SPIRITUAL AFTEREFFECTS OF INCONGRUOUS NEAR-DEATH EXPERIENCES: A HEURISTIC APPROACH A dissertation presented to the Faculty of Saybrook University in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Human Sciences by Robert Waxman San Francisco, California November 2012 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. Microform Edition © ProQuest LLC. All rights reserved. This work is protected against unauthorized copying under Title 17, United States Code ProQuest LLC. 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, MI 48106 1346 UMI 3552161 Published by ProQuest LLC (2013). Copyright in the Dissertation held by the Author. UMI Number: 3552161 UMI Number: All rights reserved © 2012 by Robert Waxman Approval of the Dissertation SPIRITUAL AFTEREFFECTS OF INCONGRUOUS NEAR-DEATH EXPERIENCES: A HEURISTIC APPROACH This dissertation by Robert Waxman has been approved by the committee members below, who recommend it be accepted by the faculty of Saybrook University in partial fulfillment of requirements for the degree of Doctor of Philosophy in Human Sciences Dissertation Committee: ______________________________ ________________________ Robert McAndrews, Ph.D., Chair Date ______________________________ ________________________ Stanley Krippner, Ph.D. Date ______________________________ ________________________ Willson Williams, Ph.D. Date ii Abstract SPIRITUAL AFTEREFFECTS OF INCONGRUOUS NEAR-DEATH EXPERIENCES: A HEURISTIC APPROACH Robert Waxman Saybrook University Many individuals have experienced a transformation of their spirituality after a near-death experience (NDE). Some of these near-death experiencers (NDErs) have reported an incongruous spiritual experience (ISE) during their NDEs. Such an experience occurs when NDErs perceive certain communications and/or visions that are incompatible or inconsistent with their previous religious/spiritual beliefs. In the present study the researcher examined NDEand ISE-related phenomena, utilizing the qualitative techniques of heuristic analysis. An initial pool of 84 survey participants completed Greyson's NDE Scale and a questionnaire developed by the researcher to measure various elements of an incongruous spiritual experience. Subsequently, eight participants were interviewed, utilizing Moustakas's heuristic analysis to investigate their NDE/ISErelated experiences. The results indicated that all the participants altered their religious/spiritual beliefs after coping with varying intensities of cognitive dissonance. Therefore, it was concluded that the participants' reports of incongruous elements during their NDEs were spiritually transformative. iii Acknowledgments I wish to thank Dr. Raymond Moody for the generous amount of time he spent with me in Virginia Beach, VA, at The Afterlife Conference. His advice was invaluable during the course of the current study. I wish to extend my sincere gratitude to Dr. Stanley Krippner for encouraging me to investigate cognitive dissonance as an aftereffect of the NDE and for offering constructive insights that have helped me to improve the quality of the research. I am grateful to Dr. Robert McAndrews for inspiring me during my coursework and for serving as Chair of the Dissertation Committee. I also wish to acknowledge and thank Dr. JoAnn McAllister for introducing me to Saybrook and for continually supporting my efforts. Finally, I offer my heartfelt appreciation to Dr. Willson Williams, who has worn several hats as my academic adviser, professor, and Dissertation Committee member. Throughout my Ph.D. program, Dr. Williams has been a source of wisdom, knowledge, and compassion. As a dedication, I wish to express my love to Dianne Martino-Reynolds, who has been patient, nurturing, and understanding all along the way. iv Table of Contents List of Tables ..................................................................................................................... vii CHAPTER 1: INTRODUCTION ........................................................................................1 Purpose .................................................................................................................................1 Personal Background ...........................................................................................................2 Definitions of Key Terms .....................................................................................................5 Statement of the Problem .....................................................................................................9 Research Question ............................................................................................................. 11 Summary ............................................................................................................................ 11 CHAPTER 2: REVIEW OF THE LITERATURE .............................................................12 Background ........................................................................................................................12 Recent and Current Scientific Research ............................................................................15 Trends in Near-Death Studies ............................................................................................17 Qualifying and Quantifying NDEs ....................................................................................18 The Core NDE ...................................................................................................................18 Moody's 12 NDE Traits .........................................................................................19 Ring's Five Phases of the NDE ..............................................................................21 Greyson's Four NDE Components ........................................................................21 Sabom's Three NDE Categories ............................................................................23 Transformative Aftereffects of NDEs ................................................................................24 Attitudes toward Life and Death ........................................................................................26 Emotional, Spiritual, and Behavioral Changes ..................................................................27 Physiological Changes .......................................................................................................29 Renewed Purpose in Life ...................................................................................................31 Cross-Cultural Research ....................................................................................................31 Recreating NDEs ...............................................................................................................35 Cognitive Dissonance ........................................................................................................37 Framework for NDEs .........................................................................................................38 Perceived Communications during NDEs .........................................................................40 Prophetic Visions ...............................................................................................................47 Prophetic Revelations ........................................................................................................49 Perceived Communications with Spiritual Beings ............................................................50 Changes in Spiritual Beliefs...............................................................................................54 Spiritually Transformative Experiences .............................................................................64 Cognitive Dissonance Relating to Changes in Spiritual Beliefs ........................................65 Summary ............................................................................................................................68 CHAPTER 3: METHODOLOGY .....................................................................................69 Choice of Method ..............................................................................................................69 Participants .........................................................................................................................70 Instruments .........................................................................................................................71 Greyson's NDE Scale (1983a) ...............................................................................71 Incongruous Spiritual Experience Questionnaire (ISEQ) ......................................72 v Procedure ...........................................................................................................................72 Heuristic Inquiry ................................................................................................................73 Initial Engagement .................................................................................................75 Immersion ..............................................................................................................75 Incubation ..............................................................................................................76 Illumination ............................................................................................................76 Explication .............................................................................................................77 Creative Synthesis ..................................................................................................77 Interviews ...............................................................................................................78 Data Collection ......................................................................................................79 Limitations .........................................................................................................................79 Summary ............................................................................................................................80 CHAPTER 4: DATA AND RESULTS ...............................................................................82 Individual Depictions .........................................................................................................82 Larry .......................................................................................................................83 Wendy ....................................................................................................................86 Betty .......................................................................................................................89 Barry ......................................................................................................................93 Laura ......................................................................................................................95 Cary ........................................................................................................................98 Exemplary Portraits .........................................................................................................100 Paul ......................................................................................................................101 Brenda ..................................................................................................................105 Themes .............................................................................................................................109 Re-evaluation of Christian Beliefs .......................................................................109 Veridical Perception ............................................................................................. 110 Perceived Communications/Visions .................................................................... 110 Cognitive Dissonance .......................................................................................... 111 Changes in Religious/Spiritual Beliefs ................................................................ 111 Loss of Fear of Death ........................................................................................... 112 Belief in Reincarnation ........................................................................................ 112 Shift to Universal Spirituality .............................................................................. 112 Summary .............................................................................................................. 112 Composite Depiction ....................................................................................................... 113 Creative Synthesis ............................................................................................................ 116 Summary .......................................................................................................................... 119 CHAPTER 5: DISCUSSION AND ANALYSIS OF RESULTS .....................................120 Relationship of Results to Scholarly Literature ...............................................................120 Attaining Higher Consciousness ..........................................................................120 Surrendering to a Higher Power ..........................................................................121 Altering Spiritual Beliefs .....................................................................................121 Exhibiting High Confidence Levels .....................................................................122 Experiencing Feelings of Ecstasy ........................................................................123 Need to Discuss the NDE ....................................................................................123 vi Experiencing Attributes of God ...........................................................................123 Implications of the Study .................................................................................................124 Suggestions for Future Research .....................................................................................129 Limitations of the Findings ..............................................................................................131 Delimitations of the Findings...........................................................................................132 Conclusion .......................................................................................................................133 REFERENCES ................................................................................................................135 APPENDICES A. Recruitment Announcement for Online NDE Survey ...................................152 B. Recruitment Correspondence to IANDS Chapters ........................................153 C. Greyson's NDE Scale (1983a) .......................................................................154 D. Incongruous Spiritual Experience Questionnaire (ISEQ) ..............................157 E. Combined Scores from Online Survey ..........................................................159 F. Interview Questions .......................................................................................160 G. Creative Synthesis ..........................................................................................161 H. Online Survey Informed Consent ..................................................................164 I. Debriefing Statement .....................................................................................165 J. Informed Consent Form for Adults ................................................................166 vii List of Tables Table 1. Highest Scoring Online Survey Respondents ......................................................................... 73 1 Chapter 1: Introduction Purpose This research study investigated eight individuals who reported incongruous elements during their near-death experiences (NDEs) that turned out to be spiritually transformative. As background to this study, the researcher explored the research previously conducted on the correspondence between the near-death experience and spiritual transformation afterwards (Atwater, 1988, 1994, 2003, 2008; Flynn, 1986; Grey, 1985; Greyson, 1992, 2006; Ring, 1980, 1984; Sabom, 1982; van Lommel, 2010), only to discover that most of these studies did not actually investigate the aftereffects of an incongruous spiritual experience (ISE) during an NDE. In a few studies the researchers found that near-death experiencers' (NDErs') religious/spiritual beliefs were incongruous with their religious/spiritual expectations of the afterlife (Abramovitch, 1988; Bush, 2002; Newsome, 1988; Ring 1984; Thibodeau, 1998). However, a comparison of the studies indicated that the results were mixed regarding changes in religious affiliation and religiosity. Some participants shifted away from their pre-NDE religious affiliation and moved toward a belief in spiritual universalism, with the feeling that God was within (Morris & Knafl, 2003; Ring, 1980, 1984; Schwaninger, Eisenberg, Schechtman, & Weiss, 2002). Others displayed a tendency to move away from pre-NDE religious beliefs (Atwater, 2001; Bonenfant, 2004; Greyson, 1983b; Sutherland, 1990). Some participants shifted toward becoming more involved with a pre-NDE religious tradition (Bonenfant, 2004; Clark, 1984; Lundahl, 1982; Sabom, 1982), while others showed no inclination to change regarding religious affiliation or non-affiliation (McLaughlin & Malony, 1984; Sabom, 1982, 1998). 2 In the current study, 84 respondents were asked to complete an online survey that included Greyson's NDE Scale (Greyson, 1983a) and a questionnaire developed by the researcher. Greyson's NDE Scale assessed whether survey respondents experienced a "core" NDE (high score of 32). The researcher's questionnaire, or the Incongruous Spiritual Experience Questionnaire (ISEQ), collected data regarding the survey respondents' theological, ontological, and metaphysical beliefs (high score of 90). Subsequently, the survey data from Greyson's NDE Scale and the ISEQ were analyzed, and the eight survey respondents with the highest combined scores were invited to join the sample. All of the eight participants were interviewed on two separate occasions over a period of two months, based on the use of Moustakas's (1990) heuristic method (see Chapter 3, Methodology), to collect data relating to the aftereffects of an incongruous spiritual experience during an NDE. Personal Background I had a near-death experience at the age of 18. I perceived certain communications that I believed were emanating from another dimension of reality. The incident occurred at a doctor's office, when I had a severe allergic reaction (anaphylaxis) to a new medication. In the middle of a blood test, my throat began to swell, and breathing became difficult. I lost consciousness and felt removed from my body. I remember floating in a gray area and receiving messages from several voices that did not make sense to me at the time. Meanwhile, my pulse was fading, and the doctor had been called to administer a shot of epinephrine and to lessen the swelling in my throat. I regained consciousness within a few minutes and told the nurses, "That's what it's like to be dead." I became interested in comparative religion, the perennial philosophy (Huxley, 3 1945), and Eastern mysticism within a few months after this experience. I had no interest in these subjects before my life-threatening episode. I told a friend about my NDE, and he referred me to the 1975 work by Raymond Moody, Life after Life. This book imparted a new level of understanding to me about the NDE phenomenon. My religious beliefs began to shift over the next few years. My feelings about God, the universe, and the purpose of life took on new meaning. I had been raised to believe in a sectarian God, but no longer felt an affinity with this proposed entity. I began searching for another concept of a Godhead that would truly resonate within me. I felt confused, alienated, and depressed along the way. I decided to travel to sacred places, read spiritual books, and speak to devoted spiritual and religious teachers. I asked many questions regarding the nature of human existence and the possibility of an afterlife. I learned a great deal from these individuals and assimilated the knowledge offered to me. At the same time, I continued to search for meaningful answers that could explain the differences between my former religious beliefs and my insights during the near-death experience. I began studying NDE literature in the 1980s, continuously reading the latest books and articles by well-known experts. I began teaching adult education classes in 2005 on the near-death experience, which included the latest NDE studies by leading researchers. Many attendees in these classes spoke to me about their own near-death experiences. These individuals had a strong desire to share the details of their experiences and explained the profound changes that had occurred in their lives. The vast majority of these NDErs told me that their spiritual beliefs changed after their NDEs. I noticed that a common theme of spiritual transformation emerged from these narratives. Consequently, 4 I developed an intense interest in the field of NDE research. My near-death experience opened my mind to the possibility that consciousness continues to exist after death. Since it had a profound effect on my spiritual beliefs, I wanted to learn more about this mysterious phenomenon. I studied transpersonal psychology in my master's program at Skidmore College, focusing on the work of Raymond Moody (1975), Kenneth Ring (1980), and Bruce Greyson (1983a). I began thinking that future NDE studies might provide the best evidence to support the notion of survival of consciousness. However, I could not conduct a research investigation on this topic in my master's program. Therefore, I entered Saybrook University's Human Sciences Ph.D. program, with the primary goal of planning a research curriculum that would culminate in the implementation of an NDE study. While working on the current study, I was inspired by the Saybrook dissertations of Fracasso (2012) and San Filippo (1998) that reported on significant aftereffects of the near-death experience. I conducted a pilot study in 2011 that inquired into these aftereffects and the transformative residuum of NDE visions and communications. Interestingly, two of the participants (referred to here by aliases to ensure confidentiality) reported that their religious beliefs had become incongruous with their expectations of the afterlife. One participant (Sally) reported that her religious expectations were not met, because Christian themes had not been present during the experience. Returning to her church, Sally continued to pray, after recovering from serious injuries. However, she knew within a year that her church could no longer fulfill her spiritual needs. Losing interest in biblical studies, she shifted away from the basic concepts of Christianity. Sally left the Methodist Church after 31 years because of a desire to gain new spiritual knowledge. She 5 became interested in altered states of consciousness and felt drawn to Hinduism. Sally began studying with a guru, claiming later that they became connected at a deep spiritual level. She reported experiencing feelings of love, joy, and ecstasy for the first time in her life. Although her incongruous spiritual experience originally led her back to her original church after the NDE, within a year Sally realized that it was Hindu teachings that truly resonated with her. A second participant, Jim, was raised Catholic. He left the Catholic Church at the age of 30 to become an agnostic. However, Jim returned to Catholicism after his NDE despite the lack of Christian themes in the experience. He began attending church every Sunday and considered quitting his job to become a priest. Feeling very close to God, he wanted to devote his life to studying the scriptures. Jim began living his life according to the teachings of Catholicism. However, after a few months he returned to his former job and attended church less frequently. His enthusiasm for Catholicism waned over time until, eventually, he left the church and joined a non-denominational interfaith congregation. In summary, Sally and Jim reported incongruous spiritual experiences during their NDEs. Their religious affiliations and spiritual beliefs changed afterwards. Consequently, my own inspiration for pursuing the current investigation was based on: (a) my own neardeath experience, (b) my 38-years of interest in NDE literature, and (c) the results of a pilot NDE study conducted at Saybrook University. Definitions of Key Terms The following working definitions are provided for key terms in this dissertation: 1. clinically dead: A person who is clinically dead shows a loss of heartbeat and 6 lack of respiration. Unless individuals are resuscitated with 10 minutes after entering this condition, they ordinarily die and are considered deceased (van Lommel, 2010). 2. cognitive dissonance: Cognitive dissonance occurs when two elements of information (cognitions) are psychologically or logically inconsistent with each other; typically, a negative effect is produced. The negative effects arising from cognitive dissonance may evoke a motivation to engage in strategies intended to reduce dissonance and restore cognitive consistency (Festinger & Carlsmith, 1959). 3. core near-death experience: The definition of a core NDE comes from Moody's (1975) common set of elements that constitute an in-depth, reportedly universal, near-death experience based on Greyson's NDE Scale (1983a). Lange, Greyson, and Houran (2004) posited that this core experience can be described by the following phenomeno-logical elements: (a) an overwhelming feeling of peace and well-being, including freedom from pain; (b) the impression of being located outside one's physical body; (c) floating or drifting through darkness, sometimes described as a tunnel; (d) awareness of a golden light; (e) encountering and perhaps communicating with a presence or a "being of light"; (f) a rapid succession of visual images of one's past; and (g) experiencing another world of much beauty, perhaps meeting spirits of deceased relatives and acquaintances with whom one also might communicate. 4. heuristic inquiry: Heuristic inquiry is a way of engaging in scientific research through methods and processes aimed at discovery. It is a way of self-inquiry and dialogue with others designed to uncover the underlying meaning of significant human experiences. This method generally includes six phases: (a) initial engagement, (b) immersion, (c) incubation, (d) illumination, (e) explication, and (f) creative synthesis. 7 Additionally, seven processes are generally included in this research: (a) focus of inquiry, (b) self-dialogue, (c) tacit knowing, (d) intuition, (e) indwelling, (f) focusing, and (g) an internal frame of reference (Moustakas, 1990). 5. incongruous spiritual experience (ISE): An ISE occurs when perceived communications or visions are incompatible with an experiencer's religious expectations and may transcend the boundaries of conventional religion. 6. near-death experience (NDE): An NDE is an emotionally powerful and lifechanging event that is perceived as taking place in a reality beyond the physical world (Holden, Greyson, & James, 2009). This phenomenon occurs when an individual is pronounced clinically dead or is on the verge of death, and after resuscitation reports an experience interpreted as spiritual or religious (Greyson, 2006). Such an experience often include a sense of separation from the physical body and communication with religious figures or a mystical or divine presence. Many experiencers report a sense of "cosmic unity or oneness, transcendence of time and space, deeply felt positive mood, sense of sacredness, noetic quality or intuitive illumination, paradoxicality, ineffability, transiency, and persistent positive aftereffects" (Greyson, 2006, p. 393). The depth of an NDE has been measured by Ring's Weighted Core Experience Index (1980) and/or Greyson's NDE Scale (1983a). Accordingly, there may be strong associations between the depth of an NDE and spiritual change after the experience. Moody (1975), Ring (1980), Sabom (1982), and Greyson (1983b), who were early pioneers in the investigation of this phenomenon, have conducted many studies in an attempt to define it. 7. near-death experiencers (NDErs): NDErs are individuals who report a neardeath experience, usually including all or most of the following: (a) an out-of-body 8 experience or separation from the physical body; (b) the sensation of being pulled through a dark tunnel; (c) an encounter with spiritual beings; (d) the presence of a bright light; (e) a panoramic life review (f) a vision of a border; (g) being met by friends or relatives; and (h) a dark tunnel that returns the individual to the physical body (Lester, 2005). 8. prophetic revelations (PRs): PRs, which have a global focus, pertain to knowledge revealed to the NDEr about the earth's future (Lundahl, 2001). Two cases describing prophetic revelations were cited by Lundahl (2001), who noted, "the future event or events are named without any further elaboration of the details in prophetic revelations" (p. 235). 9. prophetic visions (PVs): PVs are images perceived by NDErs that offer a glimpse of future such as: (a) global events, (b) the state of humankind, and/or (c) earth changes. Ring (1984) stated that PVs contain these five basic features: (1) geophysical changes, (2) meteorological changes, (3) supply and economic breakdowns, (4) nuclear war, and (5) a new era of human history characterized by universal love and world peace. 10. religious beliefs: Religious beliefs typically refer to an individual's or a group's acceptance of a set of formally structured theological doctrines that are recognized by a body of communicants who gather together for worship, rituals, and other expressions of faith (Reese, 1999). Such beliefs usually include: (a) a set of implicit and explicit propositions concerning the superhuman world and the individual's relationship to this world, (b) faith in superhuman beings and miracles of various kinds, and (c) acceptance of a wide variety of existences both prior and subsequent to the present existence (Spiro, 2004). At the same time, surveys of religious belief have often found 9 that the official doctrines offered by religious authorities do not always correspond with the privately held beliefs of religious adherents (Braithwaite, 1975). 11. spiritual beliefs: Spiritual beliefs, which are usually not bound to any one particular religious tradition, constitute broader concepts, although religion is one expression of a spiritual belief system (Burkhardt, 1989). Such beliefs usually include a personal commitment to engage in a process of inner development to experience one's totality (Teasdale, 1999). In humanistic psychology, the individual with spiritual beliefs lives with the intention to experience the full potential of being human (Vaughn, 2002). 12. universal spiritual principles (or perennial wisdom): Universal spiritual principles stand as the transcendent source of virtually all of the orthodox religions of humankind (Minnaar, 2007). This discernment is the quintessence of all spirituality; carried to its highest level or reduced to its purest substance, it constitutes the underlying universality in every great spiritual tradition of humanity (Schuon, 2005). These principles include the belief "that finds in the soul something similar to, or even identical with, divine Reality; the ethic that places man's final end in the knowledge of the immanent and transcendent Ground of all being ‒ the thing is immemorial and universal" (Huxley, 1945, p. vii). 13. veridical perception: Veridical perception refers to observations and reports of events from outside the physical body (Parnia, 2007). In NDE research, veridical perception occurs during an out-of-body experience (OBE). Statement of the Problem The research studies by Ring (1980, 1984), Sutherland (1990), and Musgrave (1997) suggest that a large number of NDErs tend to experience religious/spiritual 10 changes after their NDEs. These changes correspond to the notion of spiritual transformation as "a dramatic change in religious belief, attitude, and behavior that occurs over a relatively short period of time" (Schwartz, 2000, p. 4). In such cases, the near-death experience caused a shift in NDErs' religious/spiritual beliefs or non-beliefs (Sutherland, 1990). Accordingly, their perceptions during the NDE did not fit with their prior understandings toward religion or spirituality (Musgrave, 1997). Over time, some NDErs either strengthened their religious beliefs, affiliated with another religion, or became less involved in organized religion (McLaughlin & Malony, 1984). Some of these individuals adopted a "spiritual but not religious" perspective or developed an intrinsic belief in universal spirituality (Ring, 1984). Extensive research on NDEs has been conducted in the last four decades (Holden et al., 2009). However, an important gap remains in the literature concerning the comparison of pre-NDE religious beliefs in an afterlife with subsequent post-NDE spiritual conflicts resulting from the lack of religious motifs during the experience. The few studies focusing on the differences between pre-NDE and post-NDE religious beliefs (McLaughlin & Malony, 1984; Musgrave, 1997; Ring, 1984; Sabom, 1982; Sutherland, 1990) failed to include in-depth interview data regarding NDErs' religious backgrounds and the strength of their pre-NDE religious convictions. Consequently, scant data were available for comparing pre-NDE religious expectations with post-NDE understandings. Additionally, past studies have not inquired into the manner whereby NDErs attempted to reconcile their pre-NDE and post-NDE religious/spiritual beliefs. To date, no prior studies have been located on the relationship between NDErs' religious expectations and the aftereffect of cognitive dissonance that resulted from an 11 incongruous spiritual experience. Additionally, no prior NDE heuristic inquiries have been found in the NDE literature. Therefore, the current study is particularly important for advancing NDE research and for gaining new knowledge about the occurrence of an ISE during an NDE. This research should be of interest to NDE researchers, NDE organizations, transpersonal psychologists, parapsychologists, and scholars of esoteric philosophy, sociologists, and cultural anthropologists. Research Question The primary research question for this study was: What are the aftereffects of an incongruous spiritual experience (ISE) that is based on reported communications or visions during a near-death experience? What, if any, are the spiritual aftereffects? Summary This chapter has described the context for the research. Problems associated with the prior research have been discussed, and the research question has been stated. The context for this inquiry is based on my own near-death experience and interviews with NDErs from a pilot study. Some of the research outcomes in this field have been compromised by insufficient data collection. There are also only limited data on postNDE cognitive dissonance and the process of religious/spiritual transformation after the experience. While many studies are available on spiritual aftereffects of the NDE, no studies have been located on the aftereffects of an incongruous spiritual experience (ISE). Moreover, no heuristic inquiries have been found on this topic. The primary research question has been stated as follows: What are the aftereffects of an incongruous religious experience (ISE) that is based on reported communications or visions during a near-death experience (NDE)? 