Living with death and dying

Transcription

1 Living with death and dying

2 About this free course This free course is an adapted extract from the Open University course K260 Death and dying: This version of the content may incude video, images and interactive content that may not be optimised for your device. You can experience this free course as it was originay designed on OpenLearn, the home of free earning from The Open University - There you aso be abe to track your progress via your activity record, which you can use to demonstrate your earning. The Open University, Waton Ha, Miton Keynes MK76AA Copyright 2016 The Open University Inteectua property Uness otherwise stated, this resource is reeased under the terms of the Creative Commons Licence v4.0 Within that The Open University interprets this icence in the foowing way: Copyright and rights faing outside the terms of the Creative Commons Licence are retained or controed by The Open University. Pease read the fu text before using any of the content. We beieve the primary barrier to accessing high-quaity educationa experiences is cost, which is why we aim to pubish as much free content as possibe under an open icence. If it proves difficut to reease content under our preferred Creative Commons icence (e.g. because we can t afford or gain the cearances or find suitabe aternatives), we wi sti reease the materias for free under a persona enduser icence. This is because the earning experience wi aways be the same high quaity offering and that shoud aways be seen as positive even if at times the icensing is different to Creative Commons. When using the content you must attribute us (The Open University) (the OU) and any identified author in accordance with the terms of the Creative Commons Licence. The Acknowedgements section is used to ist, amongst other things, third party (Proprietary), icensed content which is not subject to Creative Commons icensing. Proprietary content must be used (retained) intact and in context to the content at a times. The Acknowedgements section is aso used to bring to your attention any other Specia Restrictions which may appy to the content. For exampe there may be times when the Creative Commons Non- Commercia Shareaike icence does not appy to any of the content even if owned by us (The Open University). In these instances, uness stated otherwise, the content may be used for persona and noncommercia use. We have aso identified as Proprietary other materia incuded in the content which is not subject to Creative Commons Licence. These are OU ogos, trading names and may extend to certain photographic and video images and sound recordings and any other materia as may be brought to your attention. Unauthorised use of any of the content may constitute a breach of the terms and conditions and/or inteectua property aws. We reserve the right to ater, amend or bring to an end any terms and conditions provided here without notice. A rights faing outside the terms of the Creative Commons icence are retained or controed by The Open University. 2 of 45 Friday 17 August 2018

3 Head of Inteectua Property, The Open University The Open University Printed and bound by the Charesworth Press, Huddersfied Contents Introduction 4 Learning Outcomes 5 1 Overview Living with death and dying Death and the meaning of ife Near-death experiences The quaity of dying 25 Concusion 44 References 44 Acknowedgements 45 3 of 45 Friday 17 August 2018

4 Introduction Introduction This course wi expore how knowedge and beiefs about death and encounters with death affect peope s ives. It wi aso examine the concept of a good death from an individua perspective in order to enhance the quaity of dying. This OpenLearn course provides a sampe of eve 2 study in Heath & Socia Care. If you found this interesting, take a ook at the Open University modue Death, Dying & Bereavement (K220): Aternativey, you can expore the reated OpenLearn course, An introduction to death, dying and grief. 4 of 45 Friday 17 August 2018

5 Learning Outcomes After competing this course, you shoud be abe to: reate beiefs about death to the meaning peope attach to ife refect on the way in which death structures ife criticay evauate now new encounters with death affect perspectives upon ife assess the quaity of dying criticay examine the notion of a good death in reation to individua experience.

6 1 Overview 1.1 Living with death and dying Knowedge and beiefs about death can have a profound effect both on the way peope ive and the way they approach their own death. In this course we ook in depth at these issues. There are three sections. The first section addresses the effects that the knowedge that we die has on our ives. Here we expore how the beiefs peope hod about death affect the meaning they attach to ife. We try to imagine what ife woud be ike if it did not end in death. Given that we do die, we examine how the ways in which a cose brush with death may infuence the way peope ive subsequenty. Deveoping this theme further, the second section assesses the phenomenon of near-death experiences. The fina section ooks at the way beiefs and attitudes towards death affect the quaity of dying. We take up the probematic concept of a good death and through the use of case studies anayse this concept in reation to individua experience. 1.2 Death and the meaning of ife Death and Tostoy Inevitaby, the way in which peope dea with death, whether by denia or by the construction of a compex system of beiefs and myths, eads to questions about the meaning of ife. For Juia Neuberger this is the esson of death. It is nothing to fear of itsef, but it concentrates the mind powerfuy in examining what it is we mean by ife (Neuberger and White, 1991, p. 13). Cick to view 'Death and the meaning of ife'. Activity 1 Read the artice by Leo Tostoy, Death and the meaning of ife. What effect did the knowedge of death have on Tostoy? For Tostoy his understanding of death took away a meaning, a peasure and a purpose from ife. It is a very beak picture and raises the question, Is ife aways preferabe to death? Tostoy was certainy not sure and was ceary afraid that he woud be tempted to take his own ife. You wi reca that he hid his hunting gun and other means by which he might ki himsef. Others without a reigious framework may be much more affirmative about ife and find very positive meanings and purposes. 6 of 45 Friday 17 August 2018

