Death Studies -, P

JNDAE7 26(2) 87-178 (2007)

ISSN 0891-4494

Journal nf ear - Death Studies -, p -

Editor's Foreword - Bruce Greyson, M.D.

ARTICLES

Psychophysiological and Cultural Correlates Undermining a Survivalist Interpretation of Near-Death Experiences - Keith Augustine, M.A.

Commentary on "Psychophysiological and Cultural Correlates Undermining a Survivalist Interpretation of Near-Death Experiences"- Bruce Greyson, M.D.

Culture and the Near-Death Experience: Comments on Keith Augustine's "Psychophysiological and Cultural Correlates Undermining a Survivalist Interpretation of Near-Death Experiences" * Allan Kellehear, Ph.D.

Comment on Keith Augustine's Article * Mark Fox, Ph.D.

Commentary on Keith Augustine's Paper - Harvey J. Irwin, Ph.D.

"Psychophysiological and Cultural Correlates Undermining a Survivalist Interpretation of Near-Death Experiences" Defended - Keith Augustine, M.A. OBITUARY: George G. Ritchie, M.D.

Volume 26, Number 2, Winter 2007

www.iands.org Journal of Near-Death Studies

EDITOR Bruce Greyson, M.D., University of Virginia, Charlottesville, Virginia

ASSOCIATE EDITOR Lori L. Derr, M.Ed., University of Virginia, Charlottesville, Virginia

CONSULTING EDITORS James E. Alcock, Ph.D., C.Psych., York University, Toronto, Ontario, Canada Carlos Alvarado, Ph.D., University of Virginia, Charlottesville, Virginia J. Kenneth Arnette, Ph.D., Southern Oregon University, Ashland, Oregon Boyce Batey, Academy of Religion and Psychical Research, Bloomfield, Connecticut Carl B. Becker, Ph.D., Kyoto University, Kyoto, Japan Paul Bernstein, Ph.D., Institutefor Psychologicaland Spiritual Development, Cambridge, Massachusetts Diane K. Corcoran, R.N., Ph.D., Senior University, Richmond, British Columbia, Canada Elizabeth W. Fenske, Ph.D., SpiritualFrontiers Fellowship International, Philadelphia,Pennsylvania John C. Gibbs, Ph.D., Ohio State University, Columbus, Ohio Stanislav Grof, M.D., Ph.D., California Institute of Integral Studies, San Francisco, California Michael Grosso, Ph.D., University of Virginia, Charlottesville, Virginia Bruce J. Horacek, Ph.D., University of Nebraska, Omaha, Nebraska Jeffrey Long, M.D., Near-Death Experience Research Foundation, Gallup, New Mexico Raymond A. Moody, Jr., Ph.D., M.D., Anniston, Alabama Melvin L. Morse, M.D., University of Washington, Seattle, Washington Canon Michael Perry, Churches' Fellowshipfor Psychical and SpiritualStudies, Durham, England Charles T. Tart, Ph.D., Institute of TranspersonalPsychology, Palo Alto, California Stuart W. Twemlow, M.D., Great Barrington, Massachusetts Jenny Wade, Ph.D., Institute of TranspersonalPsychology, Palo Alto, California Barbara Whitfield, R.T., C.M.T., Whitfield Associates, Atlanta, Georgia Charles L. Whitfield, M.D., F.A.S.A.M., Whitfield Associates, Atlanta, Georgia

INTERNATIONAL ASSOCIATION FOR NEAR-DEATH STUDIES (IANDS) P.O. Box 502, East Windsor Hill, CT 06028-0502, USA; internet website: www.iands.org; telephone (860) 644-5216; fax (860) 644-5759; e-mail [email protected].

OFFICERS, 2006-2007: President: Yolaine Stout - Vice President: Debbie James, M.S.N., R.N. - Secretary: Diane K. Corcoran, R.N., Ph.D. - Treasurer: Scott Taylor, Ed.D.

BOARD OF DIRECTORS: Nancy Bush, M.A. - Nancy Clark, Ph.D. - Allen Katzoff, M.B.A. - Mary Montgomery Clifford, M.A. - Dan Punzak, P.E. - Chuck Swedrock

ADMINISTRATIVE DIRECTOR: Anneliese Fox Journal of Ner-Death Studies Volume 26, Number 2, Winter 2007

Editor's Foreword 87 Bruce Greyson, M.D.

ARTICLES Psychophysiological and Cultural Correlates Undermin ing a Survivalist Interpretation of Near-Death Experiences 89 Keith Augustine, M.A.

Commentary on "Psychophysiological and Cultural Correlates Undermining a Survivalist Interpretation of Near-Death Experiences" 127 Bruce Greyson, M.D.

Comment on Keith Augustine's Article 155 Mark Fox, Ph.D.

Commentary on Keith Augustine's Paper 159 Harvey J. Irwin, Ph.D.

"Psychophysiological and Cultural Correlates Under mining a Survivalist Interpretation of Near-Death Experiences" Defended 163 Keith Augustine, M.A.

OBITUARY: George G. Ritchie, M.D. 177 JOURNAL OF NEAR-DEATH STUDIES (formerly ANABIOSIS) is sponsored by the International Association for Near-Death Studies (LANDS). The Journal publishes articles on near-death experiences and on the empirical effects and theoretical implications of such events, and on such related phenomena as out-of-body experiences, deathbed visions, the experiences of dying persons, comparable experiences occurring under other circumstances, and the implica tions of such phenomena for our understanding of human consciousness and its relation to the life and death processes. The Journal is committed to an unbiased exploration of these issues, and specifically welcomes a variety of theoretical perspectives and interpretations that are grounded in empirical observation or research. The INTERNATIONAL ASSOCIATION FOR NEAR-DEATH STUDIES (LANDS) is a worldwide organization of scientists, scholars, healthcare providers, near-death experiencers, and the general public, dedicated to the exploration of near-death experiences (NDEs) and their implications. Incorporated as a nonprofit educational and research organization in 1981, LANDS' objectives are to encourage and support research into NDEs and related phenomena; to disseminate knowledge concerning NDEs and their implications; to further the utilization of near-death research by healthcare and counseling professionals; to form local chapters of near death experiencers and interested others; to sponsor symposia and conferences on NDEs and related phenomena; and to maintain a library and archives of near-death-related material. Friends of LANDS chapters are affiliated support groups in many cities for NDErs and their families and for healthcare and counseling professionals to network locally. Information about membership in LANDS can be obtained by contacting LANDS, P.O. Box 502, East Windsor Hill, CT 06028-0502, USA; telephone: (860) 882-1211; fax: (860) 882-1212; e-mail: [email protected]; Internet website: www.iands.org. MANUSCRIPTS may be submitted by e-mail or on computer disk or CD-ROM or in hard copy to Bruce Greyson, M.D., Division of Perceptual Studies, Department of Psychiatric Medicine, University of Virginia Health System, P.O. Box 800152, Charlottesville, VA 22908-0152; telephone: (434) 924-2281; fax: (434) 924-1712; e-mail: [email protected]. See inside back cover for style requirements. SUBSCRIPTION inquiries and subscription orders, and ADVERTISING inquiries should be addressed to LANDS, P.O. Box 502, East Windsor Hill, CT 06028-0502, USA; telephone: (860) 644 5216; fax: (860) 644-5759; e-mail: [email protected]. INDEXED in Family & Society Studies Worldwide, Health Instrument File, International Bibliography of Periodical Literature, Parapsychology Abstracts International, Psychological Abstracts, PsycINFO Database, Sage Family Abstracts, Social Work Research and Abstracts, and Sociological Abstracts. JOURNAL OF NEAR-DEATH STUDIES (ISSN: 0891-4494) is published quarterly in the Fall, Winter, Spring, and Summer by LANDS, Allen Press, 810 East 10 th Street, Lawrence, KS 55044. Subscription rate is U.S. $62.00 per year for individuals who are not members of LANDS and $398.00 for institutions and libraries. Periodical postage paid at Lawrence, KS, and additional mailing offices. POSTMASTER: Send address changes to Journal of Near-Death Studies, LANDS, P.O. Box 502, East Windsor Hill, CT 06028-0502. COPYRIGHT 2007 by the International Association for Near-Death Studies. No part of this work may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the Publisher, with the exception of any material supplied specifically for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work. Editor's Foreword

This issue of the Journal contains the third and final dialogue between philosopher Keith Augustine and various commentators on the empirical evidence bearing on the interpretation of near-death experiences (NDEs). The Summer issue of the Journal featured Augustine's review of the evidence for and against paranormal perception during NDEs, with commentaries from myself, social worker Kimberly Clark Sharp, psychologist Charles Tart, and cardiologist Michael Sabom; and Augustine's response. The Fall issue included Augustine's review of features that suggest a hallucinatory origin for NDEs; commentaries by counseling educator Janice Holden, neuropsychiatrist Peter Fenwick, and hospital chaplain William Serdahely; Augustine's response to the commentaries; and additional letters to the editor from myself, psychologist Kenneth Ring, psychiatrist Raymond Moody, retired law professor Stephen Cooper, and near-death experiencer and therapist Barbara Whitfield. The current issue of the Journal features Augustine's review of psychophysiological correlates of NDEs and the roles of temporal lobe phenomenology and cultural influences in the interpretation of out-of body and near-death experiences. We follow his essay with commentar ies from myself, Australian medical sociologist Allan Kellehear, British philosopher and religious scholar Mark Fox, and Australian psychologist Harvey Irwin; and Augustine's response to the commentaries. We hope that this three-part dialogue between Augustine and the commentators will promote new ways of conceptualizing and under standing NDEs and inspire new explorations to resolve the lingering issues. Our goal was to stimulate readers to develop more sophisticated formulations of their explanatory hypotheses, and to design better research to put those hypotheses to the empirical test. We strongly encourage readers to consider these arguments carefully and to share their responses for publication as letters in future issues of the Journal. This issue concludes with the obituary of George Ritchie, the psychiatrist whose public presentations of his NDE account back in the 1960s started Raymond Moody on the research that eventually led to his coining the term "near-death experience."

Bruce Greyson, M.D.

Journal of Near-Death Studies, 26(2), Winter 2007 C 2007 LANDS 87

Psychophysiological and Cultural Correlates Undermining a Survivalist Interpretation of Near-Death Experiences

Keith Augustine, M.A. Internet Infidels, Colorado Springs, CO

ABSTRACT: This paper, Part III of a critique of survivalist interpretations of near-death experiences (NDEs), considers psychophysiological and cultural correlates of NDEs suggesting that such experiences are solely products of individuals' minds rather than windows into a transcendental realm. While current psychophysiological models do not fully explain out-of-body experi ences (OBEs) and NDEs, several psychophysiological correlates offer promis ing clues about the mechanisms implicated in their production. These correlates do not definitively identify their precise causes, but strongly imply that such experiences represent internally generated fantasies rather than genuine perceptions of a transcendental environment. Additionally, stark differences in the phenomenology of NDEs from different cultures have been uncovered. Though nonWestern samples are too limited to draw anything more than tentative conclusions, the available data suggest that prototypical Western NDE motifs derive from a cultural source, consistent with the hypothesis that NDE content reflects social conditioning and personal expectation rather than the perception of an external reality.

KEY WORDS: near-death experiences; dissociation; temporal lobe signs; cultural variation; expectation.

Keith Augustine, M.A., is Executive Director and Scholarly Paper Editor of Internet Infidels, a nonprofit educational organization dedicated to defending and promoting metaphysical naturalism on the Internet. He would like to thank Oliver Carter, lecturer of English as a Foreign Language at Matsumoto University, for his research assistance and translation of Rinshi Taiken [Near Death Experience] by Takashi Tachibana. Reprint requests should be addressed to Mr. Augustine at Internet Infidels, PO Box 142, Colorado Springs, CO 80901-0142; e-mail: [email protected].

Journal of Near-Death Studies, 26(2), Winter 2007 0 2007 LANDS 89 90 JOURNAL OF NEAR-DEATH STUDIES

Psychophysiological Correlates

Few dispute that out-of-body experiences (OBEs) and near-death experiences (NDEs) are altered states of consciousness (ASCs), temporary departures from the normal (alert) waking state. During ASCs, a variety of mental faculties appear to be altered, including arousal, attention, perceptual functions, imagery skills, memory, cognition, and sense of identity. Sometimes ASCs follow a period of unconsciousness, but they are often triggered during normal con sciousness. ASCs are typically understood to involve turning one's attention inward, into the contents of one's own mind, rather than revealing anything about the external world. For example, dreams are ASCs that are typically understood to call up internally generated imagery; that is, the world encountered during dreaming is not typically taken to involve any real terrain. Similarly, to say that alien abduction experiences involve ASCs (for example, sleep paralysis) is to imply that such experiences do not really involve extraterrestrials physically kidnapping unlucky human subjects. Thus, insofar as OBEs and NDEs are such altered states, there is a reasonable presumption that they do not reflect any objective existence outside of the normal physical body. But specific psychological traits of OBErs and NDErs also strongly imply that some psychophysiological model of OBEs and NDEs must be correct. For instance, statistically significant correlations between dissoci ation and absorption and both OBEs and NDEs have been discovered. Dissociation is the shutting out of sensory stimuli, while absorption is focusing on the imagination - but they tend to go hand-in-hand (Greyson, 2000). The classic example of dissociation is "highway hypnosis," daydreaming or consciously focusing on anything other than driving and yet still arriving at your destination, evidently subconsciously engaging in the required driving skills. Nonpathologi cal dissociation exists on a continuum best measured by absorption, the capacity to become highly engrossed in the imagination, including through books or movies (Blackmore, 1993a; Irwin, 2000). Across studies, dissociation has been consistently positively corre lated with OBEs, and a moderate correlation between absorption and OBEs has been uncovered (Alvarado, 2000). OBErs most frequently dissociate from bodily sensations, and those who experience multiple OBEs are particularly prone to such somatoform dissociation (Irwin, KEITH AUGUSTINE 91

2000). Harvey Irwin (1993) found that NDErs were more likely to have suffered childhood trauma than nonNDErs, and consequently theo rized that NDErs are predisposed to dissociate during unexpected highly stressful situations in order to "escape" from the pain or anxiety of their environments. Similarly, Kenneth Ring and Christopher Rosing (1990) found that NDErs have significantly greater dissocia tive tendencies than nonNDErs, and suggested that childhood trauma makes victims more prone to dissociation and thus NDEs. In multiple studies, OBErs have been found to have a higher capacity for absorption (Irwin, 1985a; Glicksohn, 1990; Myers, Austrin, Grisso, and Nickeson, 1983) and a greater need for absorbing experiences (Irwin, 1985a; Irwin, 1985b) than nonOBErs. Moreover, Irwin discovered that highly absorbed people can artificially induce OBEs more easily than people who are not particularly absorbed (Irwin, 2000). Similarly, NDErs have not only been found to have a higher capacity for absorption than nonNDErs (Twemlow and Gabbard, 1984), but to have higher levels of absorption the "deeper" their NDEs (Council, Greyson, and Huff, 1986). Interestingly, Stuart Twemlow and Glen Gabbard (1984) also found that NDErs were more absorbed than those who had OBEs in non-life-threatening conditions. This is not surprising given that NDEs are typically more elaborate than OBEs in other contexts. Other studies have found that fantasy-proneness is higher among OBErs than nonOBErs (Alvarado and Zingrone, 1994; Hunt, Gervais, Shearing-Johns, and Travis, 1992; Myers, Austrin, Grisso, and Nick eson, 1983; Wilson and Barber, 1983), and that NDErs were not only more fantasy-prone than nonNDErs (Twemlow and Gabbard, 1984), but more highly fantasy-prone the deeper their NDEs (Council, Greyson, and Huff, 1986). Fantasy-proneness is "characterized by a strong investment in fantasy life, vivid hallucinatory ability, intense sensory experience, and excellent eidetic [vivid visual] memory" (Greyson, 2000, p. 324). Finally, compared to nonOBErs, OBErs tend to have more hallucinatory experiences (McCreery and Claridge, 1995), perceptual distortions (McCreery and Claridge, 1996), distortions of body image (Murray and Fox, 2005), illusory experiences of changes in body size, and floating sensations (Blackmore, 1984). Overall, the best predictors of OBEs are dissociation, hypnotic susceptibility, absorption, and fantasy proneness (Alvarado, 2000). Although Ring and Rosing (1990) viewed dissociative tendencies as a psychological defense mechanism to "tune out" physical threats to 92 JOURNAL OF NEAR-DEATH STUDIES

one's well-being while simultaneously opening a door to "alternate realities," their hypothetical status as a defense mechanism makes much more sense if OBEs and NDEs do not literally involve any form of disembodiment. For instance, both OBErs and NDErs tend to have high rates of absorption, a trait that Irwin noted "might usefully be thought of as a capacity for imaginative involvement" (Irwin, 2000, p. 263). But whether it is indicative of a predisposition to have OBEs and NDEs or simply a consequence of having them, such a correlation makes little sense if something actually leaves the body during such experiences. For why would psychological mechanisms - as opposed to physiological crises alone - trigger the release of the soul? Conversely, why would literal separation from the body make individuals more prone to fantasize? Similarly, why should fear alone trigger NDEs, or the sudden onset of fear during OBEs terminate such experiences (as in Irwin, 1985a, p. 81), unless their origins are entirely psychophysiological? As Irwin noted: The sight of the physical body from the outside may terminate the experience, ... because of the emotional response (fear, contempt, revulsion) this sight evokes, but also perhaps because attention is diverted back to the body. Another factor commonly bringing an end to the OBE is the physical body's being touched by someone. (Irwin, 1999, p. 222)

Irwin added that the fact that the vast majority of OBEs were preceded by physical inactivity implied "that a lack of somatic (kinesthetic and proprioceptive) stimulation is an important condition for the OBE" (1999, p. 227). A psychophysiological process makes sense of why some OBEs originate and end due to emotional reactions or the attention given to bodily processes. But if something literally detaches from the body during OBEs, on the face of it psychological factors should neither trigger its release nor hasten its return. More troubling still for the notion that something leaves the body are various correlations between imagery skills and OBEs. Compared to nonOBErs, for instance, Susan Blackmore found that OBErs "are better at detecting the viewpoint from which a three-dimensional object is seen and are better able to switch viewpoints in their imagination" (1993a, p. 180), while Anne Cook and Irwin (1983) found that OBErs more accurately anticipated the appearance of physical objects when viewed from different perspectives. In addition, Black more's OBErs not only reported "clearer and more detailed" imagined viewpoints than her nonOBErs, but were most significantly better than her nonOBErs at "the ability to imagine the room from a position KEITH AUGUSTINE 93 on the ceiling above their own head" (1987, p. 61). Moreover, those who habitually dream in a bird's-eye view or see themselves during their dreams are more likely to have OBEs (Blackmore, 1987; Irwin, 1986). Furthermore, those who can induce OBEs at will have better dream control skills than spontaneous OBErs, a fact anticipated by psychophysiological models given that OBE adepts would be expected to have "mastered" the required psychological abilities compared to "novice" spontaneous OBErs (Alvarado, 2000). Similarly, Irwin (1985a) found that OBErs who reported more control over their OBEs tended to have better somatic imagery skills than more "passive" OBErs. Blackmore nicely summarized most of the findings: OBErs are better than others at switching from one viewpoint to another (especially to the viewpoint above the head), [are] more proficient at producing clear and detailed images from different viewpoints, and tend to use the observer viewpoint in dream recall.... [T]he easiest switch is to a viewpoint above the head, and ... an observer viewpoint is more often used in recalling unpleasant dreams. (Blackmore, 1987, p. 64)

Blackmore interpreted the greater prevalence of a bird's-eye view in OBErs' unpleasant dreams as "support for the idea that perspective is used as an escape from unpleasant situations" (1987, p. 64) among those better at switching perspective, particularly during "cases of severe pain, shock or fear [where] there is a strong incentive to dissociate oneself from the source of the pain" (p. 57). Additional support comes from Twemlow and Gabbard's (1984) finding that among NDErs, those in severe pain immediately prior to their NDEs felt more detached from their bodies, were more likely to "see" their bodies from afar, and were more likely to "occupy" the environment surrounding their bodies. That various medical factors affect the content of NDEs is equally difficult to reconcile with the notion that NDEs are transcendental journeys. Studies of medical influences on NDE content have found that cardiac arrest NDEs are more likely to feature a sense of power and an awareness of deceased persons, while NDEs resulting from accidents are more likely to feature feelings of joy and little desire to return to the body (Twemlow and Gabbard, 1984; Twemlow, Gabbard, and Coyne, 1982). A greater sense of dying among cardiac arrest NDErs might trigger visions of the deceased, while unexpected accidents trigger maximally "escapist" detached indifference. Plausible psychophysiological reasons for other correlations are not as easy to conjecture, but no less problematic for survivalist 94 JOURNAL OF NEAR-DEATH STUDIES interpretations. For example, NDEs during cardiac arrest or while anesthetized are more likely to feature tunnel experiences and experiences of light (Drab, 1981; Owens, Cook, and Stevenson, 1990; Twemlow and Gabbard, 1984; Twemlow, Gabbard, and Coyne, 1982), while NDEs resulting from the perception of imminent threats (for example, in mountain-climbing accidents) in the absence of actual medical crises more often feature feelings of euphoria, thought speeding up, time slowing down, and life review (Noyes and Kletti, 1976; Stevenson and Cook, 1995). In one study, NDErs under the influence of drugs were also more likely than other NDErs to report an awareness of and communication with other beings, suggesting that drugs directly altered the content of their experiences (Twemlow and Gabbard, 1984). But if NDEs occur when consciousness is released from the confines of the brain, then altering brain chemistry ought not have an effect on NDE content. Of course, none of these findings are inconsistent with the view that something leaves the body during OBEs and NDEs. But they are clearly not predicted by that view, whereas such correlations are anticipated by psychophysiological models. Those who insist upon a survivalist interpretation of such experiences can surely fit these findings within their particular theoretical frameworks. But on the face of it, existing studies of the traits of OBErs and NDErs make psychophysiological models of such experiences much more likely to be true than their transcendental alternatives. Whichever model turns out to be correct, a preponderance of the evidence suggests that it will be a psychophysiological one. For if OBEs and NDEs truly represent the detachment of a person's soul from his body, why would people with certain psychological characteristics have a greater ability to leave the body? If some mechanism can be activated to achieve such a detachment, why would that mechanism have any connection to purely psychological traits? The "projection theory" does not make much sense of the extensive psychological data collected on OBErs and NDErs. But those data clearly make sense on a psychophysiological understanding of such experiences.

Is the Temporal Lobe Implicated in NDEs?