12 Chapter 2: Review of the Literature The near-death experience is a significant phenomenon as reported in hundreds of scientific research studies over the last 37 years (Holden et al., 2009). In studies of patients suffering from cardiac arrest, the percentage reporting NDEs ranged from 6.3% (Parnia, Waller, Yeates, & Fenwick, 2000) to 10% (Greyson, 2003) and 12% (van Lommel, van Wees, Meyers, & Elfferich, 2001). Accounts of near-death experiences by surviving individuals share a number of common characteristics (Beauregard & O'Leary, 2007; Bonenfant, 2004; Green, 2008; Greyson, 1983a, 1983b, 1985, 1999, 2010; Holden et al., 2009; Moody, 1975, 2011; Ring, 1980, 1984, 2000a; Ring & Valarino, 1998; Sabom, 1982, 1998). Two such common elements are (1) communications with persons previously deceased or with some form of spiritual being or beings, and (2) visions about a divine/mystical presence and/or an unearthly realm (Greyson, 1981, 1999, 2006, 2010; Moody, 1975, 2011; Ring, 1980, 2000a; Sabom, 1982, 1998). NDErs consider the nature of these perceptions and determine whether such communications and/or visions are congruous or incongruous with their spiritual/religious beliefs (Abramovitch, 1988; Bush, 2002; Greyson, 2006; Musgrave, 1997; Ring, 1980; Sutherland, 1990). Background Many religions and cultures believe in some type of an afterlife, as evidenced by such works as the Tibetan Book of the Dead, the Judeo-Christian Bible, the Hindu Vedas, and the Moslem Koran (Smith, 1992). These texts include stories of individuals who returned to life after death. Throughout history, many cultures and religions have included accounts of the near-death experience (Carter, 2010). Interestingly, many wellknown historical figures such as Carl Jung, Ernest Hemingway, Thomas Edison, and 13 Benjamin Franklin have recounted personal NDEs (Walker & Serdahely, 1990). The Egyptian Book of the Dead (Budge, 1967), which is one of the oldest pieces of surviving literature (ca. 1500 BCE), spoke of prayers and formulas for navigating through the next world (Walker & Serdahely, 1990). Ancient Egyptians believed that the soul was immortal. After the body died, they believed that the soul entered into the Judgment Hall of Osiris, where it enjoyed everlasting joy and happiness (Ross, 1979). In this realm, the soul reunited with deceased friends, relatives, and loved ones (Ross, 1979; Walker & Serdahely, 1990). In like manner, Plato (ca. 380 BCE) posited that, after the soul was freed from the physical body, it would encounter deceased friends or family (Hamilton & Cairns, 1999; Rawlings, 1978). Common aspects of the NDE phenomenon include perceived communications with a mysterious presence or Being, often associated with a brilliant light (Greyson, 1998, 2008; Moody, 1975; Ring, 1980). From a historical perspective, The Epic of Gilgamesh (ca. 2100 BCE) is one of the oldest known surviving texts from Sumer (Mitchell, 2006). This book describes a near-death experience involving light and a tunnel. The story speaks of Gilgamesh, who, in his search for immortality, enters a tunnel known as the Road of the Sun: The gate to the tunnel lies here before you. Go now in peace, and return in peace. As the sun was rising, Gilgamesh entered. He began to run. For one hour he ran, deep was the darkness, with no light at all before and behind him and to either side. (Mitchell, 2006, pp. 163-164) Gilgamesh runs through the darkness for hours, seeing nothing all around him. Finally, he nears the end of a tunnel and comes out into a glorious place filled with light: 14 At the twelfth hour he emerged from the tunnel into the light. The sun was hurtling toward the entrance. He had barely escaped. Before him the garden of the gods appeared With gem-trees of all colors, dazzling to see. There were trees that grew rubies, trees with lapis lazuli flowers, trees that dangled gigantic coral clusters like dates. Everywhere, sparkling on all the branches, were enormous jewels: emeralds, sapphires, hematite, diamonds, carnelians, pearls. Gilgamesh looked up and marveled at it all. (Mitchell, 2006, pp. 163-164) Gilgamesh wants to stay in this radiant place, but he must return through the tunnel back to his former life. Gilgamesh enlists the help of his best friend Enkidu (a ghost) to retrieve various items that Gilgamesh had lost in the underworld during his quest (Mitchell, 2006). A "friendly god gave [Enkidu] back his body in order to be able to leave hell and tell his friend Gilgamesh of the horror of hell in full detail" (SchroterKunhardt, 1993, p. 225). Research into NDEs has been ongoing for centuries (Zaleski, 1987; Holden et al., 2009). In the 17th century, the Swedish philosopher and theologian Emmanuel Swedenborg wrote extensively on theories of the afterlife. In the late 1800s, research into after-death states became more empirical, when scientists expanded their interests beyond professional mediums to include anecdotal paranormal accounts by ordinary people (Audette, 1982; Walker & Serdahely, 1990). In 1882, the Society for Psychical Research was established in London to explore paranormal experiences, psychic abilities, and various such phenomena. An American branch followed in 1885, headed by a distinguished group of scholars, including William James. Members of this organization included many well-known individuals such as Charles Dodgson, Carl Jung, Alastair Sim, Sir Arthur Conan Doyle, and W. B. Yeats (Grattan-Guiness, 1982). 15 In 1975, Raymond Moody, Jr., wrote the groundbreaking book Life after Life, which defined this phenomenon of dying and coming back to life as "the near-death experience": When a person is resuscitated after having been thought, adjudged, or pronounced clinically dead by their doctors; or when the experiences of a person who, in the course of accidents or severe injury or illness, came very close to physical death; or when the experiences of a person who, as they died, told them to other people who were present. Later, these other people reported the content of the death experience. (p. 16) The introduction to Life after Life (Moody, 1975) was written by the Swiss psychiatrist Elisabeth Kübler-Ross. Over several years, she had accumulated a considerable body of research on death, dying, and near-death experiences. Kübler-Ross did not set out to become a researcher of near-death experiences. Her interest and expertise focused initially on the processes and psychological issues of dying. As the result of her work with terminally ill patients, Kübler-Ross published a landmark study in her book Death and Dying (1969) that is considered a foundational investigation into the five stages of grief (Kircher & Callanan, 2011). Her work is relevant to the study of neardeath experiences by virtue of the extensive amount of research she carried out while working with dying patients. Recent and Current Scientific Research Scientific research into NDEs has fluctuated over the last 37 years (Holden et al., 2009). In the 1970s, there was a resurgence of scientific interest in NDE research after several journal articles were written by psychiatrist Russell Noyes. For example, Noyes and Kletti (1976) documented personal interviews and clinical data from patients who had experienced life-threatening danger accompanied by feelings of hyper-alertness, depersonalization, and mystical consciousness. The more recent investigations further 16 explored the scientific meanings of the near-death experience (Ring, 1982; Walker & Serdahely, 1990). Consequently, a new field opened up for studying NDEs with a concentration on scientifically investigating the experiences of death and dying. Much of the NDE research in the 20 th century focused on identifying the commonalities and differences in NDEs, which included cross-cultural investigations (Carter, 2010). Many of Ring's (1980) findings are relevant to the advancement of NDE research. He concluded that there is no specific type of person who is more or less likely to have a near-death experience (Ring, 1984). He posited that NDEs have been reported in many populations regardless of culture, religious background, gender, age, socioeconomic status, marital status, degree of physical and psychological health, and level of education (Ring & Cooper, 1999; Ring & Franklin, 1980). Ring's findings have been supported by many other NDE research studies over the last 20 years (Belanti, Perera, & Jagadheesan, 2008; Greyson, 1986; Tobacyk & Mitchell, 1987; Zaleski, 1987). Another relevant finding by Ring (1980) is the frequent reporting by NDErs that their fear of death is greatly diminished after the experience, while their appreciation for life is greatly heightened. Regardless of their prior beliefs, many NDErs became more spiritual, although not necessarily more religious (Grof & Grof, 1980; Ring, 1980, 2000b; Ring & Valarino, 1998; Sabom, 1998). Additionally, Ring (1980, 2000b) and Ring and Valarino (1998) found that most NDErs reported that their lives were transformed in a positive way, which increased their feelings of self-acceptance and their compassion for others. Some current NDE researchers (Appelby, 1989; Beauregard & O'Leary, 2007; Blackmore, 1993) have focused on neurobiological models that examine connections 17 between the mind and brain and the brain-based nature of the phenomenon of death (Krippner & Achterberg, 2000). These hypotheses are often referred to as "biological/ psychological [or] survivalist" interpretations (Agrillo, 2011, p. 4). Neuroscience and psychology almost universally assume that "consciousness is the product of brain processes, or that the mind is merely the subjective concomitant of neurological events" (Kelly, Greyson, & Kelly, 2007, p. 367). Among the important analyses are examinations of whether NDEs are glimpses of an afterlife or merely imaginary products of diminishing physical and neurological activity. Blackmore (1993) referred to this latter theory as the "dying brain hypothesis" (p. 4). Trends in Near-Death Studies From the 1970s to the 1990s, NDE research focused heavily on conceptualization, assessment, and correlations of NDEs (Audette, 1982). More recently, the trend in NDE scholarship has shifted toward inquiring into the aftereffects of the NDE (Holden et al., 2009). Over the last 10 years, a primary area of interest in NDE studies has been the phenomenon of veridical perception (Ring & Lawrence, 1993). Studies of veridical perception concentrate on the NDErs' observations and reporting of events from outside their bodies (Parnia, 2007). In NDE research, veridical perception purportedly occurs during an out-of-body experience (OBE). In such cases, NDErs claim to observe events from a vantage point that is impossible from the location of the physical body (Long & Perry, 2010). In recent NDE studies, cardiac arrest patients have reported veridical perceptions of unfamiliar medical equipment in the emergency room and specific actions by doctors who were performing resuscitation procedures (Parnia, 2007). 18 Qualifying and Quantifying the NDE Initial NDE research focused on patient-reported NDEs. Most of these studies included participants who self-identified as having had an NDE and volunteered to participate in more in-depth research studies. The proliferation of NDE investigations highlighted the need to develop scientifically acceptable measurements for reporting core experiences in order to enable researchers to code and correlate several characteristics of NDEs for data collection and comparison. The persistence of common elements reported by NDErs suggested that NDEs might be a measurable and recognizable phenomenon (Greyson, 1983a, 1983b, 1990, 1999; Lange, Greyson, & Houran, 2004; Lange, Irwin, & Houran, 2000). Many researchers (Callanan, 2008; Greyson, 1983a, 1983b, 1990, 1999; Lange et al., 2004; Lundahl, 1982, 1993, 1997; Moody, 1975; Ring, 1980; Sabom, 1982; van Lommel, 2010) noted that adult accounts of the NDE phenomenon share common elements. Several researchers (Greyson, 1983a; Noyes, 1972; Ring, 1984; Sabom, 1982) utilized specific nomenclature to categorize the most commonly reported elements of the NDE that shared phenomenological descriptions. For example, Noyes (Noyes, 1972; Noyes & Kletti, 1976, 1977) divided the NDE phenomenon into three phases: (a) resistance – giving way to surrender and peace; (b) review – including out-of-body experiences and viewing a multiplicity of scenes from life; and (c) transcendence – the transition into some otherworldly place, apparently outside of time and space. The Core NDE In a core near-death experience, individuals who are considered clinically dead nonetheless report hallucinatory, paranormal, or mystical experiences, surviving to share 19 such accounts with others (Sutherland, 1989). In a prospective study of cardiac arrest survivors reporting NDEs, researchers van Lommel et al. (2001) defined the core neardeath experience as "the reported memory of all impressions during a special state of consciousness, including specific elements such as out-of-body experience, pleasant feelings, and seeing a tunnel, a light, deceased relatives, or a life review" (p. 2040). Individuals reporting core NDEs frequently recount having an out-of-body experience followed by several stages of paranormal activity that appear to occur while NDErs are immersed in an altered state of consciousness (Blanke & Diguez, 2009; Sutherland, 1989). Such individuals claim that, after clinical death, they experienced one or more of stages of the NDE: (a) a sensation of leaving the body, (b) floating upwards toward the ceiling, (c) overhearing discussions in the room, (d) moving through a tunnel, (e) seeing a bright light, and (f) meeting deceased relatives or spiritual beings who communicated with them (Blanke & Diguez, 2009; Moody, 1975). Throughout the last four decades, a large body of research has shed light on the nature of the core NDE (Leming & Dickinson, 2011). Rigorous studies on core NDEs were conducted by Grey (1985), Greyson (1983a), Ring (1980), and Sabom (1982), whose work supported Moody's (1975) phenomenological descriptions. However, more recent studies have called into question the universality of certain NDE stages, suggesting that this claim may fall outside the core experience (Greyson, 2001; Irwin, 1999; Knoblauch, Schmied, & Schnettler, 2001; Parker, 2001). Moody's 12 NDE Traits. Raymond Moody, Jr., (1975) described 12 traits that he believed were common to most near-death experiences: 1. The ineffability of the experience 2. A feeling of peace and quiet; pain is gone 20 3. The awareness of being dead, sometimes followed by a noise 4. An out-of-body experience (OBE); from a position outside and above their bodies, people witness their own resuscitation or operation 5. A dark space, experienced by only 15% of people as frightening; people are pulled toward a pinpoint of light in this dark space, which they describe as (a) a tunnel experience; they are drawn rapidly toward the light, or (b) a frightening NDE; approximately 1% to 2% of people linger in this dark space and experience their NDE as frightening (also known as a "hell experience") 6. The perception of an unearthly environment, a dazzling landscape with beautiful colors, gorgeous flowers, and sometimes also music 7. Meeting and communicating with deceased persons, mostly relatives 8. Seeing a brilliant light or being of light; experiencing complete acceptance and unconditional love, and gaining access to a deep knowledge and wisdom 9. A panoramic life review, or review of life from birth; people see their entire life flash before them; there appears to be no time or distance, everything happens at once, and people can talk for days about a life review that lasted only a few minutes 10. The preview or flash forward: people have the impression that they are witness to part of their life that is yet to come; again, there is no time or distance 11. The perception of a border: people are aware that if they cross this border or limit they will never be able to return to their body, and 12. The conscious return to the body, accompanied by great disappointment at having something so beautiful taken away (van Lommel, 2010, pp. 11-12) Moody (1975) noted that NDE accounts appeared strikingly similar around the world. Of course, exceptions had been found; for example, some culture-specific differences emerged pertaining to the descriptions of content (van Lommel, 2010). Additionally, many NDErs told about speaking with relatives or spiritual beings (Moody, 1975). Moody (2011) described these communications as offering information or telling NDErs that it was not their time to die. He spoke of the profound aftereffects of this experience, usually in terms of a positive influence on the future lives of NDErs (Moody, 2011). In many cases, personal transformations occurred as NDErs changed their attitudes toward spirituality, the meaning of life, and the existence of an afterlife (Moody & Perry, 1988). 21 Ring's Five Phases of the NDE. Kenneth Ring (1980) proposed that NDEs usually have five phases similar to Moody's 12 NDE traits (1975), later acknowledging (Ring, 1982) that his descriptive phases were not strictly sequential. He determined that: (a) in the first phase, 60% of NDErs experienced a sense of peace, surrender, calm, and well-being; (b) in the second phase, 37% felt separated from the physical body and most no longer felt any pain, while others reported seeing themselves lifeless from a position outside and above their body; (c) in the third phase, 23% reported arriving in a dark, peaceful environment; (d) in the fourth phase, 16% reported passing through a tunnel toward a brilliant light; and (e) in the fifth phase, 10% of the participants claimed that they entered an otherworldly dimension of great beauty, where some NDErs met with deceased friends and family. Greyson's Four NDE Components. C. Bruce Greyson (1983a, 1983b, 1985, 1990, 1999) recognized that NDE research lacked consistency in definitions, identification criteria, and tests for those criteria. He pointed out that a dichotomous diagnostic test had not been developed for determining the reliability of core NDEs (Greyson, 1983a). He also noted that researchers defined NDEs by utilizing scales summarizing common attributes of the experience, but actual experiential data had not been collected or measured (Greyson, 1983a). In a later book, Greyson (1999) called for researchers "to identify the critical dimension(s) to be assessed in determining the depth of NDEs and develop an accepted definition of the phenomenon and a fixed-interval scale with which to measure it" (p. 7). Over the last 28 years, Greyson has made significant contributions in the area of qualifying and quantifying NDEs (Lange et al., 2004). Building on Moody's (1975) work, 22 Greyson (1983a, 1985, 1990) developed a near-death experience scale that followed a Rasch-style model for codifying the experience. Rasch models are useful for analyzing subjective information (e.g., abilities or attitudes) and are frequently employed in psychometrics and the study of psychological and education measurement (Bond & Fox, 2001; von Davier & Carstensen, 2007). Greyson's NDE Scale (Greyson, 1983a) was subjected to an inter-item correlation among three cluster groups: (a) cognitive – distortion of time and life review, or panoramic memory; (b) affective – a sense of peace, calm, harmony, or joy; and c) transcendental – immersed in another realm of an ethereal reality. The scale has been found to have a high degree of internal consistency, split-half reliability, and test-retest reliability (Greyson, 1983a). It strongly correlates with Ring's Weighted Core Experience Index (Ring, 1980), which can supplement the process of quantifying results of reported experiences. Greyson's NDE Scale has helped researchers to differentiate those experiences meeting essential criteria from other experiences not congruent with typical NDEs. Additionally, the scale separates out organic brain syndromes and nonspecific stress responses, which indicate whether the individual was clinically dead (Greyson, 1983a). In 1985, Greyson refined his initial thoughts on the original three components (cognitive, affective, and transcendental) and added a fourth. He wanted to separate paranormal elements from the other aspects of the NDE. Consequently, he posited four categories of experiences during NDEs: (a) cognitive elements – time distortions, rapid thought, life reviews, and revelations; (b) affective elements – a sense of peace, unity, and encounters with light; (c) paranormal elements – putative extrasensory perception and precognitive thoughts or visions; and (d) transcendental elements – encounters with 23 mystical beings and spirits and an impassable border. Sabom's Three NDE Categories. Michael Sabom's (1982) Recollections of Death recounted interviews with 160 NDE patients. He medically documented these reported experiences, categorizing them as: (a) unconscious, (b) life-threatening, and (c) clinically dead. All of the participants were interviewed soon after recovering consciousness. Of the 160 patients, 47% reported having a NDE (Sabom, 1982). Although Sabom had been skeptical of the NDE phenomenon, he found that medical interpretations did not adequately explain such detailed accounts or the similarities of the patients' experiences (Sabom, 1982). Sabom (1982) went on to describe three categories of NDEs. The first category, reported by 53% of the participants in his study, he called autoscopic. This experience involved a perceived separation from the physical body, including observations while floating near the top of the ceiling. During this phase, NDErs mentioned moving through other people and walls. Sometimes they vividly described scenes and conversations in the emergency room while doctors attempted to resuscitate them. The second category, described by 54% of the cases, he called transcendental. These NDEs involved entering a dark but comforting void outside space and time, followed by an encounter with a brilliant light at the end of a tunnel. At this point, some NDErs reported that it was possible to communicate with deceased friends and family. Many of these communications were nonverbal; their content usually involved consideration of whether to return to the physical body. The third category, reported by 20% of the patients, was a combination of the first two categories without an interruption between stages. In addition, some of Sabom's patients mentioned seeing a border or experiencing a life review during the 24 second or third stage. Transformative Aftereffects of NDEs Moody (1975) described four recurrent aftereffects of NDEs: (a) frustration upon relating the experience to others, (b) broadened or deepened appreciation of life, (c) elimination of the fear of death, and (d) corroboration of out-of-body visions. Serdahely (1991) compared the NDE recollections of adults who had NDEs an average of 38 years earlier with NDErs who had the experience just two years before. Serdahely questioned each participant on 47 different characteristics. The study concluded that only two issues relating to "time sense" played a significant role in any differences regarding the aftereffects of the experience: I compared five childhood near-death experiences (NDEs) reported by adults and another five NDEs reported by minors, in terms of Ring's five NDE stages, Greyson's four NDE components, Moody and Perry's 12 NDE traits, Sabom's 16 general characteristics, and Gallup and Proctor's 10 basic positive experiences. In this combined pool of 47 NDE characteristics (which were interdependent), only two relating to time sense showed significant differences between the adults' retrospective reports of childhood NDEs and the children's contemporary NDE reports, and that number of differences would be expected by chance. This study therefore supports the claims of previous researchers that adults' retrospective reports of childhood NDEs are not embellished or distorted (p. 220). Morse (Morse & Perry, 1992) conducted a series of interviews with 350 adults, of whom 100 reported that they had NDEs while they were children. The researchers concluded that most of these NDErs had been changed for life by their experiences. They also noted that many NDErs are reluctant to tell their stories for fear of ridicule or ostracism, especially when speaking with skeptics. Accordingly, many NDErs keep their experiences secret, even from those closest to them (Morse, Castillo, Venecia, Milstein, & Tyler, 1986; Ring, 1984; Sabom, 1998; Zaleski, 1987). According to van Lommel (2010), "Yet many people with an NDE discover that others are incapable of listening without 25 prejudice and criticism. . . . People feel transformed while those around them remain the same" (p. 51). Hoffman (1995) identified five phases usually experienced by NDErs as they attempt to integrate the aftereffects of the NDE into their lives: (a) shock or surprise at what they saw, heard, and felt; (b) the need for affirmation from others (and frequent lack thereof); (c) changes in personal relationships; (d) an active quest for answers; and (e) assimilation of the experience into their belief systems. Understandably, Greyson (2001) reported that some NDErs experience the symptoms of posttraumatic stress disorder (PTSD) in the aftermath of their NDEs. Gibbs (1997) noted that, when NDErs express surprise and puzzlement about their NDEs, their stories have a greater feeling of authenticity. Ritchie and Sherrill (1978) reported that the element of surprise, which is a common aftereffect, is included in many NDE accounts: "My mind kept telling me that what I was doing [flying during an OBE] was impossible" (p. 38). Morse and Perry (1992) noted a similar account: "My first impression was a total surprise. How could I exist in such a comfortable way, and how could I perceive and think while being dead, and yet have no body?" (p. 12). A comparable case has been cited by van Lommel (2010): "All of a sudden I knew that I was dead. This realization struck me as odd" (p. 29). Bonenfant (2004) reported that a majority of NDErs had multiple aftereffects that continued over time, including becoming more spiritual, more accepting of paranormal events, and less religious in a traditional sense. Aftereffects of the communicative NDE include the purported healing of emotional scars, ongoing contact with deceased relatives or a guardian angel (Atwater, 2003), purported extra-sensory perception and precognition 26 (Fenwick & Fenwick, 1995), reported telepathic abilities, and out-of-body experiences (Sutherland, 1995). A considerable amount of research from the clinical and transpersonal perspectives has been carried out regarding the enduring and transformative effects of an NDE on NDErs' subsequent attitudes and values. Such aftereffects are particularly pertinent when death was thought to be imminent and when the NDE included a panoramic life review (Greyson & Stevenson, 1980; Lange et al., 2004). Atwater (2008) described the psychological aftereffects most commonly reported by NDErs, namely: (a) overcoming fear of death, (b) becoming more spiritual and less religious, (c) being more generous and charitable, (d) coping better in handling stress, (e) thinking in a philosophical manner, (f) accepting the new and different, (g) developing a disregard for time and schedules, (h) seeing things in a new light with decreased boredom, (i) forming expansive concepts of love, (j) finding it difficult to initiate and maintain satisfying relationships, (k) becoming psychic or intuitive, (l) suffering from depression, and (m) feeling less competitive. A study by Long and Perry (2010) reported that 73.1% of respondents "experienced changes in their lives" (p. 177) because of their near-death experiences. Moody (Moody & Perry, 1988) wrote that the one common feature to all NDEs was that they transformed the people who had them: "In my 20 years of intense exposure to NDErs, I have yet to find one who hasn't had a very deep and positive transformation as a result" (p. 33). Attitudes toward Life and Death One of the most common aftereffects of the NDE is an individual's ability to 27 overcome fear of death. Psychiatrist Otto Rank (1930/1998) described fear of death as "the fear of getting lost in a void, moving into stagnation, or becoming nothing" (p. 13). A great benefit of the NDE is the individual's new ability to overcome feelings relating to death such as hopelessness, dread, and despair. Additionally, most NDErs become convinced that life continues after death, because they tend to believe that they have glimpsed the afterlife. Many researchers (Agrillo, 2011; Greyson, 1983b, 1986; Moody, 1975) have stated that NDErs who had positive near-death experiences frequently claimed no longer to fear death (or fear it less). Sutherland (1990) noted that 78% of her patients spoke of having a fear of death before their NDEs, and 100% reported that, after their NDEs, they were no longer afraid to die. Some NDErs recounted experiences of such peace and bliss that they wanted to stay where they were. White (1997) described the case of John, a 34-year-old construction worker who had an NDE after shooting himself accidentally in the heart with a 13⁄4" nail gun. John said he entered a peaceful realm with waves of light and encountered the hand of God. Upon finding himself back in a hospital room and hurting, he was angry about leaving a world of total bliss in exchange for returning to a physical body in "excruciating pain" (p. 173). Emotional, Spiritual, and Behavioral Changes Positive transformations following NDEs have frequently been cited in the scientific literature (Agrillo, 2011; Greyson, 2010; Moody, 1975; Morse & Perry, 1992; Pennachio, 1986, 1988; Serdahely, 1992). Pennachio (1988) posited that the near-death experience could be "a vehicle for regeneration and transformation" (p. 162). Many studies support the notion that NDEs can lead to longstanding and often permanent forms of positive transformation. Such studies have focused on psychological, spiritual, and 28 emotional transformation. For example, Noyes and Kletti (1977) found that NDErs showed a decrease in neurotic behaviors. Researchers have also reported that, after the experience, NDErs feel the following: (a) a heightened sense of spirituality or religiosity, (b) more compassion, (c) an appreciation for life, (d) a greater sense of purpose, and (e) less concern for acquiring possessions (Grey, 1985; Greyson, 2008; Greyson & Stevenson, 1980; Ring, 1980; Sabom, 1982; Sutherland, 1989, 1990). According to Greyson (2008), "[NDErs] tend to see themselves as integral parts of a benevolent and purposeful universe in which personal gain, particularly at others' expense, is no longer relevant" (p. 11). Other research studies into post-NDE religiosity (Atwater, 1988; Grey, 1985; McLaughlin & Malony, 1984; Sabom, 1982, 1998) have suggested that some NDErs became more religious because of their near-death experiences. Alschuler (1996) and Ring (1986) inquired as to whether transformational aftereffects might be viewed as evidence of a new stage in human evolution. Although there was some support to suggest that NDErs became more altruistic and concerned about the welfare of others, others concluded that it was not appropriate to state that the NDE was an evolutionary human experience (Newsome, 1998). Thus in a Dutch study by van Lommel et al. (2001), the researchers provided data collected from 344 patients who were resuscitated after cardiac arrest; they found that 62 (18%) had reported an NDE. In two follow-up interviews in later years, the researchers discovered that NDE patients reported having more positive attitudes than they had before the experience. Additionally, NDErs scored higher than non-NDErs for having feelings of empathy, acceptance, and appreciation. 