7 Tostoy at work in his study How do others find meaning in ife? There are those who share Tostoy s view that death is an end rather than a transition, and yet are much more optimistic about ife. Hermann Bondi represents the views of many Humanists in the foowing passage: As a Humanist I beieve in the importance of human inkages, of human interactions, of our ives getting their meaning from our connections with each other. Thus I agree with Donne that anybody s death diminishes us a. Yet our oss, our grief, our sorrow at matters that have been eft unsaid for too ong, services that we regret not having performed in time, and the sheer feeing of void must a be seen in proportion, difficut as this may be. If a person dies in ripe od age, after a ife that has had more ups than downs, a ife that was at east in some sense fufiing, then one s grief shoud surey be imited in duration, if not in depth. The very naturaness of death, the fact that it is unavoidabe, shoud reconcie one graduay to what has happened in such cases. But if a young, fit person dies, then the grief, the horror, yes, the anger at the event cannot easiy be bounded. To have to remain for ever ignorant of how the one who died woud have ived, to reaise that we must a manage without the unique contribution that person coud have made to society, a this may border on the unbearabe. (Neuberger and White, 1991, p. 125) 7 of 45 Friday 17 August 2018

8 Unike Tostoy, for some peope it is the very knowedge that ife ends in death that gives ife meaning and structure. Another of Rosemary Dinnage s contributors fet this: Life is a tremendous gift, an amazing gift, an astonishing gift, and that it seems simpy crumudgeony not to make a response. And for me the response is writing down what I experience; otherwise it ooks as though I ve been given a this, a this daiy experience, and I don t do anything about it. So for me it s a doing something about it which, as I said, I think is reay reated to the fact that one knows that it s finite experience, that it s coming to an end. (Dinnage, 1990, p. 181) If the fact that ife ends in death gives ife at east some structure, coud we contempate ife without death? Activity 2 What if we didn t die? How do you think you woud fee? And which bit of the ife-span woud you stick with? Pease fee free to et your imagination run riot you need not take this activity entirey seriousy. You coud try these questions on your famiy and friends. I (Moyra Side) woud find it a great reief not to worry about osing those whom I ove or about them not osing me. I think I woud be much more adventurous and woud certainy fy a ot more. Sady, I find the idea of ife without end a bit daunting and my imagination seems very inhibited by the birth-ife-death cyce. Of course without end begs a ot of questions. Woud we arrive in a mature state and woud we degenerate? In his book Guiver s Traves, Jonathan Swift s depiction of not dying is very beak. Guiver encounters the Strudrugs, who are a species who do not die but ive out their eterna ives in a ghasty parody of od age, doddery, senie and atogether not to be envied, which doubtess was the object of this exercise, Swift being the satirist that he was. If I was to ive forever I woud certainy want to be in good shape. Most of the peope quoted in both Dinnage and Neuberger and White were not too happy about the idea of eterna ife; ony Thomas, who had from a very eary age found the idea of death very frightening, coud contempate the idea with equanimity. He said, as ong as you don t age, there are aways new books to read, there s music to isten to, there s the countryside to enjoy. But he does go on to say that yes, the ending does structure our thought about things, very deepy. Ceary, the fact that we die, whether it is an end or a transition, does affect our reationship with ife. 8 of 45 Friday 17 August 2018

9 Jonathan Swift s Strudrugs, as conceived by Arthur Rackham around The effect of death on ife In some cutures, or groups within a cuture, there is an attempt to integrate the fact of mortaity into the centre of iving so that members are activey encouraged to see death as norma and to face the fact that each of us wi die. In others there is a tendency to combat or deny the fact of death, to the extent that ife becomes an exercise in keeping thoughts of death at bay. Yet it remains true that some ways of ife and systems of beief do activey prepare peope to acknowedge the reaity of death whist others encourage denia of that reaity. Mosty we find ourseves somewhere between the two, shifting back and forth according to situation, time, pace, company, age and so on. It is amost as though denia and affirmation of death form two ends or poes of a continuum aong which we move. To highight the process, this section describes an exampe of what it is ike at each end. 9 of 45 Friday 17 August 2018

10 Buddha rock carving at Ajanta, India Theravada Buddhism In a schoos of Buddhism, the inevitabiity of death is seen as a fruitfu topic for refection and meditation, but in the Theravada tradition, which originated in Thaiand, foowers are especiay encouraged to meditate upon death. In the beginning the meditator is asked to dwe on deaths of peope who have ed a peasant ife. Then the mind of the meditator can be turned to the inevitabiity of his or her own death, so as to deveop one-pointed concentration on this. To aid this are various refections such as: The nights and days go sipping by, As ife keeps dwinding steadiy Ti mortas span, ike water poos In faiing ris, is a used up. (Samyutta Nikaya 1:109, cited in Dinnage, 1990) One meditates upon the possibe causes of death: be they externa causes or the sma organisms with which one shares ones body. Life is frai; it wi end if one acks air to breathe or food to eat, or if the body is either too hot or cod. Death is unpredictabe as to the age at which one may die, at what time of day, of what, and where. One may ive ony another day or the time it takes to eat a mea or chew the next mouthfu or take the next breath but one shoud use whatever time one has to rouse energy and mindfuness for spiritua practice. Insight into impermanence and nonattachment to ife wi then deveop and a person wi die without fear. (Harvey, in Neuberger and White, 1991, pp ) 10 of 45 Friday 17 August 2018

