Experiencing death to improve life

The history of the near-death experience (NDE) is most commonly associated with the work of Raymond Moody and his 1975 book Life after Life; with parapsychology and spiritually oriented practitioners; with successfully reanimated cardiac arrest patients (Van Lommel et al., 2001); and, more recently, with the neurosciences (Blanke & Dieguez, 2008). But another tradition of research preceded all this, in which psychologists and psychiatrists played a major role.

This alternative history started in thanatology, palliative care and psychotraumatology. It investigated the NDE in its various manifestations – anticipation of death by incurable patients, experiences in extreme danger by survivors of accidents, attempted suicides. I will demonstrate this neglected chapter by presenting one particular body of work: the research conducted by the American psychiatrist Russell Noyes, professor emeritus at the University of Iowa Hospitals and Clinics.

A respected psychosomaticist, specialist of anxiety disorders and author of more than 250 scholarly published articles, Noyes dedicated his research during the 1960s and 70s to the experience of dying and near-death. He interpreted the NDE in psychological terms, defining it as a protective mechanism. His work is a window on the motivations of a psychiatrist for engaging in the study of NDE, the clinical and therapeutic implications of his results, and both healthcare practices and attitudes towards the dying patient during that period of history.

The popularisation of death

Let's all die,
Let's practice a little,
Let's play dead for a couple of hours
Let's everybody weave elegant everlasting cerements
Build fantastic tombs
Carve lifelong coffins
And devise great ways to die let's!
(Corso 1960, p.40).

Gregory Corso's pieces of advice, taken from his collection of poems The Happy Birthday of Death, reflects the popularisation of death that captured the American public sphere in the 1960s. Numerous scientific and popular books dealing with death, dying and fears of dying were published: among them, Elisabeth Kübler-Ross' On Death and Dying (1969), Barney Glaser and Anselm Strauss' Awareness of Dying (1965) and Herman Feifel's collected essays and studies Meaning of Death (1959).

One of the main concerns for these authors was contemporary manners of dying, especially those occurring in hospitals. In the late 1960s, early in his career, Noyes joined this discussion enthusiastically by publishing articles such as 'The taboo of suicide', 'The dying patient', 'The art of dying', or 'The care and the management of the dying' (Noyes 1967, 1968b, 1971a, 1971b). His argument was that progress in biomedicine (oncology, transplantation of organs, gerontology) caused a 'taboo of death'. To undo this taboo, the practitioners looked to publish extensively on what it is to die.

Psychological and psychiatric skills were in high demand in the domain of the care of the dying and incurably ill. Psychiatrists started to systematically describe emotional reactions of terminally ill patients suffering from cancer and incurable illnesses, emphasising the importance of psychotherapeutic supervision in the care of these patients (Cappon, 1959; Chodoff, 1960; Eissler, 1955; Weisman 1972). Noyes referred to empirical findings on survivors of catastrophes and concepts of grief, such as the 'anticipatory grief reaction' (Aldrich, 1963), in order to emphasise the condition of a dying patient. In his perspective, dying patients had similar emotional distress as survivors or persons who had lost a beloved one, because they had to accept that reality and relationships as they experienced them no longer existed (Noyes, 1968a).

Along with many other health practitioners Noyes believed that emotional distress experienced by incurably ill patients may also lead to benefits, if the process of anticipating death is approached as a learning experience. Elisabeth Kübler-Ross's five-stages model of dying is one of the most famous and controversial examples of an instruction on how to die in a psychological manner; by evolving from denial toward acceptance (Kübler-Ross, 1969). Psychedelic researchers formulated similar arguments. At the Maryland Psychiatric Research Center in Baltimore for example, multi-professional teams administered LSD in several sessions to terminally ill patients suffering from cancer in order to provoke a 'peak experience' and a better appreciation for life (Pahnke et al., 1970) [see also our 'Hallucinogens' special issue, September 2014].

Eager to find out what happens at The very edge of death, Noyes turned his interest away from narratives of incurably ill patients toward those of survivors. From 1970 on, Noyes started to collect narratives on near-death states from literature, poetry and first-hand accounts. Among them was Michel de Montaigne's essays on death: in particular the passage where the French philosopher recounts his own near-death experience, which occurred after a riding accident and left him so impressed that he was less fearful of death afterwards. Another example includes a narrative from a survivor of a nearly drowned admiral cited in William Munk's Euthanasia. Or, Medical Treatment in Aid of an Easy Death (1877/1977). The survivor describes that when all exertion had ceased, 'a calm feeling of the most perfect tranquility superseded the previous tumultuous sensations' (Munk, 1977, p.12).

Noyes' historical researches eventually led him to an 1892 compilation of near-death experiences in the Yearbook of the Swiss Alpine Club. Albert Heim (1849–1937), a famous Swiss geologist and alpinist, had written a description of his spectacular 20-metre fall following a failed attempt to catch his hat:
I saw my whole past life take place in many images, as though on a stage at some distance from me. I saw myself as the chief character in the performance... Everything was beautiful and without grief, without anxiety, and without pain... I felt no conflict or strife; conflict had been transmuted into love...(Noyes & Kletti, 1972, p.50)

In the original article entitled 'Notizen über den Tod durch Absturz' (Notes on Fatal Falls), Heim compared his sensations and perceptions with the accounts of more than 20 other survivors, mostly alpinists from the Alpine Club. He concluded that 95 per cent of the persons having faced death did not feel any pain, but rather sensations of well-being. Inspired by this reading, Noyes and his former colleague, the psychologist Roy Kletti, translated the article into English and published it in 1972 in a journal of thanatology, Omega. From this was developed a three-stage model of the experience of dying evolving from denial to acceptance: (1) resistance, (2) (panoramic) review, (3) transcendence (Noyes, 1972).