29 Physiological Changes Some researchers (Atwater, 1994; Bonenfant, 2005; Fracasso, 2012; Nouri, 2008; Ring, 2000b) have argued that NDEs might cause physiological changes, citing anecdotal and case study evidence indicating that NDErs had problems when being exposed to electromagnetic devices. These reports included the unexpected starting or stopping of devices such as lights, clocks, watches, computers, and cell phones. Such incidents were common when NDErs were in the presence of other NDErs. Additionally, the electromagnetic effects were especially strong when NDErs had been emotionally aroused (Fracasso, 2012). Nouri (2008) conducted a systematic investigation into physiological changes in NDErs with respect to electromagnetic aftereffects (EMEs). In his quantitative analysis of comparative incidences of EMEs among NDErs, Nouri studied: (a) 36 people who had NDEs, (b) 20 people who had a close brush with death (CBrs), and (c) 46 people who encountered a life-changing event (LCE). To assess the NDErs, Nouri used Greyson's NDE Scale (Greyson, 1983a); for those who had a close brush with death (CBrs) and for those who had a life-changing event (LCErs), he developed similar scales. He also put together an EME questionnaire that asked the participants about their experiences with flickering lights, cell phones, computer reliability, and the behavior of clocks, lights, and other electromagnetic devices. Nouri found that, with respect to lights and cell phones, NDErs reported a higher incidence of issues with electromagnetic effects compared with the CBrs or LCErs. Near-death experiencers also displayed a heightened emotional state when undergoing the effects of electromagnetic devices. Additionally, more electromagnetic effects were reported by NDErs than by LCErs or CBrs. These results suggest 30 that near-death experiences may lead to strong physiological aftereffects for NDErs compared to other individuals who were not clinically dead. Furthermore, the findings of this study showed a correlation between the depth of NDEs and the strength of EMEs. Nouri's (2008) findings correspond with earlier findings by Morse and Perry (1992). Morse wrote the introduction to Atwater's (1994) book Beyond the Light: What Isn't Being Said about the Near-Death Experience. He stated that Atwater was the first to suggest that the average person is surrounded by an electromagnetic field, one that is somehow altered in the event of a near-death experience. In his surveys, Morse asked whether NDErs had experienced problems with lights, appliances, or watches. Morse and Perry (1992) found that "more than one-fourth of all adults who survived near-death as children said that they could not wear watches because they simply stopped running" (p. 132). One man bought three watches in five years and none of them worked. However, when he gave the watches to his sons, all the timepieces resumed working properly. Another man owned a $200 watch that would run when it was in his dresser drawer but not when he wore it. Morse and Perry concluded that this phenomenon is the result of some nonspecific communication during the NDE that somehow altered the electromagnetic forces surrounding the body: "Those changes are more profound in the NDErs who have experiences of light" (p. 159). Atwater (2008) presented a paper based on thirty years of NDE research, which summarized the physiological aftereffects of NDEs. She posited that the physiological aftereffects most commonly reported by NDErs include: (a) more sensitivity to light and sound, (b) looking younger (adults) or appearing older (children), (c) substantial changes or surges in energy levels, (d) lower blood pressure, (e) brighter skin and eyes, (f) a 31 reversal of brain hemisphere dominance, and (i) an ability to heal more rapidly. Renewed Purpose in Life According to Greyson (2008), "NDEs generally have a profound and apparently lasting impact on many who experience them, often precipitating a significant change in values and attitude toward death and a new sense of purpose or meaning in life" (p. 7). In terms of valuing their lives, studies have shown that NDErs who had attempted suicide were less likely to make subsequent attempts (Greyson, 1986). Conversely, non-NDErs were more likely to repeat this behavior (Nock, Park, Finn, Deliberto, Dour, & Banaji, 2010; Wichstrom, 2000). Morse and Perry (1992) reported numerous cases of NDErs who found a new or increased sense of determination for living a meaningful life: "They all feel that their lives have a purpose, that they are here to fulfill a goal" (p. 68). Cross-Cultural Research There are significant variations among NDEs, which could be the result of cultural differences (Carter, 2010). For instance, Knoblauch, Smied, and Schnettler (2001) found significant distinctions between East German and West German participants based on their socio-cultural backgrounds. Not only were the interpretations of the NDEs distinctive, but the content of the experiences differed dramatically. Thus, the researchers concluded, "the content of NDEs is culturally constructed" (p. 28). Belanti et al. (2008) proposed that in cross-cultural NDEs the stages of the experience might vary; however, such variations could be attributed to differences in language, religion, education, and societal belief systems. Kellehear (1996) reported different interpretations of NDEs based on various descriptions of the experience by Chinese Marxists and Americans. However, when he 32 subsequently (2008) conducted a cross-cultural comparison of non-Western NDEs through 2005, he found several similarities to Western accounts. Some of the cultures examined were India, China, Hawaii, Tibet, New Zealand, Africa, and Guam. Kellehear found that non-Western NDEs included reports of encountering deceased relatives, friends, or supernatural beings within a realm of unlimited knowledge, but did not mention visions of a tunnel. At the same time, many reports of floating in a dark place appeared to resemble the tunnel experience. Osis and Haraldsson (1977) compared 64 accounts of NDEs of medical personnel from India with 56 accounts of NDEs reported by American patients. The elements were similar, with about 80% of both samples reporting meetings with deceased persons or spiritual beings who sent them back to their physical bodies. However, the American patients most often reported that the beings told them that it was not their time to die or that they needed to complete unfinished business. In contrast, the Indian patients described the process in bureaucratic terms, often reporting that they were escorted to a clerk who discovered a mistake; when the error was corrected, the dying patient was told to return to earth (Carter, 2010). National Taiwan University Hospital nephrologists Lai et al. (2007) studied 710 dialysis patients in seven centers in Taipei. They noted that the high percentage of lifethreatening events, along with the availability of medical records and the accessibility of the patients, made the dialysis population suitable for NDE research. Their analysis revealed that NDEs are not uncommon among the dialysis population, whose experiences tended to have positive aftereffects. Of the 710 patients interviewed, 70 reported NDEs, with 51 scoring 7 or above on Greyson's (1983a) NDE Scale. Of these 51 patients, 26 33 patients had an OBE and watched from above as the doctors resuscitated them. The researchers also found that: (a) three NDEs were described as "hellish," (b) five were unpleasant, (c) three resulted in the subjects feeling afraid, and (d) "two felt suffering" (p. 127). Lai et al. noted that NDErs were more likely to feel kindness and compassion toward others and had stronger motivations for achievement after the NDE. In comparison to the findings of other researchers (Greyson, 1983b, 1986; Moody, 1975), Lai et al. posited that NDErs were not significantly less afraid of dying or more optimistic about the future, even though 30 patients (43.3%) admitted to being "slightly less afraid of death" (p. 128). Lai et al. also found that NDErs reported less severe depression after the experience. However, Finkelstein and Finkelstein (2000) observed that dialysis patients in general experienced a high rate of depression. Epstein (1990) compared Western views of near-death experiences with the Tibetan 'das-log experience (both the experience and the experiencer are referred to by the word 'das-log). The 'das-log experience is similar to an altered state of consciousness or a form of dissociation often caused by a painful illness (Epstein, 1990). While the elements or episodes that occur during the 'das-log are strikingly similar to the NDE stages as outlined by Moody (1975), Epstein noted that such phases do not progress in a linear sequence. Accordingly, the 'das-log does not recognize the state of "death" as proceeding from one particular starting point, as typically reported by Western NDErs. The life review in the 'das-log is usually reported as confusing and frightening. The emphasis of the review is on the remorse felt by the individual for not having led a better life. Significantly, the 'das-log takes a tour of "hell" (p. 319) with a supernatural guide: "The Dharmaraja explains matters to the 'das-log, exhorting him to lead a moral life and 34 spread the word among the quick. The 'das-log returns to his own body with the same fear and revulsion with which he left it" (p. 319). In contrast to Western NDErs (who usually describe positive experiences of peace and joy), the Tibetans typically describe negative experiences filled with "remorse, pain, fear, disappointment and disillusionment" (p. 320). Feng and Liu (1992) interviewed 81 survivors following a devastating earthquake in Tangshan, China, in 1976. Nearly half of these individuals reported having a neardeath experience. This high percentage of NDErs may have resulted from the fact that the survivors had all been victims of the same disaster (Carter, 2010). The researchers found that the elements reported in the NDEs did not vary according to respondents' age, occupation, educational level, gender, marital status, personality, prior knowledge of NDEs, or belief in God (Feng & Liu, 1992). These findings were consistent with those by other researchers (Greyson, 1986; Ring, 1980, 1984; Ring & Cooper, 1999; Ring & Franklin, 1980; Tobacyk & Mitchell, 1987; Zaleski, 1987). Compared with Western studies, the Chinese respondents reported fewer feelings of peace, fewer OBEs, and fewer encounters with darkness or light. Interestingly, a higher percentage of NDErs reported a life review, but the incidence of meeting deceased friends or family or spiritual beings was similar to that in most Western studies (Carter, 2010; Feng & Liu, 1992). Gordon (2007) noted the importance of assisting NDErs who have been coping with the aftereffects of the NDE and with the integration of diverse cultural meanings resulting from this experience. She suggested that it is important to assess and address the educational and counseling challenges of millions of NDErs, many of whom have been affected by escalating social crises and a shift away from the Newtonian/Cartesian 35 material worldview of Western culture. Gordon also recognized the potential social value of NDErs' sacred worldviews, stating that such beliefs were linked to different kinds of indigenous knowledge and quantum physics. She reported the following results: (a) 29 of 50 participants did not identify near-death studies as a useful NDE integration resource; (b) near-death studies were described negatively, if mentioned at all; and (c) 21 participants who had sought a connection with near-death studies for integration purposes expressed similar dissatisfactions (Gordon, 2007). Lundahl (1982) posited that Mormon NDEs are different in content from those described by Moody, Ring, and Greyson. He noted, "The Mormon descriptions suggest the other world is vast and located near the earth. It contains buildings that are better constructed than the buildings on earth and landscape and vegetation 'indescribably beautiful'" (p. 165). Many of the respondents believed that they had superhuman powers during their NDEs and perceived their bodies in another form. Lundahl concluded that most Mormon NDErs have culturally-constructed NDEs that are in keeping with Mormon values: "The societal system of the other world is very organized and based on a moral order. The basic societal unit is the family" (p. 165). Recreating NDEs The impossibility of anticipating a near-death experience has led some psychologists to explore ways of re-creating NDEs. Botkin (2000) used a psychotherapeutic technique known as eye-movement desensitization and reprocessing (EMDR) to enhance bilateral stimulation of the area of the brain that affects memory processing (Shapiro, 1999). Although this technique has been used primarily to help patients with posttraumatic stress disorder (PTSD), Botkin discovered that it could be used to induce what 36 seemed to be after-death communications (ADCs). The primary benefit of using EMDR was to stop intrusive memories, which are usually disturbing thoughts related to dying and death. Using this form of therapy, individuals were able to eradicate such memories by "seeing" deceased individuals in a state of peace in an afterlife. For example, Botkin cited the case of Bob, who had been troubled by intrusive memories from his military days. His problems began after he discovered that he and another soldier had accidentally shot an unarmed Vietnamese woman and her infant. While undergoing EMDR, Bob watched the woman's spirit rise from her body and drift peacefully through a tunnel toward a bright light. Botkin (2000) used EMDR on another patient, Mark, who had been found guilty of negligent homicide in the vehicular deaths of two adults and a 12-year-old girl. Mark reported that he saw the three victims standing together and appearing content in the afterlife. While Mark claimed that he had never seen photographs of the deceased individuals nor had he read any newspaper accounts about the victims, during his EMDR treatment Mark noticed that the deceased girl had short red hair and freckles. Mark also experienced an after-death communication, when one of the deceased males told him that, before being killed in the car accident, he had suffered from multiple sclerosis (MS). He told Mark that he was unable to move freely during life, but now he was happy to be mobile again. After this therapeutic session with Botkin, Mark asked his sister to retrieve an old newspaper account of the car accident. Mark discovered that the girl indeed had short red hair and freckles, and a man from the accident had been wheelchair-bound with MS for years. Thus, some EMDR cases suggest that alternative methods may be available for studying after-death communications. 37 Cognitive Dissonance Festinger's (1957) theory of cognitive dissonance appears to have relevance to the nature of incongruous spiritual experiences. Cognitive dissonance occurs when an individual holds two cognitions that are incompatible with one another. The incongruence of the two beliefs causes a person to experience various forms of emotional and cognitive distress or confusion, which is referred to as cognitive dissonance (Aronson, 1997). Festinger and Carlsmith (1959) posited that people would usually change one of the two beliefs to relieve the dissonance between the two cognitions. Festinger, Riecken, and Schachter (1956) observed the effects of cognitive dissonance in a field study conducted with members of a religious group who were predicting the end of the world. The researchers were present at the appointed time when the group's leader had predicted that the world would end. However, when the catastrophe did not occur, the group did not disband or dismiss the validity of their prior belief. Subsequently, the group began believing that their lives had been spared in order for them to teach others about their beliefs. The researchers posited that the group developed this new belief to justify and resolve the conflict between their previous expectations and reality. Therefore, Festinger and Carlsmith (1959) argued, in such situations individuals tend to respond with dissonance-reducing behaviors such as belief intensification. An increasing number of studies on cognitive dissonance are being conducted in many areas of psychological research. According to Aronson (1997), The wide array of dissonance research has been truly astonishing. It runs the gamut from decision-making in adults to the socialization of children; from interpersonal attraction to antecedents of hunger and thirst; from color preference to informational exposure; from the proselytizing behavior of religious zealots to the certainty of winning among gamblers at a race track; from inducing people to conserve water by taking shorter showers to inducing people to practice safe sex 38 (p. 129). In addition to the topics listed above, the aftereffects of an incongruous spiritual experience (ISE) may cause NDErs to experience cognitive dissonance. Such NDErs may have a difficult time reconciling and expressing their changed spiritual beliefs to friends, family, and business associates for fear of being criticized, ostracized, or referred to as delusional (which will maximize the dissonance). Therefore, some NDErs may choose to live with minimal levels of dissonance by not speaking about their changed (true) spiritual beliefs after experiencing an incongruous spiritual experience. Frameworks for NDEs It is important to review the current theories related to the context in which researchers classify studies on the near-death experience (NDE). Scientific investigations into the accounts of individuals (NDErs) who report this phenomenon generally follow two frameworks or modes of thought. The first is a metaphysical framework in which the experience is seen as a real event occurring outside the prevailing realm of space and time (Greene, 1983; Greene & Krippner, 1990; Jung & Jaffe, 1955; Ring, 1980, 1982; Sabom, 1982). The second is a neurobiological framework in which the experience is seen as the physical result of chemical and biological activities in the brain as various bodily processes slow down and cease to function (Blackmore, 1993; Gómez-Jeria & Saavedra-Aguilar, 1994; Moody, 1975; Morse, Venecia, & Milstein, 1989). Audain (1999) offered a third alternative that attempted to link the neurobiological and metaphysical frameworks with a theoretical bridge. This possible realm of existence he called extraneuronal hyperspace, building his theory on Jung's (1955) concept of a "nervous substrate" (p. 124). Jung's theory is itself different from the "cerebrospinal system" (p. 39 124); he posited that it could produce thoughts and perceptions. Greene (1983) was the first to apply the term hyperspace in this context, defining it as "any space with more than three dimensions" (p. 121). Audain (1999) described six basic propositions related to the theory of extraneuronal hyperspace. These propositions address the plausibility and possible mechanisms of what may be occurring during a near-death experience. The transduction preposition suggests that the brain does not control thought, but rather that thought controls the brain. Accepting this conceptual reversal makes it easier to understand how consciousness might exist beyond the physical body and possibly after clinical death. The complexity proposition states that simple signals channeled through increasingly complex ganglia combine to form "signals that have already been made complex [and therefore] are the chief candidates for transduction by the brain [into] extraneuronal element[s] or cognon[s]" (p. 109). The hyperspace proposition holds that these cognons and their aggregations are "transduced into an energy form and a space beyond three dimensions" (p. 110), a concept similar to the Einstein-Rosen Bridge (Einstein & Rosen, 1935) or a wormhole as described in theoretical physics. This latter concept provides a plausible explanation for why some NDEs can occur in minutes or even seconds. The bidirectional proposition asserts that the transduction of signals can travel in and out of extra-neuronal hyperspace. The matrix proposition organizes the cognons into rational thought, thereby providing an explanation for puzzling NDE reports such as the ability of blind NDErs to "see" or NDErs to understand communications intuitively. Finally, the tunnel closure proposition says that the degree of physical alertness corresponds to the degree of closure of the Einstein-Rosen (1935) hyperspace tunnel and the amount of 40 information passing back and forth. Death in this model would be a permanent and irreversible closure of the tunnel and a severing of the connection between the matrix and the physical body. Therefore, life in the physical body would exist only on one side of the hyperspace tunnel. Audain's (1999) alternative model includes many correlating propositions that require further research. As Beck and Colli (2003) noted, "Advances in quantum physics, biomechanics, holographic information theory, and consciousness studies support a fully realizable quantum biomechanical basis for near-death life reviews" (p. 169). Therefore, linking the neurobiological and metaphysical frameworks for NDEs provides a possible foundation for understanding the basis of the near-death experience. Perceived Communications during NDEs Sabom (1982) reported that 54% of NDErs reported that they entered a tunnel, with some stating that it was possible to communicate with deceased friends and family. Many of these communications, reported as telepathic, included information that was relevant to the individual's decision to return to life. In most cases of NDE communications, a presence or a being of light appears during a life review to offer encouragement or instructions for the future (Bonenfant, 2000; Greyson & Stevenson, 1980; Moody, 1975; Morse & Perry, 1992; Ring, 1980; Serdahely, 1992; Sutherland, 1990). Ring (1984) reported that children received messages during the NDE, and one young girl was shown how devastated her mother would be if she died. In the same study, another child saw her parents and grandparents grieving after learning of her death. Pennachio (1988) offered research suggesting that NDEs activate renewal and 41 transformation, which have a lasting effect "in the psyche" (p. 162). He reported the case of a woman who had three successive NDEs over a time span of only four weeks. During the first NDE, the woman encountered "someone" (p. 165) who told her that she did not belong in the darkness. She said, "I had the feeling that I was not wanted in the afterlife and was not wanted on earth" (p. 165). Her second NDE was frightening; it was filled with distorted faces, feelings of loss, intense loneliness, and a conviction that there was no place of eternal peace. She reported that, after this NDE, "I was able to evaluate all of my friends. They appeared to me as they actually were [not distorted]. I knew who was and was not my friend" (p. 166). This NDE account suggests a form of increased intuition, which is similar to that described by other researchers (Brinkley & Perry, 1994; Morse & Perry, 1992). The woman's third NDE was markedly different from the first two experiences. According to Pennachio (1988), the woman described having an out-of-body experience (OBE), followed by an NDE. She claimed to have been "filled with knowledge [that] led to great love and understanding of humanity" (p. 166). She described the experience as a massive infusion of knowledge and a form of training for changes that were to follow: "I was being completely turned around; I was being made over. I was made different; I'm not the person I was" (p. 167). Ring (1991) discussed the emotional healing that occurs during an NDE. In his study, he attempted to determine if visuals and communications of an all-powerful divine being had been the cause for emotional healing during an NDE. Ring documented the life histories of four participants that played a crucial role in understanding the content of their NDEs, all of whom had felt scarred by severe psychological trauma before the NDE. Subsequently, however, they felt healed by a divine being or angelic presence. The after42 effects of these healing and communicative encounters allowed the NDErs to overcome emotional wounds, thereby dramatically improving their lives. Ring concluded that the timing of these experiences coincided with certain periods in the lives of the NDErs when they were spinning out of control or reaching a point of hopelessness. He also claimed that certain NDErs were able to heal psychologically and find the inner strength to improve their lives. Lundahl (1992) reported that participants saw their future children and communicated with them. He noted that some individuals familiar with the typical stages of the near-death experience would meet with surprises while experiencing this phenomenon. For example, some NDErs discover new knowledge; others see into the future; and others hear voices with surprising messages about what they still need to accomplish in life. Morse and Perry (1992) reported another long-lasting aftereffect of NDE communications, namely, the continuation of receiving messages long after the experience. According to the researchers, 12% of their subjects experienced regular or repeated contact with the spiritual beings that they encountered during their NDEs. Liester (1998) cited the case of a 31-year-old woman (Ms. C) who experienced three separate NDEs. Her first NDE with an OBE occurred at age six, following an accidental overdose of anesthesia during surgery. Afterward, she discovered that there was someone or something she could speak with to ask questions and get answers "in the form of an inner voice" (p. 240). Two years later, Ms. C suffered an accidental puncture in her portal vein during a biopsy, which led to her second NDE. This time she saw a tunnel and a bright light and encountered a spiritual guide, who told her she could stay where she was or return to life. She was assured that she would always be able to communicate with "the 43 other side [until the time of her] true death" (p. 240). The spirit guide told Ms. C that, if she returned to life, she would find herself back in this same place after death, as everyone goes to that place after death regardless of what people had done in their physical life. Ms. C had her third NDE after suffering from a ruptured ectopic pregnancy. This time, she met another spiritual guide who told her, "We want you to teach people when they come into your path that they need to be very aware of what they pray for, and they need to keep the big picture in mind" (p. 240). After her last NDE, Ms. C claimed that she continued to communicate with these spiritual guides. Morse and Perry (1992) recounted the case of Olaf Sunden, whose NDE provides evidence of a major life-changing transformation. Olaf was a poor Swedish student who was thought to have a learning disability. He was 14 years old when he stopped breathing after an overdose of ether during a tonsillectomy. Olaf was pronounced clinically dead; subsequently, he had a near-death experience. He felt a sensation of leaving his body and crossing a barrier into another dimension or reality. Later on, he said, "the boundary between life and death is a strange creation of our mind" (p. 11). He described standing before a bright light that gave him universal understanding, and recalled how surprised he was to have no body. Olaf understood that he was dead, but he was still thinking, perceiving, and being aware of the events going on around him. Morse and Perry noted that Olaf claimed to have acquired a lasting aftereffect in the form of increased knowledge and intuition. He called this his "cosmic gift" (p. 13). Olaf stated that his advanced intuition was his source of inspiration for becoming an honors student. After graduating from college, he chose to become an engineer and received over 100 patent grants in chemistry. 44 Sutherland (1995) interviewed children who claimed to have met God. She related the story of a young man who described God as a feeling or as a Being with a voice but not an anthropomorphic form. Another young woman claimed to have engaged in several communications with God, whom she described as a genderless, loving presence. This woman also felt an all-pervading force surrounding her, which was part of the space she had occupied during the experience. Sutherland (1995) presented the case of a young mother of two small girls who introduced herself as Olivia. When she told her own mother about the experience, she learned that Olivia was the name of her older sister, who had died before she was born. Sutherland also spoke of a young man who said that God was a voice, a feeling, and a Being that was not human. In the same study, a young woman claimed to have several communications with God and felt a loving presence all around her that was like a force. After her NDE, she described this force as the space she had occupied that had no gender. Fenwick and Fenwick (1995) interviewed a young boy who had experienced an NDE. He found himself in a beautiful world surrounded by a powerful presence with a deep resonant voice that spoke to him in a compassionate and reassuring manner. The boy felt that he was inside an invisible force field that made him feel safe and warm. During communicative NDEs, the encounters may be visual with no audio, visual with audio, or audio with no visuals. Steiger and Steiger (1995) reported the NDE of a young boy who met several deceased relatives, including a sister whom he thought was alive. The next day he found out that his sister had died in a car accident before the time of his NDE. Liester (1998) spoke of several cases with multiple forms of communication 45 during the NDE and long after the experience. He cited the case of a woman (Mrs. B) who recalled the details of her NDE 18 years after it occurred. She remembered seeing several deceased persons who communicated with her in a form of "thought transfer" (p. 239). Liester noted that, over time, Mrs. B continued to receive messages in several ways. She referred to one form of communication as "the voice of the presence [and] a feeling of vibration from the heart area, causing recognition and acceptance within myself" (p. 239). At other times, Mrs. B heard a voice speaking directly to her. Once a voice told her to go to a certain grocery store instead of another, and there she encountered a friend she had not seen in 15 years. Interestingly, her friend told her that she had been trying to contact Mrs. B for several years. She also reported hearing "divine music that has no source," (p. 239) and on several occasions engaged in automatic writing and automatic speech. In a subsequent study, Greyson and Liester (2004) found that 80% of the NDErs reported hearing an inner voice or auditory hallucination, whereas only 40% reported having these communications before their NDEs. NDErs' attitudes toward these communications were largely positive, in contrast with schizophrenics' attitudes toward their auditory hallucinations. The NDErs regarded these inner voices as helpful sources of inspiration, intuition, and guidance. Communications during NDEs may come in many forms. In a study of 344 patients resuscitated after cardiac arrest, van Lommel et al. (2001) found that 62 (18%) reported an NDE, with 41 (12%) of those being core experiences. Among these, 24% involved out-of-body experiences, 23% involved communications with a light, 32% involved meeting with deceased persons, and 13% involved a life review. 