11 As Peter Harvey, a British convert to Buddhism, expains, this kind of meditation invoves not ony contempating one s own death and the feeings associated with that but aso the deaths of oved ones who are presenty aive. This means that deaing with the death of a oved one can begin before it happens [and] iving with an awareness of one s own death heps one to ive ife better In our famiy, tak may concern death and rebirth Neither my wife nor my daughter see it as an unpeasant or embarrassing subject. (Harvey, in Neuberger and White, 1991, p. 114) There is a sense in which, for the Buddhist, ife is very much a preparation for death, because it is beieved that the state of mind in which one dies is a key factor in what kind of rebirth foows: obviousy, someone who has consistenty meditated upon their death is more ikey to approach it in a cam state of mind. In another sense death is in the very midst of ife, for it is seen not simpy as something that happens at the end of our ives, but from moment to moment. In the basic Theravada view every moment is a birth and death in itsef (John Sneing, quoted in Dinnage, 1990, p. 146) Together Forever At the opposite end of the spectrum stand Pau and Gemma Massey, the British coordinators of Together Forever, an affiiation of the Fame Foundation, a group of sefprocaimed physicay immorta peope in Arizona. The Foundation began some 30 years ago after an Evangeica minister, Chares Pau Brown, caimed to have had a ceuar awakening in which Christ tod him that physica immortaity was the true Christian message. The group caims to have about 2,000 members word-wide. Its basic phiosophy is that death isn't natura. Life is based on ceuar unity, and by fostering this through group intimacy ife can go on for ever. Gemma Massey expains: Death is a withdrawa of energy. In being together we continuay keep each other energised. We beieve that by creating a network of peope around the word strong enough and powerfu enough, we can keep each other aive. There is no reason that is obvious to me why ces that have been happiy repicating for years have to stop doing so. The ony difference I can see is whether that process continues to be energised by my choice, my ifestye. In a sense we are taking psychic heaing to the utimate concusion. If you can do it once, why not over and over again? (Massey, 1991) The crucia factor is group commitment. Members of Together Forever meet twice a week to energize and inspire one another. At these meetings, expains Pau Massey, there is a persona warmth, a passion for each other that passion for the fesh, the physica human being that makes the difference (Massey, 1991). Activity 3 Draw a ine with Buddhism at one end and Together Forever at the other. Try to mark where you are on the ine at the moment, in your everyday ife. Is your ife shaped more by consciousness of death or by attempts to secure physica immortaity? 11 of 45 Friday 17 August 2018

12 Most peope find they tend to move around in reation to the ine rather than occupy a consistent position. Sometimes such movement is prompted by a particuar experience which acts as a sharp reminder of our own mortaity, as when a friend unexpectedy dies or when we ourseves become seriousy i Encounters with death Athough we each die ony once, there may be many a brush with death throughout the course of a person s ife. The experience of having been cose to death can have a major impact on the way in which a person continues iving. For Eaine, the awareness that she might be about to die has affected the way she ives now that her prognosis is good. She describes hersef as prepared for death and impatient of those who are not. She aso has difficuty entering fuy back into ife. I think it s important to be prepared for death I can ony agree with Hamet, the readiness is a When I found out the prognosis was good I found it very hard to ift the vei that had descended between me and ife. I think if you are dying you withdraw from ife necessariy because it s too painfu otherwise and so athough you re in ife you re not of ife and whoe areas of existence cease to have an interest for you because you think you haven t got a future I definitey fet as if I d moved on to the hard shouder of ife as it were I have gone back into ife, very much so with my chid [but] sometimes when I m with other peope I think I don t want to tak about that, it s trivia. For a different kind of person there might be a very different response. Here are just a few exampes Margaret Margaret was in her thirties when she earnt she had breast cancer. Some three years ater, after the remova of the affected breast, she was eading a very busy ife working futime at the Open University, studying part-time for an OU degree and running a famiy. Fitness activities such as jogging and various sports had become very important in her ife. She was aso very invoved in cancer research fundraising activities. She described the impact of her brush with death in this way: Unti I was tod I had breast cancer I had never seriousy contempated my own mortaity. Fortunatey the prognosis is good and I seem to have survived the trauma in reativey good menta shape. I attribute this argey to my positive, optimistic nature but the experience has certainy changed my ife and outook in many ways, some obvious, some not so. My overa view of ife has changed. These days, no matter how bad things seem, I sti have a sense of how good it is just to be aive. Things I worried about in the past don t seem as important. When I had my operation [a mastectomy] I experienced itte, if any, physica pain, not requiring seeping pis or pain kiers. I put this down to the fact that I was generay very physicay fit, earier that year having taken up jogging, tennis and aerobics. These days I have a passion for exercise and I know this is based on an inner feeing that if the cancer recurs I wi be in good physica 12 of 45 Friday 17 August 2018