There have long been indications that the temporal lobe is implicated in NDEs. That OBEs could be induced by electrical stimulation of the temporal lobe has been known at least since 1941 KEITH AUGUSTINE 95

(Tong, 2003). However, the phenomenology of electrically stimulated "OBEs of neurological origin" is clearly distinct from that of spontaneous OBEs. Unlike most spontaneous OBEs, electrical stimulation of the brain tends to produce OBEs in which patients perceive only parts of their bodies from above and perceive clearly illusory distortions and movements of those parts, where patients do not see the environment surrounding their bodies, and in which the experience lacks the realism, continuity, and stability characteristic of spontaneous OBEs (Holden, Long, and MacLurg, 2006; Neppe, 2002). Moreover, spontaneous OBEs seem just as likely to occur in unconscious subjects as conscious ones, but if electrically stimulated OBEs depend upon a conflict between information from the vestibular and visual senses, electrically stimulated OBErs would evidently need to be conscious and perceiving their surroundings with open eyes. And Frank Tong observed that for a patient of Olaf Blanke "stimulation applied while the patient's eyes were closed elicited reports of shifts in perceived body position but failed to elicit out-of-body experiences" (2003, p. 105). Vernon Neppe (2002) noted that he had previously established the existence of four distinct kinds of d6ji vu - the common spontaneous form of associative d6ja vu, subjective paranormal d6ja vu experiences, temporal lobe epilepsy d6ji vu, and d6ja vu accompanying schizo phrenia - and hypothesized that there may be phenomenologically distinct subtypes of OBEs as well. Perhaps spontaneous OBEs, OBEs induced by relaxation techniques, near-death OBEs, and electrically stimulated OBEs are variants generated by different physiological mechanisms. Alternatively, distinct subtypes might reflect the activation of different parts of a single complex neural mechanism for generating OBEs. On the former hypothesis, multisensory disintegration would be irrelevant to spontaneous, induced, and near-death OBEs, but on the latter, it may well play a role in their production. While electrically stimulated OBEs may be phenomenologically distinct from spontaneous ones, realistic, continuous, stable, ecstatic, and otherwise apparently indistinguishable OBEs have been reported accompanying temporal lobe seizures (Devinsky, Feldmann, Bur rowes, and Bromfield, 1989; Vuilleumier, Despland, Assal, and Regli, 1997). Like spontaneous cases, OBEs evoked by temporal lobe seizures often incorporate accurate reconstructions of events surrounding OBErs' bodies (for example, case 7, and patients 33, 39, and 40, in 96 JOURNAL OF NEAR-DEATH STUDIES

Devinsky, Feldmann, Burrowes, and Bromfield, 1989, p. 1082, 1086, respectively; and in a single epileptic who had recurring OBEs for over 10 years in Vuilleumier, Despland, Assal, and Regli, 1997, p. 116), as well as occasional small but significant out-of-body discrepancies (for example, case 4 in Devinsky, Feldmann, Burrowes, and Bromfield, 1989, p. 1081, where an epileptic OBEr would see his body in the correct clothing but with combed hair even when he knew it to be uncombed beforehand). Additionally, Christopher French noted that peace or euphoria and mystical feelings "are often reported by temporal lobe epileptics just prior to a seizure," quoting a patient stating that nonepileptics "can't imagine the happiness that we epileptics feel during the second before our attack" (French, 2005, p. 358). Some epileptics "even see apparitions of dead friends and relatives" (Blackmore, 1993a, p. 206). So several NDE elements - including feelings of peace, OBEs, a sense of timelessness, life reviews, and encounters with others suggest a role for the temporal lobe in the phenomenology of the experience (French, 2005). Bruce Greyson has argued that "key features of NDEs ... have not in fact been reported either in clinical seizures or in electrical stimulation of [temporal lobe] brain structures" (Greyson, 2000, p. 335). But the observations above illustrate that many key features of NDEs are found in such circumstances. Moreover, no one is claiming that NDEs "just are" temporal lobe seizures, but rather that similar temporal lobe activity, in conjunction with other activity in a dying brain, is implicated in NDEs (for example, Blackmore, 1993a, pp. 215-216). Mark Fox noted that complete NDE accounts from the Religious Experience Research Centre (RERC) archives revealed signs of hypergraphia, a compulsion to write extensively about spiritual realities. One man reported an OBE, a tunnel experience, encounters with deceased relatives, and a life review, followed by 11 pages of speculative hypergraphic testimony about the meaning of life, the purpose of existence, the soul, and the beginning of the universe (Fox, 2003). Fox concluded that: hypergraphia has long been recognized as a symptom of temporal lobe epilepsy. Whilst the presence of hypergraphia within NDErs' reports has been hidden from view often because of the editing of accounts carried out by near-death researchers themselves, an examination of original accounts ... reveals that hypergraphia is a significant feature of a significant number of accounts. (Fox, 2003, p. 161) KEITH AUGUSTINE 97

Plausibly, OBErs and NDErs have greater dissociative tendencies than control groups because they are predisposed to dissociate. Dissociative tendencies, in turn, are correlated with nonpathological temporal lobe instability as measured by various temporal lobe signs (Richards and Persinger, 1991). This suggests that those with greater temporal lobe instability may be more prone to have NDEs than others, a hypothesis that is testable in any number of ways, one of which was suggested by Blackmore, who predicted "that the highest level of temporal lobe signs would be found in those who have NDEs when not medically near death, next highest in those who have NDEs near death and lowest in those who come close to death but have no NDE" (1993a, p. 218). Though circumstantial, evidence of temporal lobe instability among NDErs comes from findings that NDErs report undergoing more mystical experiences than average prior to their NDEs (Greyson and Stevenson, 1980), and having more OBEs and "psychic" experiences than nonNDErs (Kohr, 1983; Makarec and Persinger, 1985). Greyson and Ian Stevenson (1980) also found that perceptions of time distortion were significantly correlated with ecstatic feelings during NDEs. These elements are associated with temporal lobe instability in nonNDE contexts, and there is no other apparent reason for them to be correlated in NDEs. Recently, Willoughby Britton and Richard Bootzin carried out a more systematic investigation. Their NDE group included subjects who had experienced "life-threatening physical distress as the result of an accident or other injury and [received] a minimum score of 7 on the Near-Death Experience Scale" (Britton and Bootzin, 2004, p. 254). Their nonNDE control group consisted of age- and gender-matched individuals who had not come close to death and who had scored below 7 on Greyson's NDE Scale. Despite having used a less-than-ideal control group, their findings confirmed a role for the temporal lobe in the production of NDEs. First, NDErs were about four times as likely to have temporal lobe epileptiform electroencephalographic (EEG) activity during sleep than nonNDErs. Second, NDErs "reported significantly more temporal lobe symp toms" than nonNDErs, such as "frequent anomalous experiences, sleepwalking, olfactory hypersensitivity, and hypergraphia," and scored significantly higher than nonNDErs on a measure of epileptic signs typical of temporal lobe activity, including "feelings of intense 98 JOURNAL OF NEAR-DEATH STUDIES

personal significance and unusual olfactory, auditory, or visual perceptual experiences" (Britton and Bootzin, 2004, p. 255). Third, not only did NDErs take longer to enter rapid eye movement (REM) sleep than nonNDErs, but there was a positive correlation between the depth of a subject's NDE (as measured by the NDE scale) and the delay in REM sleep onset, so that the deeper the NDE, the greater the delay in the onset of REM sleep. Fourth, NDErs scored significantly higher on measures of coping skills than nonNDErs. Fifth, NDErs scored significantly higher than nonNDErs on the Amnestic subscale of the Dissociative Experiences Scale, which measures things like not remembering how you arrived at your destination. Thus NDErs show a greater (nonpathological) tendency to dissociate than nonNDErs. Britton and Bootzin's findings would have been more decisive if they had used the ideal control group, nonNDErs who came close to death. It is possible that the general trauma of coming close to death - not whether subjects had an NDE - is what accounted for the differences between the two groups. However, they provided substantial evidence that it was the occurrence of the NDE itself that was correlated with these differences. This implied that certain people were physiologi cally prone to have NDEs. First, there was a significant correlation between NDE Scale scores and both the temporal lobe epileptiform EEG activity and the delayed onset of REM sleep; but these characteristics were not correlated with any of the collected scores for measures of trauma. If coming close to death had caused the epileptiform EEGs in the NDE group, then those EEGs should have been correlated "with trauma-related factors to a similar degree," but they were not (Britton and Bootzin, 2004, p. 256). Instead, left temporal lobe activity was more highly correlated with NDE Scale scores than with scores on measurements of posttraumatic stress disorder or dissociative disorders, or with a history of head trauma. Second, a regression analysis found that head trauma was unrelated to epileptiform EEG activity. Additionally, the general incidence of epileptiform EEG activity in those who become unconscious without head trauma is 5.7 percent, as compared to the significantly higher rate of 22 percent in Britton and Bootzin's NDE group. Third, that the epileptiform EEG activity in the NDE group was almost entirely limited to the left temporal lobe was atypical of any other group, KEITH AUGUSTINE 99 implying that NDErs were neurophysiologically unique. Finally, unlike typical trauma survivors, the physiological differences between the NDE group and the nonNDE control group "were not associated with negative stress reactions" but "instead with positive coping styles" (Britton and Bootzin, 2004, p. 258). A preponderance of the evidence, then, implicated the temporal lobe in the production of NDEs.

Cultural Differences

In the industrialized West, where Christian imagery dominates, people who encounter religious figures in their NDEs typically encounter Christianreligious figures who appear as they are standardly depicted. For example, one woman who reported seeing a light form above her bedroom door just before "floating" over her body said: "Jesus came walking up to me with arms outstretched. He was dressed in a long white robe, his hair to his shoulders, ginger-auburn, and he had a short beard" (Fenwick and Fenwick, 1997, p. 62). By contrast, the dominant religious imagery of India is Hindu, and predictably NDEs from India typically involve encounters with recognizably Hindu religious figures, such as Yamraj (the Hindu god of death) or his black messengers. One Indian NDEr, for example, reported that "Yamraj was there sitting on a high chair with a white beard and wearing yellow clothes" (Pasricha and Stevenson, 1986, p. 167). Moreover, while Western NDErs tend to encounter dead friends and relatives more often than religious figures, Hindu religious figures nearly always appear in NDEs from India. Finally, while Western NDErs are often "sent back" in order to take care of immediate family or for some assumed but unknown purpose, NDErs from India report meeting clerks in an impersonal afterlife bureaucracy who send them back because they have been sent the wrong person due to paperwork mistakes (Pasricha and Stevenson, 1986). Cultural conditioning is evident even in children's NDEs. In the West, children's encounters with other beings during NDEs tend to be more imaginative than those of adults. Morse paraphrased one girl's encounter with Jesus: He was in a very bright light that she could not describe other than by saying that it made her feel good. He was sitting there with a round belly and a red hat, looking like Santa Claus. (Morse and Perry, 1992, p. 125) 100 JOURNAL OF NEAR-DEATH STUDIES

In other cases children have reported encountering wizards, doctors, guardian angels, living teachers, living playmates, pets, and other animals during NDEs (Morse, 1994). Todd Murphy translated into English 11 published accounts of NDEs in Thailand, three of which reported two NDEs from the same subject, yielding a total of 14 cases (www.altered-states.net). Because one of the published accounts was so similar to another, Murphy analyzed 10 of them in his paper in this Journal (Murphy, 2001; T. Murphy, personal communication, January 24, 2006). Like NDEs from India, Thai NDEs contrasted starkly with those reported in the West. For instance, like Indian NDErs, Thai NDErs were far more likely to encounter religious figures than deceased friends and relatives: in 9 out of 10 accounts Thai NDErs met Yamatoots, messengers of the god of death Yama. And in half of the accounts Thai NDErs reported "being told that they were the wrong person, and being ordered back to life" (Murphy, 2001, p. 175). While OBEs are rather common early on in Western NDEs, being visited by a Yamatoot is "the most common initial phase" of Thai NDEs (Murphy, 2001, p. 170). Where OBEs did occur, "OBEs in Thai NDEs tend immediately to precede meetings with Yamatoots" (2001, p. 171). Tunnels were "largely absent in Thai NDEs," and feelings of peace or euphoria and experiences of light have not been reported (2001, p. 172). Thai NDErs were sometimes judged, but their deeds were recounted by reviewing written records of their lives or the testimony of others. The following case is typical: I ... found myself in the judgment hall of Yama's palace. I knew that they were ready to judge me for my sins. A giant rooster appeared who told Yama that I had killed him. He emphasized that I had tried to kill him again and again. The rooster also said that he remembered me exactly. An entire flock of roosters also [appeared] and testified that I had killed them, as well. I remembered my actions, and I had to admit that the roosters had told the truth. Yama said that I had committed many sins, and sentenced me to many rebirths both as a chicken, and many other types of birds as well.... But, quite suddenly, an enormous turtle appeared. It screamed at Yama, saying "Don't take him; he is a good human, and should be allowed to live." Yama answered the turtle "What did he do to help you?" (Murphy, 2001, p. 167; ellipses in the original)

Unlike Western cases, life events were not viewed or relived as flashbacks. Landscapes were common in these Thai NDEs, but typically hellish. And while "Western NDErs may reach a 'point of KEITH AUGUSTINE 101 no return' and choose to return to life, Thai NDErs are typically told they were taken because of a clerical mistake and told to return to the body" (Murphy, 2001, p. 177). Given such stark phenomenological differences, Murphy concluded: "The fact that Thai (and Indian) NDEs do not follow the typical Western progression ... seems to rule out the possibility that there is an ideal or normal NDE scenario, except within a particular cultural context" (2001, p. 169). He nevertheless conceded vague crosscultural commonalities "in which individuals commonly use culturally-derived patterns to confabulate individualized death-process phenomena that serve common psychological functions" (2001, p. 177). Such common alities may reflect common beliefs across societies, such as the idea of postmortem judgment for Earthly behavior, tied to an expectation or sense of being dead. Journalists Hiroshi Tanami and Takashi Tachibana originally presented an investigation of 46 Japanese NDEs on NHK television (Morse, 1994, p. 70; Tachibana, 2000, Vol. 2, p. 90). Tachibana subsequently expanded the investigation to that of 243 NDEs (some individuals reported multiple NDEs) discussed in the Japanese language book Rinshi taiken [Near death experience], which includes a section on the cultural differences between Japanese and other NDEs (Tachibana, 2000, Vol. 2, pp. 80-91). The study confirmed that Japanese NDErs often reported "seeing long, dark rivers and beautiful flowers, two common symbols that frequently appear as images in Japanese art" (Mauro, 1992, p. 57). In a tabulated chart, 73 reports noted an affective component that was predominantly positive: 32 included being at peace and another 32 included feeling happy, while only 9 were fearful. Leaving the body was reported in 59 NDEs. Of 45 experiences of light, 16 were preceded by travel through a tunnel. Altogether 30 tunnel experiences were reported, implying that some experiences of light preceded (as in the Tatsuo Katayama case) or did not accompany tunnel experiences. Twenty-four NDEs included encountering darkness. In 153 accounts there was an encounter with others, most commonly with friends or relatives, but also occasionally with otherworldy beings or religious figures. Six NDEs included reviews of the events of the NDErs' lives. Landscape visions were most consistent between accounts, with reports of a field of flowers in 102 NDEs. Of the 82 NDEs featuring a border, 70 featured rivers, 6 featured a sea or lake, and 6 featured a gate or wall. In 72 accounts a reason for the NDErs' return was given: 102 JOURNAL OF NEAR-DEATH STUDIES

in 37 cases NDErs were "brought" back to life, in 23 they were told to return, and in 12 they chose to return (Tachibana, 2000, Vol. 2, p. 89). Tachibana had noted that, unlike Western NDEs, the "light is not a personal (or personified) existence. ... [It] is an indescribably beautiful and natural light, yet is just light" (Tachibana, 2000, Vol. 2, p. 81, translated by 0. Carter), and that there was not a single instance of a Japanese NDEr having any sort of communication with the light. Nevertheless, occasional similarities between these Japanese NDEs and typical Western cases are fascinating exceptions to the general rule of cultural diversity. By the time of their collection in the 1990s, it is hard to say whether the popularization of common Western NDE features had influenced Japanese reports in this "East meets West" society. It is nevertheless notable that one Japanese NDEr recounted an experience dating back to World War II in which he began reviewing his childhood memories before he lost consciousness and had an NDE (Tachibana, 2000, Vol. 1, pp. 452-453). In contrast to the Tachibana study, Yoshia Hata and collaborators at Kyorin University interviewed 17 patients who went into comas with "minimal signs of life" after heart attacks, strokes, asthma attacks, and drug poisoning. Eight of the 17 reported "dreams" where rivers and ponds were prominent, while the remaining 9 had no experiences. Five of the 8 NDErs reported "fear, pain and suffering," unlike typical NDEs from the West. While one of the patients from the Kyorin study reported repeatedly doing handstands in the shallows of a reservoir, a cardiac arrest survivor "saw a cloud filled with dead people. 'It was a dark, gloomy day. I was chanting sutras. I believed they could be saved if they chanted sutras, so that is what I was telling them to do"' (Hadfield, 1991, p. 11). University of Zambia physician Nsama Mumbwe collected 15 NDE reports from Africa (Morse and Perry, 1992). In one case, after being attacked by a lioness protecting her cubs, a 60-year-old truck driver reported that a highway opened up for him going endlessly into the sky, surrounded by stars; when he tried to go on to the highway, the stars blocked his way, and he stood there until the highway and stars disappeared. In another case, an 85-year-old stroke survivor reported: "I felt I was put into a big calabash [the hollow shell of a gourd] with a big opening. But somehow I couldn't get out of it. Then a voice from somewhere said to me, 'be brave. Take my hand and come out. It is not yet your time to go"' (Morse and Perry, 1992, pp. 122-123). In the first case the man attributed his NDE to a "bad omen"; in the second the KEITH AUGUSTINE 103

NDEr thought someone was trying to "bewitch her" into death. Clearly these were culture-bound interpretations of the experience; but what of the reports of what was experienced? The single report of being caught inside a calabash with a large opening has been interpreted as the tunnel experience, but may indicate feeling caught inside something more like a bottle with only one opening. So we have a single African NDE that may or may not include a tunnel experience. There is little reason to describe the other African case where a "highway" through the stars opens up as either a tunnel experience or an OBE, since there is no indication of enclosure or of looking down on one's body. In the South Pacific region known as Melanesia, anthropologist Dorothy Counts surveyed NDEs among the hunter-gatherer Kaliai, who described an NDE world "having factories and wage employment. ... that reminds me of the view approaching Los Angeles from the air" (Counts, 1983, p. 130). One Kaliai NDEr reported walking through a flower field to a road that forked in two. In each fork of the road a man was standing, trying to persuade the NDEr to come with him. The NDEr picked one of the forks at random and he and his guide traveled to a village where they climbed a ladder going up into a house floating in mid-air. When they reached the top, a voice declared that the NDEr's time was yet to come and that a group of people would be summoned to take him back. The NDEr nevertheless caught a glimpse of what was inside the house, finding "some men working with steel, and some men building ships, and another group of men building cars" (Counts, 1983, p. 120). Once taken down the steps, the NDEr tried to return to the house, but found that with each attempt to approach its door, the house would turn as if on an axle so that the door moved elsewhere. When the NDEr could not find a road to follow to come back, a "beam of light" appeared that he walked along, and then he climbed down the steps, now finding "nothing but forest" at the bottom. The NDEr then reported: "So I walked along the beam of light, through the forest and along a narrow path. I came back to my house and re-entered my body and was alive again" (Counts, 1983, p. 120). The NDE world of the Kaliai conformed to their cargo belief that white people were "spirit people" or ancestors who had returned from the dead. The Kaliai believed that spirits or ancestors gave technology to human beings, and that the afterlife was "rich with divinely given technology," including "factories, automobiles, highways, airplanes, 104 JOURNAL OF NEAR-DEATH STUDIES

European houses and buildings in great numbers, and manufactured goods" (Counts, 1983, p. 130). After discovering such major differences between Western and nonWestern descriptions, Counts concluded that the NDE world "often is a pleasant, happy place" whose content "varies and seems to be culturally defined," noting that Western NDErs often "see a beautiful garden, while Kaliai find an industri alized world of factories, highways, and urban sprawl" (Counts, 1983, p. 132). Counts also thought that this cultural variability indicated that OBEs and NDEs were probably just "the result of a psychological state. ... rather than an objectively experienced 'life after death"' (Counts, 1983, p. 132).

How Consistent Are NDE Features Across Cultures?