46 Knoblauch et al. (2001) surveyed 2,044 people, of whom only 79 (4%) reported communicative NDEs. Among these, 38% claimed to have entered a heavenly realm; 32% perceived meeting living persons; 16% believed they met deceased persons; and 11% said they met non-human beings. Additionally, 32 (40%) described visual contrast between light and dark that "lacked emotional features and the respondents took an almost distanced observational stance" (p. 23). Nearly 50% of the study participants interviewed by Greyson and Stevenson (1980) described meeting someone during the NDE who was deceased. Greyson (2010) reported several cases in which NDErs recounted seeing friends or relatives whom they believed to be alive but discovered afterward were dead. Bush (2002) interviewed a woman after an NDE who was sitting in a rocking chair, examining her life while communicating with a dead aunt. Miller (2010) expanded on the NDE studies of Greyson to include such variables as expansion of consciousness and space. The subjects entered into altered states of reality, where they experienced psychological illumination that transcended the physical world. They described these experiences as occurring in a transcendent space that exists between time and space and life and death. According to Rousseau (2011), approximately 40% of NDErs find themselves in an otherworldly realm where they encounter friendly spirits or deceased friends and/or relatives. Blanke and Diguez (2009) noted that a number of researchers examined cases in which individuals reported seeing or speaking to deceased persons. Significantly, 40% of Ring's (1980) subjects and 52% of Greyson's (2006) reported encounters with deceased individuals. In studies by Kelly (2001), Ring (1980), and van Lommel et al. 47 (2001), the NDErs reported that they met mostly deceased relatives. Prophetic Visions A nationwide survey in 1982 estimated that as many as eight million people might have reported an NDE, and as many as 500,000 NDErs may have experienced a premonition (Gallup & Proctor, 1982). Ring (1980, 1982, 1988) referred to these future-focused visions during the NDE life review as a personal flash-forward. Ring (1988) had observed another type of flash-forward that he called a prophetic vision (PV), which might present images of any of the following: (a) global events, (b) the state of humankind, or (c) earth changes. Lundahl (2001) stated that PVs contain five basic features including "geophysical changes, meteorological changes, supply and economic breakdowns, nuclear war, and a new era of human history characterized by universal love and world peace" (p. 234). According to several researchers (Brinkley & Perry, 1994; Grey, 1985; Ritchie, 1998), PVs have been a central feature in a number of studies and personal accounts of NDEs. Ring (1988) noted that PVs are uncommon events compared to personal flashforwards, which pertain solely to the personal future of the NDEr. PVs occur most often in unusually deep NDEs as measured by the Ring's Weighted Core Experience Index (Ring, 1980). Ring (1988) called these PVs "subjectively compelling flash-forwards of planetary-wide cataclysms and eventual regeneration" (p. 4). For example, one NDEr stated, "I was informed that mankind was breaking the laws of the universe." Alschuler (1996) also examined the phenomenon of PVs during NDEs, which he referred to as "planetary visions." Alschuler asserted that such visions have been seen by NDErs on a grand global scale 48 Ring (1988) observed that many planetary predictions seemed to pinpoint 1988 as the year when apocalyptic events should have occurred. For example, Ring (1984) recounted these specific PVs: "It [was] given to me that in 1988, the world will be destroyed by earthquakes and volcanic eruptions, but if people will turn to God and honor Him, some of these things will be put off" (p. 206), and "[1988 would] be the year everything would be wiped away if we didn't change" (p. 205). According to Ring (1982), NDErs who experienced PVs became aware of the earth's history and its evolution. In a prediction before 1988, an NDEr stated that "the future scenario, however, is usually of short duration, seldom extending much beyond the beginning of the 21st century" (p. 55). The ways in which these prophecies are delivered seem to vary according to the individual who had the prophetic vision. Some PVrs (many of whom had near-death experiences) described the nature of these communications as telepathic, simply understood, or shown to them like a movie. Typical introductory statements from NDErs who experienced a PV were as follows: "I was informed" (Ring, 1984, p. 198); "I was made to understand" (Grey, 1985, p. 123); "It [was] given to me" (Ring, 1984, p. 206); "I saw" (Grey, 1985, p. 126). Ring (1984) offered interpretations of PVs as (a) imagery – representing an NDEr's own life-and-death drama; (b) apocalyptic expectations – personal beliefs reflected in an NDEr's visions; (c) a view of an alternative future regarding the planet's destiny; and (d) a real vision of future events. Ring (1988) preferred the insights of prophetic visions as provided by Perry (1987), who noted that, whenever cultures undergo rapid transformation and upheaval, there is usually a surge in the number of endof-world predictions. In Perry's view, PVs should not be understood literally to bring 49 about the desired effects of inciting positive change and "cultural regeneration" (p. 13). Brinkley (Brinkley & Perry, 1994) described one of the longest NDEs on record (28 minutes). According to Brinkley, he received 117 prophetic visions from 13 spiritual beings who told him that his life's purpose was to "create spiritualistic capitalism" (p. 48). Brinkley stated that these Beings instructed him to create centers where people could develop their spiritual selves. In 1997, Brinkley founded The Twilight Brigade, a nonprofit end-of-life care community that operates independently within Veterans Administration hospitals and hospices (Brinkley & Brinkley, 2009). According to Brinkley, he also co-founded Veterans Care Plus, a health savings program for U.S. military veterans. This organization, which is currently in operation, purportedly works closely with veterans service organizations such as the American Legion and the Veterans of Foreign Wars (Brinkley & Brinkley, 2009). Prophetic Revelations Lundahl (2001) differentiated another experience related to prophetic visions (PVs), which he called prophetic revelations (PRs). He claimed that PRs differ from PVs in two ways: (1) PVs are not delivered by beings of light or spirit guides but are usually communicated by deceased relatives or a person in the afterlife; and (2) PVs are not detailed descriptions of future events, but are mostly glimpses without elaboration of what may happen. Morse (Morse & Perry, 1992) related a story including a prophetic revelation that occurred during the NDE of a 66-year-old man: My wife and I had been told that she couldn't have any more children. But then, in June 1959, I was involved in a serious pit accident at a coalmine. I was taken to the hospital and found to be dead on arrival. But somehow, I was revived and remained in a coma for a week. While unconscious, I had a vision of walking 50 along the sun's rays and seeing a hand with a long white sleeve reaching down. I was almost touching the hand when I felt myself being pulled back, and I heard a voice say: "Don't worry. You are going to be all right and your son will be all right." A few months later we learned my wife was pregnant and our son was born almost a year to the day after my accident (p. 115). Some researchers (Grey, 1985; Ring, 1982, 1984, 1988) described NDE accounts that included a form of prophetic revelation. A few accounts spoke of predicted events in these terms, as they actually occurred at a future date. Walker, Serdahely, and Bechtel (1991) reported on three such cases, concluding that PRs informed NDErs to return to their physical bodies. In one account, a 34-year-old woman described an NDE that she had when she was 4 years old. She reported being out of her body and saw her "soul body" (p. 191) as a grayish mist. She claimed to have moved through physical objects and walls and saw her parents and grandparents grieving over her death in "threedimensional color" (p. 191). Next, she described being outside her house looking in and "decided I couldn't let them go through that" (p. 191). By focusing her attention on the vision of the family, she returned to her physical body. Perceived Communications with Spiritual Beings Spiritual aftereffects of NDEs are commonly reported in the literature (Bauer 1985; Flynn 1982, 1986; Grey, 1985; Greyson, 1983a, 1992; McLaughlin & Malony, 1984; Noyes, 1980; Ring, 1980, 1984; Sabom, 1982, 1998). Such aftereffects relate to NDErs' reports of communications and/or visions of deceased family, friends, loved ones, spiritual beings, God, or a bright light (Greyson, 1999; Moody, 1975; Ring, 1980; Sutherland, 1990). However, very few NDErs reported meeting biblical characters or sectarian gods (Moody, 1975; Moody & Perry, 1988; Ring, 1984; Sabom, 1982; Schwaninger et al., 2002; Sutherland, 1990; Twemlow & Gabbard, 1984). Consequently, 51 there have been discrepancies between NDErs' religious expectations of an afterlife and their post-NDE recollections of entering into a non-religious realm. Such NDEs lacked religious qualities and themes that are described in the Bible and other religious texts. Additionally, NDErs' perceptions of an afterlife were not affected by their prior knowledge of an archetypal NDE as described by Moody (1975) and others (Athappilly, Greyson, & Stevenson, 2006; Greyson, 1990; Greyson & Stevenson, 1980). Ring (1984) suggested that the NDE aftereffect of positive transformation is an encouraging indicator for the future enlightenment of human beings. Providing some support to this theory, Serdahely (1992) noted that some NDEs involved individuals who received "loving help from the other side" (p. 171). Many researchers (Greyson, 1983b; Moody & Perry, 1988; Ring, 1980; Sutherland, 1990) reported that NDErs received messages instructing them to be more loving, compassionate, accepting, tolerant, and selfless. Serdahely (1992) found that 10 NDErs received loving help after the experience, but they did not receive specific commitments or any emotional support. Several NDErs reported the appearance of friendly and welcoming spiritual beings that were "rooting for them" (p. 174). Others encountered spiritual beings (in one case, a deceased grandmother), whom the NDErs understood to be "guardian angels" (p. 174). Additionally, a number of NDErs in this study reported seeing figures whom they interpreted as being Jesus or God. Walker et al. (1991) reported that, during an NDE, a female patient encountered two friendly spirit beings that were part of a tunnel of bright light. The Beings took the 15-year-old girl's hands, and together they floated toward the brilliant light at the end of a tunnel. While floating, the girl saw an image of her parents, sister, and niece grieving 52 over her death: "Upon seeing the image of her family and feeling her concern for them, the light figures set her down. She then walked back through the tunnel and returned to her physical body" (p. 193). In the same study, the researchers described a retrospective NDE account in which an 8-year-old girl had been drowning and noticed seven pastel spirit beings that she called angels. She felt herself traveling along a road and stopping at a house. From outside the house, she watched her parents crying as they read her obituary in the newspaper. At that moment, she was revived and found herself back in her physical body. Lundahl (1992) defined angels as psychic presences that often are perceived as guides, messengers, or escorts. Lundahl and other researchers (Callanan & Kelley, 1997; Sabom, 1982, 1998; Sutherland, 1995) reported accounts of deceased family members or friends appearing to loved ones as angelic presences. Bonenfant (2000) related the case of a drowning woman whose NDE involved several detailed flashback memories. In her childhood, the drowning woman claimed to have encountered a beautiful woman in white during an NDE. She described the woman in white as having long dark hair and blue eyes with an angelic presence and radiating a sense of "motherly love" (p. 104). Although the drowning woman reported that she wanted to join the angelic presence with the outstretched hands, the figure told her that she would have to return to life. About two minutes after she lost consciousness, the drowning woman was revived and showed no physical or mental aftereffects following the episode. In a sad turn of events, 15 years later the woman's daughter was attacked by a dog and needed numerous surgeries to repair her face. While in the hospital following a graft procedure, the daughter was having terrible nightmares, so the woman lay down with her and cradled her daughter's 53 head. Next, the woman saw a light appear behind her left shoulder, but she could not find the source of the light. When she turned to her daughter, she noticed that they were joined by the same beautiful angelic presence of a woman in white whom she had encountered during her NDE. The "angel" assured the woman that her daughter would fully recover. Bonenfant (2000) found that the drowning woman's NDE contained many of the common features described by NDE researchers (Greyson, 1983b; Moody, 1975), including: (a) a dark environment, (b) a sense of peace and calm, (c) a dark tunnel leading toward a bright light in the distance, (d) a Being of light, (e) a feeling of unconditional love emanating from a presence of the light, (f) receiving instructions to return to life, and( g) feeling unwilling to leave the peaceful environment. Bonenfant reported that the drowning woman had experienced 13 of the 16 items on Greyson's NDE Scale (Greyson, 1983a), with an overall score of 26. However, the visions of her life were not typical of a life review, but were seemingly random memories devoid of any relevance to her drowning. The woman did not characterize herself as particularly religious before or after the NDE. She reported that, following the NDE, she had become more loving toward others and decided to spend less time on materialistic pursuits and more time providing service. She said that her positive attitude brought forth a transformation that strengthened over time. The drowning woman believed that the woman in white was her guardian angel, who had helped to restore her faith after her daughter was attacked. Bonenfant (2000) noted that the drowning woman's intuitive abilities had been enhanced by these experiences. She also reported four specific changes in her life: (a) her wristwatch was always running fast, (b) her eyes were extremely sensitive to light, (c) 54 light bulbs frequently dimmed or burned out in her presence, and (4) she perceived various psychic manifestations. In addition, the woman claimed to have seen the spirits of two women in 19 thcentury outfits in her home. This type of report of a visitation by "angels" has not been described extensively in the scientific literature. However, Bonenfant stated that a vast number of cases have been reported by individuals (religious and non-religious), who claimed to have seen and communicated with angelic apparitions. Changes in Spiritual Beliefs Many researchers noted an enhanced sense of spirituality in NDErs (Atwater, 1988; Flynn, 1986; Grey, 1985; Greyson, 1992, 2006; Musgrave, 1997; Ring, 1984; Sutherland, 1990). Some NDErs reported that their belief in God had been strengthened after the experience (Bonenfant, 2004; Clark, 1984; Sabom, 1982), while others indicated that they had found favor with God or acquired the feeling that God was within them (Morris & Knafl, 2003; Ring, 1980; Schwaninger et al., 2002). Additionally, diverse spiritual beliefs, expectations, and affiliations were thought to affect the content of the NDE (Bauer, 1985; Flynn, 1982, 1986; Grey, 1985; Greyson, 1983b, 1992; McLaughlin & Malony, 1984; Noyes, 1980; Ring, 1980, 1984; Sabom, 1982, 1998). In Ring's first book, Life at Death (1980), he reported on: (a) demographic data about NDErs and their profiles, (b) the frequency of NDE common elements as an overall pattern, (c) the causes of the NDE, and (d) the circumstances when NDEs most frequently occur. Ring summarized his findings on personality and value changes thus: "The things that [the experiencer] values are love and service to others; material comforts are no longer so important. He becomes more compassionate toward others, more able to accept 55 them unconditionally" (p. 158). Ring noted that a "heightened inner religious feeling" (p. 162) follows the NDE. While interviewing study participants who had core NDE experiences, Ring said that they "left me with the impression that a spiritual awakening had definitely occurred in a number of them" (p. 166). There were problems associated with Ring's (1980) study. The investigation lacked experiential data regarding NDErs' spiritual beliefs before the NDE compared to the changes occurring after the experience. Ring (1980) also noted that he knew some of the participants from their involvement with national NDE organizations. Consequently, if the participants knew the researcher prior to the study, they may have had a bias toward helping the researcher confirm the results (Norenzayan & Schwarz, 1999). Indeed, Ring consistently called for additional qualitative and quantitative studies to confirm his findings. In Ring's (1984) second study, he constructed three questionnaires to elicit additional data about personality and value changes. The participants completed two questionnaires, and individuals who knew the NDEr before the experience were asked to complete a third questionnaire. The study found that NDErs reported profound and lasting change in values, attitudes, and behaviors. Additionally, Ring's three questionnaires provided more reliable data than the narratives that had been utilized in past studies. Especially useful were the data collected from the third questionnaire by individuals who knew the NDEr. According to Ring, "we can tentatively conclude that there is no indication whatever that the self-reports of NDErs are biased or in any way invalid" (p. 141). With such a dramatic shift in value structures, Ring suggested that the spiritual aftereffects of the NDE may be characteristic of "an evolutionary thrust toward 56 higher consciousness" (p. 255). Ring concluded by indicating that the NDE may serve as a vehicle for transforming individuals into more spiritual, loving, and compassionate human beings. McLaughlin and Malony (1984) stated that NDEs affect individuals' religious experiences in a multitude of ways. They found that some NDEs reaffirmed the participants' religious beliefs and that their relationship with God had intensified. One NDEr converted to Christianity, and several others converted to other religions. However, most claimed that the NDE was not the cause of their conversion. The researchers also found that several NDErs abandoned their religious beliefs after the NDE: "These subjects reported the NDE did not fit with their prior religious understanding, so that they subsequently changed their religious beliefs, either endorsing belief in a new religion or becoming less involved in any form of organized religion" (p. 158). These individuals adopted a belief system that was spiritual but not religious. McLaughlin and Malony (1984) found a lack of statistical correlation between NDEs and religious orientation. In their study, they interviewed 40 NDErs including Protestants, Roman Catholics, Jews, followers of the Baha'i faith, and others with no religious affiliation. The participants completed a standardized measure of religious orientation that included three basic religious attitudes: (a) compliance to religion for personal gain (extrinsic religious orientation), (b) identification with religion for support (consensual religious orientation), and (c) internalization of religion for its own intrinsic value (intrinsic religious orientation). They found no significant relationship between the depth of the NDE and various measures of religious orientation or other religious measures (Greyson, 2006). McLaughlin and Malony concluded that spiritual experiences 57 after the NDE are unpredictable. McLaughlin and Malony (1984) also noted that "the NDE is just as likely to happen to those with little or no religious belief" (p. 158). However, further statistical analysis did reveal a relationship between the depth of an NDE and measures of religious change. The researchers surmised that changes in spiritual beliefs after the NDE may range from conversion, to disillusionment with prior religious beliefs, to strengthening existing religious beliefs, to becoming more active in religious organizations, or to adopting a more spiritual perspective with less emphasis on organized religion. There were problems associated with the McLaughlin and Malony (1984) study as well. During one interview lasting between 30 and 90 minutes, participants were asked to (1) report demographic information, (2) recount the near-death episode, (3) answer questions designed to determine the presence or absence of the various elements of the near-death experience, (4) answer five questions developed by Ring (1980) concerning religious beliefs prior to and after the NDE, and (5) complete the Attitudes about Religion Scale (Fleck, 1981), which incorporates a 37-item measure of religious orientation (McLaughlin & Malony, 1984). Moreover, no follow-up interviews were conducted with the participants to confirm the data or to clarify the vast amount of information provided in a very short time. Newsome (1988) agreed with Ring's (1984) assessments, positing that the NDE "is a moment of the heart seeking to transcend limitations of time, space, and personality, letting go and giving up the human ego, surrendering itself to the ultimate reality" (p. 104). Newsome noted that a common aftereffect of the NDE among her sample was an ardent feeling of love and compassion for others. She asserted that NDEs appear to (a) 58 cause a shift in perception, allowing experiencers to reach a realm of existence that is out of the realm of space and time; (b) permit the NDEr to experience physical, spiritual, and nonphysical realities in total; and (c) allow the body to become diminished into the lower self (ego), which includes attitudes, personality traits, and desires organized around the needs, appetites, and desires of the physical being. In terms of spiritual transformation, Newsome posited that NDErs perceived the higher self as being released from the lower self. She also claimed that NDErs released their fears and became aware of their true selves. Newsome theorized that, during the NDE, a shift in perception occurred from selfcenteredness to the whole of humanity. NDErs acquired new feelings of unconditional love and felt a universal connectedness to all things and beings. Abramovitch (1988) discussed the incongruous spiritual experience of Chaim Ralbag, a man who grew up in a Jewish family in Israel. He did not have a deeply seated belief in the afterlife, although he had been vaguely familiar with the afterlife teachings of Jewish mysticism. Ralbag reported a near-death experience as a young man but without a panoramic life review. His description of the NDE included most of the features mentioned by Moody (1975), including: (a) an out-of-body experience, (b) floating and moving through darkness, (c) feelings of intense peace, (d) exhilaration and awareness of an extraordinary light, (e) images and sounds, and (f) meeting with deceased family members (his father and brother). During the NDE, Ralbag's father expressed anger toward him and asked him what he was doing there. Then his father and brother advised him to return to his physical body, which caused Ralbag to become emotionally distraught. After his NDE, Ralbag was tormented by "his inability to integrate and/or relate this strange encounter with some pre-existing cultural form" (p. 183). Abramovitch 59 concluded that Ralbag's mental anguish was partly caused by "the lack of overall congruence between these near-death traditions of his native culture and what he actually experienced. That his implicit cultural expectations were imperfectly met led him to be fearful" (p. 183). Sutherland (1990) conducted a survey among 50 participants that revealed "an established shift on all nine items away from organized religion and church attendance and towards private informal prayer, meditation, and a general quest for spiritual values" (p. 28). One of the church-going respondents in this study described her religious experience thus: "They say if you're not a Christian none of you will be able to come in through the eye of the needle. . . . I went up there and I saw it, and I certainly wasn't a Christian at the time" (p. 28). In terms of spiritual growth, Sutherland reported that the participants displayed a loving attitude, knowledge of God, and inner peace after their NDEs. In general, the respondents felt that they had an ongoing relationship with a Higher Power that "requires no mediation by institutions such as a church or interpre-tation by the teachings of any denomination or tradition" (p. 30). After their NDEs, 84% claimed to have no religion, 80% perceived no value in organized religion, 78% did not attend church, and 6% claimed to be religious (Sutherland, 1990). Additionally, Sutherland noted that "100 percent of my respondents now believe in life after death, and base that belief on their own experience, which in many cases explicitly contradicts the views held earlier" (p. 29). Ring and Rosing (1990) conducted a study of 74 NDErs and 54 control subjects to assess the role of psychological factors in influencing susceptibility to NDEs and to measure the aftereffects related to these experiences. They concluded that NDErs were 60 not more imaginative or more prone to fantasy than the control groups. However, Ring and Rosing found that NDErs reported a higher incidence of abuse and trauma during their childhoods and were more sensitive to "non-ordinary realities as children" (p. 211). Ring and Rosing collected data utilizing their own Omega Project Battery, which is a series of specially designed questionnaires, surveys, and instruments to assess the following issues: (a) background information, (b) experiences and interests, (c) psychological and paranormal experiences during childhood, (d) home inventory of childhood trauma, (e) psychological inventory and measure of tendencies toward dissociation, (f) psychophysical changes inventory, (g) life changes inventory, (h) religious beliefs inventory, and (i) opinions inventory. The researchers concluded that no demographic profile could predict the likelihood of someone having an NDE. However, some individuals tested as being NDE-prone according to a specific personality profile. Ring and Rosing described people with this personality type as "psychological sensitives with low stress thresholds" (p. 232). Such individuals might be more perceptive, less resistant, or more likely to remember NDEs. Ring and Rosing reported that, as a group, NDErs were more likely to report an experience of profound, longstanding psychological change than individuals who had other types of trans-formative experiences. Musgrave (1997) discussed the spiritually transformative effects of the NDE on 51 participants. These NDErs had been surveyed by mail and in person. She designed a 31-item questionnaire that revealed changes in religious beliefs, lifestyles, careers, and relationships. Musgrave stated that, after an NDE, 88% reported changes in their spiritual beliefs, 92% believed in an afterlife (compared to 22% before the NDE), and 77% confirmed that dramatic changes had occurred in their post-NDE lives. 61 Thibodeau (1998) conducted a study that included 41 NDErs and 32 non-NDErs. She reported that most NDErs changed their occupations and spiritual beliefs after the NDE. The study also found that NDErs scored higher than non-NDErs on confidence levels, which Thibodeau believed were relative to the strength of the participants' spiritual beliefs. She also produced qualitative data indicating that NDErs felt a need to disclose their experience to others, but were usually hesitant to do so for fear of being judged. Schwaninger et al. (2002) reported that NDErs (as compared to non-NDErs) have strong feelings regarding: (a) an inner sense of God's presence, (b) a sense of the sacredness of life, (c) a need to pray, (d) wanting to belong to an organized religion, (e) belief in life after death, (f) religious beliefs, (g) appreciation of nature, (h) belief in a higher power, (i) a desire to achieve a higher consciousness,( j) a sense of purpose, (k) a concern with spiritual matters, (l) an interest in self-understanding, and (m) a desire for solitude. The researchers noted, "In summary, patients with near-death experiences have a heightened spiritual awareness and experience significant changes in their attitudes toward understanding of life and self, attitudes toward others, and changes in social customs and religious beliefs" (p. 231). Fox (2003) reported that spiritual transformation as an aftereffect of the NDE does not necessarily follow a pattern of conversion or a preference toward any religion: "NDEs cannot unambiguously be used as apologetic tools for the propagation of any one particular religious or spiritual tradition or be somehow fitted into any one tradition to the exclusion of all others" (p. 339). However, he posited that the NDE could lead to spiritual growth. 62 Fox commented on the contradiction between traditional Christian beliefs about heaven and NDErs' perceptions of an afterlife. He stated that most reports of NDEs do the following: (a) suggest a separation of the soul from the body after death, which contradicts the biblical notion of resurrection; (b) indicate that life after death is a universal phenomenon and not a gift from God; (c) refute the notion that the return of Christ is necessary for a soul to be judged after death; and (d) do not identify the bright light as being that of Christ (Fox, 2003). Fox also noted that most NDErs perceived going through a tunnel and being in the presence of a bright light after death. He acknowledged that this realm with the bright light is not the Christian heaven that NDErs expected to enter after being saved or born again. However, Fox attempted to reconcile Christian teachings with NDE accounts by stating that the NDE is a form of a dream (or sleep) that lasts until the final Judgment Day. Greyson (2006) noted that many NDErs become more empathic and spiritual but not more religious after the NDE. He also found that NDErs (a) overcome fear of death, (b) find new meaning in life, (c) shift from ego-centric to other-centric orientation, (c) understand how to love unconditionally, (d) believe in the continuation of life after death, and (e) contend that everything happens for a reason. According to Greyson, "These changes meet the definition of spiritual transformation" (p. 393). Greyson also found that the NDE "does not necessarily promote any one particular religious or spiritual tradition over others, but they do foster general spiritual growth both in the experiencers themselves and in human society at large" (p. 393). In terms of spiritual transformation, Greyson (2008) discussed the similarities between the aftereffects of the NDE and the mystical experience. He stated that both 63 experiences "have a profound and apparently lasting impact on many people who experience them, often precipitating a significant change in values and attitude toward death and a new sense of purpose or meaning in life" (Greyson, 2006, p. 399). However, Cressy (1994) concluded from her study that not all NDErs experience a spiritual transformation after an NDE. Greyson (2006) stated that a shift in spiritual beliefs resulting from an NDE usually takes effect over a period of time, as with other types of spiritual encounters. Greyson (2008) also commented on other studies that have investigated whether individuals with different religious beliefs are more or less likely to have NDEs or a specific type of NDE, noting that some skeptics view the NDE as "essentially a religiously inspired illusion: The crisis of impending death triggers a series of hallucinations in keeping with an individual's religious belief system and expectations concerning an afterlife" (Greyson, 2006, p. 400). Finally, Greyson (2006) recognized that most NDE studies on spiritual aftereffects have not included quantitative measures, which could have gathered essential information on the profiles of the participants. Flanagan (2008) posited that many NDE studies focused on changes in spiritual beliefs as an aftereffect of the NDE. She noted, "For some there is a shift away from institutionalized religious practice and a move toward more informal spiritual practices. These practices may include analysis of dreams, regular meditation, yoga, and/or selfhypnosis" (p. 7). Flanagan reported, "All 14 subjects indicated a change in spiritual beliefs and practices. Only two of the 14 indicated feeling a renewed sense of religiosity resulting in more regular attendance of religious services" (p. 31). After their NDEs, many of these participants had a total lack of feeling for any type of organized religion. 64 One participant said, "My belief system had changed so that I didn't need a religion" (p. 31). A second respondent said, "I have no sense of religion at all" (p. 31), and a third said, "I went to another church for a few years, but their truths weren't good for me either. I kept thinking there were too many rules. These are man's rules" (p. 31). A fourth experiencer, who was raised as a conservative Southern Baptist, said, "All of my faithbased belief system was replaced by knowledge" (p. 31). Flanagan concluded that all the participants in her study had experienced changes in their spiritual beliefs. Spiritually Transformative Experiences In recent years, some researchers (Cole, Hopkins, Tisak, Steel, & Carr, 2008; Mahoney & Pargament, 2004; Shaw, Joseph, & Linley, 2005; Smith, 2006) have contributed to a growing body of literature on spiritually transformative experiences (STEs). Smith (2006) stated that spiritual/religious transformation is a common and powerful experience that usually results from engaging in normal religious activities, surviving an illness or accident, or re-evaluating one's life after the death of a friend or loved one. Shaw, Joseph, and Linley (2005) reviewed 11 studies on spiritual transformation that produced three main findings: (1) religion and spirituality are usually beneficial to people in dealing with the aftermath of trauma; (2) traumatic experiences may lead to a deepening of religion or spirituality, and (3) positive religious coping, religious openness, readiness to face existential questions, religious participation, and intrinsic religiousness are typically associated with posttraumatic growth. Smith (2006) also asserted that the most common aftereffect of an STE had been a strengthening of faith, which was usually followed by changes in character and cessation of bad habits. Mahoney and Pargament (2004) proposed that some STEs resulted in spiritual 65 conversion, which helped individuals to discover what was most significant in their lives. The researchers suggested that, unlike other transformative experiences, spiritual conversion incorporated the element of religion or "the sacred" into the content of change. In a study conducted by Cole et al. (2008), the researchers assessed the factor structure, reliability, and validity of an instrument they called the Spiritual Transformation Scale (2008). This scale was designed to measure spiritual growth and spiritual decline with respect to worldview, goals, priorities, sense of self, and relationships. After it was administered to 253 people diagnosed with cancer, the results indicated that the Spiritual Transformation Scale (STS) was psychometrically sound (Cole et al., 2008). Groth-Marnat and Summers (1998) investigated altered beliefs, attitudes, and values among 53 NDErs that included a control group of 27 individuals who reported other types of life-threatening incidents. The extent and types of changes were rated by "significant others" to obtain outside corroboration. The researchers found that the areas of change included: (a) increased concern for others, (b) reduced death anxiety, with a strengthened belief in an afterlife,( c) increased transcendental experience, (d) reduced interest in material possessions, (e) increased self-worth, (f) increased appreciation for natural phenomena, and (g) an enhanced awareness of paranormal phenomena. These results suggested that it was the NDE itself, rather than being exposed to a lifethreatening situation, that was the most crucial factor in facilitating change (GrothMarnat & Summers, 1998). Cognitive Dissonance Relating to Changes in Spiritual Beliefs Saavedra-Aguilar and Gómez-Jeria (1989) theorized that NDErs could minimize 66 cognitive dissonance by reconstructing their experience into words consistent with their previous set of beliefs and cultural background. The researchers asserted that a function of the verbal system "appears to be the construction of logical, coherent, and explicative hypotheses based on the functioning of other cognitive and emotional systems. These hypotheses can sometimes be completely erroneous, but they are taken as absolute truth" (p. 216). That is, the verbal system integrates emotions, perceptions, and memory in accordance with a person's previous beliefs (Gazzaniga, 1985). In order for individuals to minimize cognitive dissonance, the verbal system becomes the final arbiter of multiple mental systems (Gazzaniga & LeDoux, 1978). For NDErs, their perceptions of being ordered back to life by otherworldly beings can be understood in terms of another posterior, logical, and culturally-based recollection provided by the linguistic brain (Gazzaniga, 1985). Mahaffy (1996) investigated the effects of Christian identity and dissonance with a sample of 163 self-identified lesbians. The study focused on the source of dissonance as either internal, external, or non-existent. According to Mahaffy, "Resolution strategies included altering one's religious beliefs, leaving the church, or living with the dissonance. Respondents experiencing internal dissonance were more likely to alter their beliefs" (p. 392). Mahaffy also noted that the individual's age when becoming a Christian and the age of suspecting her lesbianism had an effect on the timing of external dissonance resolution. Burris, Harmon-Jones, and Tarpley (1997) conducted a study derived from cognitive dissonance theory. The researchers pointed to a means by which cognitive dissonance might be reduced through transcendence, thus supporting Abelson's theory 67 (1959): "The theosophical dilemma of God's presumed permissiveness toward evil is sometimes resolved by appeal to transcendent concepts" (p. 346). Additionally, Allport (1950) noted that "the suffering of innocent persons is for most people the hardest of all facts to integrate into a religious sentiment" (p. 81). Smull (2000) investigated the experiences of 10 women who were disillusioned with Christian fundamentalism. She utilized Moustakas's (1990) method of heuristic research to explore the participants' conflicting feelings toward church doctrines on absolute truth and strict rules of behavior in daily life. While the participants had feelings of despair in regard to these issues, they simultaneously formed stronger ties to their religious doctrines. Consequently, this intensification of belief resulted in confusion, disorientation, and turmoil. Smull reported that the participants first tried to resolve or eliminate religious/biblical contradictions before altering their beliefs. In sum, these behaviors correspond to the manner in which individuals cope with the negative effects of cognitive dissonance. According to Feinstein and Krippner (1997), many individuals tend to become disillusioned with their "personal mythologies" at various stages in life. In their 1997 work The Mythic Path, Feinstein and Krippner noted, "Your personal mythology is the system of complementary as well as contradictory personal myths that organizes your experiences and guides your actions" (p. 6). They added, "Much of the psychological suffering people experience is entangled in personal myths that are not attuned to their actual needs, potential, or circumstances" (p. 2). However, when individuals become aware of the source of their suffering, they can examine and evaluate old myths and begin constructing new ones. In relation to the difficulties of overcoming cognitive dissonance, 68 Feinstein and Krippner (1997) explained, "Long-standing myths tend to die hard. However dysfunctional they may be, they are also deeply embedded in lifestyle and habits of thought and behavior. Marching even to an inspiring new myth may require substantial focus and commitment" (p. 264). Summary This chapter surveyed the literature regarding topics such as NDE aftereffects, communications and/or visions perceived during NDEs, changes in religious/spiritual beliefs after NDEs, incongruous spiritual experiences during NDEs, and personality factors of NDErs after an ISE. At the present time, there is little or no available published research on ISE/NDE-related phenomena. It is likely that a gap in the NDE literature has been identified, which the current study attempts to address by utilizing Moustakas's (1990) heuristic research method. 