13 shape to fight it again. Since then I have aso heped to raise money through sponsored events for charities, usuay cancer-based though not aways, and this is something I had not done before, perhaps through a feeing of wanting to repay or put something back for my good fortune in surviving. I fee fortunate that I have a positive disposition but I reaise that it isn t this way for everyone. I wonder how peope without this optimism cope. I don t aways fee happy, occasionay I am frightened and pessimistic. At these times I fee my famiy and friends find it difficut to cope too, they are used to the positive me, reassuring them. I fee as though I m etting them down and strugge to regain contro quicky. Fortunatey this doesn t happen very often. Six years ater Looking back at what I wrote in 1992 I reaise that things have changed quite a ot. I sti ike to exercise and keep fit, but I m no onger obsessive about doing so, and no onger fee as though I owe a debt for surviving. Overa, I m very positive and optimistic, I hardy ever dwe on the prospect of the cancer recurring and now assume I wi ive to a ripe od age and die of natura causes. Three years ago I had reconstructive surgery and a breast impant a difficut and compicated decision which took three years to make and I ve found that not having to use a prosthesis or wear specia or adapted cothing has aso distanced me from the event Caroine Caroine s experience was rather different. She was brought face to face with death when she was invoved in a fata car accident. Her friend who was driving at the time was kied outright whist Caroine escaped unhurt. She found the reaity of this difficut to assimiate and fet a sense of guit. 13 of 45 Friday 17 August 2018

14 For a ong time after the accident severa months I kept repaying it over and over again in my mind and working out how it coud have been avoided then reaising nothing coud change what had happened. I aso regretted very much not seeing Heen s body I didn t want to impose on her famiy at the time, but reay wanted to say goodbye to her. My ast sight of her was just her back sumped over the steering whee in the dark. She was aready dead then. I think I knew she was bady hurt if not actuay dead immediatey when I got out of the car to get hep I eft my bag in the car. Peope thought it was shock, but actuay it was because I fet I was abandoning her by eaving so I eft my bag to show I was coming back. The poice gave me the bag ater I sti wish I had seen her again. I think it woud have heped me come to terms with her dying whie I waked away unhurt if I had sat with her or seen her body ater part of me sti fees I ran away. I aso have a good feeing now that she has become part of my ife not that I am iving for her, but that somehow I sti carry a itte of her ife, even perhaps just remembering her and having been the ast person to see her aive Nick In our society we tend to expect not to have to face the ikeihood of death unti our 70s at east, but one group of peope who are having to face the prospect of death at a reativey young age are those diagnosed as HIV-positive. Controversy surrounds the issue of whether those at risk of contracting the virus shoud have the bood test which might give them that death sentence. At the time of writing there is no cear evidence that any treatment can improve the prognosis, even if taken at an eary stage, and opinion is divided on the ikey effects of knowing you have the virus before any symptoms occur. Some beieve that this enabes the person to take good care of their genera heath and we-being, perhaps therefore improving the prognosis. Others fee that the diagnosis brings despair and depression and can create difficuties with reationships and empoyment. The Terrence Higgins Trust, a charitabe organisation providing support for those with AIDS, produces iterature on the subject. If you woud ike to pursue the issues invoved in greater depth, their website is Peope react in their own way to the knowedge that they have the HIV virus. Here we present a brief extract from Jacqueine Hockings book Waking the Tightrope (1988), in which she taked to peope who were diagnosed HIV-positive. Nick dispays tremendous courage and manages to ive his ife positivey in spite of or perhaps because of, his diagnosis. I met Nick through my work at the Terrence Higgins Trust. He is 23, was diagnosed as HIV positive a year ago, when he was 22, after his first sexua encounter. He spends much of his time traveing around the country, taking to peope about his experiences, and working in training groups. I took the test after my first reationship with a man. I'd just come back from France, where I had this reationship. A friend of mine and I decided to go aong together for a test. It made it a ot easier, going with someone ese. I received the resuts by etter on January 19th, Receiving the resuts by etter was not so good. I thought I d be a hero, and I thought I coud cope with it, but I certainy coudn t. My partner at that time was not infected and because I was, and because we didn t actuay ove each other, we decided to spit up. He was too young he coudn t cope with it. 14 of 45 Friday 17 August 2018