Despite a few core elements, descriptions of the world encountered during Western NDEs are nearly as variable as dreams. Even the identity of "the light" is variable: in some cases it has a personality, in others it does not; sometimes it has a specific identity that varies between people - a "bright angel" in one case, Jesus in another; in other cases it is a path, or simply the illumination of another world at the other end of a tunnel (Fox, 2003). Its function also varies significantly, "sometimes merely acting as a destination, sometimes lighting the way, sometimes judging, sometimes asking questions, and sometimes simply returning NDErs to where they came from" (Fox, 2003, p. 140). Nevertheless, different near-death researchers have suggested that most of the following elements constitute core commonalities of the prototypical Western NDE: (1) feelings of peace or euphoria, lack of pain; (2) an out-of-body experience; (3) traveling through a tunnel or darkness from the physical world to an ostensibly transcendental realm; (4) encountering a sun-like light; (5) meeting others; (6) a life review where one's own life events are viewed or relived and sometimes judged; (7) seeing some sort of landscape; and (8) encountering a barrier or threshold between life and death. Because most Western NDEs do not include all of these elements, I will define the prototypical Western NDE as an experience succeeding a real or perceived imminent physical threat containing at least two of the elements listed above. In nonWestern contexts an NDE should generally be understood as an ASC precipitated by either an expectation of dying or actual proximity to death. KEITH AUGUSTINE 105

Consistency between different Western NDE accounts has been well established. But to determine whether their commonalities can be found in nonWestern NDEs, we must search existing nonWestern NDE accounts for elements of the prototypical Western NDE. Table 1 summarizes whether or not prototypical Western NDE elements were reported in 11 studies of nonWestern NDEs. For the sake of fidelity, I have excluded from this crosscultural survey ambiguous NDE cases, unsoundly procured accounts, and case studies of just one account. For instance, whether various historical narratives are accounts of experiences by individuals who were dying or expected to die is unclear, or otherwise their status as unedited, first-person accounts rather than legendary inventions or accretions is dubious. I also excluded studies in which contemporary nonWestern accounts were derived solely from second-hand sources rather than from interviews with NDErs themselves. Finally, I have excluded data that are likely to have been contaminated by knowledge of Western NDE motifs, such as findings based on responses to advertisements in nonnative languages (for example, Blackmore, 1993b) or on composite accounts of Western NDEs presented to respondents beforehand (for example, Kellehear, Heaven, and Gao, 1990). It is nevertheless worth noting that none of the excluded nonWestern historical narratives (Bailey, 2001; Becker 1981, 1984; McClenon, 1991; Schorer, 1985; Wade 2003), second-hand accounts (Osis and Haraldsson, 1977), or single accounts (Berndt and Berndt, 1989; G6mez-Jeria, 1993; Kellehear, 2001; King, 1985) reported initial euphoria, transitional passage through a tunnel or darkness, encountering a sun-like light, or anything like the Western life review. In 11 studies of seven nonWestern cultures (with three studies in India, two in Japan, and two in central Africa), very few elements of the prototypical Western NDE were universally present. Feelings of peace have only been reported in China and Japan, and unfortunately Feng Zhi-ying and Liu Jian-xun (1992) simply tabulated reported elements without including NDErs' narratives, making it impossible for us to determine how similar the Chinese elements were to prototypical Western ones. A single Thai NDEr did report "a deep sense of beauty" after an OBE, followed by walking down a road, encountering Yamatoots, and desperately trying to escape from them (www. altered-states.net). OBEs were widely present, but absent from NDEs in Zambia, the Congo, and Melanesia, and only one OBE was reported in the 55 106 JOURNAL OF NEAR-DEATH STUDIES

. OO-c zzzzz~

's' o

Oe a U, Q U, C)

C.) 0 14 U,4 0C O b1) c) a Cal) a) ) ) ) ) L a) O. W) Te o C.)

a)4 CD Q zCmzZZ QO C < 0

e ce A ~ CL) es

o A a a)U) z azza*$ZZZ 0 0z 0 zC$z0 c0 0 a) ~W U) U)2% z '-4

0 0o)000a cz boR 0 a 4 -x

C. zzzzzzzz 04N m to-e.c$$ e

c ... z .c C a) c 0 C PC$ ) CZ C.)000 NzQ CZ 0) C' c ,- c c c 0 --0 cd onesoCo- a W) -'e cd 0 e 0o V N C)V to o N 00 c KEITH AUGUSTINE 107 reports of NDEs from India. Moreover, the OBEs from Guam did not involve looking down on one's body or the area around it, but of out-of body "flights" to relatives living in America. Perhaps OBEs are not universal in NDEs because "not all cultures recognize OBEs as a herald of death" (Murphy, 2001, p. 171). Tunnel experiences were limited virtually to China and Japan. One NDEr from Zambia may have reported one, depending on whether "calabash" should be interpreted as "tunnel," and in a tabulated chart three NDErs from India were paraphrased as reporting a "Feeling of intense darkness" that may or may not represent transitional passage (Singh, Bagadia, Pradhan, and Acharya, 1988 p. 303). In one Thai account an NDEr encountered a tunnel twice, first as a means to travel to Yama's hall of judgment, skipped due to "bad weather" (an elevator was taken instead), and then later to "access" the first level of Hell, where people with the "heads of chickens, buffalos, and cows" were encountered (www.altered-states.net); but Thai NDErs typically traversed roads in their NDEs (Murphy, 2001). An experience of a sun-like light can be found among Japanese NDE reports, but otherwise only a Congo NDEr "saw a bright, dazzling light" (McClenon, 2006, p. 25), and an NDEr from India was paraphrased as reporting "Feeling of bright light and exploding firecrackers" (Singh, Bagadia, Pradhan, and Acharya, 1988, p. 303). A "light that was too bright to bear" was seen where "the cries of those being tortured" could be heard in the fourth level of Hell (reserved for arsonists) in a single Thai NDE (www.altered-states.net). Meeting others was the only truly universal element found in every nonWestern NDE study, but it hardly lent support for the existence of any substantial core NDE across cultures, as it would not be surprising to find encounters with others in many hallucinatory human experiences. Moreover, it covered much variation, such as meeting deceased friends or relatives, strangers, religious figures, animals, living persons, and mythological creatures. Viewing or reliving one's own life events was reported in NDEs only from China and Japan, although NDEs from India and Thailand often included readings of written records of the events of one's life, reflecting traditional Hindu and Thai beliefs (Murphy, 2001; Pasricha and Stevenson, 1986). Thai NDErs were often judged for specific actions and whether their good deeds outweighed their bad ones, but those affected by their actions (including a rooster and a turtle in one case) would testify for or against them. Outside of the limited Chinese 108 JOURNAL OF NEAR-DEATH STUDIES

and Japanese data, no "memory flashback" life reviews were reported by any nonWestern NDEr. One Melanesian NDEr reported witnessing a sorcerer being judged by loudspeaker and destroyed by fire during his NDE, but the NDEr himself never reviewed the events of his own life (Counts, 1983, pp. 121-122). Encountering a landscape was nearly universal, but absent from NDEs in India, where NDErs typically entered an administrative office and were sent back because the clerks had been sent the wrong person. This motif was also found in Thai NDEs, occasionally preceding landscape visions. The most common features of the Thai NDE world were visions of Yama's palace, various tortures being inflicted on wrongdoers, and gardens or land strewn with jewels. But NDE landscapes varied considerably across cultures: bodies of water were prominent in NDEs from Japan; fields in NDEs from Guam; and brightly lit cities with factories, cars, roads, planes, and buildings in NDEs from Melanesia. A barrier or threshold was reported in NDEs from Japan (a river, sea, gate, or wall), Zambia (stars blocking a highway), the Congo (a river), Melanesia (a house would turn if a door was approached), and Guam (a field entrance, a door, a hill in the distance to which the NDEr was prevented from traveling). In Thai NDEs, Yamatoots often forced NDErs back into their bodies after they were recognized to be the wrong person, but no barrier prevented them from going further, and no choice to stay or return was ever offered. Of the eight prototypical Western NDE elements, only "meeting others" was truly universal in nonWestern cultures. Landscapes were nearly universal, but quite variable in their details. Even the OBE did not appear to be a universal NDE element, though it was more common than many of the other elements sought in nonWestern NDEs. Encountering a barrier one cannot cross was equally prevalent. The absence of feelings of peace, a clear tunnel experience, an experience of light, and a life review in almost all of the nonWestern NDE reports was surprising given their prominence in the prototyp ical Western NDE. Presumably crosscultural consistency could be explained in terms of either similar neurological events or different encounters with the same afterlife reality. But crosscultural NDE studies demonstrate that many near-death researchers have simply assumed that the consistency between Western accounts was merely a specific instance of a crosscultural consistency. For instance, Paul Badham asserted KEITH AUGUSTINE 109

that "What is seen [in NDEs] appears to be cross-cultural, but how it is named depends on the religious or non-religious background of the believer" (1997, p. 14). Though no prototypical Western NDEs were evident among his Western and nonWestern medieval afterlife narratives, James McClenon argued that what is at "issue between 'believers' and 'skeptics' is not whether common elements exist cross culturally," but whether that alleged fact "supports belief in life after death ... [or whether] commonalities within NDEs are produced by physiological factors associated with death trauma" (1991, p. 322). But existing crosscultural studies suggest that any crosscultural core consists of a very small number of elements. Thus sociologist Allan Kellehear suggested a very general and rather meager "core NDE" after his survey of nonWestern NDE accounts: In every case discussed, deceased or supernatural beings are encountered. These are often met in another realm ... [which] is a social world not dissimilar to the one the percipient is from. The major difference is that this world is often much more pleasant socially and physically. Clearly, the consistency of these reports suggests that at least these two features of the NDE are indeed cross-cultural. (Kellehear, 1996, p. 33)

Of course, such variability does not undermine the survival hypothesis itself. It is entirely possible that an afterlife exists but that NDEs are not glimpses of it, a view similar to the Buddhist belief that the dying pass through several illusory bardo states generated by their own minds before entering the "real" afterlife (Fox, 2003). But it certainly undermines a survivalist interpretation of NDEs. That "the major cross-cultural features of the NDE appear to include encountering other beings and other realms on the brink of death" (Kellehear, 1996, p. 34) is a surprisingly modest conclusion. Such little crosscultural consistency hardly cries- out for either a neuroscientific or survivalist explanation. We would expect a real or perceived near-death crisis to produce a sensation of dying congenial to common hallucinations of deceased friends and relatives, religious figures prominent in one's own culture, and afterlife vistas that, aside from being a better place to live, appear exactly like the world of the living. Fox suggested that a more specific core NDE could be discerned: [I]t seems clear that certain motifs do recur within NDErs' testimonies with some regularity, both cross-culturally and pre Moody. The presence of some kind of light motif seems very 110 JOURNAL OF NEAR-DEATH STUDIES

widespread ... as does the experience of a period of darkness en route or prior to it. (2003, p. 136)

While these do seem to be recurrent motifs across Western NDE accounts, there is little evidence that prototypical Western NDE motifs appear in nonWestern NDEs. NDEs from India, for example, are well documented yet markedly different from those reported in the West. Traversing a tunnel or void toward a light is absent from most known nonWestern NDE accounts. In fact, it is notable that Kellehear did not include categories for "darkness" and "light" in his "Summary of Non-Western NDE Features" table (Kellehear, 1996). Since far more differences than similarities have been found between Western and nonWestern accounts, the commonalities between different Western NDEs require a special explanation. What could possibly explain consistency between Western accounts but not crosscultural consistency? Here a sociological explanation is called for rather than a neuroscientific or survivalist one. The most obvious suggestion is that the widespread dissemination of Raymond Moody's depiction of NDEs in his 1975 Life After Life produced consistency across Western NDE accounts. Selection bias (omitting incongruent reports) and interview er bias (asking leading questions) might then account for the consistency between Moody's reports (Fox, 2003). But Fox has revealed pre-Moody NDEs from the RERC archives, which contain more than 6,000 reports of religious experiences from 1925 to present (Fox, 2003). For instance, RERC account 2733 was written in August 1971 and referred to traveling down a long, whirling, black tunnel toward a bright light at the end, where an NDEr found herself floating blissfully in a warm, golden mist and saw faces coming out of the mist, smiling, and then fading away before "waking up" being slapped on both sides of the face (Fox, 2003, p. 118). The evidence for consistency between Western NDEs is not limited to this single pre-Moody case. An NDE reported by J. W. Haddock in 1851 featured an OBE and life review (Crookall, 1964, p. 86). An 1889 NDE reported by Frederic Myers included an OBE and encountering a dark cloud, a dark pathway, other beings, and a border (Kelly, Greyson, and Kelly, 2006, p. 371). In 1935 G. B. Kirkland reported his own NDE, which included an OBE, life review, traveling through "a long tunnel" with a "tiny speck of light at the far end," seeing others traveling through the tunnel, encountering an uncrossable barrier, KEITH AUGUSTINE 111 then finally returning to his body (Crookall, 1964, p. 89). And in 1970 an ineffable NDE marked by clarity of thought included an OBE, "travelling at great speed" sitting on something, noticing a "perfectly rectangular" but porous "pure white cloud-like substance" on an intercept course, and quite pleasantly "floating in a bright, pale yellow light" before ultimately regaining consciousness (MacMillan and Brown, 1971, pp. 889-890). Moreover, at about the same time that Life After Life (Moody, 1975) was published, German minister Johann Christoph Hampe had been independently collecting NDE accounts from psychical research literature and the testimonies of mountain-climbing fall survivors (Fox, 2003). His German work was translated into English as To Die is Gain in 1979. Unlike Moody's accounts, Hampe's collection included "return trips" back through tunnels, did not include ringing noises, and rarely included encounters with deceased relatives. Nevertheless, Hampe independently found many prototypical Western NDE fea tures: the realism of the experience, lucid thought during it, OBEs, tunnel experiences, experiences of light, life reviews, and transforma tions (Fox, 2003). Finally, a study of the influence of Moody's model on American and British NDE accounts compared 24 reports of NDEs collected before 1975 with 24 demographic- and situation-matched post-1975 NDE accounts (Athappilly, Greyson, and Stevenson, 2006). If familiarity with the depiction of NDEs found in Life After Life generated widespread consistency between Western NDE accounts, one would expect post 1975 accounts to "include higher frequencies of features included in Moody's synopsis than do [pre-1975] accounts" (Athappilly, Greyson, and Stevenson, 2006, p. 219). However, a systematic comparison found no statistically significant difference in the frequency of reports of 14 of Moody's 15 characteristic NDE features, with only "reports of a tunnel ... significantly more common in NDEs reported after 1975 than before" (Athappilly, Greyson, and Stevenson, 2006, p. 220). The discovery of major elements of the prototypical Western NDE in pre-Moody NDE accounts thus rules out Moody's depiction of NDEs or that of subsequent researchers as the basis of the consistency between different Western NDE accounts. Nevertheless, we should be clear about the differences even as we acknowledge the commonalities, as Kellehear wisely cautioned: [T]he full image of the NDE is an artifact of the composite picture put together by Moody and repeated endlessly in the NDE literature. Few 112 JOURNAL OF NEAR-DEATH STUDIES

people actually experience all of these images. ... Our understanding of the NDE has been shaped not by the diversity of NDEs but by a collective portrayal of features seldom occurring all together but immortalized by Moody's medical vignette. (Kellehear, 1996, p. 162)

Kellehear pointed out that about 66 percent of widows and 75 percent of parents who lose children experience bereavement hallucinations where their lost loved ones are briefly seen or heard. By contrast, in.a recent prospective study only about one third (32 percent) of those who had NDEs reported meeting deceased persons, and only about a quarter (24 percent) reported OBEs. In fact, only two of the 10 tabulated elements were found in half or more of the NDErs: positive emotions (56 percent) and an awareness of being dead (50 percent) (van Lommel, van Wees, Meyers, and Elfferich, 2001). Thus even the sort of imagery we would expect to find in hallucinations near death is not nearly as common as our image of the prototypical Western NDE suggests. Moreover, discrepancies between different researchers' accounts of the order of NDE elements - whether an OBE is directly followed by a tunnel experience or instead by otherworldly scenes, for instance - is an artifact of trying to "create a pattern out of the welter of various tunnels and paths, lights and presences, gardens and edifices" (Zaleski, 1987, p. 123). In other words, researchers have extracted features from several different NDE accounts from the West and put them back together into one coherent (but artificial) story where the stages of the NDE are clearly defined and follow a "developmental sequence" (Zaleski, 1987, p. 123). Nevertheless, there is little doubt that Western NDEs really are "patterned phenomena" marked by similar elements even if "all [of] these stages are not perceived by everyone and ... are not necessarily consecutive levels of experience" (Lindley, Bryan, and Conley, 1981, p. 105). Moreover, cliched commonalities between dreams - dreams of falling or flying, for instance - do not seem nearly as similar between individuals as NDEs do. Perhaps Western NDE motifs are found in some part of the Western cultural background other than the NDE literature since Moody. But then one is nagged by a poignant issue raised by Fox: [I]n the cases where NDEs with classic features such as tunnels and lights are reported, we might wish to question where NDErs actually derive their cultural-linguistic NDE pattern from. ... For it is clear that such experiences, complete with recurring motifs such as KEITH AUGUSTINE 113

traversing a period of darkness towards a light, do not represent part of any of the religious traditions of the West. (Fox, 2003, p. 117)

Specific NDE motifs are absent from standard depictions of the afterlife provided by Western religious traditions. But Irwin carried out a systematic survey of Western stereotypes of the afterlife to test the hypothesis that during "sudden confrontation with death people might draw upon their common cultural heritage to generate comparatively uniform hallucinatory images about a state of existence that is independent of the physical body" (Irwin, 1987, p. 1). Irwin first considered the biblical depiction of Heaven offered in Revelation 21, but noted that it was actually at variance with Western NDE motifs: The difficulty here is that the biblical account is somewhat at odds with the descriptions of the afterlife realm given by subjects of the NDE. ... [T]he general public would be well aware of [the biblical] representation of heaven as a city of buildings and streets of pure gold and a surrounding high wall with [pearly] gates. In the NDE on the other hand, the post-mortem realm commonly is reported to comprise a pastoral setting, one with rolling green hills, trees, flowers, perhaps a stream and a blue sky above. (Irwin, 1987, pp. 1-2)

On the face of it "this disparity does not sit well with the view that the near-death experient's image of the afterlife springs largely from social conditioning" (Irwin, 1987, p. 2). However, biblical imagery did feature in some NDE reports, but more importantly, it is questionable "that the portrayal of heaven in Revelation 21 forms the popular stereotypical image [of the afterlife] in our culture" (Irwin, 1987, p. 2). Consequently, Irwin set out to determine the most common Western visions of the afterlife by administering a questionnaire survey to 96 introductory psychology students concerning the appearance, inhab itants, and means of travel of the afterlife, as well as its auditory features. The most common Western images of the afterlife included a cosmic existence simultaneously everywhere and nowhere in the universe (40 percent), a pastoral scene of "lush green hills, trees, flowers and streams" (30 percent), and a formless void of pure being (29 percent) (Irwin, 1987, pp. 2-3). A mere 7 percent of respondents selected the biblical image, and 9 percent expected large gardens to figure prominently in the afterlife. Irwin drew three key conclusions. First, there were several different Western visions of the afterlife. Second, the biblical image of Heaven was not widely held, and thus sociological sources of NDE motifs "can 114 JOURNAL OF NEAR-DEATH STUDIES not be denied on the grounds that the account of the afterlife in NDEs fails to correspond to the biblical representation" (Irwin, 1987, p. 3). Finally, the image of the afterlife as a pastoral scene - an image often represented in NDEs - was quite commonplace, even though respondents indicated that "the pastoral stereotype generally is not based on familiarity with NDEs" (Irwin, 1987, p. 3; italics added). Like the image of looking down upon the Earth from the clouds in the afterlife, a pastoral scene appears to have an obscure but clearly Western cultural source independent of NDE reports themselves. And in turn this image - like that of a garden or the pearly gates - appears to have influenced the content of some Western NDE reports. As Irwin noted, religious indoctrination was one possible source for the pastoral image: "the Bible frequently appeals to pastoral metaphors ... [and] Sunday School classes often include exposure to pictures of Christ standing in a grassy, sunlit field" (Irwin, 1987, pp. 3-4). And the "cosmic" image of the afterlife, which Irwin suggested was "rooted in diverse mystical and non-Christian traditions," appeared to be represented in a "meaningless void" experience in which a 28-year old woman reported encountering a small group of jeering circles "clicking" back and forth from black to white, and vice versa, which she later discovered were Taoist yin-yang symbols, a symbol she likely was subconsciously aware of but had consciously forgotten about (Greyson and Bush, 1992, p. 102). One prototypical Western NDE element may be represented by two items in Irwin's questionnaire (items 6 and 7), which combined indicated that a full 57 percent of respondents anticipated some sort of illuminating light in the afterlife (Irwin, 1987). If we combine being "bathed in perpetual sunshine" with being "illuminated by a soft, diffuse light with no apparent source," respondents anticipated illuminating light more than any other particular item concerning the appearance of the afterlife, and this was the only feature anticipated by a majority of the respondents. Though "illuminating light" may be too vague to be identified with it, an experience of light is a major Western NDE motif - perhaps the most prominent feature of NDEs in the popular imagination. Though no other NDE elements were evident in Irwin's survey, OBEs appear to represent the most natural way to imagine what will happen to your soul immediately after the death of the body (Zaleski, 1996). Moreover, Heaven - which polls indicate is where the vast majority of people expect to end up after death (Gallup, 1992, p. 5) - is KEITH AUGUSTINE 115

explicitly conceived of as a place of bliss and peace. Tunnels might be the most natural representation of transition for Westerners (Kelle hear, 1996). And, as is evident in one of the creation accounts in Genesis, light is often associated with what is good in Judeo-Christian tradition, and God is conceived of as perfectly good. It is not much of a leap to associate God with light, and to think that God would be found on the other side of a transition between life and death. Individuals universally expect to meet others in the afterlife, and most contemporary religious traditions posit some sort of postmortem accounting or judgment of one's actions during Earthly life. Conse quently, it is possible that NDErs are interpreting their experiences of specific physiological events in terms of their cultural expectations.

Interestingly, aside from Hieronymous Bosch's suggestive 1 4 th century painting "Ascent in the Empyrean" (which parallels Gustave Dor6's 1868 painting "Vision of the Empyrean"), there is scant if any

evidence of prototypical Western NDE motifs prior to the 19 th century. Classical and medieval "afterlife experience" motifs were markedly different from those found in contemporary NDEs (Bremmer, 2002; Zaleski, 1987). The legend of Er in Plato's Republic is often cited as the oldest recorded NDE, but like all of Plato's dialogues, it is entirely fictional, and in any case the only prototypical Western NDE motif possibly present was a vague OBE. In medieval accounts "most of the modern elements, such as the feelings of peace, the tunnel, the hovering above the body, the life review, and meetings with deceased relatives, or even brethren, are generally missing" (Bremmer, 2002, pp. 99-100). Jan Bremmer surmised that contemporary NDE reports reflect a modern Western individualism absent from earlier afterlife accounts, and proposed this as a potential sociological source of prototypical Western NDE motifs. In addition to noting that the comparatively nonjudgmental nature of the contemporary life review contrasts sharply with medieval motifs, he asked: "Can it be that the relatively late [ 1 9 th century] appearance of reports of the life film have something to do with the development of the diorama and its reinforcement by the train in the nineteenth century, which enabled people to see a fast succession of scenes as they had never been able to do before?" (Bremmer, 2002, p. 102; bracketed comment added). Kellehear suggested a possible cultural source for Western NDE imagery other than religious tradition: The Velveteen Rabbit contains many of the classic images of the NDE. However, it is not unique in this respect. In The Wizard of Oz, for 116 JOURNAL OF NEAR-DEATH STUDIES

example, Dorothy is transported inside the "tunnel" of a tornado to another place, where she meets the "good witch of the east." In Alice in Wonderland, Alice begins her adventure by a long fall down a dark rabbit hole. Children's literature is replete with tunnels, extraordi nary beings, life reviews, flying experiences, and tales of reunion. (Kellehear, 1996, p. 153)

That Western NDE motifs might be derived from well-known children's stories would account for the considerable consistency between Western NDEs in the absence of evidence of significant crosscultural consistency. However, the similarities between the imagery described in children's stories and NDE imagery are superficial. Moreover, these stories do not concern what to expect when you die. Why would individuals who felt that they were dying derive NDE imagery from children's stories rather than better-known and more context-appropriate afterlife imagery from Western reli gious traditions? Evidence of substantial consistency between different NDEs in the West but only trivial crosscultural consistency opens up two avenues for future research: a sociological search for more compelling links between NDE motifs and possible cultural sources within Western tradition; and more anthropological studies of NDEs in a greater variety of nonWestern cultures with larger sample sizes. The latter avenue is paramount: If more robust studies confirm the existence of little or no crosscultural consistency between NDE reports, the need to search for NDE motifs within Western tradition will become more pressing. But if more robust studies establish that specific NDE elements are crossculturally consistent, searching for a Western source of NDE motifs will become unnecessary, and knowledge of which NDE motifs are universal or at least widespread would provide us with better data to develop and test specific neuroscientific explanations of NDEs. Given that at least some NDEs are known to be hallucinations (Augustine, 2007), should future crosscultural studies uncover universal and well-defined NDE elements, such precise and wide spread commonalities would be best explained in neuroscientific terms. Alternatively, if extensive studies fail to uncover substantial crosscultural consistency between NDE accounts, a sociological explanation for solely Western commonalities would be required. In any case, our best evidence shows that a survivalist explanation will not do. Despite the commonalities, there is considerable variation in the content of different NDEs. While one person actually sees Jesus, KEITH AUGUSTINE 117 another sees the Hindu god Yamraj. The glossed explanation that different people simply describe or interpret the same experience in different ways - an encounter with the same "being of light," for instance - does not do justice to the actual NDE reports that have been collected, where Jesus and Yamraj have very different appearances and functions. When NDErs provide very different descriptions of their experienc es, there is no reason to assume that different NDErs are simply using different labels to describe the same experience. The most straightfor ward reason why different NDErs would describe their experiences in different ways is because they actually have very different experiences. The standard survivalist explanation - that despite appearances, different NDE reports really are similar - is simply an ad hoc stipulation. This principle is widely assumed because different people would naturally be expected to report similar experiences if they were traveling to the same afterlife environment. Of course, the greater the diversity between different NDE accounts, the less credible the NDE consistency argument for survival, and thus the greater the pressure to portray different NDE accounts as more consistent than they first appear. But NDE reports themselves do not support this principle, and often contradict it, even when considering supposedly core elements. Kellehear, for example, suggested that perhaps: tunnel experiences are not cross-cultural but that a period of darkness may be. This darkness is then subject to culture-specific interpretations: a tunnel for Westerners, subterranean caverns for Melanesians, and so on. NDErs who do not report darkness may not view this aspect of the experience as an important part of their account or narrative. ... Why is the frequently reported sensation of traveling through a darkness by Western NDErs so often described as a tunnel experience? (Kellehear, 1996, pp. 35-36)