69 Chapter Three: Methodology Choice of Method I chose heuristic inquiry to learn more about the essential meanings of my own NDE and to gain knowledge about the thoughts, feelings, and experiences of eight other NDErs. I also selected this method because it provided the research tools that I needed to investigate the spiritual aftereffects of Near-Death Experiences. The heuristic method is different from other methodologies because it seeks to discover the meaning and depth of an individual's experience and to recreate the lived experience from the frame of reference of the experiencing person (Moustakas, 1990). The nature of heuristic inquiry is phenomenological, originating as a process of internal search in which one discovers the nature and meaning of human experience (Moustakas, 1994). Another reason I chose heuristic inquiry was in order to conduct in-depth interviews and to probe deeply into the participants' subjective phenomenological experiences. I actively participated in the heuristic process through all stages of the research, including before, during, and after the interviews with the eight participants. The primary research question for this study was: What are the aftereffects of an incongruous religious experience (ISE) that is based on reported communications or visions during a Near-Death Experience (NDE)? My intention was to explore the participants' religious expectations of an afterlife prior to their NDEs and to investigate whether such expectations were met during their NDEs. I also wanted to understand their thoughts and feelings regarding perceived communications or visions that may have been incongruous with their afterlife beliefs. Moustakas's (1990) method provided a research approach that helped me to understand more fully what an incongruous spiritual experience is and means. According to 70 Moustakas (1990), the assumptions of the heuristic method are: 1. Understanding of phenomena is deepened with the persistent, disciplined devotion of intensive study. 2. The researcher's frame of reference, self-discipline, intuition, and introspection are considered to be reliable sources for finding the meaning of a human experience. The heuristic method is an organized and systematic design for investigating human experiences. Although this form of inquiry has differences from other approaches, it also has qualities similar to other research methods utilized in human science research such as: (a) recognizing the value of qualitative designs and methods; (b) focusing on the experience as a whole rather than on its objects or parts; (c) searching for meanings and essences of experience rather than measurements and explanations; (d) obtaining descriptions of experiences through first-person accounts during conversations and interviews; (e) regarding the data of an experience as imperative for understanding human behavior and as evidence for scientific investigations; (f) formulating questions and problems that reflect the interest, involvements, and personal commitment of the researcher; and (g) viewing the experience as an integrated and inseparable relationship of subject and object, of parts and the whole (Moustakas, 1990). Participants All participants found a link to the survey site on a dedicated Facebook page. The announcement explained the purpose of the study and the need for NDE volunteers (see Appendix A). Emails were sent to regional chapters of IANDS (International Association for Near-Death Studies) to ask them to notify their members of the opportunity to partici71 pate in the study (see Appendix B). A total of 84 individuals volunteered to complete an online NDE-related inventory and a questionnaire that I developed. When the survey participants were asked if they could be contacted at a later date by email or phone, 70 respondents (83%) provided their contact information. Subsequently, eight participants with the highest combined scores on the two online survey instruments were selected for interviews utilizing methods of heuristic inquiry (see Table 1). The sample consisted of five women and three men from various locations within the United States. The use of eight participants in a qualitative study is appropriate, according to some researchers (Lester, 2009; Polkinghorne, 1989). Instruments Greyson's NDE Scale. The participants completed Greyson's NDE Scale (Greyson, 1983a) to assess their experience in terms of the identified elements of "core" NDEs (see Appendix C). According to Greyson (1983a), "The scale was found to have high internal consistency, split-half reliability, and test–retest reliability" (p. 369). The scale is, indeed, highly correlated with Ring's Weighted Core Experience Index (Ring, 1980) and has "differentiated those who unequivocally claimed to have had NDEs from those with qualified or questionable claims" (p. 369). Greyson (2007) retested the reliability of his NDE scale to measure consistency in the memories of NDErs over a period of two decades: "Scores on the NDE scale administered in the 1980s and again to the same individuals an average of more than 19 years later showed no significant differences" (p. 410). "Mean scores and standard deviations on the two halves were 7.64 ± 4.22 and 7.38 ± 3.94; the resultant Pearson product-moment reliability coefficient 72 between the two halves was .84, Spearman-Brown corrected to .92" (p. 373). Possible scores for this instrument range from 0 to 32. Incongruous Spiritual Experience Questionnaire (ISEQ). I developed an experience inventory based on the hypothesized elements of an incongruous spiritual experience (see Appendix D). The instrument was designed to gather information on an individual's beliefs relating to religion/spirituality, God, and the afterlife. The format of the ISEQ is based on Ring's (1984) Religious Beliefs Inventory, but the questions and categories in the ISEQ are different from those in Ring's instrument. The questionnaire is divided into three sub-scales of six questions each that inquire into theological, ontological, and metaphysical beliefs. The samples' ISEQ scores helped to identify them as NDErs who may have experienced an ISE. These participants were interviewed on two occasions to gather phenomenological perspectives on their ISE/NDE-related experiences. Possible scores for the ISEQ range from 18 to 90. Procedure The online surveys were posted on a web link created by the internet-based research firm Psychdata. This company, which utilizes state-of-the art technology, has strict security policies and procedures. It provided the IP (Internet Protocol) addresses for all survey respondents, including 22 additional individuals who entered the survey site but did not complete the two instruments. A score of 7 or higher on Greyson's NDE Scale (1983a) is considered an NDE for research purposes. Of the 84 respondents who completed the online survey, 27 scored less than 7 on Greyson's NDE Scale (1983a), whereas 57 scored 7 or higher. These 57 respondents also completed the researcher's questionnaire (ISEQ), earning scores that 73 ranged from 36 to 90. The combined scores for these two instruments ranged from 43 to 122 (see Appendix E). Table 1 shows the highest combined total scores of the eight participants selected for the study. Table 1 Highest-Scoring Online Survey Respondents Name Greyson's Scale Score ISEQ Score Combined Score 1. Cary 25 90 115 2. Paul 22 90 112 3. Laura 21 90 111 4. Larry 20 84 104 5. Barry 18 85 103 6. Wendy 18 81 99 7. Brenda 16 83 99 8. Betty 19 77 96 Average scores 19.88 85 104.88 Heuristic Inquiry The heuristic method begins with the internal search to discover the meanings and essences of a particular human experience (Moustakas, 1994). I actively participated in the heuristic process with a passionate desire to pursue a research question that is con74 nected to my identity. I utilized Moustakas's (1990) recommendations for: (a) identifying the focus of the inquiry, (b) self-dialoguing, (c) tacit knowing, (d) utilizing intuition, (e) indwelling, (f) focusing, and (g) finding an internal frame of reference. I also completed the research steps as outlined by Moustakas (1990) by engaging in the following stages of heuristic inquiry: (a) initial engagement, (b) immersion, (c) incubation, (d) illumination, (e) explication, and (f) creative synthesis. In addition, I followed Moustakas's guidelines for creating individual depictions, exemplary portraits, a composite depiction, and a creative synthesis. I began the heuristic process by searching within and reflecting on my personal experience with the phenomena that are the subjects of this study. My motivation for studying them revealed itself through a process of introspection that led to self-discovery. Throughout the research study, I was committed to understanding the fundamental qualities, conditions, and relationships that underlie these phenomena. I discovered new ways of understanding the aftereffects of an incongruous spiritual experience during a near-death experience. I felt a sense of illumination welling up within me after conducting this study. I intimately and autobiographically related to the essence of the research question. I developed an inner knowing about the phenomena through a process of indwelling and gained a fuller realization and understanding of them. I had a desire to uncover new knowledge about NDE/ISE related phenomena, which led me to encourage the participants to disclose the details of their experiences. I created an atmosphere of comfort, trust, and engagement that inspired the sample members to express, explore, and explicate the meanings of their NDEs. 75 The heuristic process led to the unfolding and discovery of new insights into these phenomena as human experiences, as the research required the utilization of my personal perceptions and perspectives. Additionally, this method expanded my base of knowledge regarding the near-death experience and its spiritual aftereffects. Initial Engagement. Initial engagement begins with an autobiographical selfsearch and a demanding, disciplined commitment to the phenomenon (Moustakas, 1990). I was, in fact, deeply committed to investigating the aftereffects of an incongruous religious experience during an NDE. My passion for this subject grew out of a fervent personal connection with the phenomena of death and dying and spiritual theories of the afterlife. My research question clearly specified what I wanted to investigate, discover, and understand while studying the occurrence of an ISE during an NDE. Moustakas (1990) stated that "the [research] question itself is infused in the researcher's being" (p. 43). Immersion. Moustakas (1990) posits that each heuristic inquiry develops in its own way, yielding rich, vivid, personal descriptions of the qualities or components of the experience. Immersion is the process of living the question while awake, asleep, or engaged in daydreaming, with the goal of becoming so intimate with it that all of life provides possibilities for a greater awareness to emerge (Moustakas, 1990). I allowed the immersion process to develop on a daily basis. I was constantly aware of the qualities of my experience and impressions during the 16 interviews with the sample. The NDErs' narratives yielded interesting and diverse information, and I found myself constantly thinking about the interviews and the significance of the collected data. Moustakas (1990) commented on this method of organizing and synthesizing 76 data: "The researcher enters into the material in timeless immersion until it is understood. Knowledge of the individual participant's experience as a whole and in its detail is comprehensively apprehended by the researcher" (p. 51). I carefully reviewed the transcripts and my personal notes to identify common qualities and themes within the data. I formed impressions that helped me to recognize the unifying themes that were present. I became totally immersed in the recorded and written descriptions, as I focused on gaining a gradual sense of meaning and direction from the data. I explored NDE/ISE-related phenomena through a process of self-dialoguing and listening to my intuition. I devoted a significant amount of time to introspection and to integrating the information that had been gathered. My own process of self-searching was utilized to confirm that I had no expectations regarding any specific results for the study. Fundamental insights were achieved through this process of indwelling or personal reflection. Incubation. This stage of the research allowed time for my question to evolve within me and to "extend understanding on levels outside the immediate awareness" (Moustakas, 1990, p. 29). I moved into the incubation phase after an extended period of immersing myself in the data. This stage allowed me to develop an inner knowingness about my experiences that led to a time of personal discovery. I had flashes of insight that occurred while resting and participating in various diversions. I spent time in meditation, working in the spiritual community, and attending to family matters. Illumination. The illumination stage involved studying similar qualities or themes from the collected data that I viewed as essential. According to Moustakas (1990), "At some point an illumination will occur that facilitates the understanding and explication of certain qualities and themes" (p. 50). 77 I uncovered new knowledge about the aftereffects of an incongruous spiritual experience during the illumination stage. I experienced a sense of clarity relating to the participants' emotional conflicts that arose after their religious expectations were not met during their NDEs. I also reached personal meanings, experienced a spiritual awakening, and deciphered intimate messages. I sorted through the data, determining that the participants altered or transformed their spiritual beliefs because of an incongruous spiritual experience occurring during their NDEs. After several weeks, I had a clear sense of direction or illumination that gradually produced common elements of NDE/ISE-related phenomena. Explication. I found common themes, qualities, and essential meanings within the data. The construction of individual depictions and exemplary portraits became my assessment of each participant's experience. I continued the processes of focusing, indwelling, self-searching, and self-disclosing, in order to find multi-layered meanings within the data. I observed my personal thoughts, recognizing textures and themes from the participants' narratives. Eventually, I was able to combine a the recurring themes and essences from the interviews into one all-encompassing, composite depiction of an NDEr who perceived an incongruous spiritual experience during an NDE. Creative Synthesis. I completed the final stage of Moustakas's heuristic method by using a type of creative synthesis that "infuses the work with a personal, professional, and literary value that can be expressed through a narrative, story, poem, work of art, metaphor, analogy, or tale" (Moustakas, 1990, p. 52). The creative synthesis gave me an opportunity to express my own inner feelings about these phenomena and to articulate my views on death and dying. 78 I utilized the composite depiction, exemplary portraits, and my knowledge of these phenomena to produce a creative synthesis that found expression in the form of a musical composition. My passionate feelings for this subject provided the inspiration for creating a work that encapsulated the entire experience. I tapped into my imagination after living with the data for a while, expressing my emotions in musical form. The music and lyrics to the song From Here to There (2012) captured my impressions of communications and visions during a near-death experience (see Appendix G). Interviews. Moustakas (1990) noted, "In heuristic interviewing, the data is [sic] dependent upon accurate, empathetic listening; being open to oneself and to the coresearcher; being flexible and free to vary procedures to respond to what is required in the flow of the dialogue;" (p. 48). I engaged each participant in two in-depth telephone interviews that lasted up to one hour per interview. Face-to-face interviews would have given me the opportunity to observe the participants' facial expressions and body language, but I made the decision to conduct the interviews by telephone because of the high costs of traveling to each participant's locale. The benefits of telephone interviews for the participants included: (a) being at home in a safe and relaxed environment, (b) having the option to reschedule for another time, (c) having the ability to control distractions, and (d) not being concerned about physical appearances or expressions of emotion in the presence of a researcher. The sample members offered detailed narratives of their near-death experiences during the interviews. They answered a minimum of 10 questions relating to: (a) religious upbringing, (b) details of the NDE, (c) pre-NDE beliefs in an afterlife, (d) emotional reactions after religious expectations were not met, (e) fear of death, (f) belief in reincar79 nation, and (g) changes or alterations in religious/spiritual beliefs (see Appendix F). I listened carefully as they answered my questions, and I envisioned their experiences as their stories unfolded. Kvale (1996) noted that the qualitative interview "attempts to understand the world from the subjects' points of view, to unfold the meaning of peoples' experiences, and to uncover their lived world to scientific explanations" (p. 1). At certain times, participants were unable to find words to express their feelings. At these times, I encouraged them to pause for a moment and tap into their innermost thoughts regarding the transcendent nature of the NDE. I also asked additional questions whenever the dialogue moved in new and interesting directions. Data Collection. Moustakas (1990) noted, "A typical way of gathering material in heuristic investigations is through extended interviews that often take the form of dialogues with oneself and one's research participants" (p. 46). I inquired into the religious backgrounds of the participants and the spiritual aftereffects of their NDEs. I also self-dialogued and questioned the participants about the nature of perceived communications and/or visions that had led to an incongruous spiritual experience. Next, I asked the sample members to describe their feelings about the absence of religious themes during their NDEs. I reviewed, categorized, and analyzed the data after completing the interviews. Since I was following the heuristic method as outlined by Moustakas (1990) throughout the data collection process, I asked myself the same questions that I posed to the sample. The interviews were tape-recorded and later transcribed verbatim. Limitations One limitation of the study was the size of the survey and sample groups. The survey group included 84 participants, while the sample was limited to eight members. 80 Another limitation was the lack of human diversity within the sample, as all the participants were American Caucasians between the ages of 50 and 74 years. My decision to forgo face-to-face interviews may have been another limitation; however; I felt that the participants were comfortable and forthcoming while speaking on the telephone. Although I was unable to have eye contact with them and could not observe their body language, I felt that the participants were open and honest with me during the interviews. Summary A total of 84 individuals completed an online NDE survey consisting of Greyson's NDE Scale (Greyson, 1983a) and a questionnaire that I developed to measure the elements of an incongruous spiritual experience. The eight survey participants with the highest combined total score from these two instruments agreed to join the sample. I engaged each participant in two telephone interviews to inquire into the details of the NDE/ISE-related phenomenon. I also self-dialogued and posed the same interview questions to myself to discover new meanings related to my own NDE. I completed qualitative data collection and analysis according to Moustakas's (1990) heuristic method, the phases of which included: (a) gathering relevant data from each participant; (b) being immersed in the data until the meaning of the experience was fully comprehended and knowledge was gained from the interviews; (c) taking a step back to regain objectivity and to approach the subject with a renewed passion and a fresh perspective; (d) reviewing notes and tape recordings for the purpose of constructing individual depictions of the sample; (e) returning to the original research question (and interview questions) to reflect on the reasons for pursuing the study and determine whether a sharp focus had been maintained on the original objectives; (f) analyzing the 81 data to search for common themes and qualities within the participants' narratives;( g) reviewing answers to the interview questions and comparing them to the original intent of the study; (h) re-reading the interview materials to ensure that the collected data were reflective of the individual depictions; (i) seeking confirmation that the composite depiction had fairly and adequately represented the experiences of the sample; (j) continuing to refine the composite depiction of an NDEr who had an ISE; (k) writing a composite depiction utilizing data collected from the sample to construct a single, unified description of an NDEr who experienced an ISE; and (l) developing a creative synthesis in the form of a musical composition that integrated my personal impressions, feelings, and essential meanings into an original work. 82 Chapter Four: Data And Results This chapter presents the data collection, analysis, and results of this qualitative heuristic study that asked the question: What are the aftereffects of an incongruous religious experience (ISE) that is based on reported communications or visions during a near-death experience (NDE)? An incongruous spiritual experience for the purposes of this study is defined as communications or visions during an NDE that are perceived as incompatible or inconsistent with NDErs' religious/spiritual beliefs or expectations of an afterlife. The goal of the study was to examine the NDE/ISE through the context of individual narratives that fully and richly illuminate the meaning of these inter-related phenomena. This chapter begins with a description of the participants' NDEs, followed by the results of the data analyses for the research question posed in the study. Individual Depictions According to Moustakas (1990), "The focus in a heuristic quest is on recreation of the lived experience; full and complete depictions of the experience from the frame of reference of the experiencing person" (p. 39). The following individual depictions of the participants' NDE/ISE-related experiences are based primarily on transcriptions of two telephone interviews with each participant. These transcripts were supplemented with my personal observations, carefully noted during the interviews. I became more aware of each participant's experience after living with the data for several weeks. I took time to assimilate the "constituents of the experience, as well as the ambiguities and conflicting qualities that distinguish it from other human experiences" (Moustakas, 1990, p. 61). I absorbed the collective essence of NDE/ISE phenomena that each participant expressed in different words but with similar emotional 83 overtones and descriptive phrases. All the participants, who had their own unique ways of speaking while describing their NDEs, communicated in a sincere, authentic, and truthful manner. Their words were profound, and they spoke from the heart while answering the interview questions. I wrote the individual depictions from these points of reference. I have chosen to present six individual depictions and two exemplary portraits from the sample. The individual depictions include narratives, quotations, qualities, and themes of the participants' NDEs. The exemplary portraits, which include similar detailed information, represent the cumulative experiences of the sample. I chose two participants' narratives for exemplary portraits as per Moustakas's (1990) recommendation: "From these data, the researcher selects two or three participants who clearly exemplify the group as a whole" (p. 52). I have made every attempt to convey the content, style, and emotion of the participants' experiences in an accurate manner. In certain instances, verbatim quotations have been included to clarify a participant's specific intention. To maintain the flow of the narratives, I have chosen to include participants' quotations in separate sentences to avoid repetition of introductory phrases such as "he/she said." Additionally, I have preserved the anonymity of all the participants by using aliases. Their actual names and the names of other individuals mentioned during the interviews have been removed for purposes of confidentiality. Larry Larry is 70 years old, lives in Florida, grew up with parents who were Roman Catholics, and was raised in the Catholic faith. His family attended church regularly, and his devotion to religion was an important part of his life. As a boy he went to catechism 84 on Saturdays and learned to recite prayers at a young age. "They were very dogmatic and demanding." His beliefs included the essential teachings of the New Testament and the concept of the Catholic Trinity. In 1978, Larry was living in Cleveland. Visiting a tennis club while on vacation, he joined a volleyball game. A player on the other side of the net spiked the ball, and his fist slammed into Larry's eye. Immediately, Larry fell to the ground and lost consciousness. This event triggered his NDE. Larry entered a long, dark tunnel that he perceived as having a 20-foot radius. With every step, "it was more pleasant, it was warm, but it was just, it wasn't like being in a sauna, it had, it just, every step I took, it was a more and more joyful feeling." He perceived a humming sound and noticed various colors. "At the end of the tunnel, it was bright yellow, maybe with some white mixed in. The walls were subtle, subtle colors, browns, grayish black, nothing vibrant." He had a vision of a reddish color in the atmosphere. Larry stood enveloped in a bright yellow-white light and reported experiencing the "light of God." Standing in the light, he felt "beauty, and that warmth and joy, exhilaration, happiness, no, complete comfort, no animosity, no feelings of fear, the absence of anything negative." He saw his grandmother, grandfather, and a great aunt in the distance and in full color. It was "as if I had taken a Polaroid shot of them at that moment." They looked happy and about the same age as he remembered them. They were beckoning Larry to come toward them. However, he realized that if he went any further he would not be able to return to his physical body. He decided to turn around and step back; suddenly, the vision of his relatives disappeared. Next, he re-entered the tunnel and instantly found 85 himself back in his body. Larry believes it was his choice to return to physical life. "I was given a choice to proceed, to move on, to leave this earth as I knew it, or to return and continue life as I had known it." After his NDE, Larry felt that he "couldn't fit in." He experienced confusion and disillusionment. He tried going back to church in the months following his NDE, but felt out of place. Then he was excluded from family and social functions, because his religious beliefs had changed. His sister-in-law tried bringing him back to the Catholic Church. "She thinks she can get me back into the fold. I can't." Larry could no longer accept the concept of the Trinity or the basis of Christian teachings. He and his wife decided to join a Unitarian-Universalist church. However, he struggled with feelings of "separateness and isolation" and felt guilty about leaving Catholicism. The Unitarian church was across the street from the Catholic church. Every Sunday, he would look at his former church and realize that he could no longer go there. Today, Larry feels that the Catholic church "is foreign; it's like entering an institution that is controlling, just a controlling environment. You know, if you believe, you're fully accepted. If you challenge it at all, you're criticized, and if you go too far, you're ostracized." Some of Larry's friends and acquaintances do not speak to him anymore because of his changed religious beliefs. "There are some family cousins that I haven't spoken to in 20 or 25 years. I've tried to contact them on a couple of occasions, and they've, you know, it's been rather distant." He noticed that his friends and relatives were not interested in hearing about his NDE. He believes these relationships have suffered, because his NDE did not include Catholic themes of the afterlife. "I have, you know, I've lost a lot of friends, but I've moved on." 86 Larry developed an interest in yoga and meditation. "I was drawn to yoga because it, yoga, means union with the Divine." He wanted to recreate the feeling of being in the presence of the yellow-white light during his NDE. "I had the feeling of being with the Divine, experiencing the Divine in that NDE, and wanted to practice it consciously." Meditation has opened his mind to other faiths and to exploring other religions and spiritual philosophies. "Meditation, it has no brand. It has no religious affiliation. The nearest thing to it would be Hinduism, because it evolved from that community." Larry changed his religious belief in the Trinity to a spiritual belief in a "highlevel divine being," or a universal source of consciousness. He has lost his fear of death and has accepted the concept of reincarnation. "I don't feel a fear of death, because when death comes, it's not going to be quote, unquote, destructive." He added, "I believe in reincarnation, because people have to come back." Larry is drawn to the teachings of the world's major religions and especially to Vedic studies. "All faiths, there is that, there are themes running through them, underlying themes that are universal." His spiritual beliefs continue to expand and evolve. Looking back at his NDE, he acknowledges the profound aftereffects of the experience. "It was like a record had been erased, and a new tape was in its place. You carry this wisdom with you every day." Today, Larry is pursuing his interests in yoga and meditation. He attends services at the Unitarian church and at the Vedanta Society. Wendy Wendy is 52 years old, lives in New York, and was raised Greek Orthodox. Her parents were Greek Orthodox, and she accepted the teachings of this faith as a child. She believed in the Bible and accepted Jesus as the Son of God. Her mother taught her "that 87 you do right or you're going to hell." Fear of God's condemnation had been ingrained in her from a young age. She had been baptized as an adult in a large Greek Orthodox church. Wendy was shot by an intruder in her home in 1987 at the age of 27. She was married at the time, with a two-year-old son and a five-year-old daughter. Entering her home, Wendy heard a sound in the bedroom. She grabbed her daughter and told her to run for help. She re-entered the house to retrieve her son and was shot in the abdomen by the intruder. Her husband arrived home a few minutes after the incident. Wendy was bleeding profusely, so her husband rushed her to the hospital. Her pulse was fading fast, and she lost consciousness. This incident triggered her NDE. Wendy reported leaving her body while waiting in the emergency room at the hospital. She recalls seeing her physical body from above and watching the doctors and staff carrying out the necessary medical procedures. She remembers perceiving "lots of light, noise, and confusion" all