15 Being HIV-positive was difficut, it was horribe. When I received the news, I went into shock. I fee that I ceased to exist, everything ceased to be rea. I wasn t even part of things which were happening around me. Peope went by and said: Hi and I said Hi, but it was ony a very automatic response. I came back from France feeing quite positive and trying to pease my parents. I thought Right, I m reay f*cked up in ife with regards to my parents, it s something to do with them and it s something to do with me, but at east I can do my bit and get that sorted out. I tried to do things to pease them. I started ooking for a job, I started ooking fanaticay for what they termed as a rea job, I wanted to pease them. They thought my job in France wasn t a rea job. I started ooking for this job, going head over hees rushing up to London, ooking for this eusive job. I don t think I reay wanted to do it, so I was quite gad and reieved, when I didn t find this rea job. I fe i during that period. I fet so i that I wasn t abe to move propery, I had spots a over my body, I was out of breath, had very high temperatures. A of a sudden a my feeings disappeared out of the window. Suddeny I wasn t abe to breathe anymore. I was on a drip, and suddeny, just very, very suddeny, that was it. I coudn t breathe. I was out of my mind, so scared. I didn t understand what was happening. I thought it was probaby death on the way and got hod of Mum s skirt and asked her to ask them I was on fu oxygen at the time and I remember taking to my mother and father teing them I wanted to be cremated. My father said: Don t be stupid, you re not going to die. I got very frustrated with him, because of course I was going to die. It was obvious to them, it was obvious to me, that I was going to die, aso to the doctors they said to me that I had a 30 per cent chance of surviva. My sense of humour seemed to get better at that point. I said: At east that s better than 20 per cent. I think I d read it somewhere, you know, the kind of things one might say on one s death bed. I discussed my cremation, where I wanted my ashes scattered. That meant a ot to me. I thought about my death. I fee very privieged to have thought about death. I used to think of mysef, even now, as being immorta. We do certain things to our bodies, which shoudn t be done, ike me, during the HIV period. I seemed to be trying to cheat death. I drunk a ot, took quite a few drugs, skiied ike a madman, because death was quite cose anyway. I was cheating my immortaity. I was trying to say to mysef: I am immorta, by doing these things to my body. One of the things that pued me through was that I wasn t ready to die. I reay wanted to ive, and now because I am iving and I have been through that, I can appreciate ife a ot more. I ove ife. I think it s fabuous, the most important thing that has ever happened to me, to be aive. I often think I m a iving mirace here. Maybe I sound ike a Bibe basher here, but I do think that ife is a mirace. I am doing a ot, I fee worthwhie, I fee ike I am a worthwhie human being. Sometimes I need other peope to say that to me, because I regard mysef as being a economic crippe, sexua crippe, a bit of a faiure. Reiant on my parents, there is nothing much going for me 15 of 45 Friday 17 August 2018

16 Sometimes I view having AIDS as cimbing mountains. I used to do a ot of mountaineering. There are a ot of mountains to cimb. You cimb over one mountain, and when you re on the top of one mountain, you can see some more mountains. You get down into the vaey and up to another mountain. You see some more. There are forever more mountains to cimb. (Hockings, 1988) Activity 4 (Pease omit this activity if you wish.) If it fees comfortabe, ask yoursef what is the nearest you have come to your own death. This might be a serious iness, a near-accident or something ese. Note down any effect this has had, either in the short term or the ong term, on the way you ive your ife and the way in which you view death. Has it changed your reationships in any way? Has it affected your view about what reay matters in ife? Has it made any difference to your enjoyment of ife? Has it made you more or ess fearfu of death? If you chose to do this activity you may find it has brought back uncomfortabe memories you need to share with someone; on the other hand, it may have been an entirey positive experience. You may fee you have never reay been cose to death. Or maybe you have but it makes itte difference to you and you prefer not to think about it. On the other hand, you might want or need to remember the experience but find it difficut to discuss, because it s hard to find the right words or because other peope aren t interested or, worse, regard your experience as pathoogica or frightening. This is, perhaps, most ikey to occur if there are unusua aspects in your experience, as there were for this person: As the pain reached its peak it suddeny stopped and I found mysef suspended up under the ceiing. I coud not see mysef, there was some mist beow and as I eaned over to try to see under my body I had the sensation that I woud fa down. Athough I coudn t see my body I coud nevertheess see everything in the room, ike the teephone which was not visibe from the bed, I coud see quite ceary from my position above. I coud aso hear everything that was going on and the nurse who was sti trying to get me to move my eg. Then I heard her say, My God, she s gone. (Grey, 1985,p. 37) This out-of-body experience is one aspect of what has come to be described as neardeath experiences. 16 of 45 Friday 17 August 2018