From 1970 to 1977 Noyes replicated Heim's approach by contacting members of the American Alpine Club. Noyes also investigated skydivers and contacted several institutes of Public Health to find records of people who had nearly drowned. In all, Noyes assembled 250 folders of correspondences from around the world. From these he developed questionnaires to measure perceptions, sensations and emotions of the survivors during their experiences in extreme danger. However, the most important question for Noyes was whether NDE – although described in psychopathological terms – could be a protective mechanism capable of preventing the subject from a traumatic experience.

Depersonalisation in danger

From 1975 to 1977 Noyes compared sensations of selected survivors of car accidents with testimonies of psychiatric patients suffering from various disorders. After analysing the questionnaires, Noyes argued that the experience of near-death corresponded to a 'transient syndrome of depersonalisation'. Noyes postulated that in situations of extreme danger an individual's personality would split into a 'participating self' and an 'observing self' (Noyes & Kletti, 1976). In this state the individual would experience opposite sensations of rapid thought processing and heightened perception, combined with a feeling of distance from reality. This simultaneous hyperactivity and detachment enabled the individual to make corrective movements, while falling or nearly drowning, but also to revive images of a joyful past (panoramic memory) to enable acceptance of life's end. This conception of near death was partly inspired by the Swiss psychoanalyst Oskar Pfister's theory of 'shock phantasies' (Schockphantasien), which suggested that in a moment of extreme danger a person protects herself with a 'real' and an 'autistic' element (Pfister, 1930).

Noyes' empirical findings and methods were widely copied to measure death attitudes and NDE from the 1980s on, but his interpretation of NDE fell out of step with developments. With the newly defined PTSD a survivor of a life-threatening danger was associated with traumatic rather than transformative experiences. On the other hand, parapsychologists have dominated the debate on NDE since the 1980s, explaining experiences close to death as extrasensory perceptions, rather than (just) meaningful experiences capable of altering fears related to death.

Nevertheless, Noyes' research shows that it was not controversial for an 'orthodox' psychiatrist to study near-death during the 60s and 70s. This changed after 1980: as psychiatry became more specialised and 'new age' approaches proliferated in parallel, it became polemic to study NDE.

Noyes' research sheds light on how death was thought to be prepared in the 60s and 70s: individuals should train themselves to experience their own death, at least simulate it, in order to reduce their fears. Narratives of survivors proved to be an excellent illustration of the simple but urgent argument: dying is a fear- and pain-free experience. Noyes' findings, which complete the longstanding tradition of ars moriendi, may still be of interest today, namely when it comes to know whether it is necessary to prepare one's own death, and if yes, how.

Dr Jelena Martinovic is a research associate at the Institut d'histoire de la médecine (IUHMSP), University of Lausanne
[email protected]

References

Aldrich, K. (1963). The dying patient's grief. Journal of the American Medical Association, 184, 329–331.
Blanke, O. & Dieguez, S. (2008). Leaving body and life behind: Out-of-body and near-neath experience. In S. Laureys & S. Tononi (Eds.) The neurology of consciousness (pp.303–325). New York: Elsevier.
Cappon, D. (1959). The dying patient. Psychoanalytic Quarterly, 23, 466–489.
Chodoff, P. (1960). A psychiatric approach to the dying patient. CA: Bulletin Cancer Progress, 10, 29–32.
Corso, G. (1960). The happy birthday of death. New York: New Directions.
Eissler, K. (1955). Dying patient and the psychiatrist. New York: International Universities Press.
Kübler-Ross, E. (1969). On death and dying. London: Routledge.
Moody, R. (1975). Life after Life. Covington, GA: Mockingbird Books.
Munk, W. (1977). Euthanasia. Or, Medical treatment in the aid of an easy death. Baltimore, MD: Williams & Wilkins. (Original work published 1877)
Noyes, R. (1967). The dying patient. Diseases of the Nervous System, 28, 790–797.
Noyes, R. (1968a). Grief. Journal of the Iowa Medical Society, 59, 317–323.
Noyes, R. (1968b). The taboo of suicide. Psychiatry, 31, 173–183.
Noyes, R. (1971a). The art of dying. Perspectives in Biology and Medicine, 14, 432–446.
Noyes, R. (1971b). The care and the management of the dying. Archives of Internal Medicine, 128, 299–303.
Noyes, R. (1972). The experience of dying. Psychiatry, 35, 174–184.
Noyes, R. & Kletti, R. (1972). The experience of dying from falls. Omega, 2, 45–52.
Noyes, R. & Kletti, R. (1976). Depersonalization in the face of life-threatening danger: A description. Psychiatry, 39, 19–27.
Pahnke, W., Kurland, A., Sanford, U. et al. (1977). The experimental use of psychedelic (LSD) therapy. Journal of the American Medical Association, 212, 1856–1863.
Pfister, O. (1930). Schockdenken und Schockphantasien bei höchster Lebensgefahr. Internationale Zeitschrift für Psychoanalyse, 16, 340–455.
Van Lommel, P., Van Wees, R., Meyers, V. & Elfferich, I. (2001). Near-death experiences in survivors of cardiac arrest: A prospective study in the Netherlands. Lancet, 358, 2039–2245.
Weisman, A. (1972). On death and denying: Psychiatric study of terminality. New York: Behavioral Publications.