Reviewed by Robert A. Charman
Dr Sartori has worked as an intensive care nurse for over twenty years, during which time she has helped to care for hundreds of patients who were close to death and recovered, and hundreds more who died. As a result of a very distressing experience early in her career, when she realised that a terminally ill patient was pleading with his eyes to be allowed to die as an escape from his sufferings but was being kept alive, she felt impelled to explore the literature on death. This inevitably included accounts of NDEs and their possible implications concerning life after death, and apparent veridical OBEs in which the experient claimed to have observed the clinical procedures being carried out by paramedical, medical and nursing staff on their unconscious body. This led her to design and undertake a five-year interview-based study of patients in Intensive Therapy and High Dependency Units at Moriston Hospital, Swansea, and record the recollections of any patient who claimed to have experienced an NDE and/or OBE whilst clinically unconscious. Much of her research has been in co-operation with ongoing studies undertaken by Drs Peter Fenwick, Sam Parnia and Pim van Lommel, and the last-named has written the Foreword to her book. She was awarded a PhD in 2005 and later published her PhD monograph (Sartori, 2008). Since then, through giving lectures, attending conferences and writing newspaper articles, she has received a flood of reports of such experiences and has been able to interview many more people.
This book is a combination of her wider knowledge of the academic literature and her personal reflection on experiences of these interviews that explored the impact that NDEs had upon the subsequent life and beliefs of experients. It is divided into ten chapters covering the following subjectmatter: “The Near-Death Experience”, “The After-Effects of the NDE”, “Childhood NDEs”, “The Cultural Variations of the NDE”, “End-of-Life Experiences and After-Death Communication”, “Proposed Physiological and Psychological Explanations for the NDE”, “A Five-Year Prospective Study of NDEs”, “A Brief History of the Medicalization of Death”, “Implications for a Greater Understanding and Acknowledgement of NDEs”, “Conclusion” and “Epilogue”. The book is fully referenced and has an index. Many features will be very familiar to readers from the extensive popular literature on the subject, including the tunnel phenomena, bright light, glorious colours and scenery, meeting dead relatives and sometimes a ‘Someone’ who tells them that it is not their time to die and they must return, but Sartori provides many new accounts to illustrate the phenomena.
For her study Sartori interviewed hundreds of patients, but many were unable to co-operate because of the effects of post-operative mental confusion, drug therapy and continuing illness, and some did not wish to participate. Of the 243 ITU patients admitted suffering from a wide range of illnesses and trauma whom she was able to interview successfully during the first year, only two reported an NDE (0.8%) and two reported an OBE (0.8%). Realising that she could not sustain such a commitment she decided to restrict her study to cardiac arrest patients only, unless she received a report that a non-cardiac patient had reported an NDE. The reason for her decision was that the literature indicated that NDEs were more common in this group of survivors than any other. Her study supported this finding, as of the 39 patients who survived cardiac arrest and were fit enough to be interviewed seven reported an NDE (17.9%). Over the five years of her study a total of 15 patients reported an NDE and 8 reported an OBE.
In discussion of the after-effects of NDEs, Patient 10’s experience is probably unique. In 2005 while in an ITU he suddenly lapsed into unconsciousness, had a veridical OBE in which he looked down and saw staff resuscitating him, including Sartori cleaning his mouth with a ‘pink lollipop thing’, then had a fairly typical NDE and was told that he had to return and re-enter his body, which was still in agony. This patient suffered from congenital cerebral palsy, as a result of which his right hand was permanently clenched into a fist with the flexor muscles and tendons of his fingers and hand becoming permanently shortened. On recovery he was able to open his hand and use it normally. As a physiotherapist who has worked with cerebral palsy patients, I know from personal experience that once muscles and tendons become chronically shortened through sustained spasticity they stay that way, so this is truly astonishing. On re-interview in 2013 he told Sartori that he was slowly losing this ability to open his hand and extend his fingers.
While fear of death disappears because of an emotional certainty that they have seen the afterlife, so know that they (and we in our turn) will survive bodily death, the after-effects of a NDE are not always beneficial for these people. To family and their pre-NDE friends they are ‘no longer the same person’, personal relationships can break down, divorce is common, they may become depressed with what now seem the superficialities of everyday life, and long to return to the blissful state of their NDE. For others the opposite occurs, as they now have a sense of spiritual mission. What intrigues me is that many report that after their NDE watches stop working, and some experience severe shocks when touching electrical switches, their electrical appliances break down, light bulbs fuse, kettles and radios and televisions spontaneously switch on or off and computers malfunction. On the psychic level some find themselves very aware of the thoughts of others, some experience precognition of illness and/or death in others and some become healers. It should be noted here that two patients experienced hellish NDEs which left them terrified by the implications.
Sartori reviews the wide range of proposed explanations for NDEs. Some are based upon the orthodox neuroscience hypothesis that brain generates mind: these encompass changes in blood gases, release of neurohormones, effects of drug therapy and so on. These may demonstrate very partial NDEtype experiences but none seems able to account for the highly structured, coherent NDE experiences that can occur when cerebral blood flow drops, brain function falters and fades towards flatlining or during deep anaesthesia, nor the clarity of recall on recovering consciousness. The closer patients come to death as in cardiac arrest, the more likely they are to experience a coherent NDE. Comparisons between NDEs and hallucinations, whether caused by brain tumours, ITU psychosis or recreational drugs, indicate that the two are qualitatively quite distinct.
The same lack of explanation applies to accounts of veridical OBEs occurring in the same circumstances. When Sartori compared accounts of what they believed had happened during their resuscitation when unconscious, those who had not had an OBE could offer no more than a generalised idea based mainly upon television dramas, whereas those who reported an OBE gave detail that correlated very closely with what actually did happen during their resuscitation. In veridical deathbed visions the dying persons report surprise at seeing relatives that they did not know had died.
After reviewing how death is, or was, perceived in other cultures, Sartori makes the interesting point that in the Western world during the mid-to-late nineteenth century death became feared. From 1885 onwards, funeral directors and services increasingly took over from families and by the 1930s an increasing number of patients entered hospitals and died there as doctors took on what Sartori calls “the medicalisation of death”. This change in culture has culminated in the huge development of Intensive Therapy and High Dependency Units, emergency paramedic care, and so-called ‘heroic’ medical procedures that she feels are often unintentionally barbaric. Death has become the enemy to be denied at all cost and dying is seen as medical failure. Sartori thinks that NDEs and deathbed visions carry the implication that dying is usually a peaceful process and may even be a transition from one life to another, and that this should be taught to medical, nursing and paramedical students. At present few are willing to talk about death between themselves, let alone with patients or carers, and remain in emotional denial. Talk of spirituality is embarrassing.
For the wider public Sartori feels that knowledge of these experiences and their spiritual implications should lead to a realisation that we are more united in a transpersonal common humanity than divided, and should use this knowledge to reduce division, hatred and aggression. She makes no exaggerated claims but asks us to assess the possible implications of NDEs, veridical OBEs and veridical death-bed visions for the relationship between brain and mind. My impression is that Dr Sartori thinks that we may survive physical death. Whether there is any wisdom in NDEs, and whether knowledge that some 15–20% of patients experience NDEs can help us live our lives more fully, is a question that each person must decide for him- or herself. What of the 80–85% majority who do not experience a remembered NDE? Whatever your views, this thoughtful book is a valuable addition to the literature and deserves a wide readership.
References
Borjigin, J., Lee, U., Liu, T., Pal, D., Huff, S., Klarr, D., ... & Mashour, G. A. (2013). Surge of neurophysiological coherence and connectivity in the dying brain. Proceedings of the National Academy of Sciences, 110(35), 14432-14437.
Sartori, P. (2008) The Near-Death Experiences of Hospitalized Intensive Care Patients: A Five-Year Clinical Study. New York: Edwin Mellen Press.
Robert A. Charman can be reached at email: [email protected]
This review first appeared in the Journal of the Society for Psychical Research Vol 78(2).