17 1.3 Near-death experiences Reactions to near-death experiences A number of peope have caimed that they have been at death s door and can reca some of the sensations. Attempts to speak about near-death experiences (a term used to describe the extra-ordinary experiences some peope have when cose to death or when deepy unconscious) can meet with incomprehension, fear and hostiity from friends as we as medica experts and researchers, many of whom refute the existence of neardeath experiences. As Toates (1999, p. 1) says: to the hard nosed no nonsense scientist, it either risks undermining the materiaist foundations of modern bioogy and psychoogy or, at the very east, serves to se arge numbers of pseudo-scientific books that misead the naïve and neurotic into superstitious beiefs more appropriate to the Midde Ages. The medica estabishment has by and arge been sceptica about the reiabiity of accounts of near-death experiences. Michae Sabom, a medica doctor who studied neardeath experiences, found that some of the peope he interviewed had been very disturbed by the unwiingness of others to isten or take them seriousy. For some this even ed to a fear of insanity, as in the case of this woman who spoke of her experience as a teenager during a severe car accident. I tod the doctor that something had happened to me. I said There was this ight and this voice spoke to me. Do you think that was God? he said No, I don t, and he tod my parents. At first they thought I was in shock and then they reaised that I wasn t in shock and that I was aright. I was never afraid then two months ater we were going downtown or something and they said we were going to visit this doctor and I said OK thinking it was for them. Then there was this psychiatrist and I said, You ve got to be kidding I fet I had done something wrong by saying what had happened I am 37 years od, and I have never tod anyone about it since. (Sabom, 1982, pp ) Near-death experiences are not as uncommon as you might think. Fenwick and Fenwick (1996) quote a Nationa Opinion Po in the USA which suggests that over a miion Americans have experienced this phenomenon. It is therefore necessary to take it seriousy. In this section we provide descriptions of near-death experiences and iustrate the impact on those who have experienced them. There are three main points: a significant number of norma peope may have had such an experience and may wish to tak about it for many, but not a, the experience has ed to a more positive view of both ife and death there is considerabe debate about the wider significance of this phenomenon and whether it is to be expained in physioogica or spiritua terms. 17 of 45 Friday 17 August 2018

18 1.3.2 Recurrent themes When the accounts of peope who have described a near-death experience are ooked at side by side it is possibe to identify some common features. This isn t to say that a of these features are present in every account, but that amidst variations there are certainy recurrent themes. The foowing ist is compied from a variety of studies, incuding the important study undertaken by Sabom (1982), himsef initiay sceptica Ineffabiity Most peope who speak of their near-death experience say they have great difficuty putting it into words because, as one person put it, There is no feeing you experience in norma ife that is anything ike this Sense of timeessness In Sabom s study, everyone described their near-death experience as if it had occurred in a timeess dimension: peope were unabe to make any judgement about how ong the experience asted. There was no measurement of time. I don t know if it was a minute or five or ten hours, commented one Sense of reaity Sabom aso found most peope emphasised at east once during their interview that the experience was as rea as the more ordinary events of ife. In this vein a typica comment was, It s reaity. I know for mysef that I didn t experience no fantasy. There was no socaed dream or nothing. These things reay happened to me. It happened. I know. I went through it. For one man it was reaer than here After that the word seemed ike a mockery to rea ife Sense of death For amost everyone, quite eary in the experience there was a strong feeing that they were dying or had aready died, but this wasn t preceded by a conscious anticipation of the nearness of death. One survivor of a heart attack said the first thing he reaised after osing consciousness was that something funny was going on I reaised I was dead that I had died. [I thought] I don t know whether the doctor knows it or not, but I know it Emotiona feeings In Sabom s study a who reported a near-death experience were asked to describe their emotions during the experience. The predominant picture was one of cam, peace and tranquiity, in marked contrast to the physica pain and suffering fet before or after the event. Some spoke of sadness at seeing the efforts and distress of others trying to bring them back to ife, and one woman spoke of being very happy unti she remembered she was eaving her chidren behind. A few referred to a sense of oneiness or darkness, though for some this was foowed by a movement towards ight. Sometimes this darkness was described as entering a vast, back space or a tunne through which one moves at great speed. I was in what fet ike outer space. It was absoutey back out there and I fet ike I was being drawn towards an opening ike at the end of a tunne. I knew this because I coud see a ight at the end. 18 of 45 Friday 17 August 2018

19 1.3.8 Separation from the physica body Very common is the experience of foating, sometimes on the ceiing, ooking down on the body a sense that the essentia part of the person has separated from the physica body. In Michae Sabom s survey of near-death experiences among non-surgica cases everyone had this sensation, but other studies indicate it is not universa. One woman recorded these feeings in a poem. Hovering beneath the ceiing, I ooked down Upon a body, untenanted my own Strangey at peace, airy, weightess as ight, I foated there freed from pain-fied days and nights Unti a voice I heard, an urgent ca, And again I dwet within my body s wa. (Sabom, 1982, p. 21) This out-of-body experience was typicay accompanied by aertness and carity of thought Other common features In addition to these very common features there are in many accounts further distinctive eements. A sense of entering into or being met by ight and/or an area of great beauty has been expressed in a significant number of accounts. Here are just two iustrations: I was just in a wonderfu peace and weness in a beautifu andscape setting of grass, awns and trees and briiant ight. (Fenwick and Fenwick, 1996) A man who neary died of pneumonia recounted: A bue-god ight which reappeared and grew brighter and brighter. I went forward towards the ight and as I did so I had such a feeing of freedom and joy, it s beyond words to expain. I had a boundess sense of expansion. (Grey, 1985,p. 47) 19 of 45 Friday 17 August 2018