But the most straightforward interpretation of apparent diversity is actual diversity: that Westerners actually see tunnels in their experiences, while Melanesians see underground caverns. But since acknowledging actual diversity tends to undermine arguments for survival based on NDE commonalities, it is not surprising that researchers sympathetic to survival after death tend to interpret markedly different NDE reports in terms of the "same experience, different descriptions" principle. 118 JOURNAL OF NEAR-DEATH STUDIES

After finding several accounts of visiting outer space in the RERC archives, Fox asserted that many NDErs "were found to use the descriptor 'space' to describe the episode of darkness" (Fox, 2003, p. 265). Soon after he wrote: "The significance of the word 'space' to describe the darkness encountered in these experiences will be returned to" (Fox, 2003, p. 265). Finally, Fox skewed what was actually reported by NDErs by concluding that many of his RERC respondents "describe an encounter with some sort of darkness motif in terms seemingly suggestive of a visit to outer space" (Fox, 2003, p. 277). Fox was speaking as if he knew ahead of time what these different people had experienced. But of course assuming that these reports were describing the same thing regardless of what they actually said begs the question, for that is the very issue of contention. Fox asserted that the episode of darkness was what was encountered, but that it was being described as "space" - but how did he know that it was not space that was actually encountered? Of course he did not know; he just assumed. If we look at such NDErs' actual testimonies, one person reports encountering a tunnel while another reports encountering space. But should we not take each at his word instead of assuming that both are encountering the same darkness in order to fit our artificial NDE models? Just because space, tunnels, and underground caverns are dark does not mean that astronauts, motorists, and miners are using different terminology to describe traveling to the same place. One wonders just how much consistency is being derived from NDE reports rather than being read into them. Worse still, many NDErs report encountering tunnels with physical properties, such a being made of bricks. Consider a case reported by Peter and Elizabeth Fenwick: [T]he tunnel was made of polished metal, jointed and held together with something like rivets. ... I felt it should have been more ethereal somehow. ... My feet felt like lead but as I walked back to life the light threw my shadow on to the floor of the tunnel as I walked away from it. (Fenwick and Fenwick, 1997, p. 55)

Clearly a case like this could not simply be a description or interpretation of a mere "episode of darkness." More plausibly, different NDErs experience different things: traveling down tunnels, floating in "outer space," walking down a road, being caught in a calabash, and so on. KEITH AUGUSTINE 119

Greyson has conceded stark crosscultural variation, but argued that "experiences which conflict with [NDErs'] specific religious and personal expectations of death" challenge the view "that NDEs are products of imagination, constructed from one's personal and cultural expectations" (Greyson, 2000, p. 332). However, his argument fails, and in any case a few cases of apparent "cultural dissonance" in NDEs certainly does not outweigh an abundance of evidence for the predominant role of expectation in NDEs from different cultures, such as those from India and Thailand. Greyson (2000) cited the case of the Jewish NDEr Chaim Ralbag, who experienced an unusual cardiac arrest NDE in which he was falling into a dark void a high speed, hovering over a sea of nothingness, then pushing himself back out of the void. As he traveled upward through the void, his surroundings were illuminated, and eventually he saw his body lying on the ground (Abramovitch, 1988). He then had an experience of light, communicated with another being, and encountered his deceased father and brother, before finally hovering over his body and then waking up in the recovery room. Henry Abramovitch offered two reasons why expectation could not account for the content of Ralbag's NDE. First, Ralbag was taught that the biblical Adam would appear to the dying, but this did not happen in his NDE. Second, he was taught that he would face judgment in the afterlife, but had no life review (Abramovitch, 1988). That an individual's visions of the afterlife do not exactly mirror what he was taught, however, hardly requires an encounter with the afterlife to explain it. The real issue is whether such experiences conflict with an individual's personal expectations. But what a person consciously claims to expect of the afterlife says nothing of his subconscious expectations, and many individuals do not simply accept whatever dogma was taught to them in childhood, but grow to elaborate upon, modify, or reject what they were taught. Murphy found clear evidence of this in an NDE reported by the Chinese-Thai Kodien. During his NDE, He noticed that some groups [of deceased people] had food and water, while others had only piles of ash. ... His friend said that those who made merit by donating food to the monks during their lives would have food [in the afterlife], while those who only helped their own ancestors (by burning joss-paper replicas of food according to Chinese tradition) would only have piles of ash. Kodien realized that his friend was suggesting that he create merit according to the Thai custom, but 120 JOURNAL OF NEAR-DEATH STUDIES

during his life he had not believed in the practice. He had thought that the Chinese forms of religious observance were better, and had only made joss-paper offerings. (Murphy, 2001, pp. 168-69)

Here an NDE was shaped almost entirely by cultural influences, yet the NDEr experienced something contrary to his conscious beliefs. But this "cultural dissonance" did not imply that this NDE was not expectation-driven, as Murphy explained: His NDE seemed to reveal that he was actually more drawn to the Thai ways of creating merit than to those of his own family and subculture. ... [This] suggests that it is not culture alone that determines NDE phenomenology. Rather, NDEs may be determined more by one's expectations concerning what death will be like, even when those expectations are held subconsciously or are influenced by more than one culture. (Murphy, 2001, p. 169)

Greyson went on to argue that "children too young to have received substantial cultural and religious conditioning about death report the same kinds of [NDEs] as do adults" (Greyson, 2000, p. 332). But how young is "too young" for a child to be affected by cultural conditioning? Children younger than 3 years old clearly learn concepts from sources as ubiquitous as television advertising. Moreover, how confident can we be that children's NDE reports have not been contaminated by parental influence or interviewer feedback? Children are particularly susceptible to influence from authority figures and typically have much richer imaginative lives than adults. The risk of direct contamination from parents or researchers could be minimized by closing the gap between the time of the NDE itself and when it is reported, but such information is rarely published.

Conclusion

Taken as a whole, various psychophysiological correlates of OBEs and NDEs make little sense if consciousness is literally projected outside of the body during such experiences. Though more definitive research is needed, data suggesting that one's psychological state or medical condition affects the content of one's NDE undermine the notion that NDEs are instances of literal mind-body separation. On the hypothesis that something leaves the body during OBEs and NDEs, for instance, one would not naturally anticipate that fear alone would be able to prompt a double to detach from or return to the body, KEITH AUGUSTINE 121 though one could certainly amend that hypothesis to incorporate that finding after the fact. By contrast, extreme fear might very well be expected to prompt an individual to dissociate in order to "escape" from real or perceived impending trauma. Similarly, medical factors affecting a person's brain state would not be expected to influence the course of a "brain-free" experience, and yet we find medical influences on the content of OBEs and NDEs. Finally, there are several links between NDEs and temporal lobe signs, where such signs are not taken to be indicative of mind-body separation in other contexts. Given its greater predictive power, a psychophysiological explanation is clearly a better explanation of such facts than a survivalist or dualistic one. Additionally, though different Western NDEs contain several recurrent and well-defined commonalities, very few and only broadly defined commonalities have been found crossculturally. This is problematic for a survivalist interpretation because a substantial crosscultural core would be expected if different NDErs were literally traveling, by the same means (leaving their bodies) and through the same route (passage through a tunnel or darkness toward a light), to transcendental destinations. Instead, we find a variety of culture specific NDE templates with only locally well-defined commonalities. This severely undercuts the survivalist argument that NDE common alities result from different NDErs undergoing the same journey; and in virtue of their common humanity, NDErs would not be expected to take different journeys to different places after death merely because of where and when they lived while on Earth. Due to this implication, near-death researchers sympathetic to survival have typically assumed that cultural variation in the phenomenology of NDEs is only superficial. But the crosscultural data that have been collected do not bear this out. In fact, what is superficial is the strained explanation that, despite appearances, NDErs from different cultures encounter the same sorts of things but simply describe them differently. A quick glance at the content of nonWestern NDE reports demonstrates that this explanation is patently false: the NDE elements from different cultures have starkly different visual appearances and narrative roles, even in outline. The available evidence implies that NDE motifs found in different cultures, including those found in the West, have sociological sources. Alternatively, though, this pattern could simply reflect the paucity of the available nonWestern NDE data. If so, the prototypical Western 122 JOURNAL OF NEAR-DEATH STUDIES

NDE would actually represent a substantial crosscultural core of NDE elements reflecting, perhaps, common neurophysiological processes. Only future research can definitively resolve this issue.

References

Abramovitch, H. (1988). An Israeli account of a near-death experience: A case study of cultural dissonance. Journal of Near-Death Studies, 6, 175-184. Alvarado, C. S. (2000). Out-of-body experiences. In E. Cardena, S. J. Lynn, and S. Krippner (eds.), The varieties of anomalous experience: Examining the scientific evidence (pp. 183-218). Washington, DC: American Psychological Association. Alvarado, C. S., and Zingrone, N. L. (1994). Individual differences in aura vision: Relationships to visual imagery and imaginative-fantasy experiences. European Journal of Parapsychology, 10, 1-30. Athappilly, G., Greyson, B., and Stevenson, I. (2006). Do prevailing societal models influence reports of near-death experiences? A comparison of accounts reported before and after 1975. Journal of Nervous and Mental Disease, 194, 218-222. Augustine, K. (2007). Near-death experiences with hallucinatory features. Journal of Near-Death Studies, 26, 3-31. Badham, P. (1997). Religious and near-death experience in relation to belief in a future life. Mortality, 2, 7-21. Bailey, L. W. (2001). A "little death": The near-death experience and Tibetan delogs. Journal of Near-Death Studies, 19, 139-159. Becker, C. B. (1981). The centrality of near-death experiences in Chinese Pure Land Buddhism. Anabiosis: The Journal of Near-Death Studies, 1, 154-170. Becker, C. B. (1984). The pure land revisited: Sino-Japanese meditations and near-death experiences of the next world. Anabiosis: The Journalof Near-Death Studies, 4, 51-68. Berndt, R. M., and Berndt, C. H. (1989). The speaking land: Myth and story in aboriginal Australia. Harmondsworth, England: Penguin. Blackmore, S. (1984). A postal survey of OBEs and other experiences. Journal of the Society for Psychical Research, 52, 225-244. Blackmore, S. (1987). Where am I?: Perspectives in imagery and the out-of-body experience. Journal of Mental Imagery, 11, 53-66. Blackmore, S. (1993a). Dying to live: Near-death experiences. Buffalo, NY: Prometheus. Blackmore, S. (1993b). Near-death experiences in India: They have tunnels too. Journal of Near-Death Studies, 11, 205-217. Bremmer, J. N. (2002). The rise and fall of the afterlife. New York, NY: Routledge. Britton, W. B., and Bootzin, R. R. (2004). Near-death experiences and the temporal lobe. Psychological Science, 15, 254-258. Cook, A. M., and Irwin, H. J. (1983). Visuospatial skills and the out-of-body experience. Journal of Parapsychology,47, 23-35. Council, J. R., Greyson, B., and Huff, K. D. (1986). Fantasy-proneness,hypnotizability, and reports of paranormalexperiences. Paper presented at the annual convention of the American Psychological Association, San Francisco, CA, Counts, D. A. (1983). Near-death and out-of-body experiences in a Melanesian society. Anabiosis: The Journalof Near-Death Studies, 3, 115-135. Crookall, R. (1964). More astral projections:Analyses of case histories. London, England: Aquarian Press. Devinsky, 0., Feldmann, E., Burrowes, K, and Bromfield, E. (1989). Autoscopic phenomena with seizures. Archives of Neurology, 46, 1080-1088. KEITH AUGUSTINE 123

Drab, K. J. (1981). The tunnel experience: Reality or hallucination? Anabiosis: The Journal of Near-Death Studies, 1, 126-152. Fenwick, P., and Fenwick, E. (1997). The truth in the light:An investigation of over 300 near-death experiences. New York, NY: Berkley. Fox, M. (2003). Religion, spirituality and the near-death experience. New York, NY: Routledge. Fox, O. (1962). Astral projection: A record of out-of-body experiences. New Hyde Park, NY: University Books. French, C. C. (2005). Near-death experiences in cardiac arrest survivors. In S. Laureys (ed.), The boundaries of consciousness: Neurobiology and neuropathology (pp. 351 367). New York, NY: Elsevier Science. Gallup, G. (1992). The Gallup poll: Public opinion 1991. Wilmington, DE: Scholarly Resources. Glicksohn, J. (1990). Belief in the paranormal and subjective paranormal experience. Personality and Individual Differences, 11, 675-683. G6mez-Jeria, J. S. (1993). A near-death experience among the Mapuche people. Journal of Near-Death Studies, 11, 219-222. Green, J. T. (1984). Near-death experiences in a Chammorro culture. Vital Signs, 4(1-2), 6-7. Greyson, B. (2000). Near-death experiences. In E. Cardena, S. J. Lynn, and S. Krippner (eds.), The varieties of anomalous experience: Examining the scientific evidence (pp. 315-352). Washington, DC: American Psychological Association. Greyson, B., and Bush, N. E. (1992). Distressing near-death experiences. Psychiatry, 55, 95-110. Greyson, B., and Stevenson, I. (1980). The phenomenology of near-death experiences. American Journal of Psychiatry, 137, 1193-1196. Hadfield, P. (1991). Japanese find death a depressing experience. New Scientist, 132, 11. Hampe, J. C. (1979). To die is gain: The experience of one's own death. London, England: Darton, Longman and Todd. Holden, J. M., Long, J., and MacLurg, J. (2006). Out-of-body experiences: All in the brain? Journal of Near-Death Studies, 25, 99-107. Hunt, H. T., Gervais, A., Shearing-Johns, S., and Travis, F. (1992). Transpersonal experiences in childhood: An exploratory empirical study of selected adult groups. Perceptual and Motor Skills, 75, 1135-1153. Irwin, H. J. (1985a). Flight of mind: A psychological study of the out-of-body experience. Metuchen, NJ: Scarecrow Press. Irwin, H. J. (1985b). Parapsychological phenomena and the absorption domain. Journal of the American Society for Psychical Research, 79, 1-11. Irwin, H. J. (1986). Perceptual perspective of visual imagery in OBEs, dreams, and reminiscence. Journal of the Society for Psychical Research, 53, 210-217. Irwin, H. J. (1987). Images of heaven. Parapsychology Review, 18, 1-4. Irwin, H. J. (1993). The near-death experience as a dissociative phenomenon: An empirical assessment. Journal of Near-Death Studies, 12, 95-103. Irwin, H. J. (1999). An introduction to parapsychology (3 rd ed). Jefferson, NC: McFarland. Irwin, H. J. (2000). The disembodied self: An empirical study of dissociation and the out of-body experience. Journal of Parapsychology, 64, 261-277. Kellehear, A. (1996). Experiences near death: Beyond medicine and religion. New York, NY: Oxford University Press. Kellehear, A. (2001). An Hawaiian near-death experience. Journal of Near-Death Studies, 20, 31-35. Kellehear, A., Heaven, P., and Gao, J. (1990). Community attitudes toward near-death experiences: A Chinese study. Journal of Near-Death Studies, 8, 163-173. 124 JOURNAL OF NEAR-DEATH STUDIES

Kelly, E. W., Greyson, B., and Kelly, E. F. (2006). Unusual experiences near death and related phenomena. In Kelly, E. F., Kelly, E. W., Crabtree, A., Gauld, A., Grosso, M., and Greyson, B., Irreducible mind: Toward a psychology for the 21st century (pp. 367-421). Lanham, MD: Rowman and Littlefield. King, M. (1985). Being pakeha: An encounter with New Zealand and the Maori renaissance.Auckland, New Zealand: Hodder and Stoughton. Kohr, R. (1983). Near-death experiences, altered states, and psi sensitivity. Anabiosis: The Journal of Near-Death Studies, 3, 157-176. Lindley, J. H., Bryan, S., and Conley, B. (1981). Near-death experiences in a Pacific Northwest American population: The Evergreen Study. Anabiosis: The Journal of Near-Death Studies, 1, 104-124. MacMillan, R. L., and Brown, K. W. G. (1971). Cardiac arrest remembered [Letter]. CanadianMedical Association Journal, 104, 889-890. Makarec, K., and Persinger, M. A. (1985). Temporal lobe signs: Electroencephalographic validity and enhanced scores in special populations. Perceptual and Motor Skills, 60, 831-842. Mauro, J. (1992, July/August). Bright lights, big mystery. Psychology Today, 54-57, 80-82. McClenon, J. (1991). Near-death folklore in medieval China and Japan: A comparative analysis. Asian Folklore Studies, 50, 319-342. McClenon, J. (2006). Kongo near-death experiences: Cross-cultural patterns. Journal of Near-Death Studies, 25, 21-34. McCreery, C., and Claridge, G. (1995). Out-of-the-body-experiences and personality. Journal of the Society for Psychical Research, 60, 129-148. McCreery, C., and Claridge, G. (1996). A study of hallucination in normal subjects: I. Self-report data. Personality and Individual Differences, 21, 739-747. Moody, R. A. (1975). Life after life: The investigation of a phenomenon - survival of bodily death. Covington, GA: Mockingbird Books. Morse, M. (1994). Near death experiences and death-related visions in children: Implications for the clinician. Current Problems in Pediatrics, 24, 55-83. Morse, M., and Perry, P. (1992). Transformed by the light: The powerful effect of near death experiences on people's lives. New York, NY: Villard. Murphy, T. (2001). Near-death experiences in Thailand. Journal of Near-Death Studies, 19, 161-178. Murray, C., and Fox, J. (2005). The out-of-body experience and body image: Difference between experients and nonexperients. Journal of Nervous and Mental Disease, 193, 70-72. Myers, S. A., Austrin, H. R., Grisso, J. T., and Nickeson, R. C. (1983). Personality charac teristics as related to the out-of-body experience. Journal of Parapsychology,47, 131-144. Neppe, V. M. (2002). "Out-of-body experiences" (OBEs) and brain localisation. A perspective. Australian Journal of Parapsychology, 2, 85-96. Noyes, R., and Kletti, R. (1976). Depersonalization in the face of life threatening danger: A description. Psychiatry, 39, 19-27. Osis, K., and Haraldsson, E. (1977). At the hour of death: The results of research on over 1000 afterlife experiences. New York, NY: Avon. Owens, J. E., Cook, E. W., and Stevenson, I. (1990). Features of "near-death experience" in relation to whether or not patients were near death. Lancet, 336, 1175-1177. Pasricha, S. (1993). A systematic survey of near-death experiences in south India. Journal of Scientific Exploration, 7, 161-171. Pasricha, S., and Stevenson, I. (1986). Near-death experiences in India: A preliminary report. Journal of Nervous and Mental Disease, 174, 165-174. Richards, P., and Persinger, M. A. (1991). Temporal lobe signs, the Dissociative Experiences Scale and the Hemispheric Quotient. Perceptual and Motor Skills, 72, 1139-1142. KEITH AUGUSTINE 125

Ring, K., and Rosing, C. J. (1990). The Omega Project: An empirical study of the NDE prone personality. Journal of Near-Death Studies, 8, 211-239. Schorer, C. E. (1985). Two Native North American near-death experiences. Omega: Journal of Death and Dying, 16, 111-113. Singh, A. R., Bagadia, V. N., Pradhan, P. V., and Acharya, V. N. (1988). Death, dying and near death experience. Indian Journalof Psychiatry, 30, 299-306. Stevenson, I., and Cook, E. W. (1995). Involuntary memories during severe physical illness or injury. Journal of Nervous and Mental Disease, 183, 452-458. Tachibana, T. (2000). Rinshi taiken [Near death experience] (2 vols.). Tokyo, Japan: Bungei Shunjusha. Tong, F. (2003). Out-of-body experiences: From Penfield to present. Trends in Cognitive Science, 7, 104-106. Twemlow, S. W., and Gabbard, G. O. (1984). The influence of demographic/psychological factors and preexisting conditions on the near-death experience. Omega, 15, 223-235. Twemlow, S. W., Gabbard, G. 0., and Coyne, L. (1982). A multivariate method for the classification of preexisting near-death conditions. Anabiosis: The Journal of Near Death Studies, 2, 132-139. van Lommel, P., van Wees, R., Meyers, V., and Elfferich, I. (2001). Near-death experiences in survivors of cardiac arrest: A prospective study in the Netherlands. Lancet, 358, 2039-2045. Vuilleumier, P., Despland, P. A., Assal, G., and Regli, F. (1997). Voyages astraux et hors du corps: h6autoscopie, extase et hallucinations expdrientielles d'origine dpileptique [Out-of-body and astral journeys: Heautoscopy, ecstasis and experimental hallucina tions of epileptic origin]. Revue Neurologique, 153, 115-119. Wade, J. (2003). In a sacred manner we died: Native American near-death experiences. Journal of Near-Death Studies, 22, 83-116. Wilson, S. C., and Barber, T. X. (1983). The fantasy-prone personality: Implications for understanding imagery, hypnosis, and parapsychological phenomena. In A. A. Sheikh (ed.), Imagery: Current theory, research, and application (pp. 340-387). New York, NY: Wiley. Zaleski, C. (1987). Otherworldjourneys: Accounts of near-death experience in medieval and modern times. New York, NY: Oxford University Press. Zaleski, C. (1996). The life of the world to come: Near-death experience and Christian hope. New York, NY: Oxford University Press. Zhi-ying, F., and Jian-xun, L. (1992). Near-death experiences among survivors of the 1976 Tangshan earthquake. Journal of Near-Death Studies, 11, 39-48.

