as well as those who the crew of a ship, pass through the dark valley of hear about them, new meanings that may well be the underworld, and be united with the Sun God fob therapeutic, is eternity.