around her. Suddenly, she felt a "peaceful calm, like a darkness, but not very dark." Next, she felt "serenity, beauty, and embraced by love." Then, she heard a voice say, "It's not your time." This voice was not familiar to Wendy, and she could not identify it as male or female. She did not want to return to her physical body, but felt responsible for her children and decided to come back to life. Wendy perceived a divine being while she was out of her body, who told her, "All is forgiven." He was a male figure "with beautiful white hair, skin that was creamy, peachy white, and pink lips, and breath that was so sweet." She remembered the smell of lavender and feeling the gentle embrace of love. She did not recognize the male figure and had not met him before. Suddenly, the man disappeared, and Wendy found herself 88 back in her body in the hospital room. She was in terrible pain, but wanted to reconnect with the man who appeared to her during the NDE. She told her husband and parents about this man, but no one in the hospital fit his description. "Everybody thought I was crazy, and I still smelled lavender." Wendy had told people before her NDE that she was a converted Baptist who grew up Greek Orthodox. After her NDE she said, "My whole life completely changed." She tried going back to church and struggled to maintain her Christian beliefs. However, she began realizing that her religious beliefs were starting to shift away from Christianity and the Bible. "I'm spiritual. I have a belief in all. It's all a great mystery, but one thing that I did learn is that there's something greater and more beautiful than anything that anyone can ever imagine." Wendy spoke to the pastor of her church about the NDE. She had feelings of alienation after telling him about the experience. "I was essentially told that my beliefs were completely wrong, and that I was not born again." Meanwhile, her friends at the church tried convincing her to come back to religious services. However, she felt compelled to argue with them concerning their views on moral and ethical issues. "I just remember going back to the Baptist church, and it was huge, and then all of a sudden it was anti-this and anti-that, and I can remember feeling I can't be a part of this." Wendy lost her desire to attend this church. No longer did she want to surround herself with people who had strong convictions about their religious beliefs. "And the more I started pulling away, friends and family started pushing me more, and I just remember a sense of isolation that I felt in times of my life over the past 20 years." Her feelings of loneliness and separation increased as the congregants tried to sway her to return to church. "My 89 spiritual connection deepened with spirits, and I felt a sense of peace rather than feeling persuaded." Wendy's feelings of isolation, separation, and loneliness continued until she was ready to sever her relations with certain family members and close friends who were critical of her. She and her husband filed for divorce within two years after the NDE. She decided not to attend church after the marriage ended, and her beliefs changed to "spiritual but not religious." Over time, she began to pray to "a God of energy," whom she describes as "He/She is the most divine, majestic, powerful, amazing, I mean, energy." Additionally, Wendy has lost her fear of death and has accepted the concept of reincarnation. Wendy has been drawn to the spiritual teachings of Mahatma Gandhi, Thomas Merton, Michael Beckwith, and Buddhism. No longer questioning her beliefs, she feels a connection to "divine energy." She believes that her spirit guide (the man she met in her NDE) is always with her. Today, Wendy understands the purpose of her life and realizes that she has been spiritually evolving over the past 25 years. Betty Betty is 56 years old, grew up in North Carolina, and now lives in Florida. Her father was a Southern Baptist and her mother a Methodist. Her father held traditional beliefs about the Trinity, the devil, heaven and hell, and the Bible. As a child, she accepted Jesus as the Son of God and part of the Holy Trinity. Her belief in the afterlife included sitting at the feet of Jesus and listening to his teachings. "I always loved his teachings, you know, so having been given the concept of going over to that other shore and meeting Jesus, I wanted to sit and talk, you know?" 90 In 1965, when Betty was nine years old, she had a tonsillectomy. She began choking on her blood after the surgery, when the stitches in her throat split open. She was rushed back into surgery, and the doctors worked frantically to close the stitches. With her lungs filled with blood, she could not breathe properly. Betty remarked, "That's when I died." This event triggered her NDE. Betty remembered leaving her body and seeing strange patterns on the linoleum carpet, while she was floating above. "I was hovering in the corner of the room; this was a rectangular room, and I was hovering in the far corner." Betty felt a surge of happiness while out of her body: "Just absolute joy. The way I've always described it is liquid bliss." She smelled a sharp antiseptic fragrance in the operating room and heard the doctors and nurses as they tried to revive her. She transitioned into a realm with a bright light, while floating at the top of the ceiling. Betty felt "immediate absolute bliss, homecoming, yes, yes, yes, yes. It was where I wanted to be. It was absolutely wonderful. It was the most fabulous feeling I had ever felt." The light emanated feelings of "love, benevolence, recognition, welcome, support." She spoke about being in the presence of this light for about one minute. Then she had an awareness of her "light-body." Betty recalled flying over people in a meadow and seeing big, beautiful trees. There were people in the distance, and she flew over to see them. "They had been waiting for me. They were glad to see me. They were excited to see me." Some of the people she did not recognize, but one person she knew as a friend of her parents, and another person was her grandmother. Then she had the sensation of being pulled backward and felt a physical tug. Hearing the sound of wind, she found herself in a "wormhole and things kind of streaked past, it wasn't exactly like that; it was blues and grays and whites. It was like I 91 was literally being pulled through the sides of the clouds." She felt the wind pulling at her like suction, and "there was a bit of a thud when I landed." Betty had returned to her physical body, discovering that she was in terrible pain. Betty tried maintaining her Christian beliefs after the NDE. However, within a short time she knew that her beliefs had changed. "I no longer believed that God was a benevolent Father." Her belief in Jesus changed as well, at the age of nine. She no longer believed in Jesus as the Son of God. "The part that I gravitated to was Jesus as teacher." She continued attending church, but felt uncomfortable there: "I wasn't accepting a personal savior, which I didn't believe in." She was not disappointed that Jesus did not appear in her NDE. Her reaction was, "Oh, it's bigger than that!" Betty spoke about her NDE with others, receiving mixed reactions. Her favorite teacher at school "just sort of wrote it off to imagination. I got the impression she was really uncomfortable and didn't want to go further with it." Her mother was intrigued by the NDE, but her sisters thought "I was just, you know, weaving tales." Her father had a stronger reaction: he felt "really horrified and went on a campaign that didn't end until I was baptized because he just wanted to make sure that I wasn't going to hell." He told Betty that she had seen an evil vision and the devil was trying to influence her. Betty understood the sensitive nature of her NDE because her experience had been different from the Christian teachings of the afterlife. "For a very long time, I didn't say much, because, while you're still a kid, it's just better to protect yourself." Betty agreed to baptism after the NDE to please her father. "I just wanted to ease his mind." She had a practical attitude toward her father's mission to save her from going to hell. She decided to "give him what he wants, it takes nothing from you, it will ease his 92 mind, and your life will be easier, and so I did so." However, Betty was scared of her father and understood that he was capable of physical violence. If she did not agree to his demands about going to church, "I would have dealt with some spanking, but I also would have dealt with some restrictions." Betty attended church at age 10 and "would listen to the guy up there sweating himself into a puddle and yelling about hell, and the this and the that, and I thought they were ignorant." Her parents separated within a year after the NDE, and she went to live with her father. However, when her mother heard about her father's obsession with taking Betty to church, she insisted that Betty come to live with her from that time forward. Betty felt liberated after leaving her father's home and never attended that type of church again. It took 24 years for Betty to make peace with her father, but even then she continued to avoid discussing religious matters with him. Betty shared her NDE with friends at school and most of them reacted favorably. However, she realized that this experience could not be discussed with everyone. "I had mentioned it one time and that's the time I felt I had cheapened it, so I didn't talk about it again." Betty's NDE left her with a feeling of peace that remains to this day. "I no longer wonder what may happen when we pass. I no longer wonder, will there be any more afterwards. I don't question it a bit." Today, Betty describes her spiritual beliefs in a universal light. "I genuinely, without question, believe what I believe. I know the is-ness of the universe. I know my connection with each and every blade of grass and ray of sunlight. I can feel it." She practices meditation and sings for a non-denominational spiritual congregation. She has lost her fear of death and has accepted the concept of 93 reincarnation. Recently, while comforting a friend who was dying, Betty said, "Carol, you are eternal. It's your body that's gonna die. You keep on." Barry Barry is 54 years old and lives in New York; his parents were Presbyterians. He accepted the basic teachings of the church and believed in the teachings of the Bible. He also believed in God as a male figure and accepted the concept of the Holy Trinity. Barry attended church on Sundays throughout his childhood. Barry was diagnosed with acute ulcerative colitis in 1996 at the age of 38. He needed surgery to remove his colon. When he went into surgery, he began bleeding internally. Complications developed that brought Barry to the brink of death. This event triggered Barry's NDE. Barry perceived himself outside of his body while on the operating table. "It's like just, all of a sudden, I was in this other place. I was just simply not in the operating room any longer." Barry felt that he was on the edge of an abyss and had visions of blackness that spiraled down. "There was no inclination of a bottom or anything, and I felt myself pulled in and starting to slip over." He remembered seeing a gathering of people in a library off in the distance but could not hear their conversations. Next, he found himself in a quiet, peaceful place above the earth that felt like a loving environment. He watched the earth spinning as he floated above it. "It looked like a blue marble, about the size of a quarter." Barry felt a hand on his shoulder and heard a voice telling him to move away from the edge of the abyss. He believed that the voice came from a spiritual being who is his teacher. "It was a male entity. There was no name, yet I knew him." They spoke about 94 the power of prayer, and the spiritual being told him that many people were praying for him at that moment. The male entity said, "You are going to go back. It's not your time." The voice informed him of the important work that he had to finish during his lifetime. Immediately, Barry returned to his physical body, and the nurses brought him into the recovery room. Barry shared his near-death experience with others and received some negative reactions. "I've been accused of it all being the work of the devil." He went through a difficult shift in his thinking about spiritual and religious concepts that continues to this day. "I keep studying and keep wanting, and everything changes as I gather more information." Some of his friends and family members do not want to hear about his NDE. "There's a couple of people that I just don't bother to talk to about it because it ends up in an argument." Barry's feelings about attending church changed after five years. "I don't go to church on a regular basis. I don't feel the need to." Barry decided to separate from his wife within a short time after the NDE. "My ex-wife insisted that I was not the same person that I was before. I had the experience and she wanted the old me back." She could not accept the authenticity of his NDE and made this clear to Barry. "She immediately thought, 'Well, that was because of all the drugs you were on' and that sort of stuff." Barry lost his fear of death after the NDE and accepted the concept of reincarnation. Speaking with a man dying of cancer, he told him, "Listen, don't be afraid. There's nothing to fear. One door closes and another door opens, and that's how it is." Barry's pre-NDE religious beliefs completely changed over a period of several years. He 95 concluded that the Protestant Church and its teachings did not "fit with what I've experienced." He began to believe in a "universal energy force" that includes everyone. "I've come to understand that there is a difference between spirituality and religion, and I don't really need the organized religion anymore." Today, Barry feels the need to explore other religions and spiritual philosophies. Laura Laura is 65 years old, lives in California, and grew up Roman Catholic. She believed in the theology of the Catholic Church during childhood and felt comfortable with the teachings of the Bible. Laura believed in God as an all-loving entity and accepted heaven and hell as afterlife realms. She believed in the Christian teaching of Father, Son, and Holy Spirit. She attended an all-girls boarding school and planned to become a nun. However, she changed her mind before graduation. Then she married a man who belonged to the Jehovah's Witnesses and converted to this religion to please her husband. Laura was infected with HIV in 1983. "My husband infected me with HIV at that time, and in 1996, I came down with pneumocystis carinii pneumonia, which is a macro bacteria organism. I was in the hospital for almost a year and a half." Laura's weight dropped to 86 pounds. "They flew me up to Salt Lake City, Utah, to the hospital up there in Flight for Life, not thinking that I would make it." She felt extremely weak and did not want people around her. Her daughter arrived at the hospital to say her final goodbyes and to spend one last night with her. In the morning, her daughter left the hospital, promising to return later. Laura lost consciousness as soon as her daughter left the room. This event triggered her NDE. Laura had the perception of moving outside of her body. "I was looking down at 96 my body below, and I could see it, and it looked like me, but I knew it wasn't me. My spirit lifted out of the body, and I felt so healed." She felt a tingling sensation and a feeling of love inside. "I was just joyous. I was so happy. I was peaceful." She started moving into the universe, and then two spirit beings came toward her. One was male and the other female. "They were wearing long white gowns, and they said telepathically that they wanted to show me a review of my life." Next, she watched about nine scenes from her life, after which the spirit beings showed her a tunnel with a light emanating from inside. While inside the tunnel, she had visions of a group of gray beings. "Then I continue down the tunnel, and I'm feeling calm, and I'm feeling love and just at peace basically, and then, all of a sudden I completely emerge into the light of God." The light told Laura that she could either stay in the afterlife or return to her physical body. She decided to return, because she felt responsible for her daughter. Instantly, she found herself inside the tunnel on her way back. Next, Laura remembers being back in her body in a hospital bed. Laura's religious beliefs began to change after the NDE, as she struggled with letting them go. Within a year her pre-NDE religious beliefs had, in fact, changed. She encountered resistance when speaking to others about the experience. "I did lose some friends because my beliefs, religious beliefs, or spiritual beliefs, had changed." Laura had to stand up for her own beliefs, and some people did not like what they heard. She spoke about her NDE while presenting at an AIDS conference, and many members of the audience turned against her. "I think half the auditorium, I felt like they were out to kill me. I mean it was so hostile. It was very scary." For safety reasons, she needed a security guard to escort her out. 97 According to Laura, if she had spoken about an NDE that included Jesus, the audience would have responded in a supportive manner. She realized that most people wanted to hear about a Christian afterlife. Fortunately, she has learned to overcome the negativity and criticism of others. She has also accepted profound and personal beliefs that were first uncovered during her NDE. "I used to go to church with certain people, and I no longer wanted to go to church with them, and they asked me why, and I said you know my beliefs have changed." Laura could no longer accept the idea of God sitting on a throne nor feel any joy or excitement about biblical stories. "I needed to step away from it." Laura's father still attends church every Sunday. "He just doesn't understand me at all." Her father expressed anger toward her when she left the church. However, her mother has accepted her changed spiritual beliefs. Laura's cousin and aunt are also Catholic and do not want to hear about her NDE. Laura visited Machu Picchu in Peru and began exploring various spiritual philosophies. She found that Eastern religions resonated with her. "I think a lot of it was on the healing side of it, you know the mind, body, spirit, and also just the confirmation that we are all one, and we are connected, and the mindfulness." She has been attracted to the belief that God is not outside of her, and she studies quantum physics and metaphysics. Today, Laura enjoys meditation, yoga, Qigong, acupuncture, and exercises designed to "open the chakras." Laura is a long-term survivor of AIDS. She is now committed to helping people with end-of-life issues. She wants to "break the silence about death and dying." She has been at the bedside of many people in hospice, helping them make a smooth transition at 98 the time of death. Additionally, Laura has lost her own fear of death and has accepted reincarnation. "I just think that the spirit, the soul, lives on." She believes that learning continues into the afterlife, where some souls become guides for others. Laura contends that souls still have lessons to learn in future lives. "I believe in reincarnation, that you'll come back." Cary Cary is 50 years old, lives in New York City, and grew up Roman Catholic. Her parents and grandparents also belonged to the Catholic faith. She believed from a young age in "the Blessed Mother, Jesus, the Holy Spirit, all of that." She went to church regularly during her childhood and read the Bible. Her mother was "really addicted to Catholicism," and her father had "his own inner spirituality." Cary worked at a community college in 1990. During her lunch break one day, she was driving her car, when a Ford F250 truck smashed into the driver's side of her small Chevette. Her injuries included three broken ribs, a collapsed lung, and head trauma. Special emergency equipment known as the Jaws of Life was needed to extract her from the vehicle. Cary lost consciousness while trapped in the car. This event triggered her NDE. Cary found herself in another realm. "It was like I was home. There's no other way to express it. It's just this all-encompassing love. I mean I was home, and it was normal, and I didn't miss anyone or anything." She described a four-dimensional NDE with vivid colors and no sense of time or space. She stood in front of her grandmother's house at the bottom of a path. Then Cary became a child on a swing-set and noticed her grandfather in the garden. Next, she was an adult, seeing her grandmother come out of 99 the house. Her grandmother asked (with a Slovak accent) if Cary wanted to come with her. Cary, who did not want to join her, said that she had to leave. Then she regained consciousness and found herself in a hospital bed. When Cary shared the details of her NDE with others, she encountered some resistance. "The people in the family reacted weird towards me." Such reactions took an emotional toll on Cary. "At the time it was very hard. I wasn't accepted." However, she coped with feelings of rejection from others and remained true to herself. "Acquaintances and maybe people I work with and stuff can't appreciate it, so I mean, that's where they're at. What're you going to do? It's what I am. I can't help it." Cary has attended church frequently since her NDE, but her traditional Catholic beliefs have been altered. In her view, "the Trinity is just a man-made concept." Cary has also accepted the notion of "a universal God energy," which she believes is expressed in Catholicism. "They said, okay, we'll start with God, then we'll make this Jesus and then the Holy Spirit and we'll get people to think that they have to go through Jesus to get to the Holy Spirit to get to God." Cary shifted away from her pre-NDE belief in the existence of hell. Her postNDE beliefs are a combination of Catholicism and universal spirituality. "My spiritual beliefs really don't fit into anything that's man-made." However, Cary still belongs to the Catholic Church and remains active in church activities. "It doesn't fulfill everything in my growing spiritual journey, but it's important." While Cary feels the need to belong to an organized religion, her own spiritual beliefs have expanded beyond the teachings of the church. "My experience shows me that we're all spiritual beings, and there are many great prophets and many great teachers throughout history." 100 Cary has been inspired to investigate other religions. "You can also draw lines from the Buddhist teachings to things that are written in the Old and New Testaments to A Course in Miracles, Kahlil Gibran's The Prophet ‒ you can just go on and on." She understands the similarities among many of the world's religions and recognizes their corresponding spiritual principles. "It's one thing if just a couple of things are similar, but when everything keeps repeating itself in a different form, okay, you know." Cary has lost her fear of death and has accepted belief in reincarnation. Her spiritual beliefs include the necessity to incarnate in the future, but she believes there comes a point when re-birth is no longer necessary. She explains that "it depends on your karmic cycle, if you've fulfilled all of the lessons that you're here to do." She contends that there are certain souls that remain connected throughout various lifetimes. "I mean spiritually, we keep coming back to learn and grow and expand our life journey, and there are a few close people in my life that I know I have been with in other lifetimes." Today, Cary's beliefs in the afterlife are based on her perceptions during the near-death experience. "I mean, physically I'm here, but I just can't wait to go back there. I was complete there." Exemplary Portraits Two portraits are included as part of the heuristic research process. In this section, the essences of all the participants' experiences are present. Various elements and common themes of NDE/ISE-related phenomena are highlighted. These portraits, which are representative of the sample, were chosen because of their richness in detail, conveyance of meaning, and the passionate manner in which NDE/ISE-related phenomena were characterized by the participants. 101 Paul Paul is 74 years old, lives in California, and grew up in a strict Roman Catholic home. He attended mass after school and on Sundays during childhood. His fear of going to hell dominated his life, and he firmly believed in the theology of Catholicism. "My belief system was 110% Catholic. Jesus, Mary, Joseph, all the saints, all the stuff, everything, the Pope. All that stuff." His parents were Catholic, and he never questioned his faith. His beliefs in the afterlife were compatible with the teachings of the Catholic church. "Well, I had this picture of Jesus on the right-hand side of the Father, the guy with the grey beard, and Jesus over there, and the Holy Spirit over here, and hell down below." Before his NDE, Paul referred to himself as a true believer who constantly prayed and "said the Rosary a billion times." In the summer of 1955, Paul had an NDE at the age of 18 while living in Michigan. He and his classmates had gone to a lake while attending their senior class picnic. Paul noticed some friends standing on a floating platform and began swimming toward them. About halfway there, he felt a cramp in his leg and could no longer swim or stay above water. He started sinking, and the sunlight disappeared. He hit the bottom of the lake and felt weeds beneath him. Paul was breathing in water and starting to drown. This event triggered his NDE. Paul remembered leaving his body and moving through a tunnel. He looked back and viewed his body at the bottom of the lake. He felt an immediate sense of warmth, describing this part of the NDE as "a moment of no time." At first, he was terrified, and then he felt "at peace, in love." He described the experience as fantastic and as pure ecstasy. He stood in the presence of a bright light, and it felt like "a thousand suns." The 102 light kept pulling him closer, like a magnet. Paul perceived communications while in the presence of the light such as "Don't be afraid," "I love you," "We love you." He described visions of an infinite realm that was filled with countless variations of colored lights. He perceived being absorbed into the light and then becoming the light. However, he continued to maintain his sense of individuality and knew that he was still Paul. He assimilated all the knowledge that the light contained. Then a voice informed him that he had to return to his physical body. Within a split second, he found himself back in his body and struggling to cough out water from his lungs. Paul explained the essential meanings of the NDE as including (a) making loving choices, (b) moving away from non-loving activities and negative situations, (c) experiencing unconditional love, (d) understanding that we are all part of the same light, (e) not judging others, (f) celebrating our differences, and (g) realizing there is no separation between human beings. He also perceived vibrations, colors, music, sounds, and variations of the white light. Paul felt lost after the NDE and did not speak to anyone about the experience. Most people were unfamiliar with this phenomenon in 1955, and he could not find any books on the subject. Paul had no rational explanation for what had happened to him. "I'm wandering around like a nomad, not knowing what the hell to do, because my brain is going through some cognitive dissonance, and all of my teachings and everything that I experienced are in complete opposition to one another." Paul studied cognitive dissonance in a psychology class at a university. He learned that dissonance occurs in situations involving conflicting attitudes, beliefs, or behaviors. Paul felt extreme 103 discomfort, because his religious beliefs were in conflict with his non-religious perceptions during the NDE. To reduce cognitive dissonance, Paul chose to intensify his religious beliefs after the NDE to restore balance in his life. In order to cope with this internal conflict, Paul admitted, "I created a series of 25 years' worth of lies." Paul knew that his spiritual turmoil and emotional stress had been caused by his near-death experience. He lied to his parents and relatives about the seriousness of the drowning incident. He tried to erase the memory from his mind. He practiced "forgetting," but the visions and communications of the near-death experience were always with him. Paul decided to enroll in a seminary to become a priest. He wanted to purge his memories of the NDE. When he met with his priest to ask him why his religious expectations did not come true during his NDE, the priest said, "That's the devil. You're going to hell in a hand basket. You didn't see Jesus there? What are you talking about? That's silly." Despite these comments, Paul still decided to attend the seminary. However, he dropped out of school just one year prior to his ordination. This decision prompted his parents, relatives, and friends to ostracize him. Paul decided to join the Marines after he left the seminary. He wanted to change his life and move forward in a completely different direction. He said that, while in boot camp, "I wanted the crap beat out of me." He tried not to dwell on the religious confusion caused by the NDE. Paul believed that, if he did not have time to think about the NDE, his inner conflicts would simply go away. At a certain point, he realized that distractions were not quieting his mind. However, he was not ready to confront the inconsistencies between his religious beliefs and his visions during the NDE. 104 After leaving the Marines, Paul decided to marry and start a family. He returned to school, received an MBA, and started working up to 60 hours a week. "I'm doing all this stuff. I'm not stopping, because if I stop, I'll think. So, finally, in 1976, I'm in California, and I'm on a business trip, and I pick up a book called Life after Life." Paul began to cry while reading this book. He felt vindicated regarding the authenticity of his NDE. He also felt that his perceptions of the afterlife were real and true. From this time forward, his religious beliefs were never the same. Paul still attended church after 1976. However, while listening to religious sermons, he realized that "it began not to make sense." While in church, he remembered being in the light during his NDE and hearing a voice that said, "Hey, we're all one." He gained an understanding that there are "no bad guys out there." "Eventually, I just dropped out and no longer became religious and just chose to be a spiritual person, a dropout." When Paul looks back on the 20 years he spent searching for the truth about his NDE, he appreciates the knowledge he has assimilated. "It took me a long time to get rid of all of my beliefs, but once I truly understood what was happening in the light, I no longer had beliefs." He recounted an incident that occurred in 2010 when he delivered a presentation on his NDE. A woman approached him and said, "You know Jesus is the light?" and Paul replied, "That's fine if Jesus is the light for you, but don't tell me Jesus is the light for me, because he didn't happen to show up that time." He realized that there was no point in arguing with this woman. He learned a lesson, namely, not to argue with religious individuals who believe that the Bible is the ultimate authority on the afterlife. Today, Paul does not care what people think of him; he emphatically states, "It's not 105 important!" He is confident that his NDE is "as clear as anything that I've ever experienced as a human being." Paul did not believe in reincarnation before his NDE, but now he accepts this spiritual concept as a natural part of life. "I have a knowing now. I got rid of all my beliefs, but I know it's true. I cannot speak for anyone else, but I know that it's true for me." Paul suggested that the process of dying should be a celebration of someone going back into the light. He believes that the concepts of birth and death are like two ends of a circle coming back together again. He feels the same happiness for those who have died as for babies who are born. Accordingly, Paul has lost his fear of death and has a calm knowingness about the journey that awaits him at the end of life. "So, there is no death. All you're doing is making a transition from a three-dimensional body back into your infinite body." Brenda Brenda is 55 years old and lives in New York. Her parents were Presbyterians who did not attend church. She had been baptized at an early age, believed in the Bible, and accepted the doctrine of the Holy Trinity. "I strongly believed that God and Jesus and the Holy Ghost were the whole shebang." She attended preschool at a church and participated in church activities as a child. In junior high school she joined a Lutheran church and celebrated her wedding there. "I wanted a church close to me, and I still went very regularly as an adult." Brenda needed back surgery in 1987. Prior to the operation, the doctors administered a test to determine if her spinal cord had been damaged. An injection of dye was administered during the test into the area of concern. An x-ray technician needed to adjust 106 the platform beneath her, as the dye entered her body. However, the technician did not realize that his finger pressed the wrong button, and Brenda's head had been lowered by mistake. Consequently, she began hyperventilating, as the dye flowed into her brain. She remembered the horrified look on the technician's face before she lost consciousness. This event triggered Brenda's NDE. Brenda explained how her NDE began. "I immediately opened my eyes, was up on the ceiling, and had an amazing sense of peace, love, and goodness." She had an acute awareness of the events going on around her. "I looked down and he [the technician] started screaming 'Code Blue.'" She watched the events unfolding in the hospital room below her. "This woman ran out of the room, and she came back with an oxygen tank, and another man came into the room, and he brought in a small square box." The box was a heart monitor and, after it was connected, "it had a little dot, with a line going across the screen." Brenda understood that she flat-lined and was clinically dead. Next, Brenda had a sensation of floating and felt the back of her head against the ceiling. She knew that she had died. "I was very calm and peaceful. I was absolutely not upset whatsoever." Then