20 Do peope draw on images such as this in their description of near-death experiences? The proportion of near-death experiences that invove these kinds of transcendenta phenomena varies from one study to another. In Sabom s research they are most common among peope undergoing surgery. Tabe 1 indicates the frequency among the 61 non-surgica cases in Sabom s study. Other recurrent features incude: Meeting deceased friends or reatives. (This was reported in 38 per cent of the respondents in the Fenwicks study; in Sabom s study this was more common among women than men.) Being in the presence of a reigious figure such as God, Jesus or the Buddha. (This was reported in 34 per cent of the Fenwick s respondents.) A ife review: a rapid menta repay of significant ife events. (The Fenwicks study did not repicate this common finding of other studies ony 12 per cent recaed reviewing past events.) 20 of 45 Friday 17 August 2018

21 Tabe 1 Eements of the near-death experience and their frequency of occurrence among 61 nonsurgica cases Eement Frequency (per cent) Subjective sense of being dead 92 Predominant feeings of cam and peace 100 Sense of bodiy separation 100 Observation of physica objects and events 53 Dark region or void 29 Life review 54 The Light 29 Beautifu environment 54 Meeting others 48 Return 100 (Source: Sabom, 1982, p. 206) A the near-death experiences described by Sabom are predominanty positive. In the Fenwicks study (where they advertised for accounts of near-death experiences) the majority of the respondents aso reported positive experiences 82 per cent fet camness and peace, 40 per cent fet joy, and 38 per cent fet ove. These were surprising findings because they had predicted many more negative experiences, particuary descriptions of terror, fear and oss, because many near-death experiences are catastrophic and overwheming. In her book Return From Death Margot Grey, a psychoogist who hersef had a positive near-death experience, maintains that negative experiences aso occur, though they are much ess frequent. She suggests they are more ikey to be spoken of immediatey after the event. A negative experience is usuay characterised by a feeing of panic or fear and may invove dark and goomy or barren and hostie visions and andscapes. Very occasionay peope report a situation that resembes cassic descriptions of he The impact of near-death experiences In many studies (Sabom, 1982; Toates 1999) the main effect of a near-death experience was to reduce a person s fear of dying. Individuas surviving simiar types of near-death crisis without an associated near-death experience did not show the same reduction in fear of death, as Tabe 2 indicates. Tabe 2 Effect of near-death crisis event on fear of death Fear of death With near-death experience (61 peope) Without near-death experience (45 peope) Increased 0 5 No change Decreased 50 1 (Source: Sabom, 1982, p. 212) 21 of 45 Friday 17 August 2018

22 The reduced fear of death doesn t impy an increased desire to die or a rejection of the vaue of iving, but rather an acceptance of both ife and death. One of Sabom s patients, who had a transcendenta near-death experience during a cardiac arrest when he was 33 years od, iustrates this we. He is seriousy disabed and can t work. I used to worry about ife and iving and trying to get ahead I don t do that anymore I just ive from day to day I m going to ive what I ve got eft and I m going to enjoy it I ve been through death and it didn t bother me I m not scared of it. (Sabom, 1982, p. 126) For some, the new attitude towards death aso affects views on the death of oved ones and frequenty strengthens reigious beiefs, especiay beiefs in an afterife (Tabe 3). Tabe 3 Effect of near-death crisis event on beief in afterife Beief in afterife With near-death experience (61 peope) Without near-death experience (45 peope) Increased 47 0 No change Decreased 0 0 (Source: Sabom, 1982, p. 212) The Fenwicks and Margot Grey s findings suggest that whie reigious beiefs do not appear to affect the ikeihood of a near-death experience occurring, the experience undoubtedy subsequenty changes the person s reationship with reigion. The main shift woud seem to be away from theoogica doctrines to a more spiritua ideoogy (Grey, 1985, p. 108). Fenwick and Fenwick quoted a simiar iustration: Athough I am sti a Roman Cathoic, I fee the experience I had is beyond any denomination. Another put it this way: I was raised in the Church of Engand, but since my experience I've become non-denominationa. I now fee a reigion is basicay the same (Fenwick and Fenwick, 1996). Among both the reigious and non-reigious aike, there is evidence of increased compassion and empathy towards other peope foowing a near-death experience: When I ook at peope now, I fee I reay do ove them, which is something I never fet before was how one person expressed this. Usuay interviews te us itte about the detaied practica working out of such changes, though some peope have described ways in which their activities have been atered. So, for instance, increased acceptance of death has ed some into an invovement with dying peope. After her near-death experience this hospita vounteer ost a fear of death and so came to be regarded as the right person to sit with those who had been tod their iness was termina: because if they were going to die it didn t bother me. It was reay easy for me to tak to the peope about it. I d fee reay good about it, and it seemed to make the peope fee better (Sabom, 1982, p. 132) The significance of the near-death experience The socioogist Aan Keehear (1995) observes that most studies have had a medica focus, investigating whether near-death experiences coud be the resut of a ack of oxygen to the brain or another medica or psychoogica cause. Keehear suggests that 22 of 45 Friday 17 August 2018

23 the search for psycho-medica expanations has focused on psycho-neuroogica and defensive mechanisms emphasising atered status of consciousness or physica functioning and not taken into account the meaning of these experiences. Keehear identifies three socia features of near-death experience: sudden and unexpected separation a transition period invoving expectation of death a sudden return to the origina socia group. Keehear suggests that these features impy a status passage and resembe other kinds of experiences, for exampe those of peope who have been shipwrecked. Status passage was described by Gaser and Strauss (1967), who conducted extensive research of dying peope and those caring for them. It invoves a changed identity or sense of sef, as we as changed behaviour (p. 2, quoted in Keehear, 1995). We experience many transitions: changing jobs, careers, partners and ocations. As our position changes we continuay have to readjust to a transitiona position, separating from our former status and then integrating and recognising our new position. Using this anaogy, near-death experiences resembe many features of modern dying it is unschedued, undesirabe, invountary and not aways predicted. For some peope the impact of near-death experience is very profound. For exampe, for some the existence of the near-death experience acts as a proof or an assurance of ife after death. A respondent in the Fenwicks study put it as foows: I ve aways beieved in ife after death, though I no onger beong to any form of organised reigion, preferring to find my own path, but if I needed anything to confirm my beief in another pane of existence, that experience certainy did. I fee so gratefu to have had it. (Fenwick and Fenwick, 1996, p. 150) For others it is no more than a subjective account of what is experienced as the brain coses down due to a ack of oxygen. A typica expression of this second view is given by Lesie Ivan (a neuro-surgeon) and Maureen Merose (a nurse) in their book The Way We Die (1986), in which they assert that a the experiences that have been described can certainy originate in the brain, caused by the we-known chemica changes that occur in near-death emergencies. They describe the steps in the dying process as foows (adapted from Ivan and Merose, 1986, p. 87): 1 The triggering mechanism is decreased bood oxygen avaiabiity. The feeing of peace and tranquiity is an eary manifestation of decreased nerve activity (the way tranquiisers work). 2 As the chemica changes increase in quantity there is an effect in the imbic system of the brain (the part activated during arousa and motivated behaviour) such that there is a sense of euphoria and body-separation. 3 With the progressive changes, other eements of the brain become invoved and when the visua cortex is affected backing out occurs (entering the darkness). 4 Further changes cause hyperactivity of the same nerve ces and visua haucinations become intensified (seeing the ight). 5 In the fina stage, just before the part of the brain responsibe for consciousness is aboished, a haucination occurs (entering the ight). 23 of 45 Friday 17 August 2018

24 This type of expanation is based on a commitment to the view that the materia word in genera, and neuro-physioogica changes in particuar, form basic reaity and that consciousness and imagery are simpy an effect or expression of these materia changes. By and arge peope trained in medicine wi tend to favour such an expanation, though some find it inadequate, as did Michae Sabom, who identified a number of discrepancies between the near-death experience accounts he gathered and existing neurophysioogica expanations. So, for instance, he was struck by the fact that some peope reca in precise and accurate detai events and objects that had been outside of their visua fied at the time of the experience. He aso found major differences between the feeings and visions associated with near-death experiences and those experienced in the deusions, haucinations, dreams and tempora obe seizures in terms of which neardeath experiences have commony been expained. Acknowedging that there are, however, strong simiarities between near-death experiences and states of consciousness associated with raised eves of carbon dioxide in the brain, Sabom ended by questioning the premise underying the neuro-physioogica expanation by asking whether the experiences were caused by the high eves of carbon dioxide per se or were they due to some other mechanism associated with the patients carbon dioxide-induced near-death condition? (p. 178). Activity 5 What possibe kinds of answer might there be to Sabom s question? If you can think of any aternatives to the medica expanation briefy jot them down before continuing. You are not being asked to find the right answer but just to guess what possibe answers there might be. A psychoogica expanation for near-death experiences Some peope put forward a psychoogica expanation of the near-death experience which goes something ike this: the personaity (or ego) is attempting to deny its imminent dissoution and so evokes such mechanisms as depersonaisation (as in eaving the body ) or ego defence (hearing voices, etc.). This expanation is ike the medica one in assuming that consciousness perishes with brain stem death. In fact Sabom wishes to chaenge that assumption and to suggest that consciousness may exist beyond or outside of the activity of the brain. He questions the phiosophica basis of the materiaist, medica framework, proposing that near-death experiences are to be taken at face vaue, as expicabe in terms of an encounter with God, an ineffabe truth encountered face to face at death s cosest moments (p. 186). At the same time Sabom doesn t caim that near-death experiences describe the afterife or that they can egitimatey be used as proof of its existence. They te us what happens during the process of dying, but they cannot be used as a description of what happens after death, for none of his interviewees actuay died (my emphasis). Despite this, the popuar media have in recent years presented the experiences as evidence of an afterife, as in the foowing artice from the Daiy Mai. Can there reay be ife after death? there is growing evidence from peope of different cutures, different jobs and aspirations a reporting startingy simiar phenomena in near-death experiences which appear to testify to the existence of something ese beyond ife. 24 of 45 Friday 17 August 2018