Commentary on "Psychophysiological and Cultural Correlates Undermining a Survivalist Interpretation of Near-Death Experiences"

Bruce Greyson, M.D. Department of Psychiatry and Neurobehavioral Sciences, University of Virginia

ABSTRACT: Keith Augustine has provided a legitimate and cogent critique of a transcendental interpretation of near-death experiences, exposing weak nesses in the research methodology, paucity of the data, and gaps in the arguments. He offers evidence from psychophysiological and cultural correlates of NDEs that he interprets as favoring a hallucinatory understand ing of these phenomena. However, his analysis relies on idiosyncratic definitions of psychological concepts, reads unidirectional causality into bivariate correlations, and underestimates the empirical predictions of the separation hypothesis. Despite less than compelling evidence for the transcendental hypothesis, it accounts for NDE phenomenology better than the materialist model.

KEY WORDS: near-death experiences; dissociation; temporal lobe; brain stimulation; mind-body models.

Keith Augustine sets forth serious challenges to a transcendental or "mind-brain separation" interpretation of near-death experiences (NDEs), and cites evidence from psychophysiological and cultural correlates of NDEs that he interprets as favoring a neurological or

Bruce Greyson, M.D., is the Chester F. Carlson Professor of Psychiatry and Neurobehavioral Sciences and Director of the Division of Perceptual Studies at the University of Virginia. Reprint requests should be addressed to Dr. Greyson at the Division of Perceptual Studies, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia Health System. P. 0. Box 800152, Charlottesville, VA 22908-0152; e-mail: [email protected].

Journal of Near-Death Studies, 26(2), Winter 2007 2007 LANDS 127 128 JOURNAL OF NEAR-DEATH STUDIES sociological understanding of these phenomena. While he raises worthwhile questions, however, his analysis relies on idiosyncratic definitions of psychological concepts, reads unidirectional causality into bivariate correlations, and underestimates the empirical predic tions of the separation hypothesis. Augustine acknowledges that "current psychophysiological models do not fully explain out-of-body experiences (OBEs) and NDEs" and that "psychophysiological correlates ... do not definitively identify their precise causes." But despite these acknowledged weaknesses, he still believes that NDEs "represent internally generated fantasies rather than genuine perceptions of a transcendental environment." I will argue that correlates of NDEs in fact have little to say about their origin and do not imply that they are "internally generated fantasies."

Psychophysiological Correlates

Augustine starts the section on "Psychophysiological Correlates" by identifying NDEs appropriately as a type of altered state of consciousness (ASC). Then he asserts, inaccurately, that ASCs "are typically understood to involve turning one's attention inward, into the contents of one's own mind, rather than revealing anything about the external world." That misleading characterization of ASCs leads logically to the conclusion that OBEs and NDEs "do not reflect any objective existence outside of the normal physical body." But ASCs do not blind us to the outside world. Whereas some ASCs, such as sleep, do involve turning inward, others demonstrably do not. Indeed, the hyperalertness and intense focus of athletes when they are "in the zone" is a type of ASC, but athletes in that particular altered state have more accurate perceptions of external events than people in the "normal" alert waking state. Arnold Ludwig, who coined the term altered state of consciousness, included in his examples not only states of decreased awareness of the external world but also states of increased awareness (Ludwig, 1966; Ludwig and Lyle, 1964). So the fact that OBEs and NDEs are ASCs, which Augustine correctly defines as "temporary departures from the normal (alert) waking state," does not by any means suggest that they "do not reflect any objective existence outside the normal physical body." Next Augustine focuses on the correlation between NDEs and the closely-related constructs of dissociation, absorption, and fantasy proneness. Augustine defines dissociation as "the shutting out of BRUCE GREYSON 129

sensory stimuli" and absorption as "focusing on the imagination." Neither of those definitions comes close to the standard clinical use of these terms. Dissociation is "the telescoping of the attentional field to concentrate on a narrow range of experience and the concomitant exclusion of other material (internal or external) from awareness" (Butler, 2006, p. 45), resulting in the separation of mental processes that are normally experienced as integrated. Dissociation is definitely not "the shutting out of sensory stimuli." When people dissociate, they can still perceive the external world accurately, although those perceptions may be divorced from other aspects of the environment or from the usual emotional reactions. Although most research into dissociation has focused on its role as a defense against trauma, the majority of dissociative experiences are normal and nonpathological (Butler, 2006). People in pleasant situations often dissociate as a way of enhancing their sensory perceptions, not of withdrawing into fantasy. More than a third of normal volunteers reported dissociating during positive experiences, such as intense athletic competition, sexual encounters, communion with nature, and enjoying music (Pica and Beere, 1995). In such circumstances, attention narrows to a particular meaningful aspect of the external sensory environment. In these dissociations, whose distinction from transcendental experience may be "simply a matter of semantics" (Pica and Beere, 1995, p. 244), sensory perception may be enhanced, and attention is not turned inward toward imagination. Kenneth Ring and Christopher Rosing (1990) and Bruce Greyson (2000) found that near-death experiencers scored higher than a comparison group on a dissociation scale, but their scores were much lower than those of patients with dissociative disorders. This suggests that near-death experiences are adaptive responses to serious stress, rather than pathological (Greyson, 2001). Related to dissociative tendencies is absorption, the ability to focus one's attention either on selected sensory experiences or on internal imagery to the diminution of other mental activity. Auke Tellegen and Gilbert Atkinson (1974), who coined the term absorption, defined it as "a 'total' attention, involving a full commitment of available percep tual, motoric, imaginative and ideational resources to a unified representation of the attentional object" (1974, p. 274, italics in the original). One can certainly become "absorbed" in imagination, but one also can (and more usually does) become "absorbed" in perception of the external world, such as reading a book, watching a movie, or 130 JOURNAL OF NEAR-DEATH STUDIES

listening to a conversation so intently that one does not perceive other things in the environment. An adaptive advantage of absorption is that it "allows for the full commitment of attention to activity and a reduction in distractibility and self-consciousness and may, therefore, enhance performance in skilled activities (such as sports or perform ing) or enhance the flow of creativity" (Butler, 2006, p. 56). Thus the moderate association of NDEs with dissociation and absorption does not by any means imply that NDE content is based on imagination. Related to dissociation and absorption is fantasy proneness, characterized by frequent and vivid fantasies and even hallucinations, intensely vivid sensory experiences, and eidetic imagery (Wilson and Barber, 1981, 1983). In noting the (again, moderate) association between NDEs and a fantasy-proneness, Augustine highlights fantasy-prone individuals' "strong investment in fantasy life," but he glosses over their more intense sensory experiences, leaving the mistaken impression that fantasy-prone individuals mistake fantasy for reality - which was specifically denied by the psychologists who developed the concept (Wilson and Barber, 1983): they stated unequivocally that fantasy-prone people have as good reality-testing as anyone else. However, this is a moot point, because there is absolutely no evidence that NDErs are fantasy-prone individuals. Although NDErs do score higher than nonNDErs on standard measures of fantasy-proneness, which may suggest nothing more than that their sensory perceptions of the outside world are much more vivid than those of nonNDErs, NDErs' scores do not come anywhere near the cut-off point on those measures for designation as a "fantasy-prone personality." Augustine writes that the "hypothetical status [of dissociation] as a defense mechanism makes much more sense if OBEs and NDEs do not literally involve any form of disembodiment." But if OBEs and NDEs were truly a disembodiment, they would be even more effective in helping a victim escape from a traumatic situation than if they were mere mental illusions. That is, being able to leave one's body during the trauma would be a much more effective defense for a victim than a mere illusion of leaving the body. Thus the defensive value of dissociation argues for rather than against OBEs and NDEs representing real disembodiment. Augustine goes on to write that the correlation between OBEs and NDEs and "capacity for imaginative involvement" does not make sense if something actually leaves the body. He argues that he would BRUCE GREYSON 131 not expect psychological crises "as opposed to physiological crises alone" to trigger separation from the body. But psychological threats can be just as terrifying as physiological ones, and it makes perfect sense for a person with an unusually rich "capacity for imaginative involvement" - and therefore greater ability to foresee a potential threat - to flee the body in anticipation of trauma. Augustine notes the correlation between OBEs and habitually dreaming in a bird's-eye view or seeing oneself during dreams. He interprets this correlation as evidence that OBEs are fantasies conditioned by one's dream life, and writes that physiological models alone predict that people who can induce OBEs would have better dream control skills than spontaneous OBErs. But these correlations are also predicted by a disembodiment model: leaving the body teaches one how to visualize oneself from another perspective, making bird's eye views of oneself during dreams more likely; and repeated induction of OBEs would reinforce these dream control skills far more than occasional spontaneous OBEs. Later he argues that physiological models predict these correlations, whereas the disembodied model must struggle to accommodate them; but that conclusion reflects his enchantment with the materialist model. Someone with a different perspective might as honestly say that physiological models must struggle to accommodate these correlations that are predicted by the disembodiment model. Still later Augustine states that Susan Blackmore's theory of OBEs as perceptual distortions (Blackmore, 1993) is supported by its predictions that OBErs have better imagery skills and visuospatial skills. But the separation hypothesis also predicts that OBErs, because of the visuospatial training they receive in their OBEs, should have better imagery and visuospatial skills. Throughout this discussion, Augustine consistently interprets correlations between OBEs and psychological traits as implying a unidirectional causal effect of the psychological variables on OBEs. But it is at least as plausible that OBEs, particularly repeated or vivid ones, may lead to these psychological changes. One cannot assume causation from correlation. Almost any human experience is likely to be correlated with a host of psychological and physiological factors, because we are whole beings with integrated psychology and physiology. Certainly an experience as profound as leaving the body would have psychological effects that would manifest as correlates to psychological traits; and it is plausible that certain psychological traits 132 JOURNAL OF NEAR-DEATH STUDIES might make it easier for someone to leave the body under stress. There is no theoretical reason to link psychological correlates to a psychophysiological model in preference to a separation model. Augustine next turns to correlations between physiological condi tions of a close brush with death and features of the NDE, again drawing sweeping conclusions from rather small correlations. It is true that some features are relatively more common in NDEs from various causes, but there is no feature of NDEs in one physiological condition, such as cardiac arrest, traumatic accident, drug overdoses, respiratory arrests during surgery, and so on, that is not seen in all the others. I see no reason why these relative frequencies should count as evidence that NDEs are hallucinations. Augustine writes that "if NDEs occur when consciousness is released from the confines of the brain, then altering brain chemistry ought not to have an effect on NDE content." But all we know about NDE content is what experiencers choose to tell us about what they are able to put into words of what they can recall about their NDE content. Regardless of whether or not altered brain chemistry affects NDE content, it certainly affects one's ability to recall, understand, and verbalize, so it is not at all surprising that experiencers with altered brain chemistry report different things than experiencers without altered brain chemistry (or with differently altered brain chemistry). In other words, reports of NDEs are necessarily filtered through the brain and linguistic patterns of the experiencer, whether the actual NDE occurred when consciousness was in or out of the brain. Because altered brain chemistry affects memory and linguistic facility, its influence on NDE reports tells us nothing about the cause of the NDE itself.

Is the Temporal Lobe Implicated in OBEs?

Augustine writes that "a preponderance of the evidence ... implicates the temporal lobe in the production of NDEs," including electrical stimulation studies of the temporal lobe and observations of patients with temporal lobe seizures. In fact, most of that evidence does not involve coherent NDE-like experiences but rather fragmen tary bits of music or singing, seeing isolated and repetitive scenes that seemed familiar, hearing voices, experiencing fear or other negative emotions, or seeing bizarre imagery that was often described as dream-like, distorted experiences quite unlike NDEs (Gloor, 1990; BRUCE GREYSON 133

Gloor, Olivier, Quesney, Andermann, and Horowitz, 1982; Penfield, 1955; Penfield and Perot, 1963, pp. 611-665). Neuropsychiatrist Peter Fenwick concluded that "abnormal discharges in the temporal lobe may produce confusional fragments of phenomena sometimes seen in NDEs. ... This is a very long way from arguing that seizure discharges in those areas, resulting from brain catastrophe, can give rise to the clearly remembered, highly structured NDE (Fenwick, 1997, p. 48). Electrical stimulation studies have produced not OBEs but rather trivial optical illusions whose experiencers do not believe themselves to have left their bodies. Despite these experiences being labeled by some researchers as OBEs, they are not. For example, in a recent report of the purported induction an out-of-body experience by brain stimulation, the single subject reported only a sensation as of "her body falling/drifting side wards and even out of the chair" (Schutter, Kammers, Enter, and Van Honk, 2006, p. 240). This illusion of the body moving has no relevance to out-of-body experiences, despite the authors' claims to have induced an OBE. Augustine, to his credit, acknowledges that these electrically stimulated illusions are "clearly distinct from" spontaneous OBEs. Certainly they are not experienced as the same: subjects in electrical stimulation experiments describe what they thought was an illusion that felt as if they were out of their bodies (or, more commonly, "half in and half out"), but they did not believe they actually were; whereas NDErs describe what they thought was a real experience of actually being separate from the physical body. Electrical stimulation at most produces only a sense of perception of things visible from the physical position of the individual's eyes, and those perceptions disappear when the eyes are closed or the person loses consciousness. Electrical brain stimulation has never produced accurate perception of anything not visible to the physical eyes, or that persists when the eyes are closed, or that is from an out-of-body perspective - all typical features of spontaneous OBEs (Giesler Petersen, in press; Holden, Long, and MacLurg, 2006). Despite Augustine's acknowledgment that the electrically-induced illusion "lacks the realism, continuity, and stability characteristic of spontaneous OBEs," he is not ready to concede that they are different phenomena. He offers as one hypothesis that electrically induced bodily illusions and spontaneous OBEs may be variants or "different parts of a single complex neural mechanism of generating OBEs." This is in principle a plausible hypothesis, but without specifying what that 134 JOURNAL OF NEAR-DEATH STUDIES

"single complex neural mechanism" might be is it an unfalsifiable hypothesis, and therefore of no scientific interest. We may someday uncover evidence suggesting that electrically induced bodily illusions and spontaneous OBEs are variants of the same phenomenon, but at present there is no evidence to suggest that these vastly different experiences are any more alike than, for example, reading a news report about war and actually participating in combat. Both experiences might provoke common emotional reactions and activate common brain sites, but they are clearly not variants of the same experience or "parts of a single complex neural mechanism." Though we might use some of the same terms to describe reading about war and participating in combat, they would differ markedly in the attribution of "reality" to the experience and in their (particularly long-term) after-effects. Augustine notes that it is not unheard of for patients to report some features of NDE during their seizures. However, the vast majority of patients with seizures do not experience any of these features. In fact, most patients with temporal lobe epilepsy also have no memory afterward for what happened during a seizure (Fenwick, 1997). Epilepsy specialist Ernst Rodin, who favors a neurological explanation of NDEs, acknowledged bluntly: "In spite of having seen hundreds of patients with temporal lobe seizures during three decades of professional life, I have never come across that symptomatology [of NDEs] as part of a seizure" (1989, p. 256). In the prospective study that Augustine cited (Devinsky, Feldmann, Burrowes, and Bromfield, 1989), only 6 percent of seizure patients described any body image anomalies, let alone OBEs. Furthermore, although these patients had suffered numerous seizures, often over a period of many years, the majority who described body image anomalies reported only one such experience. These findings suggest that localized abnormal activity in the brain is not only not necessary, but also not in general sufficient to produce an OBE (Kelly, Greyson, and Kelly, 2006). Even if the temporal lobe were shown to be implicated in NDEs (which is far from established), it is not plausible that that part of the brain is producing them. This is because both seizure activity and direct electrical stimulation typically disrupt whatever patterns of neuroelectric activity would otherwise be going on in that part of the brain. Electrical stimulation and seizures are not like physiological electrical activity and do not result simply in a localized "activation" of the stimulated region. As Wilder Penfield (1975), the neurosurgeon BRUCE GREYSON 135

who first mapped brain regions by stimulating the brain, clearly recognized, the predominant effects of electrical stimulation are disruption of electrical activity in the immediate vicinity of the electrode, accompanied by abnormal patterns of discharge into additional brain areas to which the stimulated cortex itself is linked. The net result of electrical stimulation and with epileptic seizures is a poorly controlled, poorly characterized, and spatially widespread pattern of abnormal electrical activity. In other words, seizure activity and direct electrical stimulation might explain the failure of normal perceptual integration, but not the production of coherent experiences such as NDEs (Kelly, Greyson, and Kelly, 2006). Electrical stimulation or abnormal electrical discharges in the brain cannot account for complex perception or thought because those disruptions in brain functioning would ordinarily abolish consciousness. This much was acknowledged by the very neurosurgery team Augustine cited, who called consciousness during seizures a "paradox" and "an unresolved problem" (Devinsky, Feldmann, Burrowes, and Bromfield, 1989, pp. 1087-1088). A more problematic distinction between electrically induced bodily illusions and spontaneous OBEs that challenges the claim that they comparable is that some OBEs include corroborated reports of perception of events at a distance. In many of these cases the events in question included unlikely and unexpected details that had been verified as having occurred, and the experience had been reported to someone else before that verification occurred. The evidence for accurate OBE perception has already been discussed at length in these pages by Augustine (2007a) and the commentaries that followed his article, and need not be repeated here. Suffice it to say that the evidence is not strong enough to compel belief in veridical OBE perception, yet it is too strong to be swept under the rug as "misperception" without any evidence for that unfalsifiable hypothesis. Augustine protested in his previous article that "very few cases of 'veridical perception' during NDEs have been corroborated" (2007a, p. 204). But when Janice Holden (2007) pointed out that Augustine was focusing on only the rare NDEs that contained apparent hallucinatory features, he countered that the presence of even one hallucinatory feature would be enough to prove his point: "What is problematic for a survivalist interpretation is not the frequency of such NDEs, but that they occur at all" (2007b, p. 59, italics in the original). By that same line of reasoning, what is problematic for a hallucinatory 136 JOURNAL OF NEAR-DEATH STUDIES

interpretation of NDEs is not the frequency of veridical out-of-body perception, but that they occur at all. In fact, Holden (2007) found that veridical OBE perception was not rare: more than a third of the published cases of accurate OBE perception in NDEs were corrobo rated by independent, objective sources. In discussing the EEG study of NDErs by Willoughby Britton and Richard Bootzin (2004), Augustine notes that NDErs were four times as likely to have "temporal lobe epileptiform EEG activity" during sleep as were nonNDErs. What Britton and Bootzin actually reported was that "No clinically significant seizure activity (EEG or tonic-clonic posturing) was observed in either group" (Britton and Bootzin, 2004, p. 255). They did find indirect suggestion of subclinical temporal lobe activity that was not suggestive of seizures in 22 percent of NDErs and only 5 percent of nonNDErs. If this subclinical activity in the temporal lobe, which has absolutely no clinical significance, was involved in producing NDEs, why was it absent in three-fourths of the NDErs? The NDErs in this study had better positive coping skills than the nonNDErs, but the groups did not differ on maladaptive stress responses, suggesting that whatever differentiated the NDErs from the nonNDErs was an enhanced function rather than a dysfunction. Augustine also notes that NDErs as a group scored higher on a measure of "epileptic signs typical of temporal lobe activity," but the concept of whether there are "epileptic signs typical of temporal lobe activity" remains controversial after centuries of conflicting anecdotal observations (Shetty and Trimble, 1997). Studies of personality traits of epileptic patients have been plagued by methodological problems associated with diagnostic uncertainties and difficulties operationaliz ing some of the purported psychophysiological correlates of temporal lobe epilepsy. It appears likely that patients who have right temporal lobe seizures do differ from others in certain ways, and a list of the character traits included in standard measures of a "temporal lobe personality" includes many features common among near-death experiencers. Temporal lobe epileptics and NDErs, for example, are both reported to have deeper emotions, elation, increased moral sensitivity, a sense of personal destiny, desire to write detailed notes and even books, deep religious beliefs, and interest in philosophical issues. But that common association does not necessarily mean that NDErs are happy, interested in spirituality and philosophy, feel a sense of destiny and want to write about it because their right temporal lobes BRUCE GREYSON 137 have been damaged. There are other, more obvious reasons for a person who has had a profound mystical experience to feel deep emotions, elation, and deep religious and philosophical beliefs. As an analogy, if one stays up all night, one is likely to be tired and confused the next day, with difficulty thinking and speaking clearly. The fact that those symptoms may also be associated with alcohol intoxication does not make us suspect the sleep-deprived person of having imbibed; the sleep deprivation itself is sufficient explanation. The fact that temporal lobe dysfunction can mimic (a few of) the psychospiritual effects of NDEs does not imply that the experiencer has damaged temporal lobes; the experience itself is sufficient explanation. There is a tautological character to the argument that defines certain NDE features and aftereffects as epileptic signs (or hallucinations or dissociative symptoms) and then presents the same NDE features and aftereffects as evidence that experiencers are unreliable witnesses because they have epilepsy (or hallucinate or dissociate).

Cultural Differences

Prior beliefs do influence reports of near-death experiences. The life review and tunnel sensation, for example, are common in some cultures but rare in others (Kellehear, 1993). Such cultural differences lend support to the view that the specific content of NDEs can be colored by the sociocultural context in which they occur. Other data, however, do not support the expectation theory. People who had no prior knowledge about NDEs have described the same kinds of experiences and features as have people who were more familiar with the phenomenon (Greyson, 1991; Greyson and Steven son, 1980; Ring, 1980; Sabom, 1982). And as Augustine notes, there is ample evidence from a variety of sources that experiences that were reported before 1975, when Raymond Moody's first book coined the term NDE and made it a well-known phenomenon, do not differ from those that occurred after that date. Augustine suggests that when NDE imagery contradicts personal and cultural beliefs, they can be explained as being influenced by subconscious expectations of which the experiencer is unaware. As a clinical psychiatrist, I am well aware of the influence of subconscious processes on perception. However, subconscious expectations are not "Get Out of Jail Free" cards that can be invoked at any time to avoid facing inconvenient facts. If the existence of a subconscious expecta- 138 JOURNAL OF NEAR-DEATH STUDIES

tion is not supported by independent evidence, then it has no more explanatory power than any other unfalsifiable hypothesis, such as divine intervention or fraud. Augustine does raise legitimate questions about the role of prior beliefs on NDEs of children and of nonWestern experiencers, questions whose importance researchers have underestimated. But raising these questions is not tantamount to answering them. Augustine's cogent critique of the evidence demonstrates that "prototypical" Western NDE features are not universal across cultures; but it does not demonstrate that NDE features are determined by expectation. The crosscultural differences observed are consistent with the hypothesis that expectation influences the core experience, but also with the hypothesis that expectation influences how people interpret what they have experienced. This is not a new argument: two decades ago researchers recognized that any underlying core experience, if indeed there is one, is "inevitably cast in the images, concepts and symbols available to the individual" (Roberts and Owen, 1988, p. 611; see also Knoblauch, Schmied, and Schnettler, 2001). Augustine argues that we should take experiencers' descriptions as literal descriptions of what they encountered and not consider the effect of belief on interpretation of experiences: "The most straight forward reason why different NDErs would describe their experiences in different ways is because they actually have very different experiences. ... [D]ifferent people would naturally be expected to report similar experiences if they were traveling to the same afterlife environment" (italics in the original). I do not share Augustine's expectation that people with different backgrounds and interests would "naturally" report the same things. The varying terminology and crosscultural differences in NDE accounts may argue against a physiological explanation for NDEs, but they do not discredit the reality of the experiences. Individual differences in cultural expectations influence our perceptions of the physical world; why should we expect them not to influence our perceptions of a transcendental dimension, if one exists - particularly when the NDErs report, as many do, that what they experienced was ineffable? As an analogy, imagine that three of your acquaintances describe to you their alleged visit to a place they call "France." One, a hedonistic gourmand, details the sumptuous meals she enjoyed, but does not mention architecture or people. The second, a religious artist, BRUCE GREYSON 139 describes in detail the magnificent cathedrals with their paintings and stained glass windows, but does not mention food or people. The third, a high-powered businessman, rails about the rude taxi drivers and street merchants, but does not mention food or architecture. Their descriptions of their purported visits to a place called "France" have little in common; furthermore, their "perceptions" of "France" largely conform to their expectations and their interests. Do you assume therefore that their visits to "France" took place only in their imaginations, and that no such realm actually exists? I agree with Augustine that we are not justified in assuming that diverse NDE descriptions are different ways of describing the same locale, just as we have no reason to assume that these three travelers actually visited the same country they call "France." But we are also not justified in using the discrepancies as evidence that the NDE world does not exist, any more than we can use our travelers' varied accounts as evidence that "France" does not exist. The variations in description are evidence of differences in perception, but do not by themselves allow us to make judgments about what was perceived.

The Real Challenge

Although we may eventually find that physiological, psychological, and sociocultural factors interact in complicated ways in conjunction with NDEs, theories proposed thus far consist largely of unsupported speculations about what might be happening during an NDE. None of the proposed neurophysiological mechanisms have been shown to occur in NDEs. The most important objection to current psychophysiological theories is that mental clarity, vivid sensory imagery, a clear memory of the experience, and a conviction that the experience seemed more real than ordinary consciousness are the norm for NDEs, even when they occur under conditions of drastically altered cerebral physiology. As Sam Parnia and Peter Fenwick pointed out, "any acute alteration in cerebral physiology such as occurring in hypoxia, hypercarbia, metabolic, and drug induced disturbances and seizures leads to disorganised and compromised cerebral function ... [and] impaired attention," whereas "NDEs in cardiac arrest are clearly not confu sional and in fact indicate heightened awareness, attention and consciousness at a time when consciousness and memory formation would not be expected to occur" (2002, p. 8). Moreover, experiencers of 140 JOURNAL OF NEAR-DEATH STUDIES

NDEs in connection with cardiac arrest almost invariably retain vivid memories of their experience that change little with the passage of time (van Lommel, van Wees, Meyers, and Elfferich, 2001), despite the fact that memory under such conditions is ordinarily seriously impaired. The challenge for explanatory models of NDEs is to take into account the vivid and complex thinking, sensations, and memory formation under conditions in which current neuroscientific models of the mind deem them impossible, such as under general anesthesia and in cardiac arrest (Kelly, Greyson, and Kelly, 2006). This continuation and even enhancement of mental functioning at a time when the brain is physiologically impaired present problems for the mind-brain identity model. Only when researchers approach the study of NDEs with this paradox firmly in mind will we progress in our understand ing of NDEs beyond tenuous and untestable neuroscientific conjectures. Augustine argues that a scientific explanation of NDEs must be considered in the context of a scientific explanation of all human experience. He believes that we have good evidence for hallucinations, but that we do not have such evidence for the separation of mind from brain, and that therefore it would be more parsimonious to view NDEs as hallucinations than as instances of mind-brain separation. I agree that NDEs should be evaluated in a larger context of human experiences rather than as isolated events. But there is in fact an enormous body of scientific evidence for mind-brain separation from other phenomena, encompassing data related to placebo responses, stigmata, hypnotic suggestion, memory, automatisms, multiple personalities, creative genius, mystical experience, and acquisition of information unavailable to the physical senses (Kelly, Kelly, Crabtree, Gauld, Grosso, and Greyson, 2006; Radin, 1997). In the context of this wealth of other evidence, it becomes quite parsimonious to consider NDEs as one more example of separation of mind from brain. Without exception, every report of a large study of NDEs published in a mainstream medical journal has concluded that these phenomena cannot be explained as hallucinations. Such unanimity among scientific researchers is unusual and should tell us something. Why is it that scientists who have done the most near-death research believe the mind is not exclusively housed in the brain, whereas those who regard NDEs as hallucinations by and large have not conducted any studies of the phenomenon at all? BRUCE GREYSON 141

Augustine attributes this consensus to investigator bias: that near death research has been influenced by the researchers' beliefs. But in fact he has it backwards: the researchers' beliefs have been influenced by their consistent research findings. Most near-death researchers did not go into their investigations with a belief in mind-body separation, but came to that hypothesis based on what their research found. Indeed, Michael Sabom wrote about entering the field specifically to debunk NDE reports: When I began my study of the NDE, I was convinced that the NDE would readily be accounted for using some traditional scientific explanation. I have searched for such an explanation over the past five years and have not yet found one that is adequate. In recent years I have begin to consider another approach toward explaining the NDE, and approach which holds open the possibility that the perception of an "out-of-body" experience at the point of death may be accurate, i.e., that it somehow does occur "out-of-body." (1981, p. 46)

Conclusion

Augustine raises important questions about NDErs' expectations and personalities influencing their experiences, and about research ers' oversimplification of the concept of cultural afterlife beliefs. We would be well advised to attend to these criticisms, to review our methodology, and to seek collaboration with researchers who hold conflicting perspectives. In sum, Augustine has provided a legitimate and cogent critique of near-death research, exposing weaknesses in our methodology, paucity of our data, and gaps in our arguments. For that I thank him. But the hallucinatory model he favors is supported by even fewer data than the separation model, and by speculation and innuendo rather than evidence-based argument. Augustine claims that the hallucination model of NDEs is superior because it has greater predictive power than a dualistic model. But in fact a dualistic model predicts all the psychophysiological correlates that the hallucination model does, plus the accurate perceptions that are inexplicable if NDEs are just hallucinations. The major advantage of the hallucination model is its compatibility with the materialistic worldview favored by a majority of neuroscientists (though not by a majority of physicists). The major disadvantage of the hallucination model is that it fails to account for the phenomenon, and is plausible 142 JOURNAL OF NEAR-DEATH STUDIES

only if we discredit or discount much of our data. As astronomer and spectroscopy pioneer Paul Merrill quipped, "If you eliminate the data that do not agree, the remaining data agree very well." But disregarding disagreeable data or dismissing them outright as fraud or misperception is the hallmark of pseudoscience, not science. Materialists often claim credit for the scientific advances of the past few centuries. But it is the scientific method of empirical hypothesis testing, rather than a materialistic philosophy, that has been responsible for the success of science in explaining the world. If it comes to a choice between the empirical method and a materialistic worldview, the true scientist will choose the former. Physiological models of NDEs rely on what Karl Popper (Popper and Eccles, 1977) called "promissory materialism," the position that, although we do not know enough now to explain everything in terms of materialistic models, we will some day. But although promissory materialism is a legitimate philosophical position, it is empirically unfalsifiable, and therefore not a scientific hypothesis. As neurophys iologist John Eccles, who won a Nobel Prize for his work on the synapse, summarized it: According to promissory materialism ... scientific advance will progressively restrict the phenomena that appear to require mental terms for their explanation, so that in the fullness of time everything will be describable in the materialist terms of the neurosciences. I regard this theory as being without foundation. The more we discover scientifically about the brain the more clearly do we distinguish between the brain events and the mental phenomena and the more wonderful do the mental phenomena become. Promissory materialism is simply a superstition held by dogmatic materialists. It has all the features of a Messianic prophecy, with the promise of a future freed of all problems - a kind of Nirvana for our unfortunate successors. (Eccles, 1994, p. 7)

Indeed, the materialistic lens provides so rosy a view that its proponents often overlook the perspectives offered by other lenses. Augustine presents the hallucinatory model of NDEs in opposition to a transcendental one, as if either one or the other must be true. But NDE phenomenology suggests to me that some NDE features may well be linked to physiological events, some to sociopsychological belief, and others to no known materialist cause. Indeed, many NDErs speak of having "one foot in each world," of being aware simulta neously of the physical environment (including their bodies) and also of a transcendental dimension. Is our thinking so impoverished that BRUCE GREYSON 143 we cannot imagine an experiencer dissociating awareness of the physical body out of fear, then communicating with nonmaterial entities, and then feeling pulled back into the body by feeling the surgeon's hands massaging the heart? Why must we link all NDE features to one kind of explanation? Augustine argues that parsimony requires us to choose just one model rather than two or three to explain NDEs. But a model is not preferable if it achieves parsimony only by ignoring what it cannot explain. Augustine is correct that proponents of a transcendental model of NDEs have not provided sufficient data to prove their case. But unless the internally-generated hallucination model starts to address the discomforting data from NDEs rather than ignoring them, it cannot be considered a serious alternative.

References

Augustine, K. (2007a). Does paranormal perception occur in near-death experiences? Journal of Near-Death Studies, 25, 203-244. Augustine, K. (2007b). "Near-death experiences with hallucinatory features" defended. Journal of Near-Death Studies, 26, 55-65. Blackmore, S. (1993). Dying to live: Near-death experiences. Buffalo, NY: Prometheus. Butler, L. D. (2006). Normative dissociation. Psychiatric Clinics of North America, 29, 45-62. Devinsky, 0., Feldmann, E., Burrowes, K., and Bromfield, E. (1989). Autoscopic phenomena with seizures. Archives of Neurology, 46, 1080-1088. Eccles, J. C. (1994). How the self controls its brain. Berlin, Germany: Springer-Verlag. Fenwick, P. (1997). Is the near-death experience only N-methyl-D-aspartate blocking? Journal of Near-Death Studies, 16, 43-53. Giesler-Petersen, I. (In press). Further commentary on "induced OBEs" [Letter]. Journal of Near-Death Studies, 26. Gloor, P. (1990). Experiential phenomena of temporal lobe epilepsy. Brain, 113, 1673-1694. Gloor, P., Olivier, A., Quesney, L. F., Andermann, F., and Horowitz, S. (1982). The role of the limbic system in experiential phenomena of temporal lobe epilepsy. Annals of Neurology, 12, 129-144. Greyson, B. (1991). Near-death experiences precipitated by suicide attempt: Lack of influence of psychopathology, religion, and expectations. Journal of Near-Death Studies, 9, 183-188. Greyson, B. (2000). Dissociation in people who have near-death experiences: Out of their bodies or out of their minds? Lancet, 355, 460-463. Greyson, B. (2001). Posttraumatic stress symptoms following near-death experiences. American Journal of Orthopsychiatry, 71, 358-373. Greyson, B., and Stevenson, I. (1980). The phenomenology of near-death experiences. American Journal of Psychiatry, 137, 1193-1196. Holden, J. M. (2007). More things in heaven and earth: A response to "Near-death experiences with hallucinatory features." Journal of Near-Death Studies, 26, 33-42. Holden, J. M., Long, J., and MacLurg, J. (2006). Out-of-body experiences: All in the brain? Journal of Near-Death Studies, 25, 99-107. 144 JOURNAL OF NEAR-DEATH STUDIES

Kellehear, A. (1993). Culture, biology, and the near-death experience: A reappraisal. Journal of Nervous and Mental Disease, 181, 148-156. Kelly, E. F., Kelly, E. W., Crabtree, A., Gauld, A., Grosso, M., and Greyson, B. (eds.). (2006). Irreducible mind: Toward a psychology for the 2 1St century (pp. 367-421). Lanham, MD: Rowman and Littlefield. Kelly, E. W., Greyson, B., and Kelly, E. F. (2006). Unusual experiences near death and related phenomena. In E. F. Kelly, E. W. Kelly, A. Crabtree, A. Gauld, M. Grosso, and

B. Greyson (eds.), Irreducible mind: Toward a psychology for the 2 1 St century (pp. 367-421). Lanham, MD: Rowman and Littlefield. Knoblauch, H., Schmied, I., and Schnettler, B. (2001). Different kinds of near-death experiences: A report on a survey of near-death experiences in Germany. Journal of Near-Death Studies, 20, 15-29. Ludwig, A. M. (1966). Altered states of consciousness. Archives of General Psychiatry, 15, 225-234. Ludwig, A. M., and Lyle, W. H. (1964). Tension induction and the hyper-alert trance. Journal of Abnormal and Social Psychology, 69, 70-76. Moody, R. A. (1975). Life after life. Covington, GA: Mockingbird Books. Parnia, S., and Fenwick, P. (2002). Near death experiences in cardiac arrest: Visions of a dying brain or visions of a new science of consciousness. Resuscitation, 52, 5-11. Penfield, W. (1955). The role of the temporal cortex in certain psychical phenomena. Journal of Mental Science, 101, 451-465. Penfield, W. (1975). The mystery of the mind: A critical study of consciousness and the human brain. Princeton, NJ: Princeton University Press. Penfield, W., and Perot, P. (1963). The brain's record of auditory and visual experience: A final discussion and summary. Brain, 86, 595-696. Pica, M., and Beere, D. (1995). Dissociation during positive situations. Dissociation, 8, 241-246. Popper, K. R., and Eccles, J. C. (1977). The self and its brain. Berlin, Germany: Springer. Radin, D. (1997). The conscious universe: The scientific truth of psychic phenomena. San Francisco, CA: HarperEdge. Ring, K. (1980). Life at death:A scientific investigation of the near-death experience. New York: Coward, McCann and Geoghegan. Ring, K., and Rosing, C. J. (1990). The Omega Project: An empirical study of the NDE prone personality. Journal of Near-Death Studies, 8, 211-239. Roberts, G., and Owen, J. (1988). The near-death experience. British Journal of Psychiatry, 153, 607-617. Rodin, E. (1989). Comments on "A neurobiological model for near-death experiences." Journal of Near-Death Studies, 7, 255-259. Sabom, M. (1981). The near-death experience: Myth or reality? A methodological approach. Anabiosis: The Journal of Near-Death Studies, 1, 44-56. Sabom, M. (1982). Recollections of death:A medical investigation. New York: Harper and Row. Schutter, D. J. L. G., Kammers, M. P. M., Enter, D., and Van Honk, J. (2006). A case of illusory own-body perceptions after transcranial magnetic simulation of the cerebellum. Cerebellum, 5, 238-240. Shetty, T., and Trimble, M. (1997). The Bear Fedio Inventory: Twenty years on. Journal of Epilepsy, 10, 254-262. Tellegen, A., and Atkinson, G. (1974). Openness to absorbing and self-altering experiences ("absorption"), a trait related to hypnotic susceptibility. Journal of Abnormal Psychology, 83, 268-277. van Lommel, P., van Wees, R., Meyers, V., and Elfferich, I. (2001). Near-death experiences in survivors of cardiac arrest: A prospective study in the Netherlands. Lancet, 358, 2039-2045. BRUCE GREYSON 145

Wilson, S. C., and Barber, T. X. (1981). Vivid fantasy and hallucinatory abilities in the life histories of excellent hypnotic subjects ("somnambules"): Preliminary report with female subjects. In E. Klinger (ed.), Imagery. Vol. 2: Concepts, results, and applications (pp. 133-149). New York: Plenum. Wilson, S. C., and Barber, T. X. (1983). The fantasy-prone personality: Implications for understanding imagery, hypnosis, and parapsychological phenomena. In A. A. Sheikh (ed.), Imagery: Current theory, research, and application (pp. 340-390). New York: Wiley.

Culture and the Near-Death Experience: Comments on Keith Augustine's "Psychophysiological and Cultural Correlates Undermining a Survivalist Interpretation of Near-Death Experiences"

Allan Kellehear, Ph.D. University of Bath, UK

ABSTRACT: This paper is a sociological commentary on the leading paper by Keith Augustine. It discusses the relationship between social expectations and culture as well as extending the discussion about the possibility that near death experiences may not be a singular entity. I suggest there are sound grounds for developing a typology of experiences that have different and or overlapping causes and phenomenology.

KEY WORDS: near-death experiences; cultural variation; sociology; typolo gies; social expectations.

Keith Augustine's arguments in favor of physiological explanations of the near-death experience (NDE) are a strong, critical, and welcome addition to the ongoing debate about how to explain NDEs. His philosophical position is obviously empirical and material but it is also largely inclusive; he does not foreclose, much less dismiss, the possibility that NDEs may suggest survival possibilities even if he does believe these unlikely and remote. And he is right to point out the overstated and uncritical literature coming from New Age writers and

Allan Kellehear, Ph.D., is Professor of Sociology at the University of Bath, Bath, UK. Requests for reprints should be addressed to Professor Allan Kellehear, Centre for Death and Society, Department of Social and Policy Sciences, University of Bath, Bath BA2 7AY, United Kingdom; e-mail: [email protected].

Journal of Near-Death Studies, 26(2), Winter 2007 2007 LANDS 147 148 JOURNAL OF NEAR-DEATH STUDIES

their sympathizers, some of whom cloak their bias in academic credentials and affiliations. There is a longstanding tension between the skeptics and the credulous, and reading their respective exaggerated interpretations of the data is both tiresome and more than a little annoying. I welcome several of his arguments and insights: for example, his rejection of the continually recycled sociological myth that children somehow escape from cultural conditioning and so represent socially "uncontaminated" NDEs. This is untrue, and can never be true, for experiences cannot be understood separate from the language that describes them, at the time, or retrospectively as in the cases of childhood NDEs. I also welcome Augustine's insistence on our continuing pursuit of precise physiological explanations for the NDE, for clearly, NDEs must have at least physiological correlates and prompts. Why should NDEs be exempt when attachment, grief, depression, anxiety, smiles, and exhilaration are not? But social and psychological experiences such as happiness, bereavement, or mystical experiences are not exhausted by their physiological underpinnings because we are also aware of the role culture plays in shaping, prompting, or moderating both physiological and even pharmacolog ical processes. Some have long suggested - from religious studies, theology, and even some quarters of psychiatry and psychology - that supernatural factors may further shape, prompt, or moderate the social and psychological factors. The modern debate is always about the mix of influences, and sometimes their validity, particularly for supernatural factors. But the debates are always useful to have, all sides modifying, tightening, or strengthening their respective arguments, usually around the same pool of evidence. That situation, as unfashionable as it sounds, is called "scholarship" and it is this very stuff that takes all good scientific thinking forward. I think Augustine's arguments serve us well here. I agree with Augustine when he remarks that "our best evidence shows that regardless of how NDEs are ultimately explained, a survivalist explanation will not do," but I would hasten to add "will not do alone." No doubt other commentators will address the medical aspects of Augustine's arguments, so I will confine my remaining remarks to his reanalysis of the cultural data on NDEs. First of all, I think Augustine minimizes both the differences between features of the NDE in general and those we might predict from social expectation. For example, ALLAN KELLEHEAR 149

Augustine argues that "afterlife vistas ... - aside from being a better place to live - appear exactly like the world of the living." This is not true. Many NDErs report colors they have not seen on Earth, or androgynous supernatural figures they would not expect to see, especially in a "religious figure" in Western NDEs. Melanesian NDErs would not expect to see the "floating" suspended-in-the-air huts reported in their NDEs or be expecting to fly to see relatives in America. One of the consistently reported "features" of the NDE is its ineffable nature. This refers to common difficulties in putting into meaningful words the colors, sounds, knowledge, or even appearances of things encountered in the NDE. In turn, this suggests strong caution in interpreting all NDEs, not the least those from nonWestern sources. The use of language cannot be separated from the recounting of experience, but the qualification that must accompany such cultural and linguistic analyses is that we might be dealing with major problems of internal reliability and validity as each NDEr struggles to throw words at unfamiliar experiences and sensations - the very opposite of the theoretical problem of social expectations. Nevertheless, encountering supernatural and deceased beings, otherworld vistas, and perhaps a darkness, do seem to be crosscultural features associated with NDEs. Yes, these are general, and they are what you would expect from people claiming some sort of encounter with death or dying. But that observation does not lessen their significance or validity. People expect to be happy on their wedding day, and indeed most probably are, and although this fact plays an important role in the "reality" of the happiness, it does not create the events in question. Clearly, expectation has a role to play in NDEs as in experiences at weddings, but just as clearly there are many personal and public experiences at weddings and during NDEs that are unexpected. I think Augustine actually argued this very point elsewhere, but he did not always hold this more nuanced view consistently. Often Augustine equates culture with expectation, and where expectation does not oblige, he suggests physiological influence. Like Augustine, I think the unexpected events, experience, and features of NDE are as crucial to any broad, eventual explanation as those attributed to expectation, but we need to be careful not to be too literal here. For example, Augustine rejects my linking NDE imagery with childhood stories as being a bit far-fetched. If I were making that link 150 JOURNAL OF NEAR-DEATH STUDIES literally I would agree. However, my purpose in making that connection was to demonstrate, through one example, how socializa tion of identity can occur quite early in human development (through children's stories) but also how those stories and countless others in adult literature and other media are reflected in a consistent style of interpreting our world in terms of rebirth, trial, survival, and transformation. These longstanding storylines in myth, legend, and modern literature may play an important role in how NDEs are structured as accounts of unexpected journeys and equally unexpected returns. In these ways, the interpretive structure, if not the content, of NDE narratives may be attributable, in part, to those broader cultural influences. Alice in Wonderland (Carroll, 1865) does not account for NDE motifs; please give me some credit for a wider reading of cultural influences and NDEs! Augustine writes that "there is no reason to assume that different NDErs are simply using different labels to describe the same experience," but there is in fact a reason. People often use different labels to describe the same experience - and not only different labels but also different stories in describing the same experience. For some people too much is not enough; for others "not enough" is too much. A sexual encounter between two adults at an office party might be described by one of these persons as a one-night stand, but by the other as a rape. If such differences in language and storyline did not regularly emerge from human beings we would have no use for courts and their trials and juries, semiotic traditions in literature, or psychoanalysis or counseling. Experience alone does not predict the story that will emerge from it because different interpretations, personalities, and social and cultural backgrounds will mediate, some even say help "construct" or "re-make" the experience itself. These remarks notwithstanding, I nevertheless agree with Augus tine that some NDErs may actually be having very different experiences. But clearly there are limits to how literal we should take NDE accounts. Augustine argues that instead of saying NDErs are encountering the same thing but labeling it differently, perhaps we should "take each at his word instead of assuming that both are encountering the same darkness in order to fit our artificial NDE models." This is an important point to hold, but not eternally. Augustine wants us to agree to this only for a limited time, just for individual features of NDE as described by the NDEr. If we were to take our NDErs on their word overall we would be compelled to accept ALLAN KELLEHEAR 151 their own oft-heard conclusion that NDEs are a glimpse of the afterlife, obviously not a conclusion Augustine wants us to embrace! However, there may indeed be an actual diversity of NDE features, but I do not believe that diversity of NDEs of itself makes the arguments for survival, for whoever wants to make them, less convincing. Perhaps there really are several "otherworlds"; there are several "worlds" here, so why not there? Even Augustine himself accepts this in principle, admitting later in his article that "It is entirely possible that an afterlife exists but that NDEs are not glimpses of it - a view similar to the Buddhist belief that the dying pass through several illusory bardo states generated by their own minds before entering the 'real' afterlife (Fox, 2003)." This brings me to what I believe is Augustine's most important positive contribution in his reflections about culture and NDEs. Augustine moves backwards and forwards over a complex and diverse terrain where, on the one hand, he is trying to emphasize the methodological implications of crosscultural differences and Western similarity, whereas on the other hand, he struggles to be theoretically inclusive, attempting to bring all this diversity under one multifaceted rubric of biopsychosocial explanation. This evenhanded attempt is both the strength and provocative nature of his contribution. This is not a reductionistic strategy, at least in my eyes. But it fails to convince me, because he brings multiple explanations to service what he seems often to imply is a singular entity. But what if we are not dealing with a single entity? I think, and Augustine's analysis might equally suggest, that we may actually be dealing not with one NDE, but many. Perhaps we are not, nor ever have been, talking about one type of NDE (or OBE) but rather several types of NDE. Some NDEs may indeed be outright hallucinations, some may have hallucinatory elements, and some may not fit these models at all, calling up instead other models of consciousness or even religious experience. Some years ago I was impressed at the recounting of a so-called "NDE" by the eminent philosopher A. J. Ayer. For my admittedly rather academic familiarity with the medical literature on hallucina tions and delusions, the phenomenology of this "NDE" had all the features one would expect from a hallucination. Rising levels of uremic toxicity in the bloodstream commonly associated with renal failure often create frightening or morbidly dark images, and Ayers had suffered both at the time. Other NDE reports are so vague and general 152 JOURNAL OF NEAR-DEATH STUDIES that it is equally possible to entertain both simple psychophysiological explanations and mystical ones; there is simply insufficient detail to argue the toss. Yet other individual cases of NDEs do seem to suggest more. Some cases, for example, impress with empirical knowledge of events and actions that took place while the experiencer was unconscious. These cases suggest dissociative phenomena beyond simple internally generated imagery, and may even suggest new models of perception for the unconscious person that we are only just beginning to understand. Sometimes it is more incredible to believe the patchy reductionistic explanations for why people know things they should not when unconscious than to simply take them "at their word," to take Augustine's ironic advice, and work from there. Augustine's suggestions for the two important directions for future sociological research are absolutely correct. We do need to search for more compelling links between NDE motifs and cultural sources and we need more nonWestern NDEs with larger sample sizes. He is also right to warn us against the all-too-common tendency to polarize each other over extreme and overstated arguments about the NDE. Serious research into NDEs resembles serious research everywhere: it is methodological diverse and epistemologically inclusive, or at the very least, epistemologically tolerant. No one researching the human immunodeficiency virus (HIV) seriously believes that an understand ing and medical solution to the problem of acquired immune deficiency syndrome (AIDS) is found exclusively in studying the virus. Yes, the bench science study of the virus "causing" AIDS is essential; but those facts will neither help us stop its spread nor administer its cure when and if we ever find one. The public health science of AIDS is to recognize the absolutely crucial role of sexual and drug-using behaviors and attitudes as well as those generated by poverty in places such as Africa or Southeast Asia. Multiple frames of analyses are critical in understanding human behavior, and those who choose to dismiss other ways of seeing strengthen their gaze at the cost of narrowing and decontextualizing it. There must be a biological mechanism for NDEs. Whether all NDEs are to be understood only in these terms will depend on an evolving understanding of its possible typology. The credibility of any evolving typology will depend on how sensitive we are to the different internal psychological and cultural subtleties that are inevitably associated with all altered state of consciousness. The ultimate inclusiveness of these patterns - whether these will privilege only bodily, psycholog- ALLAN KELLEHEAR 153

ical, and cultural patterns or will recognize more to our experience than these platforms - will depend on how persuasive the empirical evidence is that could suggest something more. Until that time we are left largely with arguments, and Augustine's contribution has been a helpful turn around this very old territory.

References

Carroll, L. [Dodgson, C. L.]. (1865). Alice's adventures in Wonderland. London, England: Macmillan.

Comment on Keith Augustine's Article

Mark Fox, Ph.D. Alister Hardy Religious Experience Research Centre, University of Wales, Lampeter

ABSTRACT: This commentary responds to Keith Augustine's article on the hallucinatory nature of near-death experiences (NDEs). It draws attention to his misreading of an important point made in my book Religion, Spirituality and the Near-Death Experience (Fox, 2003) regarding claims made by some NDErs to have traveled into outer space, reinforces the need for a thorough consideration of the epistemological complexities involved in asserting or denying a "common core" to NDEs, and ends by supporting the point made by Augustine that there is a pressing need for more crosscultural studies of the "core" phenomenon itself.

KEY WORDS: near-death experiences; cultural variation; epistemology.

Keith Augustine has done a fine job of drawing together a large amount of existing material in pursuit of his thesis that near-death experiences (NDEs) are essentially hallucinatory in nature. I am delighted that he has made use of extracts from my own work to further his case and with one possible exception - a point at which he appears to misunderstand what I was trying to argue - he has reproduced what I wrote fairly and accurately. I offer a few points in response. First, I'd like to clear up his misunderstanding of the conclusions I drew in my book about the number of persons within the Religious Experience Research Centre (RERC) Study who talked about the darkness as being "outer space."

Mark Fox, Ph.D., is a lecturer in philosophy and religious studies at Joseph Chamberlain College in Birmingham, England, and a member of the research committee of the Alister Hardy Religious Experience Research Centre at the University of Wales, Lampeter. Reprint requests should be addressed to Dr. Fox at Joseph Chamberlain College, Highgate, Birmingham, B20 9DS, England; e-mail: dillypickle72000@yahoo. co.uk.

Journal of Near-Death Studies, 26(2), Winter 2007 ® 2007 LANDS 155 156 JOURNAL OF NEAR-DEATH STUDIES

Augustine writes: "Fox skews what is actually reported by NDErs by concluding that many of his RERC respondents 'describe an encounter with some sort of darkness motif in terms seemingly suggestive of a visit to outer space,"' claiming that I seemed to assume in advance that "outer space" was a descriptor for what was really some kind of underlying, shared experience of "darkness." Thus, he writes: Fox is speaking as if he knows ahead of time what these different people have experienced. But of course assuming that these reports are describing the same thing regardless of what they actually say begs the question - for that is the very issue of contention. Fox asserts that the episode of darkness is what is encountered, but that it is being described as "space" - but how does he know it was not space that was actually encountered? Of course, he doesn't know; he just assumes.

Actually, a closer reading of my book reveals that I assumed no such thing. In fact, I was supercautious about the conclusions I drew about that particular RERC Study finding precisely because I did not want to be misunderstood about such an unusual point. Shortly after the quote that Augustine reproduces from my book, I went on to write: Clearly, any suggestion that whilst near-death or in other contexts persons - or aspects of persons - can literally leave the earth, either to view it from space, or to observe other planets, stars or galaxies from a point of view apart from it, sounds simply absurd. Yet this would appear to be what at least some persons - past and present have asserted, and it was certainly one of the most striking and unusual findings of the entire RERC study. (Fox, 2003, p. 278)

I would not have been so cautious here if I had made up my mind beforehand that it was not space that some NDErs had reported. For all I knew then, and for all I know now, it may indeed be space that NDErs "visit." I really have no idea, and I certainly agree with Augustine that we cannot assume in advance where NDErs actually go and what they actually encounter - if indeed they go to and encounter anything at all. In fact, my original caution about drawing conclusions at this point led me in my book to end the "outer space" discussion by suggesting that more cases of NDEs where journeys to outer space are described might in the future yield useful information and allow us to draw firmer conclusions about this fascinating issue. Apart from that one small gripe, I feel that Augustine has used my work fairly and accurately. I was a little surprised that he did not consider the epistemological complexities surrounding the issue of whether or not there is any kind of "common core" to Western NDE MARK FOX 157 reports. It is a crucial area, and one well-explored within philosophical theology, as I attempted to show in chapter three of my book. Augustine does not really engage with this at all. If he had, he might have found himself - as I did - drawn to the very real possibility that a common core is at least philosophically permissible, even though it may not be supported crossculturally. In my next book I devote a chapter to an exploration of a small but significant number of cases that I found in the RERC archive of persons having NDEs and submitting them to the archive before the publication of Moody's 1975 Life After Life (Fox, 2008). I had not uncovered these when I produced the original RERC study, and sure enough they contain the very core motifs of episodes of darkness, light, encounters with others, and out-of-body experiences that came to dominate NDE model building in the post-Moody era. Augustine may be right in asserting that we do not find that core crossculturally. But we certainly do in the West, and it cannot be accounted for wholly in terms of culturally produced expectations of what dying and death might be like. As things stand, Augustine is left in a bit of a bind. He has to acknowledge that there is a degree of consistency in Western reports of near-death experiences: the sheer weight of evidence demands that he does this. On the other hand, his analysis of existing crosscultural data leads him to the conclusion that the majority of elements of the Western "core" NDE are missing in nonWestern accounts. He pleads, rightly, for more anthropological studies of NDEs in a greater variety of nonWestern cultures with larger sample sizes. I look forward to the emergence of such studies, which may yet yield evidence that there is more commonality between and across cultures than existing studies have so far shown.

References

Fox, M. (2003). Religion, spirituality and the near-death experience. London, England: Routledge. Fox, M. (2008). Spiritual encounters with unusual light phenomena: Lightforms. Cardiff, Wales: University of Wales Press. Moody, R. A. (1975). Life after life. Covington, GA: Mockingbird Books.

Commentary on Keith Augustine's Paper

Harvey J. Irwin, Ph.D. University of New England, Armidale, Australia

ABSTRACT: Keith Augustine has provided a useful survey of the psycholog ical and neurological correlates of near-death experiences and out-of-body experiences. The empirical findings he cites may prove awkward to accommodate under current separationist accounts of these experiences, although proponents of the separationist approach may be able to refine their theories so as to enhance their predictive power in this regard.

KEY WORDS: near-death experiences; mind-body models; psychological correlates; cultural variation.

Keith Augustine offers a reasonably broad review of the psycholog ical and neurological correlates of near-death experiences (NDEs) and out-of-body experiences (OBEs). I commend him in this endeavor for resisting the common skeptical construction of these data in pathological terms; currently available evidence certainly does not justify the universal pathologizing either of these experiences or of the people who have them. By the same token Augustine might usefully have analyzed also the empirical findings of studies that have sought to investigate specifically pathological psychological characteristics as potential correlates (for example, Dalton, Zingrone, and Alvarado, 1998-99; Greyson, 2000; Irwin, 2000). The paper also concedes that the literature on psychological correlates does not actually disconfirm the separationist account of NDEs and OBEs, the hypothesis that mind may actually separate

Harvey J. Irwin, Ph.D., is a Research Fellow in the School of Psychology at the University of New England. Reprint requests should be addressed to Dr. Irwin at the School of Psychology, University of New England, Armidale NSW 2351, Australia; e-mail: [email protected].

Journal of Near-Death Studies, 26(2), Winter 2007 2007 LANDS 159 160 JOURNAL OF NEAR-DEATH STUDIES

from the body during such experiences. Nonetheless Augustine argues strongly that the separationist view does not anticipate these correlations and at best could accommodate them only by contorted rationalization after the fact. This argument is constructive in signaling to proponents of the separationist approach that their theories must be formulated not simply in terms of "something left the physical body" but also in relation to what is held to be happening neurologically and psychologically to the experiencer during this circumstance. Refinement of the separationist approach along these lines is essential to the fundamental scientific requirement of devising a theory with substantial predictive power. At the same time, in weighing the potency of Augustine's criticism of separationist theories one must also be cognizant of the fact that most of the available evidence attests not to correlates of the occurrence of these experiences as such but to correlates of the report of the experiences. This point potentially undermines Augustine's rhetorical challenge, "Why would people with certain psychological characteris tics have a greater ability to leave the body?" Thus, even under a separationist view it could well be argued there may be something psychologically or neurologically distinctive about people who are willing to acknowledge having had such an anomalous experience as an NDE or OBE. I certainly would not argue that this alternative is likely to be the most efficacious account of the empirical findings, but neither am I persuaded by Augustine's imputation that the data for psychological correlates are irrevocably inconvenient for the separa tionist approach. Augustine's review also provides a useful service in collating studies that suggest the diversity of NDEs both within and across cultures, and his call for further, more extensive investigations of NDEs in nonWestern cultures surely is laudable. Again, however, he seems to be overstating his case in asserting that advocates of the separationist view have a vested interest in seeking to demonstrate that NDEs are fundamentally thematically homogeneous across all experiencers because there can be only one "afterlife reality." Regardless of their ultimate theoretical inferences, most contemporary scientific re searchers of NDEs and OBEs strike me as being relatively objective in their efforts to identify the nature and the characteristics of these experiences. I know of no such researcher who denies, for example, that at least some of these experiences show clearly hallucinatory elements, and thus individual NDEs and OBEs are bound to HARVEY J. IRWIN 161 incorporate some idiosyncratic features. Early researchers may have been mistaken in implying the homogeneity of postmortem existence as depicted in NDEs, but in all fairness the data available at the time were open to such an interpretation. In any event, the active researchers of today seem generally to be receptive to the view that NDEs are not uniform. It is unclear if this means that proponents of the separationist view are conceding the existence of multiple "afterlife realities," but it entails too great a leap in logic to conclude that, because NDEs show some diversity, all such experiences must be wholly hallucinatory.

References

Dalton, K. S., Zingrone, N. L., and Alvarado, C. S. (1998-99). Out-of-body experiences: Alternations of consciousness and the Five-Factor Model of personality. Imagination, Cognition and Personality, 18, 297-317. Greyson, B. (2000). Dissociation in people who have near-death experiences: Out of their bodies or out of their minds? Lancet, 355, 460-463. Irwin, H. J. (2000). The disembodied self: An empirical study of dissociation and the out of-body experience. Journal of Parapsychology, 64, 261-277.

"Psychophysiological and Cultural Correlates Undermining a Survivalist Interpretation of Near-Death Experiences" Defended

Keith Augustine, M.A. Internet Infidels, Colorado Springs, CO

ABSTRACT: Some largely convergent objections arise from independent commentaries on my lead essay. These include claims that noted psychophys iological correlates can be accommodated by models which presume that something leaves the body during out-of-body experiences (OBEs) and near death experiences (NDEs), that social expectation alone cannot account for actual NDE content, that crosscultural diversity does not challenge a survivalist interpretation of NDEs, and that conceding well-defined common alities within Western NDE accounts while denying crosscultural uniformity is problematic. I concede some of these objections up to a point, but conclude that they neither strengthen the case for a survivalist interpretation of NDEs, nor weaken the case against one.

KEY WORDS: near-death experiences; altered states of consciousness; temporal lobe signs; expectation; successful explanation.

I am grateful that Bruce Greyson, Allan Kellehear, Mark Fox, and Harvey Irwin have responded to "Psychophysiological and Cultural Correlates Undermining a Survivalist Interpretation of Near-Death Experiences." Without their meticulous research, many central questions about near-death experiences (NDEs) would remain shroud

Keith Augustine, M.A., is Executive Director and Scholarly Paper Editor of Internet Infidels, a nonprofit educational organization dedicated to defending and promoting metaphysical naturalism on the Internet. Reprint requests should be addressed to Mr. Augustine at Internet Infidels, PO Box 142, Colorado Springs, CO 80901-0142; e-mail: [email protected].

Journal of Near-Death Studies, 26(2), Winter 2007 2007 LANDS 163 164 JOURNAL OF NEAR-DEATH STUDIES

ed in mystery, and my own contribution to the debate about the meaning of NDEs would be much more provisional than it already is. All of the commentators have made a number of fair points. Greyson is right to criticize my oversight in characterizing all altered states of consciousness (ASCs), rather than simply a subset of them, as inward looking. But I never claimed that ASCs must completely "blind us to the outside world," and in fact noted sleep paralysis as an example of an inward-looking ASC even though it involves the projection of internally generated imagery on to a subject's otherwise veridical perception of external events. Greyson also rightly points out that instances of extreme focus on particular aspects of the physical environment to the exclusion of "peripheral" sensory data do not call up any internally generated imagery. It is nevertheless notable that ASCs featuring either diminished or amplified awareness of one's surroundings are almost always considered to be experiences occurring within the normal physical body. Only out-of-body experiences (OBEs) and NDEs are taken to be potentially discarnate experiences, and their inclusion within a class of otherwise ostensibly embodied experiences gives us some reason to think that they are embodied experiences as well. As before, I am not suggesting that this fact entails that OBEs and NDEs must be embodied, but it does warrant "a reasonable presumption that they do not reflect any objective existence outside of the normal physical body" - and nothing more. Next Greyson criticizes me for using definitions of dissociation and absorption - "the shutting out of sensory stimuli" and "focusing on the imagination," respectively - which do not come close to standard clinical ones. Ironically, I was paraphrasing Greyson's own charac terization: "According to [Kenneth Ring's] model, to register and recall alternate realities, one must transcend the sensory world (dissocia tion) and attend to internal states (absorption)" (2000, p. 323). How I read Greyson's distinction was undoubtedly colored by other near death researchers' characterizations, such as Irwin's comment that absorption "might usefully be thought of as a capacity for imaginative involvement" (2000, p. 263) and his theory that OBEs are enabled when a "state of absorbed mentation is paralleled by a dissociation from somatic (somaesthetic and kinesthetic) stimuli" (2000, p. 272). Clinically adequate or not, my use of these terms was not far off from what near-death researchers themselves have offered. KEITH AUGUSTINE 165

I never implied that individuals could not "become 'absorbed' in perception of the external world, such as [through] reading a book, watching a movie, or [intently] listening to a conversation," and even explicitly characterized absorption as a "capacity to become highly engrossed in the imagination, including through books or movies." Out of thin air Greyson conjectures that I aimed to convey the erroneous notion that "fantasy-prone individuals mistake fantasy for reality" and falsely accuses me of highlighting "fantasy prone individuals''strong investment in fantasy life"' while glossing over "their more intense sensory experiences." In fact, I simply quoted his definition of the concept, which gave no more weight to the ability to fantasize than to intense sensory experience or excellent visual memory, and then summarized what correlations have been found. Later I asked why mind-body separation would be expected to "make individuals more prone to fantasize" - say, to daydream - but no one should take that question to suggest that NDErs are less competent reality-testers than control groups. Another issue is whether NDErs' statistically significant but only slightly higher scores on measures of fantasy proneness are sufficient to label NDErs "fantasy prone personalities." As Greyson points out, they are not; but then I never claimed as much, just as I never claimed that NDErs' dissociative tendencies were pathological rather than "adaptive responses to serious stress." My aim was never to pigeonhole NDErs into the false dichotomy of being either out of their bodies or out of their minds, but simply to ask what these psychophysiological correlations might mean. Greyson eventually returns to the issue at hand, offering an alternative explanation agreeable to a survivalist interpretation - that NDErs' "sensory perceptions of the outside world are much more vivid than those of nonNDErs." But for having criticized me earlier for imputing a survivalist bias among near-death researchers, he seems remarkably eager to attribute positions to me that I do not hold, even insinuating that I advocate the ridiculous argument that NDErs "are unreliable witnesses because they have epilepsy" - as if subtle temporal lobe instability amounted to full-blown epilepsy and constituted grounds to dismiss NDErs' testimony about their experiences. Again, he proposes an alternative explanation of "the defensive value of dissociation" which is more amenable to the hypothesis that something leaves the body during OBEs and NDEs: Literal detach ment "would be even more effective in helping a victim escape from a traumatic situation than if they were mere mental illusions." 166 JOURNAL OF NEAR-DEATH STUDIES

However, more robust instances of dissociation such as multiple personality disorder help victims escape from far greater trauma typically repeated physical or sexual abuse - than the fear that yields OBEs and NDEs, and yet "split personalities" are widely regarded as "mere mental illusions" relative to the subject's primary personality. Next Greyson opines that "it makes perfect sense for a person with unusually rich 'capacity for imaginative involvement' - and therefore greater ability to foresee a potential threat - to flee the body in anticipation of trauma." But since my original question was why any psychological mechanisms, as opposed to physiological crises, would prompt a detachment from the body, this answer strikes me as evasive. If mere anticipation is not sufficient to cause an individual to go into shock, for example, it hardly seems credible that it could be sufficient to prompt the mind to literally detach from the body, if such a thing is possible at all. To my contention that the superior imagery skills of OBErs and NDErs are more amenable to psychophysiological explanation, Grey son counters that "the separation hypothesis also predicts that OBErs, because of the visuospatial training they receive in their OBEs, should have better imagery and visuospatial skills." This is a fair point; though there are reasons to give deference to a psychophysiological explanation, these reasons are merely suggestive, leaving plenty of room for others to interpret the extant data differently. For instance, various OBE induction techniques train subjects to call up internally generated imagery before they induce their OBEs (Irwin, 1999, p. 228). However, that only gives reason to prefer a psychophysiological account of induced OBEs. If spontaneous OBEs and NDEs could be shown to be qualitatively no different than induced OBEs, then this fact would also provide reason to favor a psycho physiological account of spontaneous experiences; but I doubt that the current data show this. In the end, which model better accommodates such data can only be resolved through prospective studies where, say, dreamers' spatial perspective during dreams, or dream control skills, are measured before a certain percentage of them happen to report spontaneous OBEs or NDEs. Unfortunately, such studies seem unlikely given how difficult it would be to obtain large enough sample sizes to conduct them. Irwin proposes that ostensible psychophysiological traits of OBErs and NDErs may not actually reflect who is likely to have such experiences, but simply who is likely to report them. That NDErs KEITH AUGUSTINE 167 willing to report NDEs are psychologically distinctive from NDErs who are not so willing is less reaching than the notion that reporting NDErs are neurologically distinctive from nonreporting ones. But it is notable that the same sort of concern has never, to my knowledge, been raised when the focus was the correlates of, say, psychedelic experiences. This testifies to the implausibility of such an alternative explanation in the case of OBEs and NDEs, and in any case even Irwin concedes that this explanation is not particularly likely. Greyson mischaracterizes my aim when he writes that I draw "sweeping conclusions from rather small correlations" between medical factors and specific NDE elements. None of the implications that I drew were meant to be more than suggestive, and I conceded that my noted correlations were entirely compatible with something leaving the body. While Greyson argues that there is "no reason why these relative frequencies should count as evidence that NDEs are hallucinations," they must have some underlying causes, and psychophysiological factors seem to be the most plausible candidates. After all, Greyson offers no alternative explanations for why these relative frequencies might obtain if reported NDE content accurately reflects events occurring outside of the brain. Instead, he rejects the common assumption that reports of NDEs are accurate reflections of the experiences themselves, writing that "all we know about NDE content is what experiencers choose to tell us about what they are able to put into words of what they can recall about their NDE content." Since changes in brain chemistry may only influence reports of NDEs - namely, what NDErs are able to recall, grasp, or verbalize about their experiences - any potential influence of medical factors on NDEs themselves, he argues, is forever beyond our reach. While this response neatly discounts data inconvenient for a transcendental interpretation, there is a certain amount of irony in Greyson offering it. For one, there is a little tension between this view and Greyson's later comments that clarity of thought and "a clear memory of the experience" represent "the norm for NDEs, even when they occur under conditions of drastically altered cerebral physiology," and that cardiac arrest NDErs "almost invariably retain vivid memories of their experience." Moreover, in a previous letter he lambasted me for "arguing that [I] never claimed that the bias or embellishment or sensory cuing [I] postulated for NDE accounts actually existed, but rather simply that they might have existed, as if that provided a reasonable argument for 168 JOURNAL OF NEAR-DEATH STUDIES

anything" (Greyson, 2007, p. 69). Now that it is convenient for him, Greyson similarly argues that, though he does not claim that medical factors actually do influence NDErs' recall, grasp, or ability to verbalize their experiences, they might - as if that provided a reasonable argument for anything! As often as he complains that I invoke unfalsifiable hypotheses "of no scientific interest," he has implicitly taken the unfalsifiable position that whenever the data seem to undermine a transcendental interpretation of NDEs, we can chalk that up to the brain's effects on consciousness or memory, but when other data seem to support that interpretation, we should take that to be evidence for the mind's independence from the brain. Who is sweeping facts under the rug now? Next Greyson writes that seizures or electrical stimulation of the temporal lobe "might explain the failure of normal perceptual integration, but not the production of coherent experiences such as NDEs." However, the position that temporal lobe activity has a role in the production of NDEs does not entail that NDEs arise due to the same mechanisms that cause seizures. That "only 6 percent of seizure patients described any body image anomalies, let alone OBEs" in one study may indicate that the temporal lobe activity necessary to induce OBEs occasionally coincides with, but does not necessarily always accompany, full-blown seizures. If that finding had indicated that temporal lobe activity makes no contribution to the production of OBEs, it would have also had the unlikely consequence that such activity has nothing to do with the other body image anomalies found in the study. And in any case, there is plenty of clinical evidence contradicting Greyson's presumption that seizures cannot produce complex, integrated, multisensory hallu cinations (Daly, 1975; Kolb and Wishaw, 1990; Lukianowicz, 1958). Greyson criticizes me for proposing "that electrically induced bodily illusions and spontaneous OBEs may be variants" of a single mechanism without specifying what that mechanism might be. However, my intention was simply to hint at how a recent psychophysiological theory of OBEs might account for such differences (Bunning and Blanke, 2005), and I also noted that electrically stimulated and spontaneous OBEs may involve different mechanisms. Predictably, Greyson emphasizes that "None of the proposed neurophysiological mechanisms have been shown to occur in NDEs." Elsewhere he wrote: "No one physiological or psychological model by itself explains all the common features of near-death experiences" (Greyson, 2003, p. 275). As Irwin noted, absent decisive evidence that KEITH AUGUSTINE 169 something leaves the body, "the evaluation of the 'literal separation' theory has become a matter of disproving other potential theories" (1999, p. 212). But just as showcasing potential flaws in evolutionary theory does not enhance the credibility of young Earth creationism, rebutting specific psychophysiological theories of OBEs and NDEs does not boost the plausibility of transcendental interpretations. For it is quite plausible that OBEs and NDEs have purely psychophysiolog ical origins even if their exact mechanisms are unknown. Because correlations between specific mental states and specific brain states are generally not well-known, the lack of a demonstrable physiological explanation for each NDE element is hardly surprising even if NDEs have purely psychophysiological explanations. We can correlate specific periods of dreaming to general patterns of brain activity, after all, but are nowhere near sophisticated enough to be able to determine whether someone is dreaming about running simply by looking at that person's brain activity at the time. Greyson implicitly acknowledges this point when he offers an objection to all possible psychophysiological models. He asks why NDEs are typically characterized by "mental clarity, vivid sensory imagery, a clear memory of the experience, and a conviction that the experience seemed more real than ordinary consciousness" even when they accompany acute neurophysiological changes, citing Sam Parnia and Peter Fenwick's statement that "NDEs in cardiac arrest are clearly not confusional and in fact indicate heightened awareness" (2002, p. 8). But as I have previously noted, there are a number of potential nontranscendental explanations for why coherent NDE reports arise from the experiences of a disorganized brain (Augustine, 2007a, pp. 208-209; Fox, 2003, p. 203). Greyson adds that any adequate theory of NDEs must "take into account this vivid and complex thinking, sensation, and memory formation under conditions in which current neuroscientific models of the mind deem them impossible, such as under general anesthesia and in cardiac arrest." But this argument appears to either overstate what "current neuroscientific models of the mind deem" impossible, or rely too heavily on an incomplete neuroscientific understanding of when such things are possible. For unmistakably hallucinatory experiences have occurred under such conditions, such as NDErs imaginatively flying backward in time while in a formation of swans, being interrogated by nurses about subversive activities, and approaching giant fangs threatening to devour them (Augustine, 2007b). 170 JOURNAL OF NEAR-DEATH STUDIES

Next Greyson writes that "every report of a large study of NDEs published in a mainstream medical journal has concluded that these phenomena cannot be explained as hallucinations. Such unanimity among scientific researchers is unusual and should tell us something." Indeed: that those researchers willing to devote substantial amounts of time and energy to conduct large-scale studies of NDEs tend to be predisposed to dismiss psychophysiological explanations of them. As to why researchers "who regard NDEs as hallucinations by and large have not conducted any studies" of NDEs, my guess would be that they have different academic priorities than separationist researchers aiming to vindicate what is largely perceived to be a fringe position. For instance, researchers interested in how proprio ceptive, tactile, and visual stimuli interact in the neural representa tion of body schema are likely to be narrowly interested in studies of multisensory disintegration during OBEs which may shed light on how the brain represents one's body in extrapersonal space. Greyson concludes that, whatever the evidence for separationist accounts, psychophysiological models of OBEs and NDEs are "sup ported by even fewer data." But it seems to me that Greyson does not give enough weight to factoring in the quality of the data cited in favor of each kind of explanation. For instance, Greyson argues that attributing claims of veridical paranormal perception during NDEs to "fraud or misperception is the hallmark of pseudoscience, not science." But if our extant data are based on research that has not sufficiently controlled for these variables - as replicable positive results in NDE target identification experiments would - then our data are not impervious to error, and such possibilities remain open ones. Only improvements of the quality of the data will ever resolve these issues. Greyson ends his commentary with a sermon railing against "promissory materialism." Like separationist accounts, psychophysi ological models stand or fall according to how well they accord with the data, and to invoke "promissory materialism" in this debate is to unduly imply that my brief for a psychophysiological model of NDEs amounts to a steadfast conviction, the facts be damned. Greyson's claim that "many NDErs speak ... of being aware simultaneously of the physical environment (including their bodies) and also of a transcendental dimension" does not do justice to what NDErs typically report. If all that NDErs typically reported was "alternating" between this world and the next, then the prototypical KEITH AUGUSTINE 171

Western NDE would not consist of the elements that it does, such as ostensible perception of the physical world from a position above the body, or any sort of transitional passage between the physical world and the NDE world, "as if' they were separate places accessible in different ways. Finally, Greyson concludes that in light of the data, hallucination theories cannot be considered serious alternatives to separationist models of NDEs. If he is right about that, then separationist models have won the day; for all practical purposes, the issue is settled, even if it is not technically "proven." Like the scientific community at large, however, I am afraid that I do not share Greyson's confidence that near-death researchers have "all-but-proven" that something leaves the body during OBEs and NDEs. Kellehear rightly notes that I understate the differences between actual NDE features and what we would predict social expectation to contribute to hallucinations near death. Fox similarly maintains that commonalities between Western NDE reports "cannot be accounted for wholly in terms of culturally produced expectations of what dying and death might be like." However, a psychophysiological explanation need not maintain that NDE content is derived solely from social conditioning. The primary sources of NDE content are likely to be conscious and subconscious personal expectations - shaped but not fully determined by cultural influences - as well as NDErs' unusual physiological states. For instance, Kellehear notes that NDErs occasionally "report colors they have not seen on Earth," but unusual neurological conditions can produce experiences as exotic as adventitious synesthesia, in which colors "blend" with other sensory modalities, and hallucinatory form constants are typically perceived in saturated colors. Such bizarre and consciously unexpected imagery as androgynous beings and huts suspended in mid-air are typical of ASCs like dreams, and so not particularly noteworthy in NDEs. On the face of it, the possibility that NDErs might be using different labels to describe the same experience is no more problematic for isolating a core of recurrent, well-defined elements than the opposite possibility, that NDErs might be using the same labels to describe different experiences. For instance, the term tunnel glosses over several manifest differences between a number of things, such as caves and underground train lines. But absent evidence of either sort of extensive mislabeling, each concern seems to be balanced out by the other. 172 JOURNAL OF NEAR-DEATH STUDIES

If there were a widespread and substantial gap between descriptor and experience, then we could not have any inkling of the extent to which descriptors differ from the experiences they are intended to represent. And this would entail that we cannot know whether different NDEs themselves are either similar or dissimilar to each other. If NDErs' descriptions were not accurate enough to communi cate some novel information about what it is like to have an NDE, then NDErs could not communicate what their experiences were like to nonNDErs or even fellow NDErs, and even something as basic as the common features of NDEs would be forever inaccessible to near-death research. If an episode of darkness were a crosscultural element, for instance, then NDErs' use of the term tunnel would typically represent the use of a less-than-ideal descriptor for such an episode. But NDErs have often described encounters with tunnels exhibiting physical charac teristics, and these reports cannot be simple instances of mislabeling. So there is more to hesitating to accept hypothetical mislabeling than simply taking NDErs at their word; the essential qualifier is that we should take them at their word in the absence of adequate evidential grounds to think that their descriptions are inaccurate. Such grounds include open-ended interviews in which, as further details unfold, NDErs' initial use of the term tunnel clearly refers to an episode of darkness; but Kellehear does not produce any such evidence. By contrast, I have provided ample reasons to think that NDErs' "oft-heard conclusion that NDEs are glimpses of an afterlife" is likely to be mistaken (Augustine, 2007b). Kellehear argues that crosscultural diversity does not challenge a survivalist interpretation of NDEs because there could be several "otherworlds" after death, while Irwin infers that I needlessly presuppose that survivalists must hold that "there can be only one 'afterlife reality"' - adding that it is unclear whether NDE diversity even requires survivalists to reject that assumption. But there are two ways in which NDE diversity undermines a survivalist interpretation of NDEs that none of the commentators address. First, arguments for a survivalist interpretation are often premised on purported uniformity across times and cultures. Insofar as the rule seems to be substantial diversity, however, one foundation for a taking a survivalist interpretation of NDEs is eliminated. Second, NDE diversity provides positive grounds for thinking that a survivalist interpretation is likely to be false. Encounters with different KEITH AUGUSTINE 173

transcendental environments might explain starkly different land scape visions, but would not explain different modes of travel to those "otherworlds." For instance, if NDEs are transitions to another world initiated by something leaving the body, then all NDEs ought to begin with OBEs. But a substantial portion of prototypical Western NDEs do not, and nonWestern near-death OBE accounts are sporadic. Are NDErs who do not report OBEs simply amnesic about leaving the body, even though NDErs commonly report recalling their NDEs more sharply than any other events in their lives? Why do out-of-body NDEs in the West typically transition quickly from seeing the physical body and its immediate surroundings to another NDE element, while NDErs from Guam evidently "project" thousands of miles away to see relatives living in America? These sorts of questions are awkward for those taking a survivalist interpretation of NDEs. On a survivalist interpretation, feelings of peace, OBEs, passages through a tunnel or darkness toward a light, and life reviews are initial stages of a transitional experience from this world to the next that should be common to all or most human beings, even if "the next world" in fact consists of multiple "otherworlds." These initial stages would be expected to be present, by and large, crossculturally and across historical eras. But these elements are strikingly absent from most extant nonWestern NDE accounts. Even within highly consistent prototypical Western NDEs, there is wide variation in the form that NDErs' "astral bodies" take: sometimes they are mirror images of the normal physical body, other times they are balls of light or amorphous clouds, and sometimes NDErs do not even perceive having a "secondary body" at all (Irwin, 1999, p. 225; Moody, 1975, p. 37). But if NDErs' secondary bodies were real rather than imaginary, we would expect their described characteristics to be about as uniform as those of different human beings' normal physical bodies. And though most NDErs describe their out-of-body vision as comparable to normal 180 color vision, some report surprising idiosyncratic traits like 3600 "spherical vision" (Ring and Cooper, 1997, p. 139) or at-will x-ray vision (Lawrence, 1993, p. 125). Though such differences might be explained in terms of extremely variable astral genes or other fanciful constructs, such peculiarities are certainly awkward for a survivalist interpretation of NDEs. Fox wonders why I did not discuss epistemological concerns accompanying any attempt to identify an experiential core across 174 JOURNAL OF NEAR-DEATH STUDIES different individuals, even when limiting the discussion to whether there could be a discernable core just to Western NDE reports. I am puzzled by his comment that, had I engaged the material in his third chapter, I might have found the concept of a core NDE within cultures (if not across them) "philosophically permissible." Simply put, I did not find the philosophical objections to the possibility of a crosscultural core that he addressed to be persuasive to begin with. If I had, I could not have consistently called for further research into the sociological sources of Western NDE motifs, or the need to collect a greater variety of nonWestern NDE reports, for better empirical evidence can never resolve a purely conceptual issue. Though I noted that individual Western NDEs often contain idiosyncratic features, I never suggested that I thought that there were any significant conceptual problems with the possibility of a crosscultural core to NDEs. Rather, my contention was that according to the evidence available to us now, there seems to be no crosscultural core of well-defined NDE elements. Instead, only broadly defined elements that we would expect to see among those who feel that they are dying are evident crossculturally. This is an empirical finding, not an a priori objection. As Fox sees it, I am in a bind: I cannot deny the commonalities between Western NDE reports even while concluding that they are largely absent from extant nonWestern accounts. I concur, only I would hasten to add that all of us are in the same bind. We are pushed in two mutually exclusive directions: the absence of a clear sociological source of Western NDE motifs pushes us toward positing universal features, while evidence from current nonWestern studies suggests only locally well-defined motifs, pushing us toward positing a sociological source. This is why further research is needed.

References

Augustine, K. (2007a). Does paranormal perception occur in near-death experiences? Journal of Near-Death Studies, 25, 203-244. Augustine, K. (2007b). Near-death experiences with hallucinatory features. Journal of Near-Death Studies, 26, 3-31. Blackmore, S. (1993). Dying to live: Near-death experiences. Buffalo, NY: Prometheus. Running, S., and Blanke, 0. (2005). The out-of body experience: Precipitating factors and neural correlates. In S. Laureys (ed.), The boundaries of consciousness: Neurobiology and neuropathology (pp. 331-350). New York, NY: Elsevier. Daly, D. (1975). Ictal clinical manifestations of complex partial seizures. In J. Penry, and D. Daly (eds.), Advances in neurology (Vol. 11) (pp. 57-84). New York, NY: Raven Press. KEITH AUGUSTINE 175

Fox, M. (2003). Religion, spirituality and the near-death experience. New York, NY: Routledge. Greyson, B. (2000). Near-death experiences. In E. Cardena, S. J. Lynn, and S. Krippner (eds.), The varieties of anomalous experience: Examining the scientific evidence (pp. 315-352). Washington, DC: American Psychological Association. Greyson, B. (2003). Incidence and correlates of near-death experiences in a cardiac care unit. General Hospital Psychiatry, 25, 269-276. Greyson, B. (2007). Response to Augustine's "Does Paranormal Perception Occur in Near-Death Experiences?" [Letter]. Journal of Near-Death Studies, 26, 67-70. Irwin, H. J. (1999). An introduction to parapsychology (3rd ed). Jefferson, NC: McFarland. Irwin, H. J. (2000). The disembodied self: An empirical study of dissociation and the out of-body experience. Journal of Parapsychology, 64, 261-277. Kolb, B., and Whishaw, I. (1990). Fundamentals of human neuropsychology. New York, NY: W. H. Freeman. Lawrence, M. (1997). In a world of their own: Experiencing unconsciousness. Westport, CT: Praeger. Lukianowicz, N. (1958). Autoscopic phenomena. AMA Archives of Neurology and Psychiatry, 80, 199-220. Moody, R. (1975). Life after life. Covington, GA: Mockingbird Books. Parnia, S., and Fenwick, P. (2002). Near death experiences in cardiac arrest: Visions of a dying brain or visions of a new science of consciousness. Resuscitation, 52, 5-11. Ring, K., and Cooper, S. (1997). Near-death and out-of-body experiences in the blind: A study of apparent eyeless vision. Journal of Near-Death Studies, 16, 101-147.

Obituary: George Ritchie, M.D.

George Gordon Ritchie, Jr., M.D., 84, died at home in Irvington, VA, on October 29, 2007, after a courageous battle with cancer. Ritchie was a widely loved physician, speaker, and author of Return From Tomorrow (1978) and My Life After Dying (1991), later republished as Ordered to Return (1998). Ritchie graduated from the University of Richmond, interrupting his college education to volunteer for the Army in World War II. After the war he graduated from the Medical College of Virginia and was a general practitioner for 15 years. He then completed a residency in Psychiatry at the University of Virginia, winning the William James Award for Research in Psychiatry. He later helped found the David C. Wilson Hospital in Charlottesville and was president of the Universal Youth Corporation for 20 years. Ritchie might be regarded as the stimulus for the modern near death experience movement. While undergoing basic training in the Army in 1943, he developed double lobar pneumonia and was pronounced dead, precipitating an elaborate near-death experience that included an out-of-body trip to another city that included verified information and resulted in profound personal and spiritual transfor mation. At a lecture in 1965 in which Ritchie described that near death experience, University of Virginia philosophy student Raymond Moody first heard about these experiences. Moody later went on to medical school himself, where he encountered many patients who described similar experiences. These encounters led to Moody's coining the term "near-death experience" and the publication of his 1975 book Life After Life, which Moody dedicated to George Ritchie. Surviving Ritchie are his wife of 60 years Marguerite, two children, two grandchildren, and two great-grandchildren, and a world in which, thanks to his efforts, experiences like his can be discussed openly.

Journal of Near-Death Studies, 26(2), Winter 2007 2007 IANDS 177

THE ESSENTIAL TOOL FOR NDE RESEARCHERS

International Association for Near-Death Studies PO Box 502 East Windsor Hill, CT 06028-0502 (860) 882-1211 fax: (860) 882-1212 www.iands.org

* Interactive CD-ROM for PC and Mac * Searchable database of over 800 articles on NDEs--all scholarly articles and most non-scholarly articles published through 2001 * Includes abstracts for most scholarly articles * Indexed by 135 NDE-related topics, such as: - Accounts of NDEs-autobiographical - Characteristics of NDEs-out-of-body - Definition of NDEs - Famous People's NDEs - Media Treatment of NDEs * Enables you to create a customized list of citations for ordering reprints-either from your own source or from the Near-Death Literature Clearinghouse (order form included in CD).

Price of CD: Individuals First Time Order $85 for IANDS Professional Members and JNDS subscribers $95 for all others Upgrade (for those who purchased NDE Research BibliographyPart 1; mail jewel box insert from first CD with payment) $35 for IANDS Professional Members and JNDS subscribers $45 for all others Institutions $200

To purchase with major credit card, go to: www.iands.org + shopping cart + publications To purchase with check, money order, or major credit card: IANDS P.O. Box 502 East Windsor Hill, CT 06028-0502 860-882-1211

More information at www.iands.org 4 Resources 4 NDE Index

INSTRUCTIONS TO AUTHORS

JOURNAL OF NEAR-DEATH STUDIES encourages submission of articles in the fol lowing categories: research reports; theoretical or conceptual statements; papers expressing a particular scientific, philosophic, religious, or historical perspective on the study of near death experiences; cross-cultural studies; individual case histories with instructive unusual features; and personal accounts of near-death experiences or related phenomena.

GENERAL REQUIREMENTS: Logical organization is essential. While headings help to structure the content, titles and headings within the manuscript should be as short as pos sible. Do not use the generic masculine pronoun or other sexist terminology.

MANUSCRIPTS may be submitted in electronic format (preferred) or hard copy. Electronic manuscripts may be submitted by e-mail to the Editor, Bruce Greyson, at cbg4d@virginia. edu, or by mailing a computer diskette or CD-ROM to the Editor at the address below. Please clearly designate the name of the file containing the manuscript and the hardware and software used. IBM-compatible files are preferred in WordPerfect, but other programs for IBM-compatible or Macintosh computers are acceptable. Manuscripts submitted as hard copy should be submitted typed on one side of the page only, double spaced throughout, with a margin of at least one inch on all four sides, and all pages should be numbered. There are no absolute limits on length of articles, but authors should strive for conciseness. Send manuscripts and/or computer diskettes or CD-ROMs to: Bruce Greyson, M.D., Division of Perceptual Studies, University of Virginia Health System, P. O. Box 800152, Charlottesville, VA 22908-0152, USA.

TITLE PAGE should contain the names of the authors, as well as their academic degrees, institutional affiliations, titles, and telephone number, fax number, and e-mail address for the senior author. Include a name, postal address, and e-mail address for reprint requests.

ABSTRACTS: Abstracts of 100-200 words are required with all articles. Abstracts should include the major premises of the article, intent, hypotheses, research design, results, and conclusions. For research reports, include the purpose, hypotheses, method, major results, and conclusions. For review or discussion articles, identify the main themes and conclusions and reflect them in a balanced fashion; if sources are important (for example, previous re search), include these. For other types of articles, including replies to other authors' articles or case histories, refer briefly to the main themes and conclusions and cross-reference if nec essary. Abstracts should be nonevaluative in tone, and should include as much information as possible within the constraints of space.

KEY WORDS: Articles should include two to five key words, listed after the abstract, which will be printed in the Journal and used by abstracting services for indexing the article. This is unnecessary for book reviews and letters to the editor.

FOOTNOTES AND ENDNOTES are strongly discouraged.

REFERENCES should be listed in alphabetical order (and chronologically for each author) at the end of the article, and referred to in the text by author(s) and year of publication. Only items cited in the text should be listed as references. Personal communications and Internet websites may be cited in the text, but should not be included in the list of references. Include all authors in references with multiple authors. Do not abbreviate journal titles. Capitalize principal words in journal titles, but only the first word in a book title or subtitle. Page num bers must be provided for direct quotations.

ILLUSTRATIONS should be self-explanatory and used sparingly. Tables and figures must be in camera-ready condition and include captions. Electronic artwork submitted on disk should be in TIFF, EPS, or PDF format (1200 dpi for line and 300 dpi for halftones and gray scale art). Color art should be in the CMYK color space. Artwork should be on a separate disk from the text, and hard copy must accompany the disk.