she sensed the presence of a spiritual being. "I actually thought it was God. I had such a connection to the Being and that's why I assumed it was God." She began talking with the spiritual being. "I haven't finished my life. I haven't com-pleted the purpose that I have, the purposes that I have in life, and I need to go back and do that as well as for my children." The doctors tried frantically to revive Brenda. One doctor threw his arm against the center of her chest "and the second time he did it, my eyes simply shut from above, and I blinked, and my eyes opened, and I was back in my body with the oxygen mask on 107 my face." She told the doctors and nurses that she had been watching them from the ceiling while out of her body. The neurosurgeon said, "I am not going to stand here and listen to this." Brenda explained that she put this experience "in a box." "I didn't know the term near-death experience. I'd never heard of it, because I was really busy, you know, raising a family, and I've never been a person, you know, who follows the news." She decided not to talk about her NDE, since the doctors and her husband had such negative reactions. Brenda's husband told her that she had imagined the episode. "I had no one to support me, so I completely clammed up about it, and did not talk about it for many years." However, Brenda constantly thought about her NDE and felt frustrated that no one would take her seriously. She developed a fear of telling others about the experience and felt afraid that her friends and family would change their opinions of her. Then Brenda decided to tell her pastor about the NDE. "He had a congregation of 4,000 people, and he was really up and hip with it, and I told him about my NDE and it kind of fell on deaf ears." She felt disappointed that her pastor took so little interest in her experience. "He was nodding his head and saying, 'Oh, wow. That's amazing. I'll see you on Sunday.'" Brenda also noticed that, on the few occasions when she mentioned her NDE, people would change the subject. "My feeling was that people are not ready to hear the information, and that they're not capable of understanding what I'm saying. If they're not capable and not willing, then I choose not to share it." Brenda has questioned her religious beliefs over the last few years and no longer attends church. She realized that the communications and visions during her NDE were not consistent with Christian teachings of the afterlife. After her NDE, Brenda concluded 108 that the afterlife is not the heavenly realm as described in the Scriptures, with God sitting on a throne. "I'm not saying that Jesus isn't the way to God, but I have a question in my heart about that." She understands that her religious beliefs have shifted since her NDE, but still fears not going to heaven if she moves too far away from Christianity. "Well, sure, I believe in Jesus, but I believe in much more. So, I'm just kind of like, does that still get me in? I don't want to throw the baby out with the bathwater." Brenda feels conflicted about changing her religious beliefs, but she has slowly started looking beyond Christianity. "The whole thing is that it's so immense, and it's so loving, and it's so understanding of us, and I realize it may be bigger than Jesus." She has thought about the spiritual being whom she met during the NDE and has concluded, "It doesn't really matter. It's like putting a name on a person. I don't care who it was. It connected me to that eternity." Brenda's religious beliefs are slowly transforming, but she is resistant to change. "I'm looking at it right now and thinking that it might be scary to completely abandon my previous viewpoint of the church, so I'm assuming that, as I'm growing, I'm growing at a speed that I am comfortable with." Brenda explained that she has altered her beliefs about God and has changed many of her pre-NDE religious beliefs. "And I think that's part of the universal God delivery to me." Today, she feels relieved about shifting away from the theology of the church. "I feel absolutely happy that I don't have to go to church anymore. I realize that is dropping aside." Brenda is comfortable with the pace of change that is occurring in her spiritual life. "Like I've been helped to progress to this point, and I can see that feeling, and I can see that coming down from universal understanding of the whole thing." She feels 109 enlightened and is open to learning more about the nature of existence. After the NDE, Brenda lost her fear of death. "It's a transitory experience, and all of us die, and there is a focus for being here and not having any fear of death." She has accepted the concept of reincarnation and believes "it's like a kindergarten and that we're just here to learn and do good and love and try to grow our souls, and then there's so much more beyond this." In 2007, Brenda's friend recommended an NDE website to her. "So I ended up five years ago finding out more about it and finally opening the door to understanding it more." Since that time, Brenda has been active in the International Association for NearDeath Studies (IANDS) and has met many like-minded NDErs. Themes In this section are listings of individual themes, either stated or implied by the eight participants in relation to perceived communications and/or visions during an NDE that contributed to the occurrence of an ISE. These categories were derived from data obtained from the participants during the interviews and from my journal notes. Re-evaluation of Christian Beliefs. Five participants were raised in the Catholic faith, and three grew up in various denominations of Protestantism. The Catholic participants' parents maintained a strong sense of religious identity and taught their children the basic precepts of the Bible. These parents went to church often (in most cases every Sunday), and their children accompanied them. Most of these parents were strict about abiding by the rules of the church and honoring the lessons of the Bible. They arranged for their children to attend Sunday school or Catechism. Consequently, the five participants raised in the Catholic faith had deep religious convictions during childhood. However, after their near-death experiences, all five re-evaluated their religious beliefs in 110 relation to the biblical interpretations of heaven, a Last Judgment Day, and coming faceto-face with Jesus (as per the Book of Revelation of Saint John the Divine). The Protestant parents were not as strict with their children in terms of church attendance and religious education. However, they showed a deep concern regarding their children's bad behavior and a strong belief in the religious consequences of going to hell. The Protestant parents were less devout than the Catholic parents, but they also placed a strong emphasis on instilling their children with basic Christian beliefs. Similarly to the participants who had grown up Catholic, each participant with a Protestant upbringing reevaluated the same Christian beliefs (post-NDE) relating to biblical interpretations of the afterlife. Veridical Perception. The participants reported many of the well-documented stages of the near-death experience. The most common elements were veridical perception and the out-of-body experience (OBE). Several participants had the feeling of being in a lighter body. They also reported the sensation of floating near the top of the ceiling while watching events unfold below them. Some had the perception of moving through a tunnel that transported them to another realm. Most reported entering into the presence of a powerful bright light. Many of the participants either were told to return to their physical body or had the choice to do so. Others stated that their reasons for returning to life had to do with taking care of unfinished business and/or having feelings of responsibility toward their families. Perceived Communications/Visions. Most participants reported hearing communications during their NDEs and observed visions within the context of an unearthly realm. Some met spiritual beings, and a few met relatives and/or friends. Most perceived 111 the NDE as a glimpse of the afterlife that included colors, sounds, vibrations, and various forms. However, none of the participants perceived any communications or visions that included religious themes or biblical descriptions of the afterlife. Additionally, they did not perceive the presence of an anthropomorphic Godhead. Cognitive Dissonance. The participants experienced low to high levels of cognitive dissonance. Their beliefs in the afterlife were in conflict, because biblical themes were not present during their NDEs. As an aftereffect of an incongruous spiritual experience, the eight participants initially maintained or strongly embraced their pre-NDE religious beliefs to lower the dissonance. However, less than a year after the NDE, five participants altered their pre-NDE beliefs (an alternative dissonance-lowering behavior). Three participants coped with dissonance for more than a year, and one struggled with dissonance for many years. All the participants felt tension, stress, and discomfort caused by cognitive dissonance and were motivated to reduce or eliminate it. Eventually, they integrated their NDE perceptions into an altered spiritual belief system, which restored inner harmony and helped them to achieve consonance. Changes in Religious/Spiritual Beliefs. The participants experienced a change or alteration in their pre-NDE religious/spiritual beliefs. Six participants changed their preNDE beliefs to "spiritual but not religious," and two combined elements of Christianity with universal spiritual principles. Today, each participant holds spiritual beliefs beyond the teachings of the Bible and the church. Most participants investigated other religious/ spiritual philosophies and adopted various beliefs and practices from these traditions. After their NDEs, all the participants rejected biblical descriptions of the afterlife and gained a universal understanding of (a) the survival of consciousness after death, (b) the 112 nature of the Godhead, (c) the nature of an afterlife realm, and (d) a continuous process of living and dying. Loss of Fear of Death. Most participants felt love, happiness, acceptance, truth, beauty, and goodness during their NDEs. Consequently, the eight participants lost their fear of death as an aftereffect of an NDE/ISE. Most felt safe, joyful, and surrounded by an unconditional love during their experiences. They are looking forward to returning to this perceived realm of existence after death. Belief in Reincarnation. All the participants believe that they are part of a grand cycle of birth and rebirth. Their perceived visions and communications during the NDE deeply affected their spiritual beliefs about the continuity of life. All eight of them experienced a realization that life progresses forward according to lessons learned through multiple incarnations. Shift to Universal Spirituality. Six participants embraced universal spiritual principles as an aftereffect of an NDE/ISE. Two participants combined Christianity with universal spiritual ideals. All adopted some form of universal spiritual outlook. Two participants are still assimilating the aftereffects of the NDE/ISE and are continuing to expand their spiritual views beyond their pre-NDE religious beliefs. Summary All the participants were raised in Christian homes where they acquired values and morals based on the Bible. All perceived an unearthly realm during their NDEs and reported experiencing the phenomenon of veridical perception while out of body. Most experienced aftereffects of NDE communications and/or visions that led to an incongruous spiritual experience, which led to varying intensities of cognitive dissonance. 113 They initially reduced the dissonance by maintaining or strengthening their religious beliefs, but eventually integrated their NDE/ISE perceptions into a changed or altered religious/spiritual belief system. The dissonance lasted for a short time with most participants, but continued for years with others. The participants lost their fear of death and accepted the spiritual concept of reincarnation. As noted above, six participants adopted "spiritual but not religious" beliefs, and two combined certain aspects of Christianity with universal spiritual principles. Composite Depiction I reviewed and closely examined the implications of the individual depictions, the exemplary portraits, and my immersion in the data. I discovered "common qualities and themes that embrace the experiences of the co-researchers" (Moustakas, 1990, p. 52). I evaluated my thoughts and observations about the collected data and felt enthusiastic about the substance of the interviews and the information that had come forth. This composite depiction represents the comprehensive unified meaning of the aftereffects of NDE communications and visions resulting in an incongruous spiritual experience. I have included the essences and meanings that comprise the universal nature of NDE/ISE-related phenomena. Since the study is guided by the heuristic method, my own perceptions of an NDE are included with the experiences of the eight participants. Accordingly, I have chosen to present the composite depiction in a single collective voice, as follows: Without warning, an unexpected event occurs that brings us to the point of death. All of a sudden, we find ourselves floating outside our body. We feel calm and peaceful, as we watch the scene below. We have a keen awareness of sight, sound, vibrations, 114 colors, smells, and a lightness of being. We watch the events unfolding from above and know that something strange is happening. However, we are not afraid. A tunnel begins to form, and we enter it. A bright light is radiating at the end of the tunnel, and it draws us near. Soon, we are in its presence, and we feel joy, bliss, happiness, and ecstasy. There are actually no words to describe this feeling. We are fully engulfed by love, goodness, truth, beauty, and total acceptance. We have returned to our spiritual home and would like to stay there forever. Then a voice emanates from a bright light telling us that we have a purpose to fulfill on earth. Suddenly, we remember our family and loved ones to whom we feel responsible. We agree to return to life and, instantly, we are back in the physical body feeling intense pain. Immediately, disappointment sets in, because we have left that magnificent, loving realm of existence. Soon we begin to wonder about the implications of this experience. If we were exposed to the afterlife, then the religious teachings we learned from our parents, the Bible, and the church were not true. This is a shocking and devastating thought. Since childhood, we held the belief that we would stand before the throne of God and receive judgment. If we had been good during our lifetime, we would go to heaven and stay with Jesus throughout eternity. Consequently, we would be in a state of continuous ecstasy while living in Paradise with the angels. However, our experience of the afterlife was completely different from the heavenly realm we learned about in the Scriptures. Accordingly, we had undergone a spiritual experience that was incongruous with our life-long religious beliefs. At first, we try to reconcile our experience of the afterlife with our religious convictions. We attempt to convince ourselves of similarities between our religious 115 theology and our perceived experience. Then we decide to strengthen our faith in religious ideals, and we feel much better. However, our doubts reemerge, so we try distracting ourselves to the point where there is no time to think about our glimpse of the afterlife. We continue holding on to our deeply seated religious beliefs because our mind feels less conflicted this way. We want to believe that our experience of the afterlife was a hallucination, and our religious expectations of an afterlife will still be realized. Eventually, we realize that our religious teachings do not correspond with our afterlife experience. We understand that a spiritual discrepancy lies within the core of our being. We must look into the mirror and confront our own mind on this issue. With great mental anguish, we admit to ourselves that our perceived experience is our truth, and we can no longer accept the literal biblical teachings on this subject. Our emotional suffering increases as we share our experiences with friends and family. Some of our closet relations react to us with disbelief, hostility, resentment, and disappointment. We persevere as our experience is ridiculed and dismissed as a hallucination. We feel ostracized, wrongly judged, and misunderstood. Some individuals break off relationships with us or decide to distance themselves from our lives. Over time, we learn to discuss our NDE with only a few people who are open-minded and not threatened by the non-religious nature of our experience. We slowly let go of our traditional religious beliefs and feel drawn to spiritual concepts more congruous with our experience. We begin to investigate reports of near-death experiences. We read various books on the subject and feel vindicated. It is comforting to know that many other individuals have experienced a similar phenomenon. We do not feel alone anymore. Our mental well116 being returns, and we feel confident that our NDE is a valid human experience. We begin contacting organizations that are on the cutting-edge of NDE research. As we search for websites and articles that explain the history of the near-death experience, we discover that it is a worldwide phenomenon. We have the opportunity to meet other NDErs and feel an instant bond with them. We feel free, confident, and appreciative of the knowledge that we have gained. We no longer feel the need to attend church services on Sunday. Our religious beliefs are changing, and we recognize the universal spiritual nature of our near-death experience. We feel that organized religion is man-made, but serves an important purpose for many people. We may attend church for social reasons and on significant occasions, but most of the theology no longer resonates within us. Today, we find truth in all religions and understand the essential unity of most religious teachings. We have lost our fear of death. There is no need to fear such a loving, blissful experience. We look forward to returning to our spiritual home. Now, we have a keen awareness of the cyclical nature of our existence. After this lifetime, we will rest for a while and then incarnate again to experience love, acquire wisdom, and offer compassion to others. We have many more lessons to learn on this spiritual journey throughout many lifetimes. As we move forward, our mind is peaceful. We feel lasting happiness because our near-death experience opened our eyes to the universal nature of spiritual existence. Creative Synthesis The final phase of heuristic inquiry is creative synthesis. Through an authentic process of self-searching in combination with openness to the data, I used my imagina117 tion and originality to blend the composite depiction with my own feelings about NDE/ ISE-related phenomena. The resulting musical composition embodies the essence of the heuristic truth that I discovered while assimilating the meaning of these experiences. I developed this creative synthesis as an "original integration of the material that reflects the researcher's intuition, imagination, and personal knowledge of meanings and essences of the experience" (Moustakas, 1990, p. 50). This song includes my personal beliefs about the neardeath experience and embodies my understandings of the participants' feelings about their experiences. From Here to There (Waxman, 2012) Verse: Moving on from here to there, All my senses still aware, Watching from this point of view, Inside a cosmic rendezvous. Now I realize there's more than the eye can see. My spirit and energy rise, Transcending the next reality, Chorus: So I asked the gods of the Sea, Can I be what I want to be? And they said, "Son, we don't have the answer ‒ no ‒ no." They said, "Son, only you can find the answer." 118 Bridge: From here it's easy to see The size of the galaxy, As it reaches eternity Where I'll stay ‒ on my way. From there I knew in my mind The reasons to live with mankind, but I'm leaving my family behind, and I'll stay ‒ on my way. Verse: My inner self must learn and grow, Karma moves the ebb and flow. Words are useless on this plane, Thoughts and knowledge link the chain. The brightest levels of light shine through to infinity, Surrounded by forces of right, Searching for my own divinity. Chorus: So I asked the gods of the Sky, What happens next to those who die? And they said, "Son, we don't have the answer ‒ no ‒ no." They said, "Son, only you can find the answer." 119 Summary Moustakas's heuristic method helped me to discover common elements and underlying themes that produced meaningful results for this investigation. The sample members emphasized their feelings about the spiritual aftereffects of their NDEs. They provided a wealth of data in the form of raw interview material filled with personal meaning. The participants exuded confidence about the communications and visions they had perceived that led to an incongruous spiritual experience. During this heuristic inquiry, I expanded my knowledge about the near-death experience. I also developed a passion for gathering data to support the notion of an incongruous spiritual experience. In this chapter, I presented (a) six individual depictions, (b) two exemplary portraits, (c) the underlying common themes of NDE/ISE-related phenomena, (d) a composite depiction, and (e) a creative synthesis. After examining, assimilating, and presenting the data from my study, I feel prepared to discuss the implications and applications of my research. 120 Chapter Five: Discussion And Analysis Of Results This chapter discusses the findings of the current study in the light of available scholarly research literature. Since I uncovered only five studies exploring the spiritual aftereffects of an NDE/ISE, I utilized Moustakas's (1990, 1994) heuristic method to bring the research up to date. My research question guides the discussion in the context of the research findings, which examine an incongruous spiritual experience during an NDE as it relates to a transformative residuum and religious/spiritual aftereffects. Additionally, the following information is included: (a) the implications of the study, (b) suggestions for future research, (c) the limitations of the findings, and (d) conclusions. Relationship of Results to Scholarly Literature The prior literature in NDE studies focused primarily on inquiring into the spiritually transformative aftereffects of this phenomenon. However, no heuristic studies were located on this topic and no available research was found regarding the relationship between cognitive dissonance and ISE/NDE-related phenomena. To date, NDE researchers have been investigating spiritual aftereffects relating to (a) attaining higher consciousness, (b) surrendering to a Higher Power, (c) altering spiritual beliefs, (d) exhibiting high levels of confidence, (e) experiencing feelings of ecstasy, (f) needing to discuss the NDE, and (g) experiencing attributes of God. Attaining Higher Consciousness. Ring (1984) suggested that the spiritual aftereffects of the NDE may be characteristic of "an evolutionary thrust toward higher consciousness for humanity" (p. 255). He concluded that the NDE might serve as a vehicle for transforming individuals into more spiritual, loving, and compassionate human beings. 121 A core theme in my study corresponds with Ring's (1984) conclusion that NDErs are spiritually transformed by the NDE and are drawn to universal spiritual principles. I did not, however, find evidence to support Ring's claim that NDEs could be responsible for an evolutionary thrust forward in spiritual consciousness. My findings do confirm that NDErs tend to abandon their conditioned religious beliefs in favor of becoming "spiritual but not religious." My sample members experienced a transformative residuum by changing or altering their previous beliefs about God, the Bible, and the church. Surrendering to a Higher Power. Newsome (1988), who agreed with Ring's assessments, posited that the NDE "is a moment of the heart seeking to transcend limitations of time, space, and personality, letting go and giving up the human ego, surrendering itself to the ultimate reality" (p. 104). In my study, most participants spoke of experiencing feelings of transcendence as described by Newsome (1988). Most confirmed that the NDE had been a defining moment of spiritual insight that had a powerful and profound effect on them. My participants' observations supported Newsome's claim that NDErs seem to transcend time and space, as they reported experiencing an unearthly realm that transcended the physical world. They also spoke about merging with a light and feeling surrounded by unconditional love. The intensity of this experience caused them to re-evaluate their religious beliefs after their NDEs; indeed, they felt that the phenomenon of transcendence is a universal NDE experience. Altering Spiritual Beliefs. A few researchers (Musgrave, 1997; Ring 1980, 1984; Sutherland, 1992) reported that participants shifted away from their prior affiliations with a specific religion and changed their beliefs toward a more universal spiritual outlook. In Musgrave's study, 88% reported changes in their spiritual beliefs and 92% believed in an 122 afterlife, compared to 22% before the NDE. Sutherland (1990) found that 76% of her participants who had been affiliated with Christianity and Judaism tended to become unaffiliated with any organized religion. These NDErs adopted spiritual practices such as private informal prayer and meditation. Conversely, Sabom (1982; 1998) posited that his participants tended to become more religious after a near-death experience. Grey's (1995) study concluded that 44% of her participants also had heightened feelings of religiosity after their NDEs. In other studies (Atwater, 1988; Flynn, 1982; Grey, 1985; McLaughlin & Malony, 1984; Osis & Haraldsson, 1977), the researchers found that some participants had stronger feelings in regard to their pre-NDE religious beliefs. However, these researchers did not study the reasons for their participants' increased feelings of religiosity. The data collected in my study supported the previous findings on NDE spiritual aftereffects. Most participants initially maintained their pre-NDE religious beliefs following the NDE. However, over time they changed their religious affiliations. Six of these individuals (four Catholics and two Protestants) altered their religious/spiritual beliefs to "spiritual but not religious" and severed their ties with organized religion. Two participants (one Catholic and one Protestant) continued to maintain affiliations with their churches, but only the Catholic participant still attends church. Exhibiting High Confidence Levels. Thibodeau (1998) found that NDErs scored higher than non-NDErs on confidence levels, which she contended corresponds to their feelings of divinity. Most participants in my study explained that their divine purpose (post-NDE) has been to love others unconditionally. Most expressed high levels of confidence regarding their careers, family life, and attainment of future goals. All participants 123 were confident that their post-NDE lives had divine meaning. They believed that one of the reasons for their return to life was to help and to teach others. My sample also expressed high confidence levels regarding the significant contributions they have made to improve the human condition. Experiencing Feelings of Ecstasy. Many NDErs have reported visiting an unearthly realm and feeling utter bliss during their NDEs (Fenwick & Fenwick, 1995; Greyson, 1999; Moody, 1975; Ring, 1984). Most participants mentioned entering or merging with a light that they perceived as a divine phenomenon or god-like force. Most felt ecstasy, bliss, joy, happiness, and unconditional love while in the light. The power of this light caused them to reconsider their pre-NDE religious beliefs. Need to Discuss the NDE. As noted by Thibodeau (1998), a common theme among her participants was their need to speak with others about the NDE. Thibodeau also produced qualitative data indicating that NDErs felt hesitant to discuss this information for fear of being judged. In my study, the participants learned to be careful with whom they shared this information. While speaking to the clergy, four of my participants encountered disbelief, impatience, or a demeaning attitude. Other participants encountered a lack of interest, skepticism, or hostility while disclosing details of their NDEs to others. However, when they were speaking to non-religious individuals or to people they knew and trusted, the reactions ranged from mild interest to genuine receptivity. Additionally, some felt the need to talk about the discrepancies between their pre-NDE religious beliefs and their non-religious perceptions during the NDE. Experiencing Attributes of God. Bush (2002) posited that pre-NDE beliefs in the attributes of God were not always congruous with NDErs' perceptions of God. 124 Significantly, she found that some NDErs who believed in a punishing or vengeful God had illuminating experiences, while others who believed in a loving or compassionate God had terrifying NDEs. In my study, the participants had incongruous spiritual experiences that were associated with a lack of biblical themes and the absence of a specific Godhead. Most had believed that after death they would see Jesus, receive divine judgment, and enter a Christian heaven. The only reference to a god-like presence, however, was a divine light that emanated feelings of love, acceptance, truth, goodness, beauty, and oneness. Unlike in Bush's study, my participants did not describe the presence of a godlike biblical figure with specific personality attributes. Implications of the Study This chapter summarizes the research investigation focusing on the question: What are the aftereffects of an incongruous religious experience (ISE) that is based on perceived communications or visions during a near-death experience (NDE)? My question grew out of a personal experience at the age of 18 in which I lost consciousness during a blood test. My pulse was fading rapidly, and I found myself in an unfamiliar realm. I heard strange voices and had a deep knowingness that I had entered into another reality. There was no doubt in my mind that I had briefly visited the afterlife. Within a year after this experience, my religious beliefs began to shift toward a belief in universal spiritual principles. My near-death experience had a profound effect on me, and I became passionate about studying its spiritual aftereffects. Beginning in 1976, I was naturally drawn to the topic of near-death studies, as a direct result of my experience. I have had an intense desire to pursue the implementation of a heuristic research investigation since entering a Ph.D. program in Human Science at Saybrook University. My 125 fascination with this phenomenon provided the impetus for the formulation of my research question. Fortunately, the participants in the current study shared my enthusiasm for advancing knowledge in the field of NDE research. This study consisted of the following components: (a) an in-depth literature review, (b) an explanation of my experience utilizing a heuristic research model, (c) a description of the design and method of the study, (d) an analysis of the data, (e) a summary of the findings, and (f) an outline of the implications of the study. I sought to uncover, with my sample members, the essences, meanings, and themes inherent in NDE/ISE-related phenomena. The eight participants were selected based on their combined scores on Greyson's NDE Scale (Greyson, 1983a) and a questionnaire that I developed. Data were collected through two in-depth telephone interviews with each participant. I asked them 10 questions relating to the following: (a) their religious upbringing, (b) the stages of their NDEs, (c) perceived communications and visions during their NDEs, (d) reactions from others, (e) coping mechanisms, (f) their need to talk about the experience, (g) the non-religious nature of the NDE compared to their religious beliefs, (h) any changes in their religious/spiritual beliefs, (i) their confidence levels and sense of divinity, (j) overcoming their fear of death, (k) a belief in reincarnation, and (l) the spiritually transformative nature of the NDE. I selected Moustakas's (1990) heuristic research method to guide my study. This model gave me an opportunity to relate my personal experience to the narratives provided by the sample. The heuristic approach encouraged participation from the sample members , after which the data were collected, organized, and synthesized. 126 From my personal experience with this phenomenon, I had several insights regarding which questions to ask during the interview process. My participation in the data collection was an essential part of the heuristic process, with my personal experience providing insights into the nature of this phenomenon. The heuristic method that I utilized as developed by Moustakas (1990) included the stages of initial engagement, immersion, incubation, illumination, explication, and creative synthesis. Additionally, I created individual depictions, exemplary portraits, and a composite depiction as per Moustakas's suggested guidelines. The design and method I employed produced common themes, unified meanings, core characteristics, and other qualitative results that I reported in my findings. I continually checked the data and repeatedly reviewed the information that I had collected from interviews, personal notes, tape recordings, transcriptions, and a journal. After analyzing the data, I was satisfied that the research displayed consistent themes emanating from the raw material. I verified the collected information from the first interviews during the second interviews with the sample members. In the second interviews, two participants offered variations of their answers regarding their current religious beliefs. When I read back their answers from the first interviews, both participants agreed that their first answers had been correct. Consequently, I felt the need to verify most of the essential data during the second interviews with each participant. In the end, I concluded that consistency had been achieved after confirming the participants' answers with them during the second round. I also confirmed many of their answers from the two survey instruments to support the accuracy and reliability of the research. Therefore, I can confidently state that the 127 individual depictions, exemplary portraits, and composite depiction accurately reflect the essence of the sample members' NDEs. The reliability of the data in this qualitative research study was dependent on the participants' abilities to recognize and report the details of their near-death experiences. The collected information from their interviews included: (a) an awareness and recollection of their NDEs, (b) an openness to share the details of these experiences, and (c) a good-natured attitude and willingness to participate in the study. The sample members shared many personal details of their NDEs with me. They demonstrated their support and cooperation by (a) being ready for my telephone calls at the agreed-upon time, (b) expressing their appreciation at being included in the study, (c) answering my questions without hesitation, and (d) allowing the interviews to continue for the fully allotted time. Additionally, the participants were careful to report their experiences to me in an accurate, complete, and detailed manner. There were no predetermined outcomes for the study. If a participant did not fully understand an interview question, I explained the basis for the question in the context of the overall scope of the inquiry. The participants were under no obligation to answer every interview question, but no objections arose to any of these questions. Sometimes, when I needed additional information to clarify a certain response, they explained the full meaning of their answer. I sensed a higher comfort level from the sample during the second interviews, after I had established a good rapport with them during the first interviews. They were looking forward to the second interviews and to continuing our discussion regarding the spiritual aftereffects of their NDEs. In terms of the purpose of the study, the participants had the opportunity to 128 describe the religious/spiritual aftereffects of their near-death experiences. Each participant offered detailed narratives regarding (a) the events leading up to their NDE, (b) the trigger for the NDE, (c) the phenomenon of veridical perception, (c) out-of-body perceptions, and (d) the depth of their feelings while perceiving another realm of existence. The participants did not report perceiving any biblical characters, Christian motifs, or theological themes of any organized religion during their NDEs. Since childhood, each participant had certain expectations of the afterlife that included literal descriptions of a Christian heaven. However, none of their religious expectations had been met during their NDE. Over time, they recognized the inconsistent nature of their pre-NDE and postNDE religious beliefs. Consequently, their post-NDE religious/ spiritual beliefs were altered or transformed. Most participants reported the following sequence of spiritual changes after experiencing NDE/ISE-related phenomena: (a) feeling compelled to compare pre-NDE religious expectations with perceptions during the NDE, (b) maintaining or developing stronger religious beliefs, (c) having feelings of confusion and doubt toward religious teachings of the afterlife, (e) making a decision to shift away from pre-NDE religious beliefs, (f) deciding no longer to attend church (or attend only on special occasions), (g) having a desire to investigate various spiritual philosophies and practices, and( h) becoming "spiritual but not religious," or integrating universal spiritual concepts with certain Christian teachings. These responses fulfilled the purpose of the study, which was to investigate the aftereffects and transformative residuum relating to the occurrence of an incongruous spiritual experience during a near-death experience. The sample members' explications are fully portrayed in the individual depic129 tions, exemplary portraits, and composite depiction. Included in these descriptions are common themes, similar qualities, and essential meanings that come together in a unified manner. The individual depictions and exemplary portraits were developed from tape recordings, verbatim transcriptions, and personal notes. The composite depiction portrays core meanings and themes that the sample members presented during the interviews. The creative synthesis encapsulates the discoveries and illuminations I derived from the study. Finally, I created a musical composition with music and lyrics that expresses my personal assimilation of the research experience. Various levels and dimensions of meanings were revealed throughout the heuristic process. The following eight common themes emerged after an analysis and review of the data: (1) re-evaluation of Christian beliefs, (2) veridical perception, (3) perceived communications/visions, (4) cognitive dissonance, (5) changes in religious/spiritual beliefs, (6) loss of fear of death, (7) belief in reincarnation, and (8) a shift toward universal spirituality. The sample members experienced a process of shifting away from pre-NDE religious beliefs toward the acceptance of universal spiritual principles. Six participants adopted a "spiritual but not religious" outlook, while two combined universal spiritual beliefs with certain teachings of Christian theology. After overcoming the tensions of cognitive dissonance, most participants felt loving, joyful, peaceful, and content. All participants have achieved consonance by adopting a spiritual belief system that is congruous with their lived experience during the NDE. Suggestions for Future Research Holden, Greyson, and James (2009) noted, "The absence of a clear pattern of pre

and post-NDE religious affiliation and religiosity may be the result of methodological differences between studies." Most NDE investigations have been conducted utilizing an informal method of citing narratives and discussing the commonalities and differences from data derived from short interviews. In some cases, NDE researchers have tended to mix and match research methods or simply create their own. Therefore, my suggestion for future researchers is to consider utilizing Yin's (2009) case study method for in-depth reporting of data and for developing cross-case conclusions. This multiple case study approach would allow researchers to gather a chain of evidence to confirm or disconfirm the notion that cognitive dissonance is a common aftereffect of an NDE/ISE. In addition, therapeutic strategies should be explored to determine the most effective methods for helping NDErs overcome various levels of dissonance. I also recommend that future studies include an online survey targeting NDErs who did not change their religious beliefs after the NDE. This type of investigation would allow researchers to inquire into the reasons for heightened feelings of religiosity after an NDE. Moreover, some NDErs may have perceived biblical characters during their NDEs. For these NDErs such communications and/or visions may have reinforced their preNDE beliefs. This type of study could focus on collecting data supporting biblical interpretations of a heavenly realm and the appearance of an anthropomorphic Godhead. Finally, I suggest that researchers conduct extended interviews with their sample members. Since the integrity of the data is based on establishing trust with each participant, I recommend in-depth interviewing in face-to-face situations, on the telephone, or via internet communication networks such as Skype. Researchers may find that, in the first interview, many participants simply want to share the wonder of their experiences. 131 However, such participants may not feel comfortable discussing their innermost religious beliefs (or a lack thereof) in a first interview. Therefore, researchers should plan on conducting a minimum of two 90-minute interviews scheduled about one week apart. In my first interviews, I felt that some participants had a residual fear of going to hell if they challenged the teachings of the church. Others were slightly hesitant about discussing their true spiritual beliefs until they felt comfortable with me. In my view, if a good rapport is established during first interview, the participants will most likely disclose many more details during the second interviews. It is then that the researcher will have the best opportunities to probe deeply into core spiritual. Additionally, while conducting the second interviews, the researcher should have the transcriptions of the first interviews available as a reference tool. These transcripts are necessary for checking the consistency of participants' answers on sensitive topics. I also recommend utilizing a wide diversity of participants in future studies. Every effort should be made to recruit an equal number of male and female participants from (a) different faiths, (b) a variety of cultures, (c) various ethnic backgrounds, and (d) ages that range from 18 to 80. Limitations of the Findings There were several limitations of this research study. The participants' pre-NDE religious/spiritual beliefs were solely Christian, and most attended church throughout adulthood. All participants were American Caucasians between the ages of 50 and 75 years. They were raised by American Caucasian Christian parents and grew-up in middleincome or lower-income environments. Another limitation included the lack of face-to-face interviews. I could not see the 132 facial expressions or body language of the participants during telephone interviews. Oneon-one interviews may help to establish openness and trust in a shorter amount of time. In a few brief instances during the telephone interviews, I could not clearly hear an answer to a question or needed to repeat a question more than once. This problem related to unclear telephone connections because of the widespread use of cell phones and the accompanying degradation in voice quality compared to landlines. My findings are also limited in terms of offering therapeutic recommendations for treating cognitive dissonance as an aftereffect of an NDE/ISE. It is beyond the scope of this study to suggest psychological treatments or methods for NDErs to overcome the effects of cognitive dissonance. This investigation has been limited to inquiring into whether cognitive dissonance was itself an aftereffect of NDE/ISE-related phenomena. Finally, this inquiry has been limited by my decision to forgo an additional step in the heuristic process as proposed by Sela-Smith (2002). I understand the merits of her qualitative research method, which posits that the researcher is a participant of an internal inquiry into the often dark and hidden internal patterns that influence the personal experience of life (Sela-Smith, 2002). I also support her approach for self-search inquiry "wherein the researcher surrenders to the feeling in an experience and does not know what will be learned at the time the inquiry is begun" (p. 83). Indeed, I did not have any expectations for this inquiry in terms of results and had no attachment to its outcome. I also felt a sense of completion after fully participating in Moustakas's (1990) heuristic research method with the eight participants. Delimitations of the Findings The following delimitations applied to this study: (a) the inclusion of only 133 English-speaking participants who were raised in Western culture, (b) communications via telephone and internet, (d) one instrument and one questionnaire with multiple-choice items and without open-ended responses, and (e) two interviews with each participant lasting up to 60 minutes per interview. Conclusions Many prior scientific investigations into the spiritual aftereffects of NDEs have been inconclusive. Leading NDE researchers have reported a variety of findings regarding NDErs' religious/spiritual beliefs including: (a) a deepening feeling for pre-NDE beliefs, (b) minor alterations in post-NDE beliefs, (c) shifting away from pre-NDE beliefs, (d) shifting toward universal spiritual beliefs and/or practices, and (e) experiencing no changes in post-NDE beliefs. In this research study, 84 respondents completed an online NDE survey that included Greyson's NDE Scale (1983) and a questionnaire I developed for the study. The highest-scoring survey participants were invited to join the sample on a volunteer basis. All survey participants signed Saybrook's Online Survey Informed Consent Form. The sample members then signed the Adult Informed Consent Form that explained the confidential nature of the inquiry and included other important information relevant to the study. Additionally, the participants were advised that they would be referred to anonymously. The design chosen for the study was based on Moustakas's (1990) heuristic research method. A review of the data from interview transcriptions and personal notes led to discernment of the following common themes: (1) Christian upbringing and regular church attendance in childhood 134 (2) Christian beliefs in the afterlife before the NDE (3) Perception of communications and/or visions during the NDE (4) Veridical perception and the out-of-body-experience (5) Feelings of love, ecstasy, joy, bliss, and happiness during the NDE (6) No perceptions of religious characters or a biblical heaven (7) Choosing (or being told) to return to the physical body (8) Understanding that pre-NDE religious beliefs were incongruous with nonreligious perceptions of an afterlife (9) Coping with varying intensities of cognitive dissonance (10) Initially maintaining religious beliefs after the NDE but eventually changing former religious beliefs (11) Loss of fear of death (12) Acceptance of a belief in reincarnation This study attempted to offer new knowledge regarding the spiritual aftereffects of an incongruous spiritual experience during a near-death experience. 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Predictors of adolescent suicide attempts: A nationally representative longitudinal study of Norwegian adolescents. Journal of the American Academy of Child & Adolescent Psychiatry, 39(5), 603-610. doi:10.1097/00004583-200005000-00014 Yin, R. K. (2009). Case study research: Design and methods. Thousand Oaks, CA: Sage. Zaleski, C. (1987). Otherworld journeys: Accounts of near-death experiences in medieval and modern times. New York, NY: Oxford University. APPENDICES 152 Appendix A: Recruitment Announcement for Online NDE Survey Volunteers Needed for Near-Death Experience Online Survey and Ph.D. Study If you've had a near-death experience and if your religious/spiritual beliefs were affected afterward, please take 15 minutes to complete the following survey: Survey link: https://www.psychdata.com/s.asp?SID=148052 At the end of the survey, please include your contact information if you would like to be considered as a volunteer for my research study. All responses are strictly confidential. For additional information, please contact Bob Waxman at 941-724-5151. 153 Appendix B: Recruitment Correspondence to IANDS Chapters To: All IANDS Chapters (International Association for Near-Death Studies) Subject: Volunteers Needed for Online NDE Survey and Ph.D. Study Dear [President of Regional IANDS Chapter], I am a member of IANDS and currently a Ph.D. student at Saybrook University. Please consider asking your members to complete an online NDE survey (web link below) for my Ph.D. study. Thank you for considering my request. Here is the description of the study: Volunteer Participants Needed for Online NDE Survey & Ph.D. Study If you've had an NDE and if your religious/spiritual beliefs were affected afterward, please take 15 minutes to complete the following survey: https://www.psychdata.com/s.asp?SID=148052 At the end of the survey, please include your contact information, if you would like to be considered as a volunteer for my research study. If you have any questions, please contact Bob Waxman at 941-724-####. Thank you! Bob Waxman Ph.D. Student, Human Sciences, Saybrook University 154 Appendix C: Greyson's NDE Scale (1983a) 1. Did time seem to speed up or slow down? 0 = No 1 = Time seemed to go faster or slower than usual 2 = Everything seemed to be happening at once; or time stopped or lost all meaning 2. Were your thoughts speeded up? 0 = No 1 = Faster than usual 2 = Incredibly fast 3. Did scenes from your past come back to you? 0 = No 1 = I remembered many past events 2 = My past flashed before me, out of my control 4. Did you suddenly seem to understand everything? 0 = No 1 = Everything about myself or others 2 = Everything about the universe 5. Did you have a feeling of peace or pleasantness? 0 = No 1 = Relief or calmness 2 = Incredible peace or pleasantness 6. Did you have a feeling of joy? 0 = No 1 = Happiness 2 = Incredible joy 7. Did you feel a sense of harmony or unity with the universe? 155 0 = No 1 = I felt no longer in conflict with nature 2 = I felt united or one with the world 8. Did you see, or feel surrounded by, a brilliant light? 0 = No 1 = An unusually bright light 2 = A light clearly of mystical or other-worldly origin 9. Were your senses more vivid than usual? 0 = No 1 = More vivid than usual 2 = Incredibly more vivid 10. Did you seem to be aware of things going on elsewhere, as if by extrasensory perception (ESP)? 0 = No 1 = Yes, but the facts have not been checked out 2 = Yes, and the facts have been checked out 11. Did scenes from the future come to you? 0 = No 1 = Scenes from my personal future 2 = Scenes from the world's future 12. Did you feel separated from your body? 0 = No 1 = I lost awareness of my body 2 = I clearly left my body and existed outside it 13. Did you seem to enter some other, unearthly, world? 0 = No 156 1 = Some unfamiliar and strange place 2 = A clearly mystical or unearthly realm 14. Did you seem to encounter a mystical being or presence, or hear an unidentifiable voice? 0 = No 1 = I heard a voice I could not identify 2 = I encountered a definite being, or a voice clearly of mystical or unearthly origin 15. Did you see deceased or religious spirits? 0 = No 1 = I sensed their presence 2 = I actually saw them 16. Did you come to a border or point of no return? 0 = No 1 = I came to a definite conscious decision to "return" to life 2 = I came to a barrier that I was not permitted to cross; or was "sent back" against my will. Note: A score of 7 or above is considered a core NDE for research purposes. 157 Appendix D: Incongruous Spiritual Experience Questionnaire (ISEQ) Please indicate the extent to which you agree or disagree with the statements below: Theological sub-scale 1 2 3 4 5 strongly disagree disagree neutral agree strongly agree As a result of my near-death experience: 1. I consider myself to be "spiritual, but not religious." _____ 2. I used to have certain spiritual beliefs, but now I have changed some or all of my spiritual beliefs. _____ 3. I used to believe that certain religious scriptures were historically accurate, but now I do not believe that some of the events happened as described in the scriptures. _____ 4. I do not believe in the literal religious teachings of an afterlife as a result of my NDE____. 5. I do not believe that some people go to heaven or hell. _____ 6. I do believe that religious teachings of an afterlife were written by people. _____ Ontological sub-scale 1. I do not believe in a God who has a human form. _____ 2. I do believe in a God-force that is formless, all pervading, and universal. _____ 3. I used to believe in the God who is described in religious scriptures, but now have different beliefs._____ 4. After life, I will probably meet a Divine Presence or God. _____ 5. After life, I will probably communicate with God, or a divine presence, or family, friends, or others. _____ 6. After life, I do not expect to be judged by God or a divine presence. _____ 158 Metaphysical sub-scale 1. After life, an aspect of me will survive. _____ 2. After life, an aspect of me will move through time and space to another dimension. _____ 3. After life, I expect to go to a beautiful, loving place, but not the Heaven as described in religious scriptures. _____ 4. After life, I expect to learn the truth about the meaning and purpose of existence. _____ 5. If science could prove that the afterlife was different from religious descriptions, I believe that most people would benefit from such knowledge. _____ 6. I believe that reports of near-death experiences may offer a glimpse into the true nature of the afterlife. _____ 159 Appendix E: Combined Scores from Online Survey Of the 84 respondents who completed the online survey, 57 scored 7 or above on Greyson's NDE Scale, which meets NDE criteria for research purposes (Greyson, 1983a). The scores from Greyson's Scale and the ISEQ were combined, and the eight highest scoring respondents were selected to join the sample. Combined Scoring Range Number of Respondents Average Score 0-42 0 43-52 5 49.20 53-62 8 58.12 63-72 9 67.75 73-82 14 77.63 83-92 10 88.50 93-102 6 98.25 103-112 4 106.50 113-122 1 115.00 Total Respondents: 57 Avg. Combined Score: 82.62 160 Appendix F: Interview Questions 1. Were there any religious organizations to which your parents were affiliated? 2. What religious teachings did you believe in as a child? 3. Did you accept the idea of going to heaven and meeting God? 4. How would you describe your religious beliefs and expectations of heaven prior to your near-death experience? 5. What were the circumstances that triggered your NDE? 6. What were your perceptions during the NDE? 7. Did you hear communications or perceive visions? 8. Did you perceive any religious themes or qualities during the NDE? 9. After the NDE, did you feel that your religious expectations had been met? 10. Did you experience any changes in your religious beliefs or spiritual outlook after the NDE? Note: At the researcher's discretion, spontaneous questions were posed to the sample. 161 Appendix G: Creative Synthesis 162 163 164 Appendix H: Online Survey Informed Consent Welcome to the Dissertation Research on Aftereffects of ["title of study"] Web page. Before taking part in this study, please read the informed consent form below and click the "I Agree" button at the bottom of the page if you understand the statements and freely consent to participate in the study. Informed Consent Form This study involves a Web-based survey that examines [add appropriate information]. The study is being conducted by [your name] in partial fulfillment of a [master's/doctoral] degree at Saybrook University. It has been approved by the Saybrook Institutional Review Board. No deception is involved, and the study involves no more than minimal risk to participants (i.e., the level of risk encountered in daily life). Completion of the survey typically takes [length of time] and is strictly anonymous. Participants will respond to a series of questions about [topic]. These questions are designed to evaluate [add]. All responses are treated as confidential, and in no case will responses from individual participants be identified. Rather, all data will be pooled and published in summary form only. Participants should be aware, however, that the survey is not being run from a secure https server of the kind typically used to handle credit card transactions; so, a small possibility exists that responses could be viewed by unauthorized third parties (e.g., computer hackers). Participation is voluntary, participants may withdraw from the study at any time, and they may decline to answer any questions if they experience any discomfort with the questions asked. Participants will not be paid to participate in this research study. If you have any questions about this study or your rights as a participant, you may contact the Principal Researcher, [your name], by email at [your email address], or my Research Supervisor, [name], at [email address]. Questions or concerns about your rights as a research participant may also be directed to the Director of the Saybrook IRB at SIRB@Saybrook.edu. If you are 18 years of age or older, understand the statements above, and freely consent to participate in the study, click on the "I Agree" button to begin the survey. If not, thank you for your time. I Agree I Do Not Agree Next 165 Appendix I: Debriefing Statement (attached at end of survey) Thank you for your participation in my study. The purpose of this study is to examine [add]. The intent of this online study is to look at group data, not that of the individual. Individual identities cannot be determined, and I would like to assure you of your confidentiality and anonymity. Thank you for your participation. [your name] Submit Survey 166 Appendix J: Informed Consent Form for Adults INFORMED CONSENT TO PARTICIPATE IN RESEARCH Purpose: The purpose of this research is to investigate the aftereffects of an incongruous spiritual experience (ISE) during a near-death experience (NDE). This project is being conducted by Robert Waxman, who is a graduate student of Saybrook University, and as part of the dissertation requirement. Principal Researcher: Robert Waxman 5151 Oxford Drive Sarasota, FL 34242 941-724-5151 wax5151@comcast.net Procedures: [1] This study involves my participation in one or two interviews and one follow-up telephone conversation. [2] Completion of these procedures may require a maximum of 60 minutes per interview and 10 minutes for the follow-up telephone conversation. The maximum amount of time for participation in the study may be 2 hours and 10 minutes. [3] The interview procedure involves conversing with the researcher on the telephone or Skype. To fulfill the purpose of the research, the researcher will cover a set of 10 questions per interview regarding the aftereffects of an incongruous spiritual experience during a near-death experience on which your opinions and comments are requested. Possible Risks and Safeguards: This study is designed to minimize as much as possible any potential physical, psychological, and social risks to you. Although very unlikely, there are always risks in research, which you are entitled to know in advance of giving your consent, as well as the safeguards to be taken by those who conduct the project to minimize the risks. Those risks may include discomfort during the interviews, and therefore you or the researcher may terminate the interview at any time. 167 I understand that: [1] My participation shall in no way have any bearing on my employment or academic status, or alter or deprive me of any or all services presently received in the institution and setting in which I participate, as well as those provided by the institutions sponsoring, funding, and providing oversight, inclusively, for this research project. [2] Although my identity shall be known to the Principal Researcher, all identifying information shall be removed at the time of transcription of the tape recordings. [3] My responses to the questions will be pooled with others and all identifiers, such as names, addresses, employers, and related information that might be used to identify me, will be given a pseudonym. [4] This informed consent form will be kept separate from the data I provide, for five years, in a locked file known only to the Principal Researcher, after which it will be destroyed. [5] The data collected in their raw and transcribed forms are to be kept anonymous, stored in a locked container accessible only to the Principal Researcher for five years, after which they shall be destroyed. [6] Transcribed anonymous data, in the form of anonymous response listings from all participants to each question on a web site, will be kept indefinitely for future research. [7] All the information I give will be kept confidential to the extent required by law. The information obtained from me will be examined in terms of group findings and will be reported anonymously. [8] There is to be no individual feedback regarding my test scores, performance, and interpretations of my responses. Only general findings will be presented in a Summary Report, of which I am entitled to a copy, and my individual responses are to remain anonymous. [9] None of the personal information I provide associated with my identity will be released to any other party without my explicit written permission. 168 [10] If quotes of my responses are used in the research report for the dissertation, as well as any and all future publications of these quotations, my identity shall remain anonymous, at most making use of a fictitious name. [11] I have the right to refuse to answer any question asked of me. [12] I have the right to refuse at any time to engage in any procedure requested of me. [13] I have the right to withdraw from participation at any time for any reason without stating my reason. [14] I have the right to participate without prejudice on the part of the Principal Researcher and other persons assisting the Principal Researcher. [15] It is possible that the procedures may bring to my mind thoughts of an emotional nature that may upset me. In the unlikely event that I should experience emotional distress from my participation, the Principal Researcher present shall be available to me. He or she shall make every effort to minimize such an occurrence. However, should an upset occur and become sufficiently serious to warrant professional attention, as a condition of my participation in this study, I understand that a licensed mental health professional will be made available to me. If I do not have such a person, the Principal Researcher will refer me, and reasonable costs up to the first two visits will be paid by the Principal Researcher. [16] By my consent, I understand I am required to notify the Principal Researcher at the time of any serious emotional upset that may cause me to seek therapy and compensation for this upset. [17] I will receive a copy of this signed consent form for my records. Regarding any concern and serious upset, you may contact the Principal Researcher at: 941-724-5151. You may also contact the Research Supervisor of the project, Robert McAndrews, Ph.D. (rmcandr000@aol.com). Should you have any concerns regarding the conduct and procedures of this research project that are not addressed to your satisfaction by the Principal Researcher and his Research Supervisor, you may report and discuss them with Dr. M. Willson Williams (SIRB@Saybrook.edu), the Director of the Saybrook Institutional Review Board. 169 Possible Benefits: I understand that my participation in this study may have possible benefits. [1] I may obtain a greater personal awareness, knowledge, and understanding of the near-death experience. [2] Through future communications and possible applications of the findings of the research, indirectly my participation may bring future benefits to others who have the same incongruous spiritual experience during a near-death experience. [3] My participation may enable the Principal Researcher and others working in the topic area to contribute to knowledge and theory of the aftereffects of an incongruous spiritual experience during a near-death experience that is to be studied. Summary Report: Upon conclusion of this study, a summary report of the general findings will become available. If you would like a copy of the report, please check the box below and provide the address to which you would like it sent (your email or postal address):  I would like to receive a copy of the Summary Report Postal or Email Address: Consent of Principal Researcher I have explained the above procedures and conditions of this study, provided an opportunity for the research participant to ask questions, and have attempted to provide satisfactory answers to all questions that have been asked in the course of this explanation. Principal Researcher Signature Date Robert Waxman ______ Principal Researcher Name 170 Consent of the Participant If you have any questions of the Principal Researcher at this point, please take this opportunity to have them answered before granting your consent. If you are ready to provide your consent, read the statement below, then sign and print your name and date on the line below. I have read the above information, have had an opportunity to ask questions about any and all aspects of this study, and give my voluntary consent to participate. Participant Signature Date Participant Name (Print) Modification of SIRB-Approved Study This application is to seek approval for a modification to a currently SIRB-approved study. Any proposed changes to previously approved human subjects research must be reviewed and approved by the Saybrook IRB prior to implementation. This includes modifications to the study, inclusion or exclusion criteria, recruitment methods, research personnel, or any new or revised study materials. Approval is required for all modifications whether initiated by the investigator or an external source. SIRB ID #: 12-S-RWaxman Date of initial SIRB approval: April 6, 2012 Principal Researcher: Robert Waxman Project Title: Spiritual Aftereffects of Incongruous Near-Death Experiences: A Heuristic Approach Research Supervisor: Dr. Robert McAndrews Include with your submission the items indicated in the list below, where applicable. 171 Item 1. A concise summary of the requested modification. List and describe each proposed change. a. This study involves my participation in one or two interviews and one follow-up telephone conversation. b. Completion of these procedures may require a maximum of 60 minutes per interview and 10 minutes for the follow-up telephone conversation. The maximum amount of time for participation in the study may be 2 hours and 10 minutes. c. There will be eight participants in the sample. 2. New or revised consent forms, questionnaires, surveys, recruitment materials, advertisements, etc. Describe changes that have been made from initial submission. 3. If you have made substantive changes to the study design or procedures, submit a revised full IRB application. 1. List and describe each proposed change: a) Study participants will agree to engage in one to two interviews instead of two interviews, b) the interview(s) will last for a maximum of 60 minutes each with one follow-up conversation of 10 minutes instead of 90-minute interviews with a 20minute follow-up conversation, c) the maximum amount of time for participation will be 2 hours and 10 minutes instead of 3 hours and 20 minutes, and d) there will be eight participants in the sample instead of six. ______ 2. Is this modification being submitted in response to an unanticipated problem/adverse event or new findings?  Yes X No If Yes, explain, including whether these events or findings are relevant to participants' willingness to continue: