Correspondence: Near-Death Experiences
Buzzi (Giorgio)
Source: Lancet. Vol. 359, Issue 9323 (June 15, 2002): 2116-2117
Paper - Abstract

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Near-death experiences1 (Full Text)

  1. Sir —
    • Many of the elements of the near-death experiences2 described by Pim van Lommel and colleagues (Dec 15, p. 20393), are also described by patients after episodes of awareness or unintended consciousness occurring during general anaesthesia4,5,6.
    • These episodes of recovery of consciousness are invariably attributed to an insufficient supply of anaesthetic, for various reasons, and are not generally associated with hypoxia. They occur despite the fact that patients have received a cocktail of potent, centrally acting drugs — specific general anaesthetic agents, opioids (eg, fentanyl), benzodiazopines, and other psychotropic drugs (eg, droperidol) — given with the object of preventing consciousness. Many of van Lommel and colleagues’ patients received a similar cocktail of drugs during resuscitation. I suggest that their patients’ near-death experiences7 were simply an episode of consciousness modulated by drugs, hypoxia, hypercarbia, or other physiological stressors.
    • There does seem one element of such near-death experiences8, however, that is not so commonly reported during anaesthesia, namely the out-of-body experience. Given the circumstances of their awareness, the anaesthetised patient generally has a clear insight into their situation and their role in it. Is it possible that patients with a cardiac arrest have a poorer understanding of their predicament and impose a different interpretation upon events, possibly one that the subsequent interview and the interest of the interviewer may have inadvertently moulded?
    • John M Evans
      Nuffield Department of Anaesthetics, John Radcliffe Hospital, Oxford OX2 9DU, UK
  2. Sir —
    • Pim van Lommel and colleagues9=3 ask, how could a clear consciousness outside the body be experienced at the moment that the brain no longer functions during a period of clinical death with flat electroencephalography?
    • Evidently, they assume that the brain may not function at this time. This assumption, however, is erroneous. Normal electroencephalography techniques can detect electrical activity in only one half of the area of cerebral cortex. Possible activity in the other half and deeper structures cannot be observed.
    • Electroencephalography is not a reliable indicator of brain death10. Before clear consciousness has been proven to occur in people without cerebral blood flow, there is no need to reconsider the nature of mind-brain relation.
    • Ali Henri Bardy
      National Agency for Medicines, PO Box 55, 00301 Helsinki, Finland (e-mail:
  3. Sir —
    • Pim van Lommel and colleagues’ study11 reminds me of an apocryphal comment attributed to Kerry Packer, Australia’s wealthiest man.
    • Packer had a myocardial infarction while riding a polo pony. A nearby ambulance crew resuscitated him. Packer reported his experience with the telling comment: “Mate, I tell you there is nothing there”. He was obviously not keen to repeat the experience and promptly equipped the New South Wales ambulance service with defibrillators.
    • The most fascinating part of van Lommel and colleagues’ study, which is noted by the researchers, although it subsequently attracts little attention, is the association of these events with spiritual beliefs and subsequent strengthening of these beliefs. Taking this association further, I wonder whether some of these experiences have led to some of the myths, legends, and religious beliefs we hold today.
    • Paranormal phenomena such as ghosts, and religious events such as reincarnation12 could be explained through distortion over the ages of near-death experiences13. Bruno Bettelheim14 drew our attention to the importance of myth, legend, and fairy-tale as a roadmap to overcoming adversity on the pathway to maturity. Near-death experiences15 may prove to be a fountainhead for these devices and, as such, be central to spirituality rather than stemming from it.
    • The other element that does not attract comment is the overwhelmingly positive nature of the near-death experience16. This postivity could represent the optimism of the human spirit, or maybe it ensures that the experience is subject to recall and recounting. It may also underpin one of the most quoted biblical phrases from Psalm 23: “Yea, though I walk through the shadow of the valley of death, I will fear no evil”.
    • It is a pity that Kerry Packer, who, in his rare public utterances tells it as he sees it, could offer no further insight into the presence of the human soul.
    • Richard T L Couper
      Department of Gastroenterology, Women’s and Children’s Hospital, North Adelaide 5006, South Australia.
  4. Sir —
    • In his Dec 15 Commentary, C C French17 states that any report of veridical perception during out-of-body experiences would represent a strong challenge to any non-paranormal explanation of the near-death experience18.
    • Another context in which out-of-body experiences have been described is the dissociated rapid-eye-movement (REM) sleep19 state, defined as sleep20 paralysis. Cheyne and colleagues21 reported 17 cases of autoscopic experiences associated with sleep22 paralysis, in which the individuals viewed themselves lying on the bed, generally from a location above the bed.
    • I previously reported the results of a survey of people experiencing sleep23 paralysis24. Of 264 participants, 28 (11%) had had some kind of out-of-body experiences. Some of them reported recurrent episodes of such experiences. I invited these people to do the following simple reality tests: trying to identify objects put in unusual places; checking the time on the clock; and focusing on a detail of the scene, and comparing it with reality.
    • I received a feedback from five individuals (unpublished data). Objects put in unusual places (eg, on top of the wardrobe) were never identified during out-of-body experiences. Clocks also proved to be unreliable: a woman with nightly episodes of sleep25 paralysis had two out-of-body experiences in the same night, and for each the clock indicated an impossible time. Another participant stated “I look at my alarm clock to check, and if the bright green LED is not there, then I immediately know that it is a sleep26 disorder experience . . . my bedroom seems the same as it is during waking, only the lights don’t work”. Finally, in all cases but one, some slight but important differences in the details were noted: “I looked at ‘me’ sleeping27 peacefully in the bed while I wandered about. Trouble is the ‘me’ in the bed was wearing long johns . . . I have never worn such a thing”.
    • On the whole, out-of-body experiences in people who experience sleep28 paralysis seem not to pass reality tests. Therefore, what is seen should be thought of as a recollection of information stored in the person’s memory of his or her surroundings.
    • A clue about the origin of such experiences may come from neuroimaging studies of brain activation during REM sleep29. By use of positron emission tomography, Maquet and colleagues30 noted a significant negative correlation between regional cerebral blood flow (rCBF) and REM sleep31 in a large area of the dorsolateral prefrontal cortex and the parietal cortex, and a significant positive correlation between rCBF and REM sleep32 in limbic-system structures implicated in the formation and consolidation of memories. In dissociated REM sleep33 states, activation of such limbic structures during inhibition of the neocortex may lead to an oneiric recollection of images concerning the individual’s sleeping34 environment.
    • Likewise, in near-death experiences35, out-of-body visions, and possibly other phenomena, such as flashes of recollection from the past, and even life reviews reported by some patients, may represent a disinhibition of limbicsystem structures due to hypoxic suppression of the neocortex36, rather than paranormal phenomena or false memories.
    • Giorgio Buzzi
      Via Felisatti 49, 48100 Ravenna, Italy (e-mail:
THE LANCET • Vol 359 • June 15, 2002 • Link

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In-Page Footnotes

Footnotes 3, 9: van Lommel P, van Wees R, Meyers V, Elfferich I. Near-death experience in survivors of cardiac arrest: a prospective study in the Netherlands. Lancet 2001; 358: 2039–45.

Footnote 4: Evans JM. Patients’ experiences of awareness during general anaesthesia. In: Rosen M, Lunn JN, ed. Consciousness awareness and pain in general anaesthesia. London: Butterworths, 1987: 184–92.

Footnote 5: Moerman N, Bonke B, Oosting J. Awareness and recall during general anaesthesia: facts and feelings. Anaesthesiology 1993; 79: 454–64.

Footnote 6: Cobcroft MD, Fosdick C. Awareness under anaesthesia: the patient’s point of view. Anaesth Intensive Care 1993; 21: 837–43.

Footnote 10: Paolin A, Manuali A, Di Paola F, et al. Reliability in diagnosis of brain death. Intensive Care Med 1995; 21: 657–62.

Footnote 11: van Lommel P, van Wees R, Myers V, Elfferich I. Near-death experience in survivors of cardiac arrest: a prospective study in the Netherlands Lancet 2001; 358: 2039–45.

Footnote 14: Bettelheim B. The uses of enchantment. New York: Knopf, 1976.

Footnote 17: French CC. Dying to know the truth: visions of a dying brain, or false memories? Lancet 2001; 358: 2010–11.

Footnote 21: Cheyne JA, Rueffer SD, Newby-Clark IR. Hypnagogic and hypnopompic hallucinations during sleep paralysis: neurological and cultural construction of the night-mare. Conscious Cogn 1999; 8: 319–37.

Footnote 24: Buzzi G, Cirignotta F. Isolated sleep paralysis: a web survey. Link (accessed Feb 27, 2002).

Footnote 30: Maquet P, Péters JM, Aerts J, et al. Functional neuroanatomy of human rapideye- movement sleep and dreaming. Nature 1996; 383: 163–66.

Footnote 36: Lempert T, Bauer M, Schmidt D. Syncope and near-death experience. Lancet 1994; 